The Association between Parent Diet Quality and Child Dietary Patterns in Nine- to Eleven-Year-Old Children from Dunedin, New Zealand

Previous research investigating the relationship between parents’ and children’s diets has focused on single foods or nutrients, and not on global diet, which may be more important for good health. The aim of the study was to investigate the relationship between parental diet quality and child dietary patterns. A cross-sectional survey was conducted in 17 primary schools in Dunedin, New Zealand. Information on food consumption and related factors in children and their primary caregiver/parent were collected. Principal component analysis (PCA) was used to investigate dietary patterns in children and diet quality index (DQI) scores were calculated in parents. Relationships between parental DQI and child dietary patterns were examined in 401 child-parent pairs using mixed regression models. PCA generated two patterns; ‘Fruit and Vegetables’ and ‘Snacks’. A one unit higher parental DQI score was associated with a 0.03SD (CI: 0.02, 0.04) lower child ‘Snacks’ score. There was no significant relationship between ‘Fruit and Vegetables’ score and parental diet quality. Higher parental diet quality was associated with a lower dietary pattern score in children that was characterised by a lower consumption frequency of confectionery, chocolate, cakes, biscuits and savoury snacks. These results highlight the importance of parental modelling, in terms of their dietary choices, on the diet of children

Parental feeding practices in New Zealand

Background: Although various parental feeding practices have been associated with dietary intake and body weight in children, many studies are limited by sample size or lack of diversity, perhaps explaining conflicting results. Related areas of interest with limited exploration to date include how parental feeding practices relate to i) problem food behaviours in children and ii) food availability in the home. Objective: The aim of this thesis was to examine the relationships between parental feeding practices, diet, weight, home food availability, and problem food behaviours in a large, diverse sample of New Zealand children aged 4-8 years. Methods: 1093 children were recruited from general practice and secondary care clinics for a weight screening initiative (The MInT Study). Children and their parents attended a comprehensive health check including measurement of child body mass index (BMI) and completion of a questionnaire detailing measures of child dietary intake, parental attitudes of their child’s weight and diet, parental feeding practices, parental discipline practices, demographics, problem food behaviours and home food availability. A factor analysis of the Comprehensive Feeding Practices Questionnaire determined the feeding practices represented by the data. Examination of these factors in relation to demographic variables (ethnicity, socio-economic status, sex, maternal education and weight status) was undertaken using ANOVA. Correlations and regression analyses established associations between parental feeding practices and children’s dietary intake, the disciplining practices of parents, maternal BMI, problem food behaviours and home food availability using either the full sample or a subsample (overweight children only). This included exploration of some interactions. Bootstrap analysis was used to determine a linear regression model for BMI z-score. Results: The reassessment of the factor structure of the Comprehensive Feeding Practices Questionnaire determined that the original twelve factors did not reduce the data appropriately and that a five-factor structure was more suitable for this population. These five feeding practices were: healthy eating guidance, monitoring, parent pressure, restriction and child control. These feeding practices varied with demographics, for example parents used more restriction and less pressure with girls and with overweight children. Furthermore, healthy eating guidance and monitoring were associated with less dysfunctional parenting practices, more fruits and vegetables, and less sweet drinks. By contrast, child control exhibited inverse associations with these factors. Bootstrap analysis indicated that restriction (B=0.37, p<0.01), parent pressure (B=-0.19, p<0.01) and healthy eating guidance (B=-0.13, p=0.01), along with maternal BMI (B=0.03, p<0.01), some ethnicities and low maternal education all contributed to a linear regression model that explained 18% of the variation in BMI z-score. Some feeding practices were related to problem food behaviours and parents used different feeding practices with fussy children (more parent pressure and child control and less monitoring). A comprehensive, relatively objective measure of home food availability showed that availability was associated with dietary intake, but not strongly associated with parental feeding practices. Furthermore, home food availability generally did not moderate the associations between feeding practices and dietary intake, suggesting that these two concepts are independently related to diet. Conclusion: This thesis gives important new information about how parental feeding practices relate to the dietary intake, weight status and problem food behaviours of children, which can be used in the development of recommendations to parents

