Tracking of toddler fruit and vegetable preferences to intake and adiposity later in childhood

This study examined whether toddlers' liking for fruit and vegetables (FV) predicts intake of FV later in childhood, how both relate to childhood adiposity and how these were moderated by factors in infancy. Children in the Gateshead Millennium Study were recruited at birth in 1999–2000. Feeding data collected in the first year were linked to data from a parental questionnaire completed for 456 children at age 2.5 years (30 m) and to anthropometry, skinfolds and bioelectrical impedance and 4‐day food diary data collected for 293 of these children at age 7 years. Aged 30 months, 50% of children were reported to like eight different vegetables and three fruits, but at 7 years, children ate a median of only 1.3 (range 0–7) portions of vegetables and 1.0 portion of fruit (0–4). Early appetite, feeding problems and food neophobia showed significant univariate associations with liking for FV aged 30 m, but the number of vegetables toddlers liked was the only independent predictor of vegetable consumption at age 7 years (odds ratio (OR) 1.28 p < 0.001). Liking for fruit aged 30 m also independently predicted fruit intake (OR = 1.31, p = 0.016), but these were also related to deprivation (OR = 2.69, p = 0.001) maternal education (OR = 1.28, p = 0.039) and female gender (OR = 1.8, p = 0.024). Children eating more FV at age 7 years had slightly lower body mass index and skinfolds. An early liking for FV predicted increased later intake, so increasing early exposure to FV could have long term beneficial consequences

Diet, physical activity, sedentary behaviour and perceptions of the environment in young adults

Background Few studies have explored both food behaviour and physical activity in an environmental context. Most research in this area has focused on adults; the aim of the present study was to describe perceptions of the environment, diet, physical activity and sedentary behaviour patterns in 16–20 year olds in full-time education (Newcastle, UK). Methods Participants (n = 73) recruited from a college and sixth-form college completed a UK version of the Youth Neighbourhood Environment Walkability Survey, which included measures of sedentary behaviour. A validated food frequency questionnaire was completed and a factor applied to produce an estimated mean daily frequency of intake of each item, which was converted to nutrient intakes. A rank for Index of Multiple Deprivation (IMD) was assigned to their home postcode. Analysis explored associations between sedentary behaviours and nutrient intake. Results In this descriptive cross-sectional study, most participants reported being physically active for at least 1 h day−1 on 3–4 (n = 28) or 5–7 days (n = 31). There were no significant differences in nutrient intake according to sample quartile IMD position. Sedentary behaviours were significantly associated with less healthy eating patterns. Higher total energy (P = 0.02), higher fat (P = 0.005), percentage energy from fat (P = 0.035) and lower carbohydrate intakes (P = 0.004) were significantly associated with more time spent watching DVDs at the weekend. Conclusions This combination of sedentary behaviour and less healthy eating patterns has important implications for long-term health (e.g. the tracking of being overweight and obesity from adolescence into adulthood). Understanding behaviour relationships is an important step in developing interventions in this age group

Combining social and nutritional perspectives: from adolescence to adulthood (the ASH30 study)

Purpose The purpose of this paper is to focus specifically on the benefits of using mixed methods to investigate dietary change from adolescence to adulthood exemplified using the findings from the ASH30 longitudinal study. The ASH30 study is a longitudinal dietary survey which provided quantitative evidence of dietary change and investigated factors influencing dietary change from adolescence to adulthood. Design/methodology/approach Two three-day food diaries were collected both in 1980 (aged 11-12 years) and 2000 (aged 31-32 years) from the same 198 respondents in North East England. In 2,000 questionnaires were used to collect perceptions of, and attributions for, dietary change and open-ended responses were analysed using content analysis. Findings The use of mixed methods brings added breadth and depth to the research which cannot be achieved by a single discipline or method. Determining what has influenced change in dietary behaviour from adolescence to adulthood is a complex and multifaceted task. Eating habits are influenced by multiple factors throughout the life course. Change in food intake between adolescence and adulthood related to life-course events and trajectories. The qualitative findings highlighted relevant contextual information such as themes of moral panics, the concept of “convenience” and “fresh” foods. Practical implications Adopting mixed method approaches to exploring dietary change should offer a rich perspective from which to base realistic interventions. Originality/value Longitudinal dietary surveys present an opportunity to understand the complex process of dietary change throughout the life course in terms both of how diets have changed but also of why they have changed

