Article

The frequency of family meals and nutritional health in children: a meta-analysis: Family meals and children's health

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Abstract

Findings on the relationship between family meal frequency and children's nutritional health are inconsistent. The reasons for these mixed results have to date remained largely unexplored. This systematic review and meta-analysis of 57 studies (203,706 participants) examines (i) the relationship between family meal frequency and various nutritional health outcomes and (ii) two potential explanations for the inconsistent findings: sociodemographic characteristics and mealtime characteristics. Separate meta-analyses revealed significant associations between higher family meal frequency and better overall diet quality (r = 0.13), more healthy diet (r = 0.10), less unhealthy diet (r = −0.04) and lower body mass index, BMI (r = −0.05). Child's age, country, number of family members present at meals and meal type (i.e. breakfast, lunch or dinner) did not moderate the relationship of meal frequency with healthy diet, unhealthy diet or BMI. Socioeconomic status only moderated the relationship with BMI. The findings show a significant relationship between frequent family meals and better nutritional health – in younger and older children, across countries and socioeconomic groups, and for meals taken with the whole family vs. one parent. Building on these findings, research can now target the causal direction of the relationship between family meal frequency and nutritional health.

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... Some studies proposed that the entire family has to sit at the table to maximize the positive aspects of eating together (e.g., Øverby et al., 2020), whereas others used a less strict definition (e.g., Robson et al., 2020). Importantly, the meta-analysis by Dallacker et al. (2018) did not find an effect of the number of family members at the table on the relation between family meal frequency and children's nutritional health. As a practical consequence, meals with as few as two people eating together can count as family meals. ...
... Over the past 20 years, numerous studies have consistently shown that more frequent family meals are associated with several positive outcomes regarding children's nutritional health, including higher fruit and vegetable intake and overall healthy eating, lower soft drink consumption, lower body mass index (BMI), and fewer eating disorders (e. g., Dallacker et al., 2018;Glanz et al., 2021;Robson et al., 2020). Yet, the underlying mechanisms are still not well understood (Rosemond et al., 2019), despite promising findings from cross-sectional studies: A meta-analysis by Dallacker et al. (2018) identified six mealtime routines that are linked to healthier nutrition and body weight in children. ...
... Over the past 20 years, numerous studies have consistently shown that more frequent family meals are associated with several positive outcomes regarding children's nutritional health, including higher fruit and vegetable intake and overall healthy eating, lower soft drink consumption, lower body mass index (BMI), and fewer eating disorders (e. g., Dallacker et al., 2018;Glanz et al., 2021;Robson et al., 2020). Yet, the underlying mechanisms are still not well understood (Rosemond et al., 2019), despite promising findings from cross-sectional studies: A meta-analysis by Dallacker et al. (2018) identified six mealtime routines that are linked to healthier nutrition and body weight in children. These routines include parental modeling, TV off during meals, meals prepared at home, children's involvement in preparation, longer meal duration, and positive mealtime atmosphere. ...
Article
Children eat most of their meals in a family context, making family meals a key environment in which to learn about healthy food. What makes a family meal “healthy”? This diary study examined the practice of seven family mealtime routines (e.g., positive mealtime atmosphere, parental modeling, and longer meal duration) and their predictive value for children's healthier nutrition focusing on everyday family meal settings. Over 7 consecutive days, parents from N = 310 families (Mage = 42 years) described their most important family meal of the day and food intake for an index child (Mage = 9 years) and indicated what mealtime routines were practiced during the family meal. On average, each parent responded to 5.6 (SD = 1.4) of seven daily surveys. Mean correlations between mealtime routines were small (rs between −0.14 and 0.25), suggesting independent and distinct routines. Creating a positive atmosphere and turning TV and smartphones off were reported most often (on average, 91.2% and 90.5%, respectively). Parent's fruit and vegetable intake and creating a positive mealtime atmosphere were the strongest predictors for children's higher nutritional quality (i.e., higher vegetable and fruit intake; ps < .001). Findings indicate that mealtime routines obtained from independent meta-analyses represent distinct routines. Families practiced these independent and distinct routines to different degrees. Parental modeling and a positive mealtime atmosphere were most predictive of healthier child nutrition in daily family meal settings. More experimental research is needed to better understand causality and provide a better basis for effective interventions.
... Family meals are promoted in public health campaigns, the media and in the public opinion as a healthy and a convivial practice, by referring more or less accurately to results from research studies [7]. Yet, this type of promotion of family meals is misleading as, so far, only correlational associations have been shown between domestic commensality and positive health and wellbeing outcomes, has shown by systematic reviews and metaanalyses in this area, largely focussed on the frequency of family meals [8][9][10]. However, the research field on family meals is still lacking a social science review of papers that tackles this paradoxical phenomenon of promotion of family meals for health and wellbeing reasons despite strong scientific evidence supporting these claims. ...
... In France, the family meal is advertised in the latest dietary public health program as a way of achieving a better diet and reducing the risk of obesity [27], based on meta-analyses of studies, conducted by Dallacker and colleagues and Hammons and colleagues, that associate family meals with nutritional and weight benefits [10,28]. It is notable that the studies included in these meta-analyses were most commonly conducted in the United States; few of them were conducted in Europe and none in France. ...
... Moreover, eating alone is often associated with eating in front of screens, such as phones, computers, televisions and electronic tablets [55], indicative of the negative image of eating alone, as if using technological devices during meals necessarily implies isolation and is altogether detrimental to the experience of the ideal meal [50]. Having regular family meals has been associated with numerous positive health and wellbeing outcomes [8], particularly in terms of dietary and health benefits for children, including body weight [10,56]. ...
Article
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There exists a normative representation of family meals in contemporary Western societies which is promoted as imperative through public health programs, larger discourses and by some studies in the nutritional and public health research fields. Family meals, also called domestic commensality, are represented as convivial events and are associated with positive health and wellbeing outcomes but there is minimal evidence to show they are beneficial for family members and it is not known which aspect of the family meal could be responsible for these alleged benefits. This normative family meal image is based on a representation of the family as a peaceful unit exempt from external constraints. This narrative literature review of qualitative studies of family meals seeks to put forward the underlying premises of this representation and compare it with reports about actual practices. The results emphasize that eating together is still practiced and remains valued by family members, which is in contrast to discourses lamenting the decline of the family meal. However, the valorisation and recurrence of family meals depends on class, gender and cultural positions. There is a gap between the norm of healthy or convivial and achievable family meals, which can reinforce the so-called “mental load” and “emotion work” of those in charge of feeding the family and heighten inequalities within the household. In fact, there are many challenges to family meals which originate from external constraints or are inherent aspects of family life. The results from this review suggest that we should focus on family meals by taking into account the food work surrounding it and focussing on the interactional aspects of family meals. Ethnographic methods allow the researcher to observe the diversities and complexities of commensality as well as family dynamics and, in doing so, could provide more realistic representations of eating within the family.
... The findings show that the patterns "Eating with family while watching TV", "Eating away from home ", and "Eating alone in the bedroom" were associated with higher UPF consumption, whilst the pattern "Eating at school with friends" was associated with lower consumption of these products. We highlighted that, apart from the pattern "Eating at School with friends", the other eating context patterns shared a mix of characteristics, some associated with healthy eating habits, such as eating with the family (Dallacker et al., 2018), and others with unhealthy eating habits, such as eating while watching TV (Avery et al., 2017). ...
... A recent study carried out with British children demonstrated that having main meals (lunch and dinner) whilst watching TV was associated with higher UPF consumption (Martines et al., 2019). In this context, the apparent benefits of having a meal with the family (Dallacker et al., 2018;Martins et al., 2019;Scagliusi et al., 2016) were outweighed by the negative effects of having the television on during meals, as observed in a study performed by Fitz- Patrick et al. (2007) and by Avery et al. (2017). Furthermore, we observed the association between this eating pattern and greater consumption of specific UPF types, such as breakfast cereals, sweets and candies, soft drinks, and artificial fruit juices. ...
... The higher UPF consumption among children eating alone in the bedroom can be justified by family members' absence at the mealtime, considering their role in the child's eating habits development (Dallacker et al., 2018;Martins et al., 2019). Having meals with the family is associated to meals' better structuring, healthy food introduction, such as vegetables (parents serve as examples), and transmission of food-associated values (Santiago-Torres et al., 2014;Scaglioni et al., 2018). ...
Article
This study aimed to investigate the patterns of eating context and its association with ultra-processed food consumption by British children. This cross-sectional study was conducted with a representative sample of UK children aged 4–10 years old (n = 1772) from the National Diet and Nutrition Survey 2008/2014. Data on food consumption, meal context and ultra-processed food consumption were assessed through a four-day food diary. Exploratory factor analysis was used to identify the patterns of eating context and these patterns’ association with the daily consumption of ultra-processed food was verified by linear regression analyses. Ultra-processed foods comprised 65.4% of the total daily energy intake. At lunch, higher ultra-processed food consumption was associated with the patterns “Eating with family while watching TV” (64.9% in the lowest tertile to 68.1% in the highest tertile) and “Eating away from home” (65.2%–67.7%, respectively), while the eating pattern “Eating at school with friends” was associated with lower ultra-processed food consumption (66.6%–64.7%, respectively). At dinner, higher ultra-processed food consumption was associated with the patterns “Eating with family while watching TV” (64.6%–67.1%, respectively) and “Eating alone in the bedroom” (63.9%–66.5%, respectively). Eating alone, eating whilst watching TV, and eating away from home stood out as patterns of eating context associated with the increased consumption of ultra-processed food.
... The growing body of scientific evidence has shown that having more frequent family meals is positively associated with improved food intake and enhanced diet quality (DQ) in children [12]. In support of this, children who frequently have shared meals with family show healthier dietary patterns and were found to consume less sodium, sugar, and fat compared to those who seldom do so [13][14][15]. Cross-sectional and longitudinal studies suggested that regular family meals were associated with higher consumption of fruit and vegetables (FV) in children [16,17]. Other studies showed that children who eat meals with their family reported healthier dietary intake including higher consumption of fiber, FV, vitamins, and minerals [12]. ...
... The high intake of dairy products has also been reported among children who share breakfast with their family [16]. Furthermore, a metaanalysis including over 180,000 children found that children who shared their meals with parents three times or more per week had reduced odds of eating unhealthy food and becoming overweight [15], concluding that family meals' frequency is positively related to children's food intake and that further research is needed on how family meals' quality relates to children's nutritional intake. Similarly, it has been reported that children who had a lower intake of fried foods and soft drinks frequently consume their meals together with family [13]. ...
... Previous studies associating DQ of parents and children's intake have shown that improvement in parental DQ was associated with healthier food consumption of children [18,19]. In addition, more frequent family meals have been positively linked to higher DQ in parents [20] and children [15]. However, no previous study has examined whether parental DQ could have an impact in the association between family meals' frequency and the food consumption of children. ...