Parental feeding practices in New Zealand

Background: Although various parental feeding practices have been associated with dietary intake and body weight in children, many studies are limited by sample size or lack of diversity, perhaps explaining conflicting results. Related areas of interest with limited exploration to date include how parental feeding practices relate to i) problem food behaviours in children and ii) food availability in the home. Objective: The aim of this thesis was to examine the relationships between parental feeding practices, diet, weight, home food availability, and problem food behaviours in a large, diverse sample of New Zealand children aged 4-8 years. Methods: 1093 children were recruited from general practice and secondary care clinics for a weight screening initiative (The MInT Study). Children and their parents attended a comprehensive health check including measurement of child body mass index (BMI) and completion of a questionnaire detailing measures of child dietary intake, parental attitudes of their child’s weight and diet, parental feeding practices, parental discipline practices, demographics, problem food behaviours and home food availability. A factor analysis of the Comprehensive Feeding Practices Questionnaire determined the feeding practices represented by the data. Examination of these factors in relation to demographic variables (ethnicity, socio-economic status, sex, maternal education and weight status) was undertaken using ANOVA. Correlations and regression analyses established associations between parental feeding practices and children’s dietary intake, the disciplining practices of parents, maternal BMI, problem food behaviours and home food availability using either the full sample or a subsample (overweight children only). This included exploration of some interactions. Bootstrap analysis was used to determine a linear regression model for BMI z-score. Results: The reassessment of the factor structure of the Comprehensive Feeding Practices Questionnaire determined that the original twelve factors did not reduce the data appropriately and that a five-factor structure was more suitable for this population. These five feeding practices were: healthy eating guidance, monitoring, parent pressure, restriction and child control. These feeding practices varied with demographics, for example parents used more restriction and less pressure with girls and with overweight children. Furthermore, healthy eating guidance and monitoring were associated with less dysfunctional parenting practices, more fruits and vegetables, and less sweet drinks. By contrast, child control exhibited inverse associations with these factors. Bootstrap analysis indicated that restriction (B=0.37, p<0.01), parent pressure (B=-0.19, p<0.01) and healthy eating guidance (B=-0.13, p=0.01), along with maternal BMI (B=0.03, p<0.01), some ethnicities and low maternal education all contributed to a linear regression model that explained 18% of the variation in BMI z-score. Some feeding practices were related to problem food behaviours and parents used different feeding practices with fussy children (more parent pressure and child control and less monitoring). A comprehensive, relatively objective measure of home food availability showed that availability was associated with dietary intake, but not strongly associated with parental feeding practices. Furthermore, home food availability generally did not moderate the associations between feeding practices and dietary intake, suggesting that these two concepts are independently related to diet. Conclusion: This thesis gives important new information about how parental feeding practices relate to the dietary intake, weight status and problem food behaviours of children, which can be used in the development of recommendations to parents

Comparison of 24-h Diet Records, 24-h Urine, and Duplicate Diets for Estimating Dietary Intakes of Potassium, Sodium, and Iodine in Children

Accurately estimating nutrient intake can be challenging, yet it is important for informing policy. This cross-sectional validation study compared the use of three methods for estimating the intake of sodium, potassium, and iodine in children aged 9&ndash;11 years in New Zealand. Over the same 24 hour period, participants collected duplicate diets (n = 37), weighed food records (n = 84), and 24 hour urine samples (n = 82). Important differences were found between dietary estimates of sodium, potassium, and iodine using the three methods of dietary assessment, suggesting that different methods of assessment have specific limitations for the measurement of these nutrients in children. Bland Altman plots show relatively wide limits of agreement for all measures and nutrients. These results support the World Health Organization&rsquo;s (WHOs) recommendations to use urinary assessment to measure population sodium and iodine intake, while dietary assessment appears to be more accurate for estimating potassium intake. Compared to reference values, our results suggest that the children in this study consume inadequate iodine, inadequate potassium, and excess dietary sodium. Public health measures to reduce sodium intake, increase intake of fruit and vegetables, and iodine-rich foods are warranted in New Zealand

