Children's Intake Research Articles

“It's a Long-Term Process”: Description of Daily Family Life When a Child Has a Feeding Disorder

Pediatric feeding problems occur in 25% of the general pediatric population and up to 80% of those who have developmental delays. When feeding problems place the child at nutritional risk, families are typically encouraged to increase their child's intake. Family mealtime can become a battle, which further reinforces problematic feeding behaviors from the child and intensifies well-intentioned but unguided parental mealtime efforts. Family has an essential influence on feeding; however, studies to date neglect to address the family context of feeding difficulty. In this study we describe, in the context of everyday life, family management of feeding when a child had a significant feeding problem. Parents of children with feeding problems were interviewed with the Family Management Style Framework components as a guide. Twelve parents participated, representing nine families of children with feeding disorder. Description of family management of feeding provides a foundation for development of family feeding interventions.

The relationship between socioeconomic status and beverage consumption in children: The Cuenca Study.

beverage consumption constitutes a source of children's daily energy intake. Some authors have suggested that consumption of caloric beverages is higher in children with a low socioeconomic position because families limit their spending on healthy food in order to save money. the aim of this study was to explore the relationship between socioeconomic status and Spanish children's beverage consumption. a cross-sectional study was conducted in a sub-sample of 182 children (74 girls) aged 9-11 from the province of Cuenca (Spain). Beverage consumption was assessed using the YANA-C assessment tool, validated for HELENA study. Data for parental socioeconomic status were gathered by using self-reported occupation and education questions answered by parents and classified according to the scale proposed by the Spanish Society of Epidemiology. beverage intake was higher in children belonging to a middle-status family than in those of upper socioeconomic status (p = 0.037). The energy from beverages was similar in most water intake categories, except for water from beverages (p = 0.046). Regarding other beverages categories, middle-status children had higher consumption levels. In contrast, lower status children drank more fruit juices and skimmed milk. All of these do not show statistically significant differences. our study did not find significant associations between beverages consumption and socioeconomic status in children. In fact, intake for most beverage categories was higher in middle-status children than in both other socioeconomic groups. Future research is needed in order to identify this complex relation between socioeconomic inequality and beverage intake behavior.

Sugar-Sweetened Beverage and Water Intake in Relation to Diet Quality in U.S. Children

Sugar-sweetened beverages (SSBs) are a major contributor to children's added sugar consumption. This study examines whether children's SSB and water intakes are associated with diet quality and total energy intake. Using data on children aged 2-18 years from the 2009-2014 National Health and Nutrition Examination Survey, linear regression models were used to analyze SSB and water intake in relation to Healthy Eating Index 2010 (HEI-2010) scores and total energy intake. Generalized linear models were used to analyze SSB and water intake in relation to the HEI-2010 scores. Analyses were conducted including and excluding caloric contributions from SSBs and were conducted in 2016-2017. SSB intake was inversely associated with the HEI-2010 total scores (9.5-point lower score comparing more than two servings/day with zero servings/day, p-trend<0.0001) and positively associated with total energy intake (394 kcal higher comparing more than two servings/day with zero servings/day, p-trend<0.0001). The associations between SSB and HEI-2010 total scores were similar when SSBs were excluded from HEI-2010 calculations. Water intake was positively associated with HEI-2010 total scores, but not associated with total energy intake. SSB intake was inversely associated with several HEI-2010 component scores, notably vegetables, total fruit, whole fruit, greens and beans, whole grains, dairy, seafood and plant proteins, and empty calories. Water intake was positively associated with most of the same HEI-2010 component scores. Children who consume SSBs have poorer diet quality and higher total energy intake than children who do not consume SSBs. Interventions for obesity and chronic disease should focus on replacing SSBs with water and improving other aspects of diet quality that correlate with SSB consumption.

Research- and Practice-Based Nutrition Education and Cooking Workshops in Pediatric Oncology: Protocol for Implementation and Development of Curriculum.

