Toddlers' food preferences: The impact of novel food exposure, maternal preferences and food neophobia

Food preferences have been identified as a key determinant of children’s food acceptance and consumption. The aim of this study was to identify factors that influence children’s liking for fruits, vegetables and non-core foods. Participants were Australian mothers (median age at delivery=31 years, 18-46 years) and their two-year-old children (M=25 months, SD=1 month; 52% female) allocated to the control group (N=230) of the NOURISH RCT. The effects of repeated exposure to new foods, maternal food preferences and child food neophobia on toddlers’ liking of vegetables, fruits and non-core foods and the proportion never tried were examined via hierarchical regression models; adjusting for key maternal (age, BMI, education) and child covariates (birth weight Z-score, gender), duration of breastfeeding and age of introduction to solids. Maternal preferences corresponded with child preferences. Food neophobia among toddlers was associated with liking fewer vegetables and fruits, and trying fewer vegetables. Number of repeated exposures to new food was not significantly associated with food liking at this age. Results highlight the need to: (i) encourage parents to offer a wide range of foods, regardless of their own food preferences, and (ii) provide parents with guidance on managing food neophobia

Recruiting and engaging new mothers in nutrition research studies: lessons from the Australian NOURISH randomised controlled trial

Background: Despite important implications for the budgets, statistical power and generalisability of research findings, detailed reports of recruitment and retention in randomised controlled trials (RCTs) are rare. The NOURISH RCT evaluated a community-based intervention for first-time mothers that promoted protective infant feeding practices as a primary prevention strategy for childhood obesity. The aim of this paper is to provide a detailed description and evaluation of the recruitment and retention strategies used. Methods: A two stage recruitment process designed to provide a consecutive sampling framework was used. First time mothers delivering healthy term infants were initially approached in postnatal wards of the major maternity services in two Australian cities for consent to later contact (Stage 1). When infants were about four months old mothers were re-contacted by mail for enrolment (Stage 2), baseline measurements (Time 1) and subsequent random allocation to the intervention or control condition. Outcomes were assessed at infant ages 14 months (Time 2) and 24 months (Time 3). Results: At Stage 1, 86% of eligible mothers were approached and of these women, 76% consented to later contact. At Stage 2, 3% had become ineligible and 76% could be recontacted. Of the latter, 44% consented to full enrolment and were allocated. This represented 21% of mothers screened as eligible at Stage 1. Retention at Time 3 was 78%. Mothers who did not consent or discontinued the study were younger and less likely to have a university education. Conclusions: The consent and retention rates of our sample of first time mothers are comparable with or better than other similar studies. The recruitment strategy used allowed for detailed information from non-consenters to be collected; thus selection bias could be estimated. Recommendations for future studies include being able to contact participants via mobile phone (particular text messaging), offering home visits to reduce participant burden and considering the use of financial incentives to support participant retention

Student perceptions of effective feedback in psychology

Receiving, interpreting and adopting feedback is a crucial component of higher education learning. Rubrics offer structured feedback and are widely used to increase marker consistency, increase feedback detail and increase student self-regulation. Despite widespread use, the empirical evidence for these claims across different forms of rubrics remains lacking. This cohort-controlled trial examined 491 psychology student perceptions of assessment task feedback using a detailed assessment rubric compared to a graded rating scale including a description of the highest level. Across two years, students completing two introduction to psychology units (one per semester) received feedback on the major assessment for each unit using an alternate assessment rubric or graded rating scale. The two introductory units were consecutive courses with the same cohort of students. Using a novel 9-itemed measure, students completed anonymous online questionnaires about both forms of feedback. There was a significant difference for one item, student understanding of the feedback, suggesting a preference for the graded rating scale. Across 8 other items there was no significant difference between feedback forms. These outcomes included other items measuring student comprehension, helpfulness for future similar tasks, usefulness when preparing the task, and whether feedback was read. Despite widespread academic preference for assessment rubrics, these results indicate no strong advantage for this form of feedback. This finding challenges traditional approaches to providing feedback and calls for further research to examine reasons why the rubric feedback was harder for students to understand, and identify characteristics of feedback that is preferred by both educators and students