Article
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A family meal is defined as a meal consumed together by the members of a family or by having ≥ 1 parent present during a meal. The frequency of family meals has been associated with healthier food intake patterns in both children and parents. This study aimed to investigate in families at high risk for developing type 2 diabetes across Europe the association (i) between family meals’ frequency and food consumption and diet quality among parents and (ii) between family meals’ frequency and children’s food consumption. Moreover, the study aimed to elucidate the mediating effect of parental diet quality on the association between family meals’ frequency and children’s food consumption. Food consumption frequency and anthropometric were collected cross-sectionally from a representative sample of 1964 families from the European Feel4Diabetes-study. Regression and mediation analyses were applied by gender of children. Positive and significant associations were found between the frequency of family meals and parental food consumption ( β = 0.84; 95% CI 0.57, 1.45) and diet quality ( β = 0.30; 95% CI 0.19, 0.42). For children, more frequent family meals were significantly associated with healthier food consumption (boys, β = 0.172, p < 0.05; girls, β = 0.114, p < 0.01). A partial mediation effect of the parental diet quality was shown on the association between the frequency of family meals and the consumption of some selected food items (i.e., milk products and salty snacks) among boys and girls. The strongest mediation effect of parental diet quality was found on the association between the frequency of family breakfast and the consumption of salty snacks and milk and milk products (62.5% and 37.5%, respectively) among girls. Conclusions : The frequency of family meals is positively associated with improved food consumption patterns (i.e., higher intake of fruits and vegetables and reduced consumption of sweets) in both parents and children. However, the association in children is partially mediated by parents’ diet quality. The promotion of consuming meals together in the family could be a potentially effective strategy for interventions aiming to establish and maintain healthy food consumption patterns among children. Trial registration : The Feel4Diabetes-study is registered with the clinical trials registry (NCT02393872), http://clinicaltrials.gov , March 20, 2015. What is Known: • Parents’ eating habits and diet quality play an important role in shaping dietary patterns in children • Family meals frequency is associated with improved diet quality of children in healthy population What is New: • Frequency of family meals was significantly associated with healthier food consumption among parents and children in families at high risk of type 2 diabetes in six European countries. • Parental diet quality mediates the association between family meals frequency and the consumption of some selected food items among children.
... A number of diet-related behaviours which are highly prevalent among adolescents, such as skipping breakfast, eating infrequently with the family, eating in fast-food restaurants and in front of a screen, and dietary habits such as consuming sugar-sweetened beverages, have been studied in relation to overweight and obesity [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. More specifically, skipping breakfast has been associated with increased body mass index (BMI) and a higher risk of becoming overweight or obese [6,8,18,19]. ...
... More specifically, skipping breakfast has been associated with increased body mass index (BMI) and a higher risk of becoming overweight or obese [6,8,18,19]. Having frequent family meals has been found to protect against the development of overweight and obesity among adolescents and 10 years later [9,10]. Snacking while watching TV has been reported to be positively associated with overweight [12,14,21], while similar associations, although less consistent, have been found for time spent in front of the computer or playing video games [11,13]. ...
... A negative association was found between eating family meals and overweight, although only among boys. This finding is in line with previous studies suggesting that family meals are protective against the development of overweight and obesity during adolescence [9,10,50,67,68]. Family meals encourage social interaction between family members, the consumption of healthier food choices and higher quality foods, and parental dietary modeling as well as better control of the quality and quantity of a child's meal [50,68,69]. ...
Article
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Excessive body weight during adolescence represents a significant public health problem worldwide. Identifying factors associated with its development is crucial. We estimated the prevalence of overweight and obesity in a representative sample of 11, 13 and, 15-year-olds living in Greece and explored the association with diet-related behaviours and habits. Self-reported data on weight, height, diet-related behaviours and habits were used from 3816 students (1898 boys, 1918 girls) participants in the Greek arm of the international Health Behaviour in School-Aged Children (HBSC) study during 2018. Overweight and obesity were defined using the 2007 WHO growth charts classification. Prevalence of overweight was 19.4% in the total sample, 24.1% for boys and 14.7% for girls, and prevalence of obesity was 5.3% in the total sample, 7.3% for boys and 3.4% for girls, respectively. In the total sample, overweight (including obesity) was positively associated with male gender, low family affluence, skipping breakfast, and being on a diet, and inversely associated with age and being physically active. Eating rarely with the family was positively associated with overweight only among boys and eating snacks/meals in front of screens only among girls. No association was noted for eating in fast-food restaurants, consuming vegetables, fruits, sweets, and sugar-sweetened beverages.
... Regular participation in family meals has been associated with multiple health benefits in children and adolescents, including healthier diet and eating patterns and lower odds of eating disorders, overweight and obesity [8,9]. An updated meta-analysis by Dallacker et al. [10] confirmed these findings and found that the associations were robust to potential influence of country of residence, child age, number of family members participating in the meal, and type of meal. As age was only crudely accounted for in these models (< 11 vs. ≥ 11 years), associations between family meal participation and nutritional health in the youngest sub-groups cannot be inferred. ...
... Due to social disparities in dietary intake and diet quality [14], nutritional benefits of family meal participation may differ according to parental education and family socioeconomic position. In a meta-analysis of studies addressing family meals and nutritional health in children, Dallacker et al. [10] found that socioeconomic position slightly moderated the association between frequency of family meals and BMI, but not associations with healthy diet, unhealthy diet, and overall diet quality. To our knowledge, potential moderation of associations between family meal participation and dietary intake have not been explored among the youngest children. ...
... Dallacker et al. [10] included separate estimates for boys and girls in addition to the pooled effect size if findings for boys and girls were presented separately in included studies, but they did not investigate moderation based on sex. ...
Article
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Background Family meal participation is associated with healthier eating among children and adolescents. Less is known about family meal participation among infants and toddlers. The objective of the present study was to explore whether family meal participation at 12 months of age is associated with dietary intake and whether a potential relationship differs according to maternal education or child sex. Methods Follow-up data from children born to mothers participating in the Norwegian Fit for Delivery (NFFD) trial during pregnancy were used to assess the frequency of intake of 11 dietary items according to frequency of participating in the respective family meals. Dietary differences according to seldom (0–3 times/week) or often (4–7 times/week) participating in each respective meal category were assessed in linear regression models. Potential dose-response associations with frequency of participation in all family meal categories combined were also estimated. Models were adjusted for maternal randomization status, education, and child sex. Results The sample comprised 408 children. A total of 74, 53 and 74% had breakfast, lunch, and dinner with family ≥4 times/week, respectively, while 39% had supper and 27% between-meal snacks with family ≥4 times/week. Having family dinner ≥4 times/week was associated with more frequent intake of vegetables, homemade infant cereal, milk, and water, and less frequent intake of commercial infant foods while the other family meal categories were associated with fewer dietary outcomes. For each additional meal category eaten with family ≥4 times/week, frequency of vegetable intake (β = 0.45), water (β = 0.17), and milk (β = 0.09) per day increased, while commercial infant cereal was eaten less frequently (β = − 0.18). The inverse association between family meals and commercial infant cereal was only evident in children born to mothers in the intervention group. Several associations with diet were stronger and only significant among boys. Conclusions Being fed in the context of family meals at 12 months of age was associated with a more favorable diet. Including the infant in family meals has potential in the promotion of early nutritional health.
... Furthermore, parents who had regular family meals as adolescents reported having a healthier diet and better weight-related outcomes when compared to parents who did not experience regular family meals as adolescents [83,84]. Additionally, Dallacker and colleagues conducted a systematic review and meta-analysis of the nutritional health correlates of family meals, finding positive associations between frequent shared family meals and nutritional health among children [85]. Food availability was mentioned in three news articles. ...
... From the news articles included in the study, the findings highlight rare news media reporting of FPPs involving structure and those that aim to support child autonomy, such as parental role modelling of healthy food consumption, monitoring, nutrition education, and child involvement, all of which are shown to have positive, healthy child outcomes [1,4]. Reviews of the literature in this area indicate that modelling healthy food consumption, providing a healthy home food environment, and FPPs that support encouragement and independence in children's eating behaviours are associated with a healthier dietary intake and eating behaviours [1,4,85]. Academics, researchers, and press offices in these settings who engage with news media outlets could aid future reporting by considering the readership prior to discussions. ...
Article
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The objective of this study was to qualitatively summarise the content of online news articles pertaining to food parenting practices and determine whether this content is substantiated by the scientific literature. News article data were identified and collected from United Kingdom online news published during 2010–2017 period using the News on the Web corpus. A coding framework was used to categorise the content of news articles to identify information related to food parenting practices. Then, claims made about food parenting practices were extracted from relevant news articles. Each claim was evaluated to determine the extent to which any claims were supported by the available scientific research evidence. The study identified ten claims across thirty-two relevant online news articles. Claims made across the news articles reported on the following food parenting practices: food restrictions, food-based threats and bribes, pressure to eat, use of food to control negative emotions, food availability, food preparation, and meal and snack routines. Eight out of the ten claims identified did not refer to scientific research evidence. News articles frequently lacked detail and information to explain to readers why and how the use of certain food parenting practices could have a lasting impact on children’s health outcomes. Considering the influence that news media has on parents, the reporting of food parenting practices in news articles should aim to provide a balanced view of the published scientific evidence and recognise the difficulties and barriers that prevent the use of helpful and healthy food parenting practices. The study results in this paper could be used to aid and structure of the dissemination of food parenting practice research findings in the media, inform public health education to influence perceptions of unhelpful food parenting practices, and promote parental use of responsive food parenting practices.
... A number of studies dealing with family meals or social eating, studied as a background for this scoping review revealed that the overlap of studies using the search term "family meal" or "eating together" with the term "commensality" was often inclusive. A recent meta-analysis of family meals and health showed that there is convincing evidence showing that family meals have an important impact on the future meal frequency and nutritional health of children [1]. The definitions of "family meals" has, however, been shown to be inconsistent and concentrating on number of family meals per week [2]. ...
... A scoping review mapping the body of a specific topic was used to summarize and disseminate relevant literature [10]. This scoping review followed the steps suggested by Arksey and O'Malley [11]: (1) identifying the research question, (2) identifying relevant literature, (3) selecting the studies, (4) charting the data and (5) collating, summarizing, and reporting the results. The research questions were: How has commensality been assessed in research studies? ...
Article
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This scoping review focuses on the assessment of commensality in research and attempts to identify used methods for performing research on commensality. It reflects a multidisciplinary research field and draws on findings from Web of Science Core Collection, up to April 2019. The empirical material consisted of 61 studies, whereof most were qualitative research, and some were of quantitative character, including very few dietary surveys. The findings show nine papers categorized as using quantitative approaches, 52 papers were categorized as qualitative. The results show a wide variety of different ways to try to find and understand how commensality can be understood and identified. There seems to be a shift in the very concept of commensality as well as some variations around the concept. This paper argues the need to further investigate the importance of commensality for health and wellbeing, as well as the need to gather data on health and health-related behaviors, living conditions and sociodemographic data in parallel. The review shows the broad-ranging areas where commensality is researched, from cultural and historical areas to ethnographic or anthropological areas over to dietary assessment. To complement large dietary surveys with methods of assessing who you are eating with in what environment should be a simple way to further our knowledge on the circumstances of meal intake and the importance of commensality. To add 24-h dietary recall to any study of commensality is another way of identifying the importance of commensality for dietary quality. The use of mixed methods research was encouraged by several authors as a good way forward in the assessment of commensality and its importance.
... Given this problematic epidemiological scenario, it was also evidenced that, in adolescents, some eating contexts [e.g., skipping breakfast (Azeredo et al., 2015;Giménez-Legarre et al., 2020;Ma et al., 2020;Maia et al., 2018;Monzani et al., 2019); eating out ; eating in front of screens (watching TV, playing videogames, or using smartphone/tablet/computer) or while studying (Avery, Anderson, & McCullough, 2017;Goodman et al., 2020;Maia et al., 2018); and having meals without company (Azeredo et al., 2015;Dallacker, Hertwig, & Mata, 2018;Maia et al., 2018;Martins et al., 2019;] were associated with a lower diet quality, lower daily ingestion of vitamins and minerals, and a greater body mass index (BMI). ...