BackgroundProgresses in childhood cancer treatment, diagnosis, and management have resulted in childhood cancer survival rates of over 80%. However, this therapeutic success comes with a heavy price: two-thirds of childhood cancer survivors will be affected by further complications, including cardiovascular and metabolic diseases. Adequate nutrition during cancer treatment is essential to ensure the child’s optimal development, improve tolerance to treatments, and can contribute to lower the risk of developing cardiometabolic diseases. Side effects of cancer treatments can negatively impact children’s nutritional intake and eating behaviors. Involving the families of childhood cancer patients in educational workshops could be a promising avenue to promote healthy eating during and after cancer treatment.ObjectiveThe objectives of this study were to develop, validate, and implement a family-based nutrition education and cooking workshop curriculum in a pediatric oncology setting that addresses the nutritional issues encountered during treatments while promoting the adoption of healthy eating habits for the prevention of long-term cardiometabolic effects.MethodsThe workshops were developed and validated following an 8-step iterative process, including a review of the literature and consultations with a steering committee. An evaluation tool was also developed. A nonrandomized study protocol was elaborated to implement the workshops and measure their impact. The themes of the 6 research- and practice-based lessons are as follows: meal fortification during cancer treatment, changes in taste during cancer therapy and their impact on children, adapting diet to eating-related side effects of treatments, nutritional support during cancer treatment, Mediterranean diet and health, and planning quick and economic meals. The validation process included consultations with the institution’s clinical nutrition professionals. Self-administered post questionnaires were developed according to the content of each workshop to measure short-term outcomes, namely, participants’ perception of knowledge acquisition, behavioral intention, and satisfaction. Medium-term outcomes that will be evaluated are participants’ anthropometric profile, quality of the diet, and circulating biomarkers of metabolic health.ResultsThe project was funded in 2016 and enrollment will be completed in 2021. Data analysis is currently under way and the first results are expected to be submitted for publication in 2019.ConclusionsThis research- and practice-based nutrition education and cooking demonstration curriculum could be a valuable complement to a multidisciplinary lifestyle intervention for the prevention of long-term cardiometabolic complications in childhood cancer.

How Do Child-Protection Practitioners Make Decisions in Real-Life Situations? Lessons from the Psychology of Decision Making

Child protection social workers must make difficult decisions in real life circumstances that often involve limited knowledge, uncertainty, time pressures and powerful emotions. These circumstances can pose a significant challenge to reasoning skills, especially when the cost of errors and poor judgment can be unacceptably high. The current study explores the psychological processes that underpin how child protection practitioners form judgments and make decisions in real life situations. The study had an ethnographic design with two sites; a local authority children's intake service and a specialist multi-disciplinary court assessment service. Twenty-four interviews and forty days of observations were completed. The study found that practitioners' reasoning had a dynamic interplay of intuitive and analytic processes with emotionally-informed intuitive processes as the primary driver. Experience played an important role in developing practitioners’ reasoning skills. As practitioners became more experienced, they engaged in progressively more sophisticated pattern recognition and story building processes to analyse and evaluate complex information. In conclusion, it is argued that greater attention should be given to understanding and supporting practitioner thinking to both support expert practice and reduce errors. An outline of a future research agenda is outlined and the implications for practice are discussed. This is a pre-copyedited, author-produced version of an article accepted for publication in British Journal of Social Work following peer review. The version of record Whittaker, AJ (2017) How do child protection practitioners make decisions in real life situations? Lessons from the psychology of decision making. British Journal of Social Work. is available online at: https://academic.oup.com/bjsw

Mothers Knowledge on Malnutrition: Community based Cross sectional study

Malnutrition is the major cause of many diseases and is a burden in developing countries. A child's intake can have a great impact on her/his growth and development. The mothers’ knowledge on nutrition can play a vital role in child's intake to improve nutritional status.

The δ13C Value of Fingerstick Blood Is a Valid, Reliable, and Sensitive Biomarker of Sugar-Sweetened Beverage Intake in Children and Adolescents