Food neophobia and its association with diet quality and weight in children aged 24 months : A cross sectional study

Background: Food neophobia, the rejection of unknown or novel foods, may result in poor dietary patterns. This study investigates the cross-sectional relationship between neophobia in children aged 24 months and variety of fruit and vegetable consumption, intake of discretionary foods and weight. Methods: Secondary analysis of data from 330 parents of children enrolled in the NOURISH RCT (control group only) and SAIDI studies was performed using data collected at child age 24 months. Neophobia was measured at 24 months using the Child Food Neophobia Scale (CFNS). The cross-sectional associations between total CFNS score and fruit and vegetable variety, discretionary food intake and BMI (Body Mass Index) Z-score were examined via multiple regression models; adjusting for significant covariates. Results: At 24 months, more neophobic children were found to have lower variety of fruits (β=−0.16, p = 0.003) and vegetables (β=−0.29, p  <  0.001) but have a greater proportion of daily energy from discretionary foods (β=0.11, p=0.04). There was no significant association between BMI Z-score and CFNS score. Conclusions: Neophobia is associated with poorer dietary quality. Results highlight the need for interventions to (1) begin early to expose children to a wide variety of nutritious foods before neophobia peaks and (2) enable health professionals to educate parents on strategies to overcome neophobia

Relationships between maternal overweight prior to pregnancy, feeding mode and infant feeding beliefs and practices

Aim To examine whether pre-pregnancy weight status was associated with maternal feeding beliefs and practices in the early post-partum period. Methods Secondary analysis of longitudinal data from Australian mothers. Participants (N=486) were divided into two weight status groups based on self-reported pre-pregnancy weight and measured height: healthy weight (BMI <25kg/m2; n=321) and overweight (BMI>25kg/m2; n=165). Feeding beliefs and practices were self-reported via an established questionnaire that assessed concerns about infant overeating and undereating, awareness of infant cues, feeding to a schedule, and using food to calm. Results Infants of overweight mothers were more likely to have been given solid foods in the previous 24hrs (29% vs 20%) and fewer were fully breastfed (50% vs 64%). Multivariable regression analyses (adjusted for maternal education, parity, average infant weekly weight gain, feeding mode and introduction of solids) revealed pre-pregnancy weight status was not associated with using food to calm, concern about undereating, awareness of infant cues or feeding to a schedule. However feeding mode was associated with feeding beliefs and practices. Conclusions Although no evidence for a relationship between maternal weight status and early maternal feeding beliefs and practices was observed, differences in feeding mode and early introduction of solids was observed. The emergence of a relationship between feeding practices and maternal weight status may occur when the children are older, solid feeding is established and they become more independent in feeding

Poor dietary patterns at 1-5 years of age are related to food neophobia and breastfeeding duration but not age of introduction to solids in a relatively advantaged sample

Previous studies have investigated associations between individual foods or food group intake, and breastfeeding duration, age of solid introduction and food neophobia. This study aimed to investigate associations between whole dietary patterns in young children, and breastfeeding duration, age of solid introduction and food neophobia. Parents of children (N = 234) aged 1–5 years completed an online questionnaire. Dietary risk scores were calculated using the Toddler (1–3 years) or Preschool (>3–<5 years) Dietary Questionnaires which evaluates the previous week's food-group intake (scored 0–100; higher score = higher risk of poor dietary quality). Neophobia was measured using the Child Food Neophobia scale (1.0–4.0; higher score = more neophobic). Associations were investigated using multivariable linear regression, adjusting for covariates. Children (54% female, 3.0 ± 1.4 years) were from advantaged families and were breastfed until 11.8 (5.0–16.0) months, started solids at 5.6 ± 1.4 months of age, moderately neophobic (2.1 ± 0.7) and at moderate dietary risk (29.2 ± 9.2). Shorter breastfeeding duration (β = −0.21; p = 0.001) and poorer child food neophobia scores (β = 0.36; p < 0.001) were associated with higher dietary risk scores. Age of introduction to solids showed no association with dietary risk (p = 0.744). These findings suggest that in addition to breastfeeding promotion, supporting parents to manage neophobic behaviour may be important in promoting healthy eating patterns in early childhood

Is higher formula intake and limited dietary diversity in Australian children at 14 months of age associated with dietary quality at 24 months?