... F.S. Neves et al. and having them without the company of parents/guardians were associated with a lower diet quality (more frequent consumption of sweets, treats, soda, fast food, bagged salty snacks, and other ultraprocessed salted foods) (Azeredo et al., 2015;Maia et al., 2018;Martins et al., 2019) and with obesity . Furthermore, in systematic reviews of studies carried out with children and adolescents, the conclusion was that i) the omission of breakfast was associated with a worse diet quality index [estimated with the Youth Healthy Eating Index for the United States of America (US-YHEI)] (Monzani et al., 2019) and overweight (Ma et al., 2020;Monzani et al., 2019); ii) the habit of having meals in front of the TV was associated with a lower diet quality (more frequent consumption of fatty foods and sugary drinks, and less frequent consumption of fruits and vegetables) (Avery et al., 2017); and iii) the habit of not having meals in the company of family was associated with a lower diet quality (more frequent consumption of fast food, salty and sweet snacks, and sugary drinks, and less frequent consumption of fruits and vegetables) and a greater BMI, with no change after adjusting for age, geographic region, meal type (breakfast, lunch or dinner) and number of family members at the table (Dallacker et al., 2018). We again reiterate that any comparisons must be interpreted with caution, due to methodologic differences: the aforementioned studies only took into consideration one or few expositions among a wider range of variables which composed the eating context assessment in our study. ...
Article
This cross-sectional study estimated associations of eating contexts (including regularity of meals, places where they occur, and if they take place with attention and in company) with food consumption by degree of industrial processing and overweight indicators in a sample of Brazilian adolescents (14–19 years old) enrolled in 29 public schools in Juiz de Fora, MG (n = 805). We used an exploratory questionnaire, which was submitted to cluster analysis. Three clusters were identified: cluster 1 (n = 572), “appropriate eating contexts at breakfast, lunch, and dinner”; cluster 2 (n = 139), “inappropriate eating context at breakfast”; and cluster 3 (n = 94) “inappropriate eating context at dinner”. The evaluation of food consumption involved two 24-h dietary recalls, whose items were analyzed according to the NOVA classification system. Linear regression models were performed, using cluster 1 as reference. Clusters 2 and 3 were associated with an increase in the energy fraction from ultra-processed foods [respectively, β = 2.55% (IC 95%: 0.50; 5.05) and β = 4.18% (IC 95%: 1.21; 7.14)]; and cluster 2 was associated with a reduction in the energy fraction from unprocessed or minimally processed foods and culinary preparations [β = −3.61% (IC 95%: −6.40; −0.82)]. Additionally, clusters 2 and 3 were associated with an increase of body mass index for age [respectively, β = 0.23 z-score (IC 95%: 0.01; 0.46) and β = 0.27 z-score (IC 95%: 0.02; 0.54)]; and cluster 2 was associated with an increase of body fat [β = 1.21% (IC 95%: 0.23; 2.64)]. In conclusion, inappropriate eating contexts at breakfast and dinner were associated with higher ultra-processed food intake, higher body mass index and higher body fat percentage.
... The relationship between family meals and various nutritional health outcomes is an important research topic in relation to the great importance of healthy eating [9] or in relation to quarantine issues during the Covid-19 pandemic as pointed out by the WHO [10]. Family meals offer a rich opportunity to expose children to healthy foods, where children can learn healthy eating routines and behaviors from an early age [11]. A meta-analysis of the frequency of family meals showed a positive association between frequent family meals and better nutritional health. ...
... This was the case in younger and older children, across countries and socioeconomic groups, and for meals taken with the whole family vs. one parent. Regarding these findings, more research is recommended to target the causal direction of the relationship between family meal frequency and nutritional health [11]. The review also stated that most studies had investigated either 'family dinner' or 'family meals' and some to a lesser extent explored 'family breakfast' or 'family lunch'. ...
Article
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Commensal meals seem to be related to a better nutritional and metabolic health as well as an improved quality of life. The aim of this paper was to examine to what extent research was performed using the search term commensality related to assessment of timing of meals. A scoping review was performed, where 10 papers were identified as specifically addressing the assessment of timing of commensality of meals. Time use studies, questionnaires, and telephone- and person-to-person interviews were used for assessing meal times in relation to commensality. Four of the studies used a method of time use registration, and six papers used interviews or questionnaires. Common meals with family members were the most common, and dinners late at night were often preferred for commensal activities among the working population. In conclusion, the family meal seemed to be the most important commensal meal. It is clear from the collected papers and from previous systematic reviews that more studies of commensal meals in general and about timing aspects in particular and in relation to nutritional health are essential to provide a solid background of knowledge regarding the importance of timing in relation to commensal meals.
... Most of the research in public health focuses on demonstrating the general benefits of commensality, both in terms of physical health and psychosocial well-being (or even a combination of the two) [75]. They often provide data suggesting beneficial health effects of frequent family meals for children and adolescents, such as psychosocial health, nutritional health, and other benefits [76][77][78]. Commensality has furthermore been suggested as one key social influence on eating behavior in later life, with potential benefits both in terms of culinary pleasure and nutritional status [79]. Family meals have been linked to higher consumption of key nutrients, including fruits and vegetables, and a lower consumption of sweets and soft drinks [80,81]. ...
Article
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Commensality (the act of eating together) is studied in a range of disciplines and often considered important for social communion, order, health and well-being, while simultaneously being understood as in decline (especially the family meal). However, such claims are also contested in various ways. In this paper, we discuss the expanding field of commensality research and critically reflect on the debates surrounding its social functions, including its role in public health. We illuminate the deep social and cultural significance of commensality, through time and space, and conclude that whether or not commensality is the preferred social form of eating for any given individual, it is difficult to escape its sociocultural desirability and idealization. As a cross-cultural phenomenon in both past, present, and future, we suggest that commensality deserves further research. This includes commensality as a research topic in itself and as an entry point to unveil different dimensions of social relations between people, as well as interactions between humans and material objects.
... The combination of unhealthy eating, sedentary behaviors, and screen time during the pandemic has the potential to create lasting health effects. Research suggests that regular family meals are associated with healthier eating and a reduced risk of obesity [46], but overeating, excessive snacking, and screens may threaten to override positive effects. As the country begins to transition to a new normal, a return to healthier eating habits should be the focus of public health efforts. ...
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Background: The COVID-19 pandemic, with its cyclical lockdown restrictions and school closures, has influenced family life. The home, work, and school environments have collided and merged to form a new normal for many families. This merging extends into the family food environment, and little is known about how families are currently navigating this landscape. The objective of the present study was to describe families' adaptations in the family food environment during the COVID-19 pandemic. Methods: Parents participated in one of 14 virtual focus groups (conducted in English and Spanish between December 2020 and February 2021). Reflexive thematic analysis was used to analyze the transcripts. Results: Forty-eight parents (81% Hispanic and SES diverse) participated. Five themes and one subtheme were identified around changes in eating habits and mealtime frequency, increases in snacking, family connectedness at mealtimes, and use of screens at meals. Conclusions: The COVID-19 pandemic has influenced the family food environment. Families shared how their eating habits have changed and that device usage increased at mealtimes. Some changes (e.g., weight gain) may have lasting health implications for both children and parents. Public health officials, pediatricians, and schools should work with families to resume healthy habits post pandemic.
... Similarly, whether and how meals are eaten depends on family habits and parental behavior [14,15]. However, during a school week, children and adolescents spend most of their waking time at school. ...
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Given the high prevalence of childhood overweight, school-based programs aiming at nutritional behavior may be a good starting point for community-based interventions. Therefore, we investigated associations between school-related meal patterns and weight status in 1215 schoolchildren. Anthropometry was performed on-site in schools. Children reported their meal habits, and parents provided family-related information via questionnaires. Associations between nutritional behavior and weight status were estimated using hierarchical linear and logistic regression. Analyses were adjusted for age, socio–economic status, school type, migration background, and parental weight status. Having breakfast was associated with a lower BMI-SDS (βadj = −0.51, p = 0.004) and a lower risk of being overweight (ORadj = 0.30, p = 0.009), while having two breakfasts resulting in stronger associations (BMI-SDS: βadj = −0.66, p < 0.001; risk of overweight: ORadj = 0.22, p = 0.001). Likewise, children who regularly skipped breakfast on school days showed stronger associations (BMI-SDS: β = 0.49, p < 0.001; risk of overweight: OR = 3.29, p < 0.001) than children who skipped breakfast only occasionally (BMI-SDS: β = 0.43, p < 0.001; risk of overweight: OR = 2.72, p = 0.032). The associations persisted after controlling for parental SES and weight status. Therefore, our data confirm the school setting as a suitable starting point for community-based interventions and may underline the necessity of national programs providing free breakfast and lunch to children.
... Such intervention may be aimed at children and their parents because parent modeling is key to achieving healthy food choices [59]. Parents should be equipped with strategies enabling them to model healthy behaviors for their children and make the family meal environment conducive to nutritional health [60]. The input from the target group, the involvement of various stakeholders and close collaboration between researchers and those who will eventually implement social marketing campaigns is necessary for successful research and program delivery and translation and adoption of findings into practice [61,62]. ...
Article
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Social modeling of eating is the adjustment of the amount of food eaten to the intake of the accompanying person. In this paper we provide a narrative review of literature on social modeling of eating with a particular focus on recent studies. Firstly, we describe the structure of a typical modeling experiment. Secondly, we present a variety of research in this field: experiments with various types of confederates, experiments aimed at the evaluation of the influence of gender, partner’s body weight, type of food, hunger, personal characteristics, etc. Thirdly, we present practical implications of this knowledge. The common conclusion is that social modeling of eating occurs in different situations and consumption is adapted to the standards established by the eating partner, but is not their direct reflection. Social influence of eating is not restricted to "artificial" laboratory situations; social modeling and social norms manipulations may be used to change people’s dietary practices, especially in children and young adults. Within the home environment parental modeling has been shown to promote children’s snacking and fruit and vegetable consumption. Social modeling may be used in nutrition interventions aimed at the improvement of children’s diet and in obesity prevention programs.
... Girls who have the impression that consuming 5 meals per day, is a healthy practice have a higher possibility of applying this habit and also higher chance of having more family meals. Recent meta-analysis have demonstrated a significant relationship between frequent family meals and better nutritional health-in younger and older children, across countries and socioeconomic groups [28].It can also be contemplated that those girls make healthier choices of small meals or snacks and avoid frequent snacking or poor snack choices [29]. ...
Article
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Background: The aim of the present study was to examine the effects of socioeconomic status, nutrition and physical activity lifestyle habits and perceptions on Body Mass Index (BMI) in children aged 12–15 years in Greece. Furthermore, to compare the difference between the two sexes. Methods: This is a cross-sectional study conducted on a representative secondary school cohort that included 5144 subjects, aged 12 to 15 years. Students and their parents filled in validated questionnaires evaluating socioeconomic status, nutrition and physical activity. International Obesity Task Force cut offs were used to classify the children. Factor analysis of mixed data and partial proportional ordered logistic models were used to analyze ΒΜΙ distributions. All analyses were stratified by gender. Results: Boys were 2.9 (95%CI: 2.592–3.328) times more likely to be overweight/obese than girls. Partial proportional ordinal models indicate significant associations between nutritional and physical habits and perceptions variables but also significant gender differences in socio-demographic, nutritional risk factors as well as physical activity habits and perceptions. Conclusions: A clear understanding of the factors that contribute to the sex differences in nutrition and physical activity habits and perceptions may guide intervention efforts.