Reliance on self-reported dietary intake methods is a commonly cited research limitation, and dietary misreporting is a particular problem in children and adolescents. Objective indicators of dietary intake, such as dietary biomarkers, are needed to overcome this research limitation. The added sugar (AS) biomarker δ13C, which measures the relative abundance of 13C to 12C, has demonstrated preliminary validity in adults. The purpose of this investigation was to determine the comparative validity, test-retest reliability, and sensitivity of the δ13C biomarker to detect AS and sugar-sweetened beverage (SSB) intake using fingerstick blood samples in children and adolescents. Children (aged 6-11 y, n = 126, 56% male, mean ± SD age: 9 ± 2 y) and adolescents (aged 12-18 y, n = 200, 44% male, mean ± SD age: 15 ± 2 y) completed 4 testing sessions within a 3-wk period. Participants' height, weight, demographic characteristics, and health history were determined at the first session; 24-h recalls were obtained at each visit and fingerstick blood samples were collected at visits 1 and 3. Samples were analyzed for δ13C value using natural abundance stable isotope mass spectrometry. δ13C value was compared with dietary outcomes in the full sample, and in child and adolescent subgroups. t Tests and correlational analyses were used to assess biomarker validity and reliability, whereas logistic regression and area under the receiver-operator characteristic curve (AUC) were used to evaluate sensitivity. Reported mean ± SD AS consumption was 82.2 ± 35.8 g/d and 329 ± 143 kcal/d, and SSB consumption was 222 ± 243 mL/d and 98 ± 103 kcal/d. Mean δ13C value was -19.65 ± 0.69‰, and was lower in children than in adolescents (-19.80 ± 0.67‰ compared with -19.56 ± 0.67‰, P = 0.002). δ13C values were similar across sessions (visit 1: -19.66 ± 0.68‰; visit 3: -19.64 ± 0.68‰; r = 0.99, P < 0.001) and were associated (P < 0.001) with intake of total AS (grams, kilocalories: r = 0.29) and SSB (milliliters, kilocalories: r = 0.35). The biomarker was able to better discriminate between high and low SSB consumers than high and low AS consumers, as demonstrated by the AUC (0.75 and 0.62, respectively). The δ13C biomarker is a promising, minimally invasive, objective biomarker of SSB intake in children and adolescents. Further evaluation using controlled feeding designs is warranted. Registered at clinicaltrials.gov as NCT02455388.

Comparison of school day eating behaviours of 8-11 year old children from Adelaide, South Australia, and London, England: Child eating behaviours in South Australia and England.

ObjectiveSchool food intake makes a considerable contribution to children's overall diet, especially fruit and vegetable intake. Comparing differing school food provision systems can provide novel insights for intervention and improved nutrition policy. This study compared school day food in children from Australia and England.DesignChildren completed food frequency questionnaires reporting school day food intake, breakfast intake and family evening meals. Differences in food consumed over the school day between Australian and English children were evaluated. Multinomial logistic regressions compared fruit and vegetable intake, family dinner frequency and breakfast in Australian and English children adjusting for confounders: age, sex, ethnicity and parent education.Setting27 Primary schools in Adelaide, Australia and 32 in London, England.SubjectsN = 772 children aged 8–11 years from the Australian REACH study (n = 347) and UK RHS School Gardening Trial in England (n = 425).ResultsConsiderably more English children reported consuming vegetables at school than Australian children (recess/lunchtime Australian children 3.4%/6.1%; English children recess/lunctime 3.6/51.1%). However, Australian children were more likely to consume vegetables daily (OR = 4.1; 1.3, 12.5), and have family evening meals everyday [OR = 4.01; 1.88, 8.55], and were less likely to consume breakfast (OR = 0.26; 0.08, 0.79) than English children.ConclusionsFindings indicate that provision of a school lunch meal, compared to a packed lunch from home, may be more supportive of children's vegetable intake. However, without a supportive home environment that encourages vegetable intake, children will not be able to consume sufficient amounts of vegetables.

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.

Mothers of Obese Children Use More Direct Imperatives to Restrict Eating

ObjectiveTo examine the association of mother and child characteristics with use of direct imperatives to restrict eating. MethodsA total of 237 mother–child dyads (mean child age, 70.9 months) participated in a video-recorded, laboratory-standardized eating protocol with 2 large portions of cupcakes. Videos were reliably coded for counts of maternal direct imperatives to restrict children's eating. Anthropometrics were measured. Regression models tested the association of participant characteristics with counts of direct imperatives. ResultsChild obese weight status and maternal white non-Hispanic race/ethnicity were associated with greater levels of direct imperatives to restrict eating (p = .0001 and .0004, respectively). Conclusions and ImplicationsMothers of obese children may be using more direct imperatives to restrict eating so as to achieve behavioral compliance to decrease their child's food intake. Future work should consider the effects direct imperatives have on children's short- and long-term eating behaviors and weight gain trajectories.