© 2017 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 24 month embargo from date of publication (Sept 2017) in accordance with the publisher’s archiving policyA varied and diverse diet in childhood supports optimum long-term preferences and growth. Previous analysis from 14-month-old Australian children in the NOURISH and South Australian Infants Dietary Intake (SAIDI) studies found higher formula intake was associated with lower dietary diversity. This analysis investigated whether formula intake and dietary diversity at 14 months of age is associated with dietary quality at 24 months. This is a secondary analysis of intake data from NOURISH and SAIDI cohorts. Scores for dietary diversity, fruit variety, vegetable variety and meat/alternative variety were combined using structural equation modelling to form the latent variable ‘Dietary quality’ (DQ) at age 24 months. A longitudinal model examined influence of formula (grams), cow's milk (grams) and dietary diversity at 14 months and covariates, on DQ. At age 24 months (n = 337) 27% of children obtained a maximum dietary diversity score (5/5). Variety scores were relatively low – with mean variety scores (and possible range) being four for fruit (0–30); five for vegetables (0–36); and three for meat/alternatives (0–8). Dietary diversity at 14 months (β = 0.19, p = 0.001), maternal age (β = 0.24, p < 0.001) and education (β = 0.22, p < 0.001) predicted DQ at 24 months while Child Food Neophobia Score was negatively associated with DQ (β = −0.30, p < 0.001). Formula intake was negatively associated with diversity at 14 months, but not DQ at 24. Diversity and variety were limited despite sociodemographic advantage of the sample. Diversity at 14 months, degree of neophobia and sociodemographic factors predicted DQ at 24 months. There is an ongoing need to emphasise the importance of repeated early exposure to healthy foods, such that children have the opportunity to learn to like a range of tastes and texture, thereby maximising dietary diversity and quality in infancy and early toddlerhood

Appetitive Traits associated with Higher and Lower Body Mass Index: Evaluating the Validity of the Adult Eating Behaviour Questionnaire in an Australian Sample

Background: The aims of this study were to evaluate the factor structure of the newly developed Adult Eating Behaviour Questionnaire (AEBQ) (Hunot et al., Appetite 105:356-63, 2016) in an Australian sample, and examine associations between the four food approach and four food avoidance appetitive traits with body mass index (BMI). Methods: Participants (N = 998) recruited between May and October 2016 via a university research participation scheme and online social network sites completed an online version of the AEBQ and self-reported demographic and anthropometric data. Of the sample, 84.8% were females, 29.6% had completed a university degree and the overall mean age was 24.32 years (SD = 8.32). Confirmatory factor analysis (CFA) was used to test three alternative factor structures (derived from issues raised in the original development study): the original 8 factor model, a 7 factor model with Food Responsiveness and Hunger scales combined, and a 7 factor model with the Hunger scale removed. Results: The CFA revealed that the original 8 factor model was a better fit to the data than the 7 factor model in which Food Responsiveness and Hunger scales were combined. However, while reliability estimates for 7 of the 8 scales were good (Cronbach’s α between 0.70-0.86), the reliability of the Hunger scale was modest (0.67) and dropping this factor resulted in a good fitting model. All food avoidance scales (except Food Fussiness) were negatively associated with body mass index (BMI) whereas Emotional Overeating was the only food approach scale positively associated with BMI. Conclusions: The study supports the use of the AEBQ as a reliable and valid measure of food approach and avoidance appetitive traits in adults. Longitudinal studies that examine continuity and stability of appetitive traits across the lifespan will be facilitated by the addition of this measurement tool to the literature

Maternal feeding practices and fussy eating in toddlerhood: A discordant twin analysis