... This is based on assumptions about the family as the main provider of food, parents' function as role models and children's food socialization at the dining table. Evidence supports family-based interventions [2], and family meal frequency is associated with beneficial psychosocial outcomes in youth [3] and nutritional health in children [4], although causality remains unclear. More broadly, from a social perspective, food and commensality (shared meals) have been identified as central in the regulation of eating, and, by extension, social communion and order [5,6]. ...
Article
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Background Childhood obesity prevention initiatives emphasize healthy eating within the family. However, family-focused initiatives may not benefit children whose families lack economic and/or social resources for home cooking and shared meals. The aim of this paper is to examine how adults talk about and make sense of childhood memories of food and eating, with particular attention to understandings of family life and socioeconomic conditions. Methods Semi-structured interviews with 49 adults in 16 families (22 parents and 27 grandparents of young children) were conducted in Oregon, United States. Most participants had experienced socioeconomically disadvantaged childhoods. The interviews were analyzed using thematic analysis, with a focus on the participants’ memories of food provision, preparation, and consumption in their childhood homes. Results Two main themes were developed: (1) “Food and cohesion”, with the subthemes “Care and nurturance” and “Virtue transmission through shared meals”, and (2) “Food and adversity”, with the subthemes “Lack and neglect” and “Restriction and dominance”. The first theme captures idealized notions of food in the family, with participants recounting memories of care, nurturance, and culinary pleasure. The second theme captures how participants’ recollections of neglectful or rigidly restrictive feeding, as well as food discipline tipping over into dominance, upend such idealized images. Notably, the participants alternately identified poverty as a source of lack and as an instigator of creative and caring, if not always nutritionally-ideal, feeding. Thus, they remembered food they deemed unhealthy as a symbol of both neglect and care, depending on the context in which it was provided. Conclusions Childhood memories of food and eating may express both family cohesion and family adversity, and are deeply affected by experiences of socioeconomic disadvantage. The connection between memories of food the participants deemed unhealthy and memories of care suggests that, in the context of socioeconomic disadvantage, unhealthy feeding and eating may become a form of caregiving, with nutrition considered only one aspect of well-being. This has implications for public health initiatives directed at lower-income families.
... In the analyses of healthy eating behaviors, several systematic reviews have reported that the frequency of family meals is positively associated with the consumption of nutritious foods, a balanced diet, and a healthy body mass index (BMI) [4][5][6][7][8]. However, studies examining the association between family meals or eating alone and health indicators among the elderly are limited because most examinations have involved infants, children, or adolescents. ...
Article
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This cross-sectional study investigated the association between eating alone at each meal and health status, including functional capacity among community-dwelling Japanese elderly living with others. A self-administered questionnaire was mailed to all 8004 residents aged 65 or older, residing in the same Japanese town in March 2016. Eating alone was assessed by first asking whether participants ate three separate meals each day (i.e., breakfast, lunch, and dinner), and those who answered affirmatively were then asked how many people were usually present at each meal. Health status was assessed in terms of subjective health, medical history, care needs, body mass index, depression, and functional capacity. Data from 2809 respondents were analyzed. Those who reported not being in good subjective health and a history of hypertension were significantly more likely to eat alone at breakfast (odds ratio 1.27; 95% confidence interval 1.01-1.61, and 1.26; 1.06-1.49). Depressive symptoms and many subscales of functional capacity were also significantly associated with eating alone at breakfast, lunch, and dinner (p < 0.05). Many health status indicators were related to eating alone at each meal, especially breakfast.
... Urbanization has transformed cities to obesogenic environments, a term that has been coined to describe environments that induce obesity through promoting a sedentary lifestyle and encouraging an excess calorie intake [17]. This has resulted in the first generation to have a shorter life expectancy than their parents [18]. ...
Article
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Active travel (AT) has the potential to integrate with, or in some cases substitute for, trips taken by motorized transportation. In this paper we review relevant research on AT outcomes to address the potential of AT and emerging data sources in supporting the transport paradigm shift toward AT. Our analysis identifies physical, mental, built and physical environmental, monetary, and societal outcomes. Traditional methods used to acquire AT data can be divided into manual methods that require substantial user input and automated methods that can be employed for a lengthier period and are more resilient to inclement weather. Due to the proliferation of information and communication technology, emerging data sources are prevailing and can be grouped into social fitness networks, in-house developed apps, participatory mapping, imagery, bike sharing systems, social media, and other types. We assess the emerging data sources in terms of their applications and potential limitations. Furthermore, we identify developing policies and interventions, the potential of imagery, focusing on non-cycling modes and addressing data biases. Finally, we discuss the challenges of data ownership within emerging AT data and the corresponding directions for future work.
... Thus, family meals could be confounded by the influence of having the TV on during meals. Notwithstanding, we hypothesize that the apparent benefits of having a family meal (63)(64)(65) may be outweighed by the negative effects of having the television on during meals (61,66) . At dinner, we observed that the daily consumption of ultra-processed foods increased with the greater adherence to the latter pattern. ...
Article
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This study aimed to evaluate the association between eating context patterns and ultra-processed food consumption at two main meal occasions in a representative sample of UK adolescents. Data was acquired from four-day food records of adolescents aged 11–18 years, who participated in the 2014–2016 UK National Diet and Nutrition Survey (n=542). The eating context was assessed considering the location of the meal (lunch and dinner) occasion, the individuals present, whether the television was on and if the food was consumed at a table. Ultra-processed foods were identified using the NOVA classification. Exploratory factor analysis was used to identify eating context patterns for lunch and dinner. Linear regression models adjusted for the covariates were utilised to test the association between eating context patterns and the proportion of total daily energy intake derived from ultra-processed foods. Their contribution was about 67% to total energy intake. Three patterns were retained for lunch (‘At school with friends’, ‘TV during family meal’, and ‘Out-of-home (no school)’); and three patterns were retained for dinner (‘Watching TV alone in the bedroom’, ‘TV during family meal’, and ‘Out-of-home with friends’). At lunch, there was no significant association between any of the three patterns and ultra-processed food consumption. At dinner, the patterns ‘Watching TV alone in the bedroom’ (coeff: 95%CI 4.95: 1.87–8.03) and ‘Out-of-home with friends’ (coeff: 95%CI 3.13: 0.21–6.14) were associated with higher consumption of ultra-processed food. Our findings suggest a potential relationship between the immediate eating context and ultra-processed food consumption by UK adolescents.
... 1,2 The frequency of family meals has been linked to diet quality, body mass index, psychological well-being, selfesteem, and academic success among youth. 3,4 Among preschool-aged children, characteristics of family meals (eg, inconsistent mealtime routines, eating alone) have been shown to be associated with child eating behaviors such as picky eating and food refusals. 5,6 The underlying mechanisms of these relationships are unclear but are presumed to include the predictable rhythmicity of the meal, the unifying nature of preparing for and sitting down for the meal, the positive family functioning, and communication occurring among family members. ...
Article
Objective To explore parental perspectives on the ideals and realities of family mealtimes. Design Mini-focus groups (n = 7). Setting Rural Colorado, US. Participants Parents (n = 30) were recruited at Head Start/preschool centers. Phenomenon of Interest Parent perspectives on mealtimes with preschool-aged children. Analysis Transcripts were analyzed using thematic analysis. Results Three categories of themes emerged: participant conceptions of ideal family meals, challenges to achieving their ideal family meal, and parental solutions. The theme of participant conceptions of ideal family meals composed family togetherness, children liking and eating the prepared food, healthfulness of food, and a nonchaotic mealtime. Challenges to achieving their ideal family meal included work schedules, disruptive child behaviors, child pickiness, snacking, and negative role-modeling. Finally, parental solutions to challenges incorporated having flexible meal timings, considering child preferences in premeal preparations, role-modeling, and numerous other parenting strategies. Conclusions and Implications While parents valued many aspects of a version of the ideal meal rooted in historical standards, families faced many challenges in trying to attain that ideal. Although parents employed various strategies to combat mealtime challenges, parental expectations for preschool-aged children's mealtime behaviors may be unrealistic for the developmental stage of early childhood. Future interventions could help parents develop age-appropriate mealtime expectations.
... Family mealtimes were excluded from the definition of the social home food environment as a recently published review examined the relationship between family mealtimes and child weight [22]. This meta-analysis found higher family meal frequency was associated with better overall diet quality, greater consumption of nutrient dense foods and fewer energy-dense foods and lower child BMI. ...
Article
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Background Extensive research has demonstrated the role of the Home Environment (HE) in shaping children’s energy balance behaviours. Less is known about direct relationships with bodyweight. This review examines associations between the social and physical aspects of three pre-defined Home Environment domains (food, physical activity and media) and adiposity measures in children ≤12 years. Methods Six electronic databases (PubMed, Medline, EBSCO CINAHL, EMBASE, Web of Science, PsycInfo) were systematically searched up to October 2020. Studies reporting at least one physical and/or social aspect of the food, physical activity and/or media domains of the Home Environment in relation to child adiposity outcomes were included ( n = 62). Results Most studies examined one ( n = 41) or two domains ( n = 16). Only five studies assessed all three domains of the Home Environment. Most consistent relationships were observed for physical aspects of the home media environment; with greater availability of electronic devices associated with higher child adiposity (21/29 studies). Findings were less consistent for the smaller number of studies examining physical aspects of the home food or physical activity environments. 8/15 studies examining physical food environments reported null associations with adiposity. Findings were similarly mixed for physical activity environments; with 4/7 reporting null associations, 2/7 reporting negative associations and 1/7 reporting positive associations between access to physical activity equipment/garden space and adiposity. Fewer studies assessed social aspects (e.g. caregiver modelling or limit setting) of the Home Environment in relation to child adiposity and findings were again mixed; 9/16 media environment, 7/11 food environment and 9/13 physical activity environment studies reported null associations with child adiposity outcomes. Conclusions The home media environment was most consistently associated with adiposity in childhood. Findings were less consistent for the home food and physical activity environments. Greater agreement on definitions and the measurement of the obesogenic home environment is required in order to clarify the strength and direction of relationships with child adiposity. Robust longitudinal research using comprehensive measures of the holistic home environment is needed to better identify which aspects contribute to excess weight gain in childhood. Trial registration PROSPERO Systematic review registration number: CRD42018115139 .
... Covariates were identified a priori using the published literature and included child age (25)(26)(27)(28)(29)(30)(31) , sex (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) , birth weight (32,36) , total screen time (27,(34)(35)(36) , maternal education (29)(30)(31)(32)34,36,37) , maternal ethnicity (25,27,31,35,38) , family income (25,27,33,36,38) , parental history of cardiometabolic disease (high cholesterol, hypertension, heart disease and diabetes) (39)(40)(41) and breast-feeding duration (42) . Additional covariates included unstructured free play time (26,27,29,32,34,43) , total screen time (27,(34)(35)(36) and family meals (44) . Unstructured free play was assessed using parents' response to the open-ended question 'Aside from time in daycare and school, on a typical weekday, how much time does your child spend outside in unstructured free play?'. ...