Disentangling the effects of parental food restriction on child's risk of overweight

The links between parental restriction of food intake, child's eating behaviour and child's adiposity are still unclear. Our aim was to validate a model suggesting an underlying mechanism for the impact of parental restriction on child's adiposity through a broad dimension of child's eating temperament entitled the appetite reactivity (including both appetite arousal and appetite persistence). Using an online questionnaire administered at home to children aged between 8 and 11 years (N = 414) with one or both of their parents, we measured: based on child's reports, the perceived maternal restriction of child's food intake, the appetite reactivity and both the desired and the eaten mean food portion sizes; based on parental reports, the mean food portion size given to the child and the child's BMI. Structural equation modelling was used to test a model linking measured variables. A well-fitting structural model (AGFI = 0.91; RMSEA = 0.07; SRMR = 0.08) was identified, showing that: (i) perceived maternal restriction of child's food intake negatively impacts child's appetite arousal and food portion size but positively influences child's appetite persistence; (ii) the two components of appetite reactivity have a positive effect on child's adiposity which is partly mediated by child's actual food portion size. Results suggest an explanation for the controversy surrounding the links between parental food restriction and child's adiposity: through its negative impact on child's appetite arousal and food portion size, parental control may protect against overweight, but because of its positive effect on appetite persistence, it can also be detrimental.

Diet and anthropometry at 2 years of age following an oral health promotion programme for Australian Aboriginal children and their carers: a randomised controlled trial.

There are marked disparities between indigenous and non-indigenous children's diets and oral health. Both diet and oral health are linked to longer-term health problems. We aimed to investigate whether a culturally appropriate multi-faceted oral health promotion intervention reduced Aboriginal children's intake of sugars from discretionary foods at 2 years of age. We conducted a single-blind, parallel-arm randomised controlled trial involving women who were pregnant or had given birth to an Aboriginal child in the previous 6 weeks. The treatment group received anticipatory guidance, Motivational Interviewing, health and dental care for mothers during pregnancy and children at 6, 12 and 18 months. The control group received usual care. The key dietary outcome was the percent energy intake from sugars in discretionary foods (%EI), collected from up to three 24-h dietary recalls by trained research officers who were blind to intervention group. Secondary outcomes included intake of macronutrients, food groups, anthropometric z scores (weight, height, BMI and mid-upper arm circumference) and blood pressure. We enrolled 224 children to the treatment group and 230 to the control group. Intention-to-treat analyses showed that the %EI of sugars in discretionary foods was 1·6 % lower in the treatment group compared with control (95 % CI -3·4, 0·2). This culturally appropriate intervention at four time-points from pregnancy to 18 months resulted in small changes to 2-year-old Aboriginal children's diets, which was insufficient to warrant broader implementation of the intervention. Further consultation with Aboriginal communities is necessary for understanding how to improve the diet and diet-related health outcomes of young Aboriginal children.

Is repeated exposure the holy grail for increasing children's vegetable intake? Lessons learned from a Dutch childcare intervention using various vegetable preparations

Children's failure to eat enough vegetables highlights the need for effective interventions encouraging this behaviour. The aim of this study was to investigate the effect of repeated exposure to three a priori unfamiliar vegetables, each prepared in two ways, on children's vegetable acceptance in a childcare setting. Two hundred fifty children (mean age 25 months; 57% boys) participated in a pre-test and a post-test, where they were offered pumpkin, courgette, and white radish. The intervention group (N = 125) participated in a 5-month exposure period, where they were exposed repeatedly (∼12x) to the vegetables: pumpkin blanched and as a cracker spread; courgette blanched and as soup; white radish raw and as a cracker spread. The control group (N = 125) maintained their normal routine. Mixed model analyses were used to analyse intake data and Chi-square analyses for willingness to taste.At pre-test, children ate about 20 g of pumpkin and courgette, whereas white radish intake was approximately 10 g. There was a significant positive effect of the intervention for pumpkin (+15 g; p < 0.001) and white radish (+16 g; p = 0.01). Results for willingness to taste were in the same direction. There was no repeated exposure effect for courgette (p = 0.54); this may have been due to its less distinct taste profile or familiarity with boiled courgette.From our findings, we conclude that repeated exposure to multiple unfamiliar vegetable tastes within the daily routine of a childcare setting is effective in improving children's willingness to taste and intake of some of these vegetables. However, repeated exposure may not be sufficient for more familiar or blander tasting vegetables. This implies that one size does not fit all and that additional strategies are needed to increase children's intake of these vegetables.