Background: Parental feeding practices are thought to play a causal role in shaping a child's fussiness; however, a child-responsive model suggests that feeding practices may develop in response to a child's emerging appetitive characteristics. We used a novel twin study design to test the hypothesis that mothers vary their feeding practices for twin children who differ in their 'food fussiness', in support of a child-responsive model. Methods: Participants were mothers and their 16 month old twin children (n=2026) from Gemini, a British twin birth cohort of children born in 2007. Standardized psychometric measures of maternal 'pressure to eat', 'restriction' and 'instrumental feeding', as well as child 'food fussiness', were completed by mothers. Within-family analyses examined if twin-pair differences in 'food fussiness' were associated with differences in feeding practices using linear regression models. In a subset of twins (n=247 pairs) who were the most discordant (highest quartile) on 'food fussiness' (difference score≥.50), Paired Samples T-test were used to explore the magnitude of differences in feeding practices between twins. Between-family analyses used Complex Samples General Linear Models to examine associations between feeding practices and 'food fussiness'. Results: Within-pair differences in 'food fussiness' were associated with differential 'pressure to eat' and 'instrumental feeding' (ps<.001), but not with 'restriction'. In the subset of twins most discordant on 'food fussiness', mothers used more pressure (p<.001) and food rewards (p<.05) with the fussier twin. Between-family analyses indicated that 'pressure to eat' and 'instrumental feeding' were positively associated with 'food fussiness', while 'restriction' was negatively associated with 'food fussiness' (ps<.001). Conclusions: Mothers appear to subtly adjust their feeding practices according to their perceptions of their toddler's emerging fussy eating behavior. Specifically, the fussier toddler is pressured more than their less fussy co-twin, and is more likely to be offered food rewards. Guiding parents on how to respond to fussy eating may be an important aspect of promoting feeding practices that encourage food acceptance

The relationship between appetite and food preferences in British and Australian children

Background: Appetitive traits and food preferences are key determinants of children’s eating patterns but it is unclear how these behaviours relate to one another. This study explores relationships between appetitive traits and preferences for fruits and vegetables, and energy dense, nutrient poor (noncore) foods in two distinct samples of Australian and British preschool children. Methods: This study reports secondary analyses of data from families participating in the British GEMINI cohort study (n = 1044) and the control arm of the Australian NOURISH RCT (n = 167). Food preferences were assessed by parent-completed questionnaire when children were aged 3–4 years and grouped into three categories; vegetables, fruits and noncore foods. Appetitive traits; enjoyment of food, food responsiveness, satiety responsiveness, slowness in eating, and food fussiness were measured using the Children’s Eating Behaviour Questionnaire when children were 16 months (GEMINI) or 3–4 years (NOURISH). Relationships between appetitive traits and food preferences were explored using adjusted linear regression analyses that controlled for demographic and anthropometric covariates. Results: Vegetable liking was positively associated with enjoyment of food (GEMINI; β = 0.20 ± 0.03, p < 0.001, NOURISH; β = 0.43 ± 0.07, p < 0.001) and negatively related to satiety responsiveness (GEMINI; β = -0.19 ± 0.03, p < 0.001, NOURISH; β = -0.34 ± 0.08, p < 0.001), slowness in eating (GEMINI; β = -0.10 ± 0.03, p = 0.002, NOURISH; β = -0.30 ± 0.08, p < 0.001) and food fussiness (GEMINI; β = −0.30 ± 0.03, p < 0.001, NOURISH; β = -0.60 ± 0.06, p < 0.001). Fruit liking was positively associated with enjoyment of food (GEMINI; β = 0.18 ± 0.03, p < 0.001, NOURISH; β = 0.36 ± 0.08, p < 0.001), and negatively associated with satiety responsiveness (GEMINI; β = −0.13 ± 0.03, p < 0.001, NOURISH; β = −0.24 ± 0.08, p = 0.003), food fussiness (GEMINI; β = -0.26 ± 0.03, p < 0.001, NOURISH; β = −0.51 ± 0.07, p < 0.001) and slowness in eating (GEMINI only; β = -0.09 ± 0.03, p = 0.005). Food responsiveness was unrelated to liking for fruits or vegetables in either sample but was positively associated with noncore food preference (GEMINI; β = 0.10 ± 0.03, p = 0.001, NOURISH; β = 0.21 ± 0.08, p = 0.010). Conclusion: Appetitive traits linked with lower obesity risk were related to lower liking for fruits and vegetables, while food responsiveness, a trait linked with greater risk of overweight, was uniquely associated with higher liking for noncore foods