Article
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Objectives To examine the association between mealtime media use and non-HDL-cholesterol as well as other markers of cardiometabolic risk (CMR) in children. Design A repeated measures study design was used to examine the association between mealtime media use and CMR outcomes. Multivariable linear regression with generalised estimating equations was used to examine the association between mealtime media use and CMR outcomes. Analyses were stratified a priori by age groups (1–4 and 5–13 years). Setting The TARGet Kids! Practice-based research network in Toronto, Canada. Participants 2117 children aged 1–13 years were included in the analysis. Results After adjusting for covariates, there was no evidence that total mealtime media use was associated with non-HDL-cholesterol in 1–4 year olds ( P = 0·10) or 5–13 year olds ( P = 0·29). Each additional meal with media per week was associated with decreased HDL-cholesterol in 5–13 year olds (−0·006 mmol/l; 95 % CI −0·009, −0·002; P = 0·003) and log-TAG in 1–4 year olds ( β = −0·004; 95 % CI −0·008, −0·00009; P = 0·04). Media use during breakfast was associated with decreased HDL-cholesterol in 5–13 year olds (−0·012 mmol/l; 95 % CI −0·02, −0·004; P = 0·002), while media during lunch was associated with decreased log-TAG (−0·01 mmol/l; 95 % CI −0·03, −0·002; P = 0·03) in children aged 1–4 years. Total mealtime media use was not associated with total cholesterol, glucose or insulin in either age group. Conclusions Mealtime media use may be associated with unfavourable lipid profiles through effects on HDL-cholesterol in school-aged children but likely not in pre-schoolers.
... Therefore, addressing behavioral changes embedded in daily family life might be a promising avenue for facilitating an individual's behavior change. Family meals, for example, are often an important part of everyday life in families and there is accumulating evidence that this collective behavior is associated with a better overall diet quality and body mass index [18][19][20]. In a similar vein, there is some evidence that family-based physical activity is positively associated with individual physical activity levels [21]. ...
Article
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Background: Numerous smartphone apps are targeting physical activity and healthy eating, but empirical evidence on their effectiveness for initialization and maintenance of behavior change, especially in children and adolescents, is still limited. Objectives: The aim was to conceptualize a theory-based and evidence-based mHealth intervention called SMARTFAMILY (SF) that targets physical activity and healthy eating in a collective family-based setting. Subsequently, the app will be refined and re-evaluated to analyze additional effects of just-in-time adaptive interventions (JITAIs) and gamification features. Methods: A smartphone app based on behavior change theories and behavior change techniques was developed and implemented and will be evaluated with family members individually and cooperatively (SF trial). Subsequently, eExisting evidence and gained results were used to refine and will be used to re-evaluate the app (SF2.0 trial). Both trials are cluster randomized controlled trials with 3 measurement occasions. The intervention group uses the app for 3 consecutive weeks, whereas the control group receives no treatment. Baseline measurements (T0) and post intervention measurements (T1) include physical activity (ie, self-reported and accelerometry) and healthy eating measurements (ie, self-reported fruit and vegetable intake) as the primary outcomes. The secondary outcomes (ie, self-reported) are intrinsic motivation, behavior-specific self-efficacy, and the family health climate, complemented by an intentional measure in SF2.0. Four weeks following T1, a follow-up assessment (T2) will beis completed by the participants, consisting of all questionnaire items to assess the stability of the intervention effects. Mixed-method analysis of covariance will be used to calculate the primary intervention effects (ie, physical activity, fruit and vegetable intake) while controlling for covariates, including family health climate, behavior-specific self-efficacy, and intrinsic motivation. Results: This study is funded by the German Federal Ministry of Education and Research and ethically approved by the Karlsruhe Institute of Technology. For both trials, it is hypothesized that the apps will positively influence physical activity and healthy eating in the whole family. Furthermore, SF2.0 is expected to produce stronger effects (ie, higher effect sizes) compared to SF. SF app development and piloting are completed. Data acquisition for the SF trial is terminated and discontinued due to the COVID-19 pandemic. SF2.0 app development and piloting are completed, while data acquisition is ongoing. Participant recruitment for the SF 2.0 trial started in February 2020. The results for SF are expected to be published in mid-2021, and the results of SF2.0 are expected to be published in mid-2022. Conclusion: In this study, it is hypothesized that targeting the whole family will facilitate behavior change at the individual level and the family level, as the implemented strategies address changes in daily family life. Furthermore, subsequent app development (SF2.0) with supplementary addition of motivation-enhancing features and a JITAI approach is expected to enhance positive intervention effects.
... Therefore, addressing behavioral changes embedded in daily family life might be a promising avenue for facilitating individual's behavior change. Family meals, for example, are often an important part of everyday life in families and there is accumulating evidence that this collective behavior is associated with a better overall diet quality and body mass index [18][19][20]. In a similar vein, there is some evidence that family-based PA is positively associated with individual PA levels [21]. ...
Preprint
Background Numerous smartphone apps are targeting physical activity and healthy eating, but empirical evidence on their effectiveness for initialization and maintenance of behavior change, especially in children and adolescents, is still limited. Objective The aim of this study was to conceptualize a theory-based and evidence-based mHealth intervention called SMARTFAMILY (SF) that targets physical activity and healthy eating in a collective family-based setting. Subsequently, the app will be refined and re-evaluated to analyze additional effects of just-in-time adaptive interventions (JITAIs) and gamification features. Methods A smartphone app based on behavior change theories and behavior change techniques was developed and implemented and will be evaluated with family members individually and cooperatively (SF trial). Existing evidence and gained results were used to refine and will be used to re-evaluate the app (SF2.0 trial). Both trials are cluster randomized controlled trials with 3 measurement occasions. The intervention group uses the app for 3 consecutive weeks, whereas the control group receives no treatment. Baseline measurements (T0) and postintervention measurements (T1) include physical activity (ie, self-reported and accelerometry) and healthy eating measurements (ie, self-reported fruit and vegetable intake) as the primary outcomes. The secondary outcomes (ie, self-reported) are intrinsic motivation, behavior-specific self-efficacy, and the family health climate, complemented by an intentional measure in SF2.0. Four weeks following T1, a follow-up assessment (T2) is completed by the participants, consisting of all questionnaire items to assess the stability of the intervention effects. Mixed-method analysis of covariance will be used to calculate the primary intervention effects (ie, physical activity, fruit and vegetable intake) while controlling for covariates, including family health climate, behavior-specific self-efficacy, and intrinsic motivation. Results This study is funded by the German Federal Ministry of Education and Research and ethically approved by the Karlsruhe Institute of Technology. For both trials, it is hypothesized that the apps will positively influence physical activity and healthy eating in the whole family. Furthermore, SF2.0 is expected to produce stronger effects (ie, higher effect sizes) compared to SF. SF app development and piloting are completed. Data acquisition for the SF trial is terminated and discontinued due to the COVID-19 pandemic. SF2.0 app development and piloting are completed, while data acquisition is ongoing. Participant recruitment for the SF 2.0 trial started in February 2020. The results for SF are expected to be published in mid-2021, and the results of SF2.0 are expected to be published in mid-2022. Conclusions In this study, it is hypothesized that targeting the whole family will facilitate behavior change at the individual level and the family level, as the implemented strategies address changes in daily family life. Furthermore, subsequent app development (SF2.0) with supplementary addition of motivation-enhancing features and a JITAI approach is expected to enhance positive intervention effects. Trial Registration German Clinical Trials Register DRKS00010415; https://tinyurl.com/yyo87yyu International Registered Report Identifier (IRRID) DERR1-10.2196/20534
... Por tanto, comer en casa y en familia, como las madres de este estudio describen, no necesariamente trae beneficios alimentarios y nutricionales para la familia. Además, un metaanálisis reciente describió que las comidas familiares frecuentes, independiente del número de miembros participantes, se relacionan con una buena salud nutricional en niños al promover una mejor calidad alimentaria 50 . Aunque en familias chilenas no se ha estudiado esta relación, es habitual que familias de menor nivel socioeconómico compartan las comidas con otros miembros familiares 51 , como ocurrió en este estudio. ...
Article
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Resumen Objetivo Explorar las influencias de integrantes del grupo familiar en las prácticas de alimentación de madres hacia preescolares, en familias de barrios vulnerables en la Región Metropolitana de Santiago, Chile. Diseño Estudio cualitativo. Lugar Nueve jardines infantiles de la Región Metropolitana, Santiago, Chile. Participantes Veinticuatro madres y un padre de hijos preescolares. Método Se realizaron 25 entrevistas semiestructuradas con técnica de foto-elicitación y su posterior análisis temático inductivo de las influencias familiares. Resultados Las participantes describieron que las influencias familiares sobre las prácticas de alimentación que aplicaban en sus hijos preescolares dependían de la estructura familiar y de la cercanía entre familiares. Algunas de estas influencias afectan directamente la conducta alimentaria del niño, especialmente en familiares que cohabitan juntos, mientras que otras estaban mediadas por las relaciones generadas entre padres y otros miembros de la familia. El padre, en familias biparentales, y abuelos del preescolar son los familiares más influyentes. Los padres participan en la alimentación del niño y generalmente se alinean a las prácticas de alimentación con la madre. Los abuelos enriquecen la experiencia alimentaria de preescolares ofreciendo preparaciones caseras, expresando afecto con los alimentos, incluso opciones poco saludables, y apoyando a padres a diversificar y estructurar la alimentación del niño. Conclusiones El impacto de familiares y sus dinámicas en las prácticas alimentarias parentales y la alimentación de preescolares varían según la cercanía o cohabitación entre familiares. El desarrollo de estrategias de prevención y tratamiento de obesidad infantil debería considerar un enfoque familiar en familias vulnerables.
... On Shabbat, particularly, the meals provide a positive environment with singing and discussion without distraction from television and the internet. This is important as regular family meals have been shown to be associated with healthy weight, balanced diet, long-term healthy eating habits (Dallacker, Hertwig, & Mata, 2018;Rubin et al., 2017) as well as language development and other beneficial outcomes (Rudolf, 2014). A family focused approach provides an additional advantage. ...
Article
Background Eating behaviours vary by culture and religion, and an understanding of attitudes and practices are essential for providing culturally competent nutritional guidance. The Ultra-orthodox Jewish community is characterized by poor diet, high rates of obesity, anemia and diabetes. This study aimed to acquire insights that could influence the promotion of healthier eating in the Ultra-orthodox and other closed religious communities, particularly regarding children's eating habits and the food they consume. Methods In depth face-to-face recorded interviews were conducted with 20 information-rich participants: religious leaders, opinion leaders and education/health professionals from Gur and Chabad, two Ultra-orthodox Jewish religious communities in Israel. The focus was on exploring young family eating behaviours and perceived challenges to encouraging healthier nutrition in the community. Interviews were transcribed and thematic analysis employed using grounded theory. Results Seven themes were identified with findings that had clear implications for the promotion of health at both the community and individual level. These included spiritual aspects of eating, deficits in knowledge and awareness, less relevance of kashrut than previously thought, the centrality of motherhood and family meals, the quality of food in educational institutions, the significance and sensitivity of Sabbath and festive meals and pragmatic considerations. Discussion and conclusions By illuminating attitudes and behaviors, the study broadens and enhances our understanding of the Ultra-orthodox communities' perspectives on eating behaviours in the family. The findings have the potential to contribute to strengths-based health promotion for children's nutrition. Recommendations regarding culturally competent guidance and implications for other secluded religious communities are discussed.