Development of food photographs for use with children aged 18 months to 16 years:comparison against weighed food diaries – The Young Person’s Food Atlas (UK)

Traditional dietary assessment methods, used in the UK, such as weighed food diaries impose a large participant burden, often resulting in difficulty recruiting representative samples and underreporting of energy intakes. One approach to reducing the burden placed on the participant is to use portion size assessment tools to obtain an estimate of the amount of food consumed, removing the need to weigh all foods. An age range specific food atlas was developed for use in assessing children’s dietary intakes. The foods selected and portion sizes depicted were derived from intakes recorded during the UK National Diet and Nutrition Surveys of children aged 1.5 to 16 years. Estimates of food portion sizes using the food atlas were compared against 4-day weighed intakes along with in-school / nursery observations, by the research team. Interviews were conducted with parents the day after completion of the diary, and for children aged 4 to 16 years, also with the child. Mean estimates of portion size consumed were within 7% of the weight of food recorded in the weighed food diary. The limits of agreement were wide indicating high variability of estimates at the individual level but the precision increased with increasing age. For children 11 years and over, agreement with weighed food diaries, was as good as that of their parents in terms of total weight of food consumed and of intake of energy and key nutrients. The age appropriate food photographs offer an alternative to weighed intakes for dietary assessment with children

The stability of food intake between adolescence and adulthood: a 21-year follow-up

Studies of the diet of adolescents in the UK demonstrate that dietary habits known to be detrimental to health in adulthood are evident at an early age. For example, Gregory et al (2000) found 4-18 year olds in the UK to have a frequent consumption of fatty and sugary foods and low consumption of fruit and vegetables. Concerns have therefore been expressed regarding the diet of children and adolescents and the continuation of these dietary habits into adulthood (HEA, 1995; Gaziano, 1998). This study aimed to investigate the extent to which these concerns may be justified by determining the stability of food intake of a group of adolescents followed up 21 years later in adulthood. The investigation involved 202 individuals from whom dietary data were collected in 1979-80 (mean age 11.6 years) (Hackett et al. 1984) and again in 2000-1 (mean age 32.5 years). Dietary data were collected at both time-points using two 3 d estimated food diaries followed by an interview to determine portion sizes using the method considered most appropriate at the time, i.e. calibrated food models in 1979-80 and a photographic food atlas (Nelson et al. 1997) in 2000-1. Foods consumed were allocated to one, or a combination of, the five food groups of the ‘Balance of Good Health’ food selection guide (HEA, 1994) according to Gatenby et al. (1995). The weight of food eaten from each of the five food groups was calculated (percentage of total weight of food consumed) and Pearson correlation coefficients generated to provide an estimate of the stability of food intake. The HEA guide advises that a balanced diet should consist of around 33% fruit and vegetables, 33% bread, other cereals and potatoes, 8% foods containing fat and/or sugar, 12% meat, fish and alternatives and 15% milk and dairy products (Gatenby et al. 1995). A shift in the group’s food intake towards the recommendations had occurred with age, most notably with a decrease in foods containing fat and/or sugar and an increase in fruit and vegetables. Nevertheless, at both ages, intakes of foods containing fat and/or sugar, meat, fish and alternatives were higher, and fruit, vegetables, bread, other cereals and potatoes lower than currently recommended. In addition, although there was significant evidence of tracking of relative intake of bread, cereals and potatoes (P<0.01), fruit and vegetables (P<0.01), and meat, fish and alternatives (P=0.02) between 11.6 and 32.5 years, the correlations were not strong. In conclusion, food intake patterns had changed considerably from early adolescence through to adulthood in a direction more in line with the current recommendations. The predictive value of an adolescent’s food intake of their intake in adulthood was found to be significant, but not strong. Further investigations will consider the extent to which this is influenced by factors such as social class, gender and educational level, as well as assessing tracking in terms of relative nutrient intakes