Comparison of Self-Reported Speed of Eating with an Objective Measure of Eating Rate

Slow eating may be beneficial in reducing energy intake although there is limited research quantifying eating rate. Perceived speed of eating was self-reported by 78 adults using a standard question &ldquo;On a scale of 1&ndash;5 (very slow&ndash;very fast), how fast do you believe you eat?&rdquo; Timing the completion of meals on three occasions was used to assess objective eating rate. The mean (SD) speeds of eating by self-reported categories were 49 (13.7), 42 (12.2), and 35 (10.5) g/min for fast, medium, and slow eaters, respectively. Within each self-reported category, the range of timed speed of eating resulted in considerable overlap between self-identified &lsquo;fast&rsquo;, &lsquo;medium&rsquo; and &lsquo;slow&rsquo; eaters. There was 47.4% agreement (fair) between self-reported speed of eating and the objective measure of eating rate (&kappa; = 0.219). Self-reported speed of eating was sufficient at a group level to detect a significant difference (10.9 g/min (95% CI: 2.7, 19.2 g/min, p = 0.009)) between fast and slow; and fast and medium eaters (6.0 g/min (0.5, 11.6 g/min p = 0.033)). The mean difference (95% CI) between slow and medium eaters was 4.9 (&minus;3.4, 12.2) g/min (p = 0.250). At an individual level, self-report had poor sensitivity. Compared to objectively measured speed of eating, self-reported speed of eating was found to be an unreliable means of assessing an individual&rsquo;s eating rate. There are no standard protocols for assessing speed of eating or eating rate. Establishing such protocols would enable the development of population reference ranges across various demographic groups that may be applicable for public health messages and in clinical management

Metabolic and Blood Pressure Effects of Consuming Two Kiwifruit Daily for 7 Weeks: A Randomised Controlled Trial

Background: Eating two kiwifruit before breakfast by equi-carbohydrate partial exchange of cereal has been associated with lower postprandial glucose and insulin, but it increases the intake of fruit sugar. We assessed the effects of kiwifruit ingestion at breakfast over 7 weeks on metabolic and physiologic factors. Method: Forty-three healthy Asian participants were randomised to ingest 500 mL of carbonated water (control) or 500 mL of carbonated water plus two kiwifruit (intervention), before breakfast. Three-day weighed diet records were taken before and at week 4 during the intervention. Overnight fasting blood samples were taken at baseline and week 7. Forty-two participants completed the study (n = 22 control, n = 20 intervention). Results: The kiwifruit group consumed more fructose, vitamin C, vitamin E, and carbohydrates as a percentage of energy compared with the control group (p < 0.01). There was no evidence of between-group changes in metabolic outcomes at the end of the intervention, with the following mean (95% confidence interval) differences in fasting blood samples: glucose 0.09 (−0.06, 0.24) mmol/L; insulin −1.6 (−3.5, 0.3) μU/mL; uric acid −13 (−30, 4) μmol/L; triglycerides −0.10 (−0.22, 0.03) mmol/L; and total cholesterol −0.05 (−0.24, 0.14) mmol/L. There was a −2.7 (−5.5, 0.0) mmHg difference in systolic blood pressure for the intervention group compared with the control group. Conclusion: Eating two kiwifruit as part of breakfast increased fruit consumption and intake of antioxidant nutrients without a change in fasting insulin. There was a difference in systolic blood pressure and no adverse fructose-associated increases in uric acid, triglycerides, or total cholesterol. This simple intervention may provide health benefits to other demographic groups

Cognitive Performance Following Ingestion of Glucose–Fructose Sweeteners That Impart Different Postprandial Glycaemic Responses: A Randomised Control Trial