... This may be attributed to the fact that breakfast time is a sharing habit as the family's members eat together and hence family meals have a protective influence on children's dietary behavior. [35][36][37] Thus, both parental modeling and food parenting practices could be considered as possible influencers. It is worth mentioning that in our study, no significant association was observed between children with affected parents and the rest eating behaviors as regards soft drinks and sweets which are easily accessible out of the home environment since these dietary behaviors can get away from parental control in contrast with breakfast consumption which takes place usually at home. ...
Article
Although the parental influence on children’s dietary habits has been widely studied, little is known about the effect of parental health status on children’s dietary behavior. Thus, the association between the parental burden of cardiometabolic disease and its impact on children’s eating habits and behaviors was examined. Material and Methods: 1,728 children aged 10-12 years old along with one of their parents were enrolled in a cross-sectional study conducted during 2014-2016. Among others, children’s dietary habits and parental medical history were recorded. Children’s adherence to the Mediterranean diet (MD) was evaluated through the KIDMED score while the parental health status was assessed through a cardiometabolic risk score calculated for this study. The working sample was 1,133 children with a recorded parental health status. Results: Most parents (92.1%) reported at most 2 cardiometabolic risk factors including overweight/obesity, diabetes mellitus, hypertension, and dyslipidemia. Ordinal logistic regression analyses showed a significant association between children’s eating habits and adherence to the MD with the parental burden of cardiovascular disease. Children showed 6% higher odds of higher adherence to the MD (OR: 1.06, 95% CI: 1.01-1.12) and 54% lower odds of not having breakfast at all (OR: 0.46, 95% CI: 0.27-0.80) for a one-unit increase in the cardiometabolic risk score. The stratified analysis revealed a significant association between KIDMED score and CVD risk score only among boys (OR: 1.09, 95% CI: 1.01-1.18). Conclusions: Parental health status is positively associated with children’s dietary behavior and adherence to the MD indicating an additional source of influence.
... As we could show in previous research, having breakfast and lunch is associated with lower BMI-SDS and lower risk of being overweight [24]. This finding underlines the health-promoting effect of a high meal frequency and thus confirms existing literature [53][54][55]. Given that meal skipping is particularly prevalent among low SES and ethnic minority children [40], it is promising to target utilization through a family-independent intervention-thus, a school-based approach may help to reduce SES-induced differences in participation rates [23]. ...
Article
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Despite growing school lunch availability in Germany, its utilization is still low, and students resort to unhealthy alternatives. We investigated predictors of school lunch participation and reasons for nonparticipation in 1215 schoolchildren. Children reported meal habits, parents provided family-related information (like socioeconomic status), and anthropometry was conducted on-site in schools. Associations between school lunch participation and family-related predictors were estimated using logistic regression controlling for age and gender if necessary. School was added as a random effect. School lunch participation was primarily associated with family factors. While having breakfast on schooldays was positively associated with school lunch participation (ORadj = 2.20, p = 0.002), lower secondary schools (ORadj = 0.52, p < 0.001) and low SES (ORadj = 0.25, p < 0.001) were negatively associated. The main reasons for nonparticipation were school- and lunch-related factors (taste, time constraints, pricing). Parents reported pricing as crucial a reason as an unpleasant taste for nonparticipation. Nonparticipants bought sandwiches and energy drinks significantly more often on school days, whereas participants were less often affected by overweight (OR = 0.66, p = 0.043). Our data stress school- and lunch-related factors as an important opportunity to foster school lunch utilization.
... [7][8][9]. Moreover, a cross-sectional study of children in the United States went beyond frequencies of family meals to look more closely at explanatory mechanisms, identifying an association between positive interpersonal and food-related dynamics (e.g., group enjoyment, relationship quality) during family meals and a lower risk of children having overweight [10].In addition to supporting healthier eating behaviors, eating together may hold broader psychosocial benefits for children and adults [11][12][13][14][15]. Several qualitative studies further demonstrate that commensality -both within the family and in other social constellations -is often highly valued, desired, and considered worthwhile across cultures [16][17][18][19][20][21][22]. ...
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Background The practice of eating together, commensality, is rarely explored in the context of childhood obesity treatment. This is noteworthy given long-standing debates about the physical, psychosocial, and societal benefits of meals, especially family meals. Moreover, as children with obesity experience weight bias and stigma both within and outside the home, it is important to examine meals as a locus of social exchange around food and the body. Our study is based on the premises that eating together (i) matters and (ii) occurs in different environments with diverse social organization, where food-related interactions create varying arrangements of individuals, groups, their statuses, and their actions. Method The study explores children’s experiences of meals in different social contexts. Thirty-two children (age 8–10 years) living in Sweden were interviewed, 4 years after they entered an obesity intervention trial. Thematic analysis was applied to the data. Results We thematized three meal types, with each meal type having two subthemes: (i) “The family meal”, with “Shared routines, rituals, and rules” and “Individual solutions and choices”; (ii) “The school meal”, with “Rules and norms of the school” and “Strategies of the child”; and (iii) “The friend meal”, with “Handling food that was disliked” and “Enjoyment of food”. These three different meal types carried different experiences of and knowledge about how they were socially organized. Conclusions While the children spoke about the family and school meals as meaningful, the friend meal stood out as particularly positive. Contrary to our expectations, the children did not express experiences of weight bias or obesity stigma around meals, nor did they speak negatively about parental control of their food intake. Our findings, especially regarding the friend meal, have implications for further research into commensality and social influences on eating among children with obesity, from early childhood into adolescence.
... y menor consumo de dieta no saludable (r=-0.04) (Dallacker et al., 2018). Similares resultados han sido observados en población adulta. ...
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Se presenta evidencia respecto a la influencia de la familia en la alimentación, así como el rol que se le ha asignado socialmente a la mujer al interior de la misma.
... y menor consumo de dieta no saludable (r=-0.04) (Dallacker et al., 2018). Similares resultados han sido observados en población adulta. ...
... Nutrition Knowledge (NK) is considered as one of the factors affecting food habits and food consumption patterns (5). However, NK is strongly influenced by environmental variables such as the behavior of the family (6,7), school (8), as well as external inputs such as television advertisements (9,10) or modern eating habits. In addition, socio-economic and educational levels have an important impact, especially in the youngest age group of the population (11). ...
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Background An optimal Nutrition knowledge (NK) among the population could result in greater Adherence to the Mediterranean Diet (AMD), a recognized dietary pattern capable of preventing chronic food-related diseases. This study aimed to evaluate the association between NK and AMD in Italy. Methods A national representative sample of 2,869 adults took part in an assessment that was carried out through a self-administrated questionnaire including sections relating to NK and AMD. AMD was evaluated following the PREDIMED PLUS methodology. Descriptive statistics were provided, and ordinal measures of NK score and AMD were calculated based on quartiles of the quantitative scores. A contingency analysis was performed to check associations between variables. Results In Italy, the average NK score was 50 ± 13.3, equivalent to 56.8% of correct answers. The average value of AMD was 6.8, corresponding to 40% of the maximum score with 31.4% of the population demonstrating low AMD, 31.3% in the lower-middle range, 24% in the medium-high range, and only 13.3% reporting a high AMD. A significant association between NK and AMD was found; respondents who reported the lowest AMD corresponded to those with the lowest NK (36.7%; p < 0.05) and similarly, those with the highest level of adherence to MD also achieved the highest NK scores (41.7%; p < 0.05). Conclusion This study showed that AMD in Italy is generally low, and the strong association between NK and AMD demonstrated that there is a clear connection between a healthy dietary pattern and the nutrition literacy of the population. Those with the highest AMD corresponded to the highest NK and, conversely, those with the lowest AMD displayed the lowest NK. The study also highlighted that socioeconomic aspects were strong determinants of both AMD and NK.
... Encourage family meals without electronic devices and promote conversations for social interaction. 140,141 Provide education on meal planning techniques to make the most of grocery shopping trips, including how to prepare healthy meals and snacks that use shelfstable, frozen ingredients, and longer-lasting produce. RDNs provide education on budgetfriendly meals and foster meal planning skills using low-cost, whole ingredients, which can be an important buffer against food insecurity. ...
Article
This Academy of Nutrition and Dietetics Position Paper describes current evidence on multi-component interventions with nutrition to treat pediatric overweight and obesity and discusses implications for registered dietitian nutritionists (RDNs). An umbrella review of eight systematic reviews provides evidence that multi-component interventions that include nutrition improve BMI z-scores in all ages and in a variety of settings. More evidence is needed regarding appropriate BMI measures to track weight and health status changes in children and adolescents with overweight and obesity. Current evidence describes that multi-component interventions that include nutrition do not negatively impact psychosocial outcomes, but research on long-term outcomes is needed. Evolving technology and societal circumstances have created opportunities to provide innovative, collaborative, and engaging interventions through telehealth. RDNs specializing in pediatric overweight and obesity treatment play a crucial role in providing a wide range of evidence-based interventions in a variety of settings. These skills are important for tailoring treatment to each child or adolescent while accounting for community and societal factors, which can lead to improved health across the lifespan.
... People, therefore, turn to more reliable foods for a healthy life [2]. However, the journey of babies to a healthy life, who have very little or no choice in their eating habits, depends on their parents [3,4]. Undoubtedly, every parent wants their babies to live a healthy life by feeding them most safely. ...
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This study focuses on infant formulas and baby biscuits, which have an important place in the nutrition of the most vulnerable individuals, namely babies. In this sense, the aluminum levels of 64 different baby foods, retrospectively consumed by 348 babies for dietary recall 24 h, were determined by ICP-MS. Then, the exposure resulting from the consumption of these foods was calculated via a deterministic model, and a risk assessment was made. Aluminum levels of infant formulas and baby biscuits that are of higher values compared to other studies were found in the range of 718–6987 and 1803–15,479 μg/kg, respectively. Aluminum exposure was calculated as 8.02, 7.28, 4.03, and 4.08 μg/kg bw/day in babies aged 0–6, 7–12, 13–24, and 25–36 months, respectively. There is no statistically significant difference between different age groups according to the total aluminum exposure levels. The toxicological contribution of aluminum exposure is quite limited (< 6.0% of PTWI). THQ values were calculated as 10–20 for babies aged 0–36 months. Therefore, THQ values indicate a potential health problem.
... In addition, family meal quantity and quality (i.e., emotional atmosphere, healthfulness of meal) has been shown to be associated with reduced risk for overweight/obesity in children (Horning et al., 2016;Berge et al., 2014), adolescents , young adults , and parents (Fulkerson et al., 2014); however, not all associations have been consistent Goldfield et al., 2011). Family meal frequency has also been associated with less unhealthy weight control behaviors in adolescents (Neumark-Sztainer et al., 2010;Fulkerson et al., 2006;Neumark-Sztainer et al., 2004) and emerging young adults and with higher emotional well-being and family connectedness/communication in children (Horning et al., 2016;Fulkerson et al., 2018;Dallacker et al., 2018;Dallacker et al., 2019;Robson et al., 2020), adolescents Fulkerson et al., 2009;Neumark-Sztainer et al., 2010;Fulkerson et al., 2006;Robson et al., 2020;Eisenberg et al., 2004;Fulkerson et al., 2010;Fulkerson et al., 2007;do Amaral e Melo et al., 2020), and parents (Utter et al., 2018). Furthermore, research examining shared meals with roommates or others living in the same household have shown associations between shared meal frequency and more healthful dietary intake and emotional well-being in young adults . ...