A feasibility study with process evaluation of a preschool intervention to improve child and family lifestyle behaviours

Background - Around a fifth of children starting school in England are now overweight/obese. There is a paucity of interventions with the aim of obesity prevention in preschool-age children in the UK. Previous research has demonstrated some positive results in changing specific health behaviours, however, positive trends in overall obesity rates are lacking. Preschool settings may provide valuable opportunities to access children and their families not only for promoting healthy lifestyles, but also to develop and evaluate behaviour-change interventions. Methods - This paper presents a cluster randomised feasibility study of a theory based behaviour-change preschool practitioner-led intervention tested in four preschool centres in the North East of England. The primary outcome measures were to test the acceptability and feasibility of the data collection measures and intervention. Secondary measures were collected and reported for extra information. At baseline and post intervention, children’s anthropometric, dietary and physical activity measures as well as family ‘active’ time data were collected. The preschool practitioner-led intervention included family intervention tasks such as ‘family goal-setting activities’ and ‘cooking challenges’. Preschool activities included increasing physical activity and providing activities with the potential to change behaviour with increased knowledge of and acceptance of healthy eating. The process evaluation was an on-going monthly process and was collected in multiple forms such as questionnaires, photographs and verbal feedback. Results - ‘Gatekeeper’ permission and lower-hierarchal adherence were initially a problem for recruitment and methods acceptance. However, at intervention end the preschool teachers and parents stated they found most intervention methods and activities acceptable, and some positive changes in family health behaviours were reported. However, the preschool centres appeared to have difficulties with enforcing everyday school healthy eating policies. Conclusions - The findings from the current study may have implications for nursery practitioners, nursery settings, Local Educational Authorities and policy makers, and contributes to the body of literature. However, further work with preschool practitioners is required to determine how personal attitudes and school policy application can be supported to implement successfully such an intervention

Effect of Restrictions on Television Food Advertising to Children on Exposure to Advertisements for ‘Less Healthy’ Foods: Repeat Cross-Sectional Study

<div><h3>Background</h3><p>In 2007, new scheduling restrictions on television food advertising to children in the UK were announced. The aim of the restrictions was to “reduce significantly the exposure of children under 16 to high fat, salt or sugar (HFSS) advertising”. We explored the impact of the restrictions on relative exposure to HFSS food advertising among all viewers and among child television viewers, as well as adherence to the restrictions.</p> <h3>Methods</h3><p>We conducted two cross-sectional studies of all advertisements broadcast in one region of the UK over one week periods – the first (week 1) six months before the restrictions were introduced, and the second (week 2) six months after. Data on what products were advertised were linked to data on how many people watched each advertisement. Nutritional content of foods advertised was added to the dataset and used to calculate HFSS status. Relative exposure was calculated as the proportion of all advertising person-minute-views (PMVs) that were for HFSS foods.</p> <h3>Results</h3><p>1,672,417 advertising PMV were included. 14.6% of advertising PMV were for food and 51.1% of these were for HFSS food. Relative exposure of all viewers to HFSS food advertising increased between study weeks 1 and 2 (odds ratio (99% confidence intervals) = 1·54 (1·51 to 1·57)). Exposure of children to HFSS food advertising did not change between study weeks 1 and 2 (odds ratio (99% confidence intervals) = 1·05 (0·99 to 1·12)). There was almost universal adherence to the restrictions.</p> <h3>Conclusions</h3><p>Despite good adherence to the restrictions, they did not change relative exposure of children to HFSS advertising and were associated with an increase in relative exposure of all viewers to HFSS advertising. Stronger restrictions targeting a wider range of advertisements are necessary to reduce exposure of children to marketing of less healthful foods.</p> </div

Relationship between mean daily energy intake and frequency of consumption of out-of-home meals in the UK National Diet and Nutrition Survey.