We aimed to investigate the isolated effect of glycaemia on cognitive test performance by using beverages sweetened with two different glucose&ndash;fructose disaccharides, sucrose and isomaltulose. In a randomised crossover design, 70 healthy adults received a low-glycaemic-index (GI) isomaltulose and sucralose beverage (GI 32) and a high-GI sucrose beverage (GI 65) on two occasions that were separated by two weeks. Following beverage ingestion, declarative memory and immediate word recall were examined at 30, 80 and 130 min. At 140 min, executive function was tested. To confirm that the glycaemic response of the test beverages matched published GI estimates, a subsample (n = 12) of the cognitive testing population (n = 70) underwent glycaemic response testing on different test days. A significantly lower value of mean (95% CI) blood glucose concentration incremental area under the curve (iAUC) was found for isomaltulose, in comparison to the blood glucose concentration iAUC value for sucrose, the difference corresponding to &minus;44 mmol/L∙min (&minus;70, &minus;18), p = 0.003. The mean (95% CI) difference in numbers of correct answers or words recalled between beverages at 30, 80 and 130 min were 0.1 (&minus;0.2, 0.5), &minus;0.3 (&minus;0.8, 0.2) and 0.0 (&minus;0.5, 0.5) for declarative memory, and &minus;0.5 (&minus;1.4, 0.3), 0.4 (&minus;0.4, 1.3) and &minus;0.4 (&minus;1.1, 0.4) for immediate free word recall. At 140 min, the mean difference in the trail-making test between beverages was &minus;0.3 sec (&minus;6.9, 6.3). None of these differences were statistically or clinically significant. In summary, cognitive performance was unaffected by different glycaemic responses to beverages during the postprandial period of 140 min

Development of a Healthy Dietary Habits Index for New Zealand Adults

Healthful dietary habits are individually associated with better nutrient intake and positive health outcomes; however, this information is rarely examined together to validate an indicator of diet quality. This study developed a 15-item Healthy Dietary Habits Index (HDHI) based on self-reported dietary habits information collected in the 2008/09 New Zealand Adult Nutrition Survey. The validity of HDHI as a diet quality index was examined in relation to sociodemographic factors, 24-diet recall derived nutrient intakes, and nutritional biomarkers in a representative sample of adults aged 19 years and above. Linear regression models were employed to determine associations between HDHI quintiles and energy-adjusted nutrient data and nutritional biomarkers. Significantly higher HDHI scores were found among women, older age groups, Non-Māori or Pacific ethnic groups, and less socioeconomically-deprived groups (all p &lt; 0.001). Increasing quintiles of HDHI were associated with higher intakes of dietary fibre and seven micronutrients including calcium, iron, and vitamin C, and lower intakes of energy, macronutrients, sodium, zinc, vitamins B6 and B12. Associations in the expected directions were also found for urinary sodium, whole blood folate, serum and red blood cell folate, and plasma selenium (all p &lt; 0.001). The present findings suggest that the HDHI is a valid measure of diet quality as it is capable of discerning quality of diets of subgroups and ranking nutrient intakes among NZ adults

Early maternal feeding practices: Associations with overweight later in childhood

Background Current understanding of the impact of maternal feeding practices on weight outcomes in young children remains unclear given equivocal longitudinal study outcomes. Objectives To determine whether feeding practices used by mothers when their child was less than 2 years of age were related to overweight status at ages 3.5 and 5 years in a large cross-country sample; and investigate whether these associations were moderated by weight status in early life. Design Data from mother-child dyads participating in four childhood obesity prevention trials across Australia and New Zealand were pooled (n = 723). Each trial administered items from the Comprehensive Feeding Practices Questionnaire (CFPQ) to mothers when infants were approximately 20 months of age, measuring food as a reward, modelling, restriction for health, pressure to eat, and emotion regulation. Poisson regression was used to determine risk ratios (RR) for overweight (BMI z-score ≥85th percentile) at 3.5 and 5 years by CFPQ scores. Results Greater use of emotion regulation at 20 months of age predicted higher risk for overweight at 3.5 and 5 years (RR = 1.19 and 1.28, respectively), while restriction for health predicted lower risk for overweight at 5 years (RR = 0.88). Child's weight status at 20 months moderated the association between pressure to eat and overweight risk at 5 years, such that those who were not overweight at 20 months of age had reduced risk of overweight associated with the use of pressure to eat (RR = 0.68) but those who were overweight had an increased risk (RR = 1.09). Conclusion Early maternal feeding practices are related to a child's later risk of overweight