Preliminary validation and piloting of a comprehensive measure of household food security in Australia.

To investigate the psychometric properties, validity and reliability of a newly developed measure of food insecurity, the Household Food and Nutrition Security Survey (HFNSS), among an Australian population. Cross-sectional study. Metropolitan areas of Melbourne, Australia, identified as very high, high or medium vulnerability in the 2008 Vulnerability Assessment for Mortgage, Petrol and Inflation Risks and Expenditure index. A convenience sample of 134 adults (117 females and fifteen males, aged over 18 years). Rasch modelling and factor analysis identified four items for exclusion. The remaining items yielded excellent reliability among the current sample and assessed three underlying components: the adult experience of food insecurity (component one), initial/periodic changes to children's food intakes (component two) and progressive/persistent decreases in children's food intakes (component three). Compared with the widely used US Department of Agriculture Food Security Survey Module, the HFNSS identified a significantly higher proportion of food insecurity; this is likely due to the HFNSS's identification of food insecurity due to reasons other than (and including) limited financial access. The HFNSS may be a valid and reliable tool for the assessment of food insecurity among the Australian population and provides a means of assessing multiple barriers to food security beyond poor financial access (which has been identified as a limitation of other existing tools). Future research should explore the validity and reliability of the tool among a more representative sample, as well as specifically among vulnerable population subgroups.

Cost and cost-effectiveness of a school-based education program to reduce salt intake in children and their families in China.

ObjectiveThe School-based Education Program to Reduce Salt Intake in Children and Their Families study was a cluster randomized control trial among grade five students in 28 primary schools and their families in Changzhi, China. It achieved a significant effect in lowering systolic blood pressure (SBP) in all family adults by 2.3 mmHg and in elderlies (aged > = 60 years) by 9.5 mmHg. The aim of this study was to assess the cost-effectiveness of this salt reduction program.MethodsCosts of the intervention were assessed using an ingredients approach to identify resource use. A trial-based incremental cost-effectiveness ratio (ICER) was estimated based on the observed effectiveness in lowering SBP. A Markov model was used to estimate the long-term cost-effectiveness of the intervention, and then based on population data, extrapolated to a scenario where the program is scaled up nationwide. Findings were presented in terms of an incremental cost per quality-adjusted life year (QALY). The perspective was that of the health sector.ResultsThe intervention cost Int$19.04 per family and yielded an ICER of Int$2.74 (90% CI: 1.17–12.30) per mmHg reduction of SBP in all participants (combining children and adult participants together) compared with control group. If scaled up nationwide for 10 years and assumed deterioration in treatment effect of 50% over this period, it would reach 165 million families and estimated to avert 42,720 acute myocardial infarction deaths and 107,512 stroke deaths in China. This would represent a gain of 635,816 QALYs over 10-year time frame, translating into Int$1,358 per QALY gained.ConclusionBased on WHO-CHOICE criteria, our analysis demonstrated that the proposed salt reduction strategy is highly cost-effective, and if scaled up nationwide, the benefits could be substantial.Trial registrationClinicalTrials.gov NCT01821144

Difficulty buying food, BMI, and eating habits in young children.

To determine whether parent report of difficulty buying food was associated with child body mass index (BMI) z-score or with eating habits in young children. This was a cross-sectional study in primary care offices in Toronto, Ontario. Subjects were children aged 1-5 years and their caregivers, recruited through the TARGet Kids! Research Network from July 2008 to August 2011. Regression models were developed to test the association between parent report of difficulty buying food because of cost and the following outcomes: child BMI z-score, parent's report of child's intake of fruit and vegetables, fruit juice and sweetened beverages, and fast food. Confounders included child's age, sex, birth weight, maternal BMI, education, ethnicity, immigration status, and neighbourhood income. The study sample consisted of 3333 children. Data on difficulty buying food were available for 3099 children, and 431 of these (13.9%) were from households reporting difficulty buying food. There was no association with child BMI z-score (p = 0.86). Children from households reporting difficulty buying food (compared with never having difficulty buying food) had increased odds of consuming three or fewer servings of fruits and vegetables per day (odds ratio [OR]: 1.31, 95% confidence interval [CI]: 1.03-1.69), more than one serving of fruit juice/sweetened beverage per day (OR: 1.60, 95% CI: 1.28-2.00), and, among children 1-2 years old, one or more servings of fast food per week (OR: 2.91, 95% CI: 1.67-5.08). Parental report of difficulty buying food is associated with less optimal eating habits in children but not with BMI z-score.