BACKGROUND: Out-of-home meals have been characterised as delivering excessively large portions that can lead to high energy intake. Regular consumption is linked to weight gain and diet related diseases. Consumption of out-of-home meals is associated with socio-demographic and anthropometric factors, but the relationship between habitual consumption of such meals and mean daily energy intake has not been studied in both adults and children in the UK. METHODS: We analysed adult and child data from waves 1-4 of the UK National Diet and Nutrition Survey using generalized linear modelling. We investigated whether individuals who report a higher habitual consumption of meals out in a restaurant or café, or takeaway meals at home had a higher mean daily energy intake, as estimated by a four-day food diary, whilst adjusting for key socio-demographic and anthropometric variables. RESULTS: Adults who ate meals out at least weekly had a higher mean daily energy intake consuming 75-104 kcal more per day than those who ate these meals rarely. The equivalent figures for takeaway meals at home were 63-87 kcal. There was no association between energy intake and frequency of consumption of meals out in children. Children who ate takeaway meals at home at least weekly consumed 55-168 kcal more per day than those who ate these meals rarely. Additionally, in children, there was an interaction with socio-economic position, where greater frequency of consumption of takeaway meals was associated with higher mean daily energy intake in those from less affluent households than those from more affluent households. CONCLUSIONS: Higher habitual consumption of out-of-home meals is associated with greater mean daily energy intake in the UK. More frequent takeaway meal consumption in adults and children is associated with greater daily energy intake and this effect is greater in children from less affluent households. Interventions seeking to reduce energy content through reformulation or reduction of portion sizes in restaurants, cafés and takeaways could potentially lead to reductions in mean daily energy intake, and may reduce inequalities in health in children

A repeat cross-sectional study examining the equitable impact of nutritional standards for school lunches in England in 2008 on the diets of 4-7y olds across the socio-economic spectrum

BACKGROUND: The 2008 nutritional standards for primary school lunch in England improved nutritional content. The impact on socio-economic inequalities is unknown. We examine the impact of the nutritional standards on children’s nutrient intake at lunchtime and in total diet by level of deprivation. METHODS: We conducted cross-sectional studies in 12 English primary schools before and after legislation. Dietary intake was recorded for 4-7y olds using a validated, prospective four-day food diary. Socio-economic status was estimated using the Index of Multiple Deprivation; three groups of approximately equal sizes were created. Linear, mixed-effect models explored the effect of year, lunch type (school or home-packed lunch), level of deprivation and the interaction(s) between these factors on children’s diets. RESULTS: 368 and 624 children participated in 2003–4 and 2008–9 respectively. At lunchtime, between 2003–4 and 2008–9, the increase in non-starch polysaccharide (NSP) intake was larger in the least compared to the most deprived group (difference in mean change 0.8 mg; 95% CI 0.4, 1.3). There were similar differences in mean changes for iron (0.3 mg; 0.2, 0.4) and zinc (0.3 mg; 0.1, 0.5). In total diet, differential effects were observed for NSP, iron and zinc; we found no evidence these changes were associated with lunch type. Lunch type was associated with changes in per cent energy from non-milk-extrinsic sugars (NMES) and vitamin C. Per cent energy from NMES was lower and vitamin C intake higher in school lunches in 2008–9 compared with 2003–4. The corresponding differences in home-packed lunches were not as marked and there were subtle but statistically significant effects of the level of deprivation. CONCLUSIONS: By 2008–9, NMES at lunchtime and in total diet was lower for children consuming a school lunch; this change was equitable across the deprivation groups. Vitamin C intake increased more for children in the most deprived group, narrowing the socio-economic inequality. A range of significant differential effects of the nutritional standards were observed and important socio-economic inequalities in dietary intake remain. Additional interventions to promote equitable nutrition in children are needed to support legislative measures and maximise their impact