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Background This study examined who is engaging in family/shared meals and associations between family/shared meal frequency and home food availability, dietary consumption, and emotional well-being among young adults during the COVID-19 pandemic. Methods A rapid-response online survey was sent to participants in a ten-year longitudinal study (Eating and Activity over Time: EAT 2010-2018). A total of 585 young adults (mean age=24.7±2.0 years, 63.3% female) living with at least one family member completed the COVID-EAT (C-EAT) survey during the U.S. outbreak of COVID-19. Items assessed changes in family/shared meal frequency, eating behaviors, and emotional well-being. Regression models adjusting for sociodemographic characteristics examined associations between family/shared meal frequency and home food availability, dietary consumption, and emotional well-being. Results Participants reported an average of 4.6±3.4 family/shared meals per week during COVID-19, a 0.5 meal/week increase from prior to the pandemic (p=.002). Family/shared meal frequency during COVID-19 differed by race/ethnicity, with Asian American participants being most likely to report only 1–2 family/shared meals per week. Family/shared meals during COVID-19 were associated with higher vegetable intake, greater availability of fruits, vegetables, and whole wheat bread in the home, lower levels of depressive symptoms and perceived stress, and greater perceived ability to manage stress in young adults. Conclusions Results suggest that engaging in a regular routine, such as family/shared meals, during COVID-19 may have protective associations with dietary health and emotional well-being for young adults. Results may inform practices/routines to offer protective benefits during public health crises such as the current pandemic.
... In the literature, eating out is related to the increase in energy consumption (15,16) , higher economic expenditure (17) and consumption of low nutrient energy-dense foods (18) and also with increased consumption of fat (16) . In children, the eating out is related to lower dietary adequacy (19) , while the consumption of food at home is related with better nutritional status, better eating habits and, less consistently, with better weight status (20) . ...
Article
This study aims to evaluate the interaction effect of socioeconomic environment (SEE) in the relationship between the eating location (EL) and diet quality, in children and adolescents. Data included children and adolescents (3-17y) from a National Dietary Survey Sample (IAN-AF 2015/2016, n=987). Dietary intake was obtained by 2-day food diaries (children) or 2-24-hour-recall (adolescents). Participants were classified into four groups of EL: “Home”, “Other homes”, “School” and “Restaurants”. Diet quality was measured as a higher adherence to a healthy eating pattern. A previous developed socioeconomic classification was used, and participants were grouped as belonging to a low socioeconomic environment (LSE) or middle-high socioeconomic environment (MHSE). Linear regression models were used to evaluate the association between EL and diet quality, stratified by the SEE. One-quarter of participants was classified in the “Home” group, 14% in “Other homes”, 17% in “Restaurants” and 45% in “School”. A statistically significant interaction effect was found (p<0.01) for the SEE in the association between eating location and diet quality. After adjustment for potential confounders, in LSE, children and adolescents belonging to “Other homes” (β̂=−2.07; 95%CI:−3.70;−0.44) and “Restaurants” (β̂=−3.31; 95%CI:−5.08;−1.54) had lower scores in the diet quality score, comparing to “Home”. In MHSE, comparing to “Home”, “Restaurants” showed lower diet quality (β̂=−1.56; 95%CI:−2.65;−0.48), while the “School” had better diet quality (β̂=0.90; 95%CI:0.16;1.64). The SEE influences the association between EL and diet quality and, belonging to more disadvantaged SEE, might represent a higher risk of unhealthy eating habits when eating out-of-home compared to when eating at home.
... On an interpersonal level, the proportion of the total effect of family social support explained by NL was the highest at 48.3%. Although only 20% of participants lived with their families during university study, the results implied that if students' families valued the importance of a healthy diet during their childhoods, it could lead to the development of good NL [48,49]. Moreover, even if students left their families and lived independently, these values could exert a positive effect on their healthy eating behavior. ...
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College students experience new pressures and choices as they transition to independent living and can easily develop unhealthy eating habits, resulting in obesity and obesity-related chronic diseases in later life. This study aimed to test the hypothesis that nutrition literacy (NL) mediated the relationship between multi-level factors influencing healthy eating behavior identified from the social-ecological model and healthy eating behavior of college students. A four-part questionnaire was completed by 412 participants recruited from six different four-year universities in Taiwan (effective response rate = 85.8%). Data were analyzed using descriptive statistics, an independent samples t-test, hierarchical multiple regression, and mediation analysis. The results indicated that the students’ mean nutrition literacy score was 4.32 (SD = 0.78, range = 1–6). In the social-ecological framework, nutrition literacy significantly predicted healthy eating behavior (β = 0.28, p < 0.001; ΔF = 32.54, p < 0.001; ΔR2 = 0.05) with control variables of background, intrapersonal, interpersonal, environmental, and macrosystem factors. Nutrition literacy mediated the effects of seven factors on healthy eating behavior across four levels. These findings suggested that strengthening influential multi-level factors associated with healthy eating behavior not only enhanced NL, but also improved individuals’ healthy eating behavior.
Article
The aim of this study was to identify social determinants of health associated with the experience of hunger among school-age adolescents in Brazil. We conducted a cross-sectional study with a sample of 16,526 adolescents using data from the 2015 National School-based Student Health Survey. Experience of hunger was determined based on the answer to the question “In the last 30 days, how often have you been hungry because there wasn’t enough food at home?” The social determinants of health were analyzed using Poisson regression with robust variance. The prevalence of the experience of hunger was 22.8% (95%CI: 21.9-23.7). The experience of hunger was directly associated with being male (PR = 1.12; 95%CI: 1.07-1.16); not being overweight (PR = 1.08; 95%CI: 1.04-1.13 ); irregular consumption of beans (PR = 1.20; 95%CI: 1.13-1.26), vegetables (PR=1.16; 95%CI: 1.09-1.22) and fruit (PR = 1.19; 95%CI: 1.13-1.24); body dissatisfaction (PR = 1.26; 95%CI: 1.18-1.35); and not regularly eating lunch or dinner with parents or guardians (PR = 1.41; 95%CI: 1.32-1.52). An inverse association was found between the experience of hunger and maternal education level and living in the Mid-West, Southeast and South. The findings show that the experience of hunger among Brazilian adolescents coexists with risky eating behaviors, body dissatisfaction, and social inequality.
Article
Background Parents' feeding practices are associated with children's food intake. Little is known about how children's eating behaviours (fussiness, enjoyment of food, food responsiveness, satiety responsiveness) moderate these associations. This study examines the relationships between feeding practices and pre-school children's dietary quality and whether children's eating behaviours moderate these relationships. Methods In 2018, 1349 Australian mothers of children aged 2–5 years completed an online survey including validated measures of feeding practices (n = 9), child eating behaviours (n = 4) and dietary quality. Thirteen items from a food frequency questionnaire were summed as a measure of dietary quality. Linear regression assessed associations between feeding practices and dietary quality, including interactions between feeding practices and child eating behaviours. Results The feeding practices positively associated with dietary quality were structured meal timing, monitoring, covert restriction, modelling healthy eating and structured meal setting (B coefficients: 0.63 to 2.70). The feeding practices inversely associated with dietary quality were overt restriction, persuasive feeding, reward for eating and reward for behaviour (B coefficients: −0.88 to −1.85). Child eating behaviours moderated associations between three feeding practices and dietary quality. Conclusions This exploratory study showed that some associations between feeding practices and child dietary quality were moderated by children's eating behaviours. The potential for tailoring nutrition promotion strategies for parents of children with differing eating behaviours should be further investigated.
Article
The goal of the present study was to characterize more than 500 families regarding family mealtime organization patterns. Family profiles were developed based on patterns detected across a set of sociological and psychological variables. Latent profile analyses indicated three distinct subgroups of families: Food Secure and Organized (55% of the sample), Very Low Food Security and Disorganized (27%), and Low Food Security and Organized (18%). Examination of group membership correlates revealed significant differences related to family mealtime behaviors and food preparation strategies, but not food shopping location or areas of requested change around family mealtimes. Findings highlight homogenous subgroups of families on the basis of co-occurring psychological and sociological factors pertinent to family mealtimes, with those families possessing the highest levels of risk in multiple domains also reporting family mealtime organization patterns associated with less healthy eating. Findings provide a snapshot into the organization, and complexities, of family meals for the American family today, highlighting the need for researchers and practitioners interested in promoting healthy food intake within American families to consider both psychological and sociological factors that influence family mealtime organization.
Article
The family meal has been recognised as an integral part of family life. With the positive health outcomes associated with the family meal, it has been proposed as a strategy for encouraging health-promoting behaviours. However, a detailed understanding of the physical and mental work required to execute the family meal is lacking. The aim of this research was to conduct a grounded theory study to understand the components required to successfully execute the family meal. Two temporal data sets (1993-4/2020) in which diverse participants were sampled were used for this study. Methods used to conduct qualitative interviews with parents in the 1990s were mirrored in the conduct of qualitative interviews with parents in 2020. The interview data was analysed drawing on grounded theory methodology and methods. The entire sample included 54 parents from 28 families. A conceptual framework, 'The Family Meal Framework', was developed from the analyses. The five main components of The Framework are the cognitions (invisible work considering the needs of the family), actions (physical tasks required for the family meal), outcomes (the event of the family meal), the beliefs and feelings (expectations and attitudes toward the family meal), and the person(s) responsible (who undertakes the work). This framework provides a novel theory describing the reactive, cyclical nature of the work required to execute the family meal. This new understanding provides discrete opportunities for intervention in family meal research, practice, policy and promotion.
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Objective To examine the association between family environment variables (parenting styles, family meal atmosphere), gender-based stereotypes, and food intake in Latin American adolescents. Design Structural equation modeling applied to cross-sectional data, 2017. Setting Urban and rural sites of San José, Costa Rica. Participants n = 813; 13-18 years old. Results Data suggest direct associations between gender-based stereotypes and intake of fruits and vegetables (FV) ( β = 0.20, p < 0.05), unhealthy foods (fast food, FF) ( β = -0.24, p < 0.01), and ultra-processed foods (UPF) ( β = -0.15, p < 0.05) among urban girls; intake of legumes among rural girls ( β = 0.16, p < 0.05) and intake of sugar-sweetened beverages (SSB) among rural boys ( β = 0.22, p < 0.05). Family meal atmosphere was associated with legume intake ( β = 0.19, p < .05) among rural girls. Authoritative parenting style was associated with FV intake ( β = 0.23, p < 0.05) among urban boys and FF intake ( β = 0.17, p < 0.05) among urban girls. Authoritarian parenting style was associated with FV consumption ( β = 0.19, p < 0.05) among rural boys, and with SSB and FF consumption ( β = 0.21, p < 0 .05; β = 0.14, p < 0.05, respectively) among urban girls. Conclusions Findings are the first to describe the complex family environment and gender-based stereotypes within the context of a Latin American country. They emphasize the need for culturally relevant measurements to characterize the sociocultural context in which parent-adolescent dyads socialize and influence food consumption.
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Few studies have integrated positive parenting and motivational strategies to address dietary outcomes such as frequency of family mealtime. The Families Improving Together (FIT) for Weight Loss trial was a randomized group cohort trial (n = 241 dyads) testing the efficacy of integrating a motivational plus family weight loss (M + FWL) intervention for healthy eating and weight loss in overweight and obese African American adolescents. The current study tested the interaction of parenting styles (responsiveness, demandingness) and parental feeding practices (restriction, concern about child’s weight, pressure to eat) and the FIT intervention on frequency of family mealtime over 16 weeks. Multilevel modeling demonstrated significant interactions between the group-based treatment and responsiveness (p = 0.018) and demandingness (p = 0.010) on family mealtime. For the group-based M + FWL intervention, increased responsiveness and reduced demandingness were associated with increased frequency of family mealtime from baseline to 16 weeks. There was also a negative association between parental restriction and frequency of family mealtime, but a positive association between parental concerns about their adolescent’s weight and frequency of mealtime. These findings are the first to demonstrate that an authoritative or nurturing parenting style moderated intervention effects for improving the frequency of family mealtime in overweight and obese African American adolescents.
Article
Purpose The purpose of this study was to investigate the association of individual and environmental indicators with body mass-index-for-age-z-score (BAZ) of female adolescents living in the North-West of Iran. Design/methodology/approach In this cross-sectional study, 380 female adolescents aged 16-18 years were selected from two major ethnic groups (Azeri and Kurd) in Urmia city selected by stratified cluster sampling method. In total, 13 high schools (9 public and 4 private) were selected across all municipality zones of Urmia city. BAZ was calculated by Anthro-Plus software. Demographic and socioeconomic information of samples were collected by a questionnaire through interviews. Home environment features (including physical activity facilities, television, computer games and social media use, food consumption habits and family rules) and school environment features (including socioeconomic status [SES], physical activity facilities, food consumption habits) were evaluated by two separate self-constructed questionnaires via an interview with adolescents and schools’ deans, respectively. Findings Azeri adolescents had parents with higher education and job level and higher SES compared to Kurds ( p = 0.000). A higher percent of Azeri adolescents were obese than their Kurd counterparts ( p = 0.006). No association was found between individual factors and BAZ in each ethnic group. Considering home environment characteristics, in Kurd adolescents, the maternal occupational level was positively associated with BAZ ( p = 0.02). With regard to school environmental features, accessibility of physical activity facilities in school was inversely associated with BAZ only in Kurds ( p = 0.005). Originality/value To the best of the authors’ knowledge, this is the first study to investigate various environmental factors in association with adolescent’s overweight/obesity prevalence in different ethnical groups in northwest Iran.
Article
Objective Sharing a meal together offers an innovative approach to study the family environment. How often families eat together may not capture the distinct experience for sons and daughters. Instead, studying family meal characteristics might be more enlightening. This study aims to examine the prospective associations between family meal environment quality at age 6 years and later well-being at age 12 years in 734 boys and 758 girls. Method Participants are from the Quebec Longitudinal Study of Child Development birth cohort. When children were aged 6 years, parents reported on their family meal environment experience. At age 12 years, child outcomes included parent-reported healthy lifestyle habits, teacher-reported academic achievement, and self-reported social adjustment. The relationship between early family meal environment quality and later child outcomes were analyzed using multivariate linear regressions. Results For girls, better family meal environment quality at age 6 years predicted an earlier bedtime, a lower consumption of soft drinks and sweet snacks, more classroom engagement, and fewer behavior problems at age 12 years. For boys, better family meal environment quality at age 6 years predicted an earlier bedtime and less anxiety and more prosocial behaviour at age 12 years. These significant relationships were adjusted for a multitude of child/family characteristics. Conclusion From a population-health perspective, our findings suggest that family meals represent a cost-efficient, effective protective factor that likely has long-term influences on bio-psycho-social development. Information campaigns that promote family meals as a health intervention could optimize the well-being of boys and girls.
Article
Resumo Objetivou-se identificar determinantes sociais em saúde associados à vivência da fome entre adolescentes escolares brasileiros. Foi realizado um estudo transversal com microdados de 16.526 adolescentes da Pesquisa Nacional de Saúde do Escolar 2015. A vivência da fome foi estimada considerando a frequência com que o adolescente havia ficado com fome por não ter comida suficiente em casa no mês anterior à pesquisa. Para a análise dos determinantes sociais em saúde foi realizada Regressão de Poisson com variância robusta. Verificou-se, no Brasil, que a vivência da fome foi de 22,8% (IC95%: 21,9-23,7) entre adolescentes. Essa associou-se diretamente ao sexo masculino (RP=1,12; IC95%: 1,07-1,16), a não ter excesso de peso (RP=1,08; IC95%: 1,04-1,13), ao consumo irregular de feijão (RP=1,20; IC95%: 1,13-1,26), de legumes e verduras (RP=1,16; IC95%: 1,09-1,22) e de frutas (RP=1,19; IC95%: 1,13-1,24), à insatisfação corporal (RP=1,26; IC95%: 1,18-1,35) e ao consumo irregular de almoço ou jantar com os responsáveis (RP=1,41; IC95%: 1,32-1,52); e inversamente ao gradiente de escolaridade materna, e às macrorregiões do complexo Centro-Sul. Os resultados indicam a coexistência da fome, comportamentos alimentares de risco nutricional, insatisfação corporal e condições de iniquidade social entre adolescentes brasileiros.
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Background An essential component of systematic reviews is the assessment of risk of bias. To date, there has been no investigation of how reviews of non-randomised studies of nutritional exposures (called ‘nutritional epidemiologic studies’) assess risk of bias. Objective To describe methods for the assessment of risk of bias in reviews of nutritional epidemiologic studies. Methods We searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews (Jan 2018–Aug 2019) and sampled 150 systematic reviews of nutritional epidemiologic studies. Results Most reviews (n=131/150; 87.3%) attempted to assess risk of bias. Commonly used tools neglected to address all important sources of bias, such as selective reporting (n=25/28; 89.3%), and frequently included constructs unrelated to risk of bias, such as reporting (n=14/28; 50.0%). Most reviews (n=66/101; 65.3%) did not incorporate risk of bias in the synthesis. While more than half of reviews considered biases due to confounding and misclassification of the exposure in their interpretation of findings, other biases, such as selective reporting, were rarely considered (n=1/150; 0.7%). Conclusion Reviews of nutritional epidemiologic studies have important limitations in their assessment of risk of bias.
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Families face many barriers in providing nutritious home-cooked family meals. Meal kit subscription services are increasingly popular among families and may address obstacles to cooking at home and facilitate shared family meals. This study aimed to understand why families use meal kits and what they perceived to be the main impacts on family dynamics, nutrition, social and mental health. Sixteen primary meal providers with at least one child 18 years and under living at home, were recruited via social media (e.g., Facebook, Twitter) to participate in a semi-structured interview using Zoom videoconferencing. Interviews were conducted with participants who currently purchased and used commercially available meal kits in Australia (e.g., HelloFresh, Marley Spoon). Thematic analysis of interview transcripts revealed that women, as the primary carers responsible for family meals, primarily reported the role that meal kits played in reducing their mental load through reduced food-related decision making, enhanced family participation in meal preparation, and opportunities for food literacy. Additionally, meal kits were reported to reduce food eaten away-from-home with the majority of participants perceiving meal kits to provide nutritionally dense meals and appropriate portion sizes aligned with National dietary guidelines. This study provides important insights into the potential physical, mental and social health benefits of meal kits in supporting families to cook and eat meals together at home. While meal kits have the capacity to positively influence population health and wellbeing, it is necessary that meal kit subscription services address the nutritional quality of their meals and provide evidence-based nutrition messaging to facilitate improvements in food literacy and nutritional intake.
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Background: Mealtime television use has been cross-sectionally associated with suboptimal diets in children. This study aimed to assess the two-year prospective association between baseline mealtime television use and subsequent diets in young children, and identify socioeconomic differences. Methods: Parents reported their child’s television use at meals, and fruit, vegetable, and discretionary food intakes. Multivariable linear and logistic regression analyses assessed the association between baseline mealtime television use and follow-up diet outcomes. Differences were assessed by socioeconomic position. Results: Participants were 352 Australian parents of children aged six months to six years. Daily mealtime television use (average frequency/day) was associated with higher daily frequency of discretionary food intakes (β 0.2, 95% confidence interval (CI) 0.07–0.67) at the 2-year follow-up. Individually, television use during breakfast and dinner (1–2 days/week compared to never) predicted higher daily intake frequency of discretionary food, β 0.36 (95% CI 0.12–0.60) and β 0.19 (95% CI 0.00–0.39), respectively. Similarly, 3–7 days/week of television use during breakfast and lunch predicted higher frequency of discretionary food intake, β 0.18 (95% CI 0.02–0.37) and β 0.31 (95% CI 0.07–0.55), respectively. Associations were not socioeconomically patterned. Conclusions: Investigating mealtime television use motivators across the socioeconomic spectrum could inform interventions targeting the high consumption of discretionary foods in children.
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Background: Questions remain about the strength and shape of the dose-response relationship between fruit and vegetable intake and risk of cardiovascular disease, cancer and mortality, and the effects of specific types of fruit and vegetables. We conducted a systematic review and meta-analysis to clarify these associations. Methods: PubMed and Embase were searched up to 29 September 2016. Prospective studies of fruit and vegetable intake and cardiovascular disease, total cancer and all-cause mortality were included. Summary relative risks (RRs) were calculated using a random effects model, and the mortality burden globally was estimated; 95 studies (142 publications) were included. Results: For fruits and vegetables combined, the summary RR per 200 g/day was 0.92 [95% confidence interval (CI): 0.90-0.94, I 2 = 0%, n = 15] for coronary heart disease, 0.84 (95% CI: 0.76-0.92, I 2 = 73%, n = 10) for stroke, 0.92 (95% CI: 0.90-0.95, I 2 = 31%, n = 13) for cardiovascular disease, 0.97 (95% CI: 0.95-0.99, I 2 = 49%, n = 12) for total cancer and 0.90 (95% CI: 0.87-0.93, I 2 = 83%, n = 15) for all-cause mortality. Similar associations were observed for fruits and vegetables separately. Reductions in risk were observed up to 800 g/day for all outcomes except cancer (600 g/day). Inverse associations were observed between the intake of apples and pears, citrus fruits, green leafy vegetables, cruciferous vegetables, and salads and cardiovascular disease and all-cause mortality, and between the intake of green-yellow vegetables and cruciferous vegetables and total cancer risk. An estimated 5.6 and 7.8 million premature deaths worldwide in 2013 may be attributable to a fruit and vegetable intake below 500 and 800 g/day, respectively, if the observed associations are causal. Conclusions: Fruit and vegetable intakes were associated with reduced risk of cardiovascular disease, cancer and all-cause mortality. These results support public health recommendations to increase fruit and vegetable intake for the prevention of cardiovascular disease, cancer, and premature mortality.
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Background In Canada, 31.5 % of children are overweight or obese, putting them at an increased risk of chronic co-morbidities and premature mortality. Physical activity, healthy eating, and screen time are important behavioural determinants of childhood overweight and obesity that are influenced by the family environment, and particularly parents’ support behaviours. However, there is currently a limited understanding of which types of these support behaviours have the greatest positive impact on healthy child behaviours. This study aims to determine the relative contribution of different types of parental support behaviours for predicting the likelihood that children meet established guidelines for daily physical activity, daily fruit and vegetable consumption, and recreational screen time. Methods A Computer Assisted Telephone Interