Next Steps for Interventions Targeting Adolescent Dietary Behaviour

Adolescents in many countries consume poor quality diets that include high intakes of sugary drinks and fast food and low intakes of vegetables. The aims of this Special Issue on adolescent dietary behaviour were to identify methods and approaches for successful interventions to improve diet quality in this age group and identify at risk subgroups that need particular attention. In total, 11 manuscripts were published in this Special Issue—three qualitative studies which included a systematic review, five cross-sectional studies and three quantitative evaluations of interventions. This Editorial discusses the contribution of the studies and provides suggestions to improve the success of future interventions in adolescents. It is important that adolescents are involved in the design of interventions to improve social and cultural acceptability and relevance. Interventions targeting schools or communities framed within a larger food system such as issues around climate change and the carbon footprint of food may improve engagement. Furthermore, targeting adolescents in areas of lower deprivation is a priority where diet quality is particularly poor. Potentially successful interventions also include environmental policies that impact on the cost and marketing of food and drinks, although evaluations of these were not included in this issue

Quality assessment of nutrition coverage in the media: A 6 week survey of five popular UK newspapers

Objectives: To investigate the quality of nutrition articles in popular national daily newspapers in the UK and to identify important predictors of article quality. Setting: Newspapers are a primary source of nutrition information for the public. Design: Newspaper articles were collected on 6 days of the week (excluding Sunday) for 6 weeks in summer 2014. Predictors included food type and health outcome, size of article, whether the journalist was named and day of the week. Outcome measures: A validated quality assessment tool was used to assess each article, with a minimum possible score of −12 and a maximum score of 17. Newspapers were checked in duplicate for relevant articles. The association of each predictor on article quality score was analysed adjusting for remaining predictors. A logistic regression model was implemented with quality score as the binary outcome, categorised as poor (score less than zero) or satisfactory (score of zero or more). Results: Over 6 weeks, 141 nutrition articles were included across the five newspapers. The median quality score was 2 (IQR −2–6), and 44 (31%) articles were poor quality. There was no substantial variation in quality of reporting between newspapers once other factors such as anonymous publishing, health outcome, aspect of diet covered and day of the week were taken into account. Particularly low-quality scores were obtained for anonymously published articles with no named journalist, articles that focused on obesity and articles that reported on high fat and processed foods. Conclusions: The general public are regularly exposed to poor quality information in newspapers about what to eat to promote health, particularly articles reporting on obesity. Journalists, researchers, university press officers and scientific journals need to work together more closely to ensure clear, consistent nutrition messages are communicated to the public in an engaging way

The impact of HENRY on parenting and family lifestyle: Exploratory analysis of the mechanisms for change

Background Childhood obesity is a major public health concern. In the UK, a quarter of children are overweight or obese at age five years. Overweight and obese children are more likely to develop serious health issues such as diabetes later in life. Consequently, there is an urgent need for effective, early obesity prevention and intervention. This study investigated the impact of an eight‐week child obesity intervention ‐ HENRY (Health Exercise Nutrition for the Really Young) ‐ designed to help parents with preschool children develop the skills and knowledge needed to improve family lifestyle and wellbeing. We were particularly interested in exploring the potential mechanisms by which HENRY may have a positive impact. Method Focus groups (n=7, total participants = 39) were completed with mothers attending the HENRY programme at one of seven locations across England. They took place within two weeks of programme completion. Follow‐up telephone interviews were completed with a subsample of participants (n=10) between 17 and 21 weeks later. Results Parents consistently reported enhanced self‐efficacy in terms of improved confidence in their ability to encourage healthier behaviours such as eating fruit and increasing physical activity, and improvements to family health behaviours. Many changes were reportedly sustained at follow‐up. Data provided insights into the potential mechanisms that created the conditions for the positive changes. Participants described the importance of mutual support, being listened to by facilitators and encouragement to identify their own ideas. Their comments indicated the success of a solution‐focused, strength‐based, partnership approach to supporting family lifestyle change. Conclusion The results of this study contribute to the body of evidence suggesting that HENRY may have a positive impact on parenting and family lifestyle behaviour. Although data were collected in 2011, the findings contribute to an understanding of the components of effective obesity prevention in young children

A repeated cross-sectional survey assessing changes in diet and nutrient quality of English primary school children’s packed lunches between 2006 and 2016

Objective: Mandatory school meal standards were introduced in 2006 in England; however, no legislation exists for packed lunches. This study analyses provision of foods and nutrients in packed lunches in 2016 to highlight differences in diet and nutrient quality since 2006. Design: Two cross-sectional surveys of children’s packed lunches were conducted in 2006 and 2016. Data were analysed using multilevel regression models taking into account the clustering of children within primary schools. Setting: Data were collected from 1148 children who attended 76 schools across England in 2006 and from 323 children attending 18 schools across England in 2016. Participants: Children were included if they regularly ate a packed lunch prepared at home (approximately half of children take a packed lunch to school) and were aged 8–9 years (in year 4), for both surveys. Outcome measures: Data collected in both years included provision of weight and type of food, nutrients and proportion of lunches meeting individual and combined school meal standards. Results: Frequency of provision and portion size of some food types changed substantially between surveys. Frequency of provision of confectionery in lunches reduced by 9.9% (95% CI −20.0 to 0.2%), sweetened drinks reduced by 14.4% (95% CI −24.8 to −4.0%), and cakes and biscuits not containing chocolate increased by 9.6% (95% CI 3.0 to 16.3%). Vegetable provision in lunches remained low. Substantial changes were seen in the percentage of lunches meeting some nutrient standards: non-milk extrinsic sugars (19%, 95% CI 10 to 29%), vitamin A (−8%, 95% CI −12 to −4%), vitamin C (−35%, 95% CI −42 to −28%) and zinc (−8%, 95% CI −14 to −1%). Conclusions: Packed lunches remain low quality with few meeting standards set for school meals. Provision of sugars has reduced due to reductions in provision and portion size of sugary drinks and packaged sweet foods; however, provision of some nutrients has worsened

Impact of Taste on Food Choices in Adolescence—Systematic Review and Meta-Analysis

Studies of adults report that perceived taste affects food choices and intake, which in turn may have an impact on health. However, corresponding evidence on adolescents is limited.  Our aim was to summarize current evidence of the impact of taste perception on food choice preferences or dietary intakes among adolescents (mean age 10–19.9 years). Systematic searches identified 13 papers, 12 cross-sectional and one cohort study published between 1 January 2000 to 20 February 2020 assessing the impact of taste (using phenotypic and/or genotypic markers) on food choices in adolescents without any disease conditions. Qualitative assessment in the current review indicated that individuals sensitive to bitter tastes often have a lower preference of bitter-tasting food and higher preference for sweet-tasting food. A meta-analysis of three studies on bitter-taste sensitivity revealed no difference in preference for bitter-tasting vegetables between bitter tasters and non-tasters (standardized mean difference (SMD) = 0.04; 95% CI: −0.18, 0.26; p = 0.72). Overall, a limited number of studies were available for review. As a result, we report no clear relationship between taste perception and food choices or intake in adolescents. More studies are needed to evaluate the link between adolescents’ taste perceptions and dietary intake

National nutrition surveys in Europe: a review on the current status in the 53 countries of the WHO European region

Objectives: The objectives of this study were (1) to determine the coverage of national nutrition surveys in the 53 countries monitored by the World Health Organization (WHO) Regional Office for Europe and identify gaps in provision, (2) to describe relevant survey attributes and (3) to check whether energy and nutrients are reported with a view to providing information for evidence-based nutrition policy planning. Design: Dietary survey information was gathered using three methods: (1) direct email to survey authors and other relevant contacts, (2) systematic review of literature databases and (3) general web-based searches. Survey characteristics relating to time frame, sampling and dietary methodology and nutrients reported were tabled from all relevant surveys found since 1990. Setting: Fifty-three countries of the WHO Regional Office for Europe, which have need for an overview of dietary surveys across the life course. Subjects: European individuals (adults and children) in national diet surveys. Results: A total of 109 nationally representative dietary surveys undertaken post-1990 were found across 34 countries. Of these, 78 surveys from 33 countries were found post-2000, and of these, 48 surveys from 27 countries included children and 60 surveys from 30 countries included adults. No nationally representative surveys were found for 19 of 53 countries, mainly from Central and Eastern Europe. Multiple 24hr recall and food diaries were the most common dietary assessment methods. Only 22 countries reported energy and nutrient intakes from post-2000 surveys; macronutrients were more widely reported than micronutrients. Conclusions: Less than two-thirds of WHO Europe countries have nationally representative diet surveys, mainly collected post-2000. The main availability gaps lie in Central and Eastern European countries, where nutrition policies may therefore lack an appropriate evidence base. Dietary methodological differences may limit the scope for inter-country comparisons

Interventions to reduce consumption of sugar-sweetened beverages or increase water intake: evidence from a systematic review and meta-analysis

A systematic review and meta-analyses were conducted to evaluate the effects of interventions to reduce sugar-sweetened beverages (SSB) or increase water intakes and to examine the impact of behaviour change techniques (BCTs) in consumption patterns. Randomized and nonrandomized controlled trials published after January 1990 and until December 2016 reporting daily changes in intakes of SSB or water in volumetric measurements (mL d¯¹) were included. References were retrieved through searches of electronic databases and quality appraisal followed Cochrane principles. We calculated mean differences (MD) and synthesized data with random-effects models. Forty studies with 16 505 participants were meta-analysed. Interventions significantly decreased consumption of SSB in children by 76 mL d¯¹ (95% confidence interval [CI] −105 to −46; 23 studies, P < 0.01), and in adolescents (−66 mL d¯¹, 95% CI −130 to −2; 5 studies, P = 0.04) but not in adults (−13 mL d¯¹, 95% CI −44 to 18; 12 studies, P = 0.16). Pooled estimates of water intakes were only possible for interventions in children, and results were indicative of increases in water intake (MD +67 mL d¯¹, 95% CI 6 to 128; 7 studies, P = 0.04). For children, there was evidence to suggest that modelling/demonstrating the behaviour helped to reduce SSB intake and that interventions within the home environment had greater effects than school-based interventions. In conclusion, public health interventions – mainly via nutritional education/counselling – are moderately successful at reducing intakes of SSB and increasing water intakes in children. However, on average, only small reductions in SSBs have been achieved by interventions targeting adolescents and adults. Complementary measures may be needed to achieve greater improvements in both dietary behaviours across all age groups

Dietary fibre intake and risk of cardiovascular disease: systematic review and meta-analysis

To investigate dietary fibre intake and any potential dose-response association with coronary heart disease and cardiovascular disease