Can a Nasogastric Tube be Seen As the First Option When Children Intake Peg Prior to Colonoscopy?

Can a Nasogastric Tube be Seen As the First Option When Children Intake Peg Prior to Colonoscopy?

The Relationship Between Parental Mediation of Adolescent Media Use and Ugandan Adolescents' Sexual Attitudes and Behavior

ABSTRACTIn sub-Saharan Africa, research about the role of media as an influence on adolescent sexual behavior has focused almost exclusively on the effects of health communication campaigns. Little research has explored the association between parents' attempts to guide their children's entertainment media intake, and adolescents' sexual attitudes and behaviors. The authors surveyed 360 Ugandan high school students regarding their parents' mediation of their media use; their attitudes about stereotypical gender roles in sexual relationships and casual sex; and their sexual behaviors. Co-using media with opposite sex friends was associated with higher endorsement of casual sex. Adolescents who reported their parents limited the amount of time they spent with media were less likely to report having ever had sex. However, both effects were smaller than the effects of relationship and demographic variables.

Familial Resemblance in Dietary Intakes of Children, Adolescents, and Parents: Does Dietary Quality Play a Role?

Information on familial resemblance is important for the design of effective family-based interventions. We aimed to quantify familial correlations and estimate the proportion of variation attributable to genetic and shared environmental effects (i.e., familiality) for dietary intake variables and determine whether they vary by generation, sex, dietary quality, or by the age of the children. The study sample consisted of 1435 families (1007 mothers, 438 fathers, 1035 daughters, and 1080 sons) from the multi-center I.Family study. Dietary intake was assessed in parents and their 2–19 years old children using repeated 24-h dietary recalls, from which the usual energy and food intakes were estimated with the U.S. National Cancer Institute Method. Food items were categorized as healthy or unhealthy based on their sugar, fat, and fiber content. Interclass and intraclass correlations were calculated for relative pairs. Familiality was estimated using variance component methods. Parent–offspring (r = 0.11–0.33), sibling (r = 0.21–0.43), and spouse (r = 0.15–0.33) correlations were modest. Parent–offspring correlations were stronger for the intake of healthy (r = 0.33) than unhealthy (r = 0.10) foods. Familiality estimates were 61% (95% CI: 54–68%) for the intake of fruit and vegetables and the sum of healthy foods and only 30% (95% CI: 23–38%) for the sum of unhealthy foods. Familial factors explained a larger proportion of the variance in healthy food intake (71%; 95% CI: 62–81%) in younger children below the age of 11 than in older children equal or above the age of 11 (48%; 95% CI: 38–58%). Factors shared by family members such as genetics and/or the shared home environment play a stronger role in shaping children’s intake of healthy foods than unhealthy foods. This suggests that family-based interventions are likely to have greater effects when targeting healthy food choices and families with younger children, and that other sorts of intervention are needed to address the intake of unhealthy foods by children.

Validity of the Remote Food Photography Method Against Doubly Labeled Water Among Minority Preschoolers.

ObjectiveTo determine the validity of energy intake (EI) estimations made using the Remote Food Photography Method (RFPM) compared to the doubly-labeled water (DLW) method in minority preschool children in a free-living environment.MethodsSeven days of food intake and spot urine samples excluding first void collections for DLW analysis were obtained on 39 3-to-5 year old Hispanic and African American children. Using an iPhone, caregivers captured before and after pictures of the child’s intake and pictures were wirelessly transmitted to trained raters who estimated portion size using existing visual estimation procedures and energy and macronutrients were calculated. Paired t-test, mean differences and Bland-Altman limits of agreement were performed.ResultsThe mean EI using the RFPM was 1,191 ± 256 kcal/d and 1,412 ± 220 kcal/d by the DLW method, resulting in a mean underestimate of 222 kcal/d (−15.6%) (p<0.0001) that was consistent regardless of intake. The RFPM underestimated EI by −28.5% in 34 children and overestimated EI by 15.6% in 5 children.ConclusionsThe RFPM underestimated total EI when compared to the DLW method among preschoolers. Further refinement of the RFPM is needed for assessing EI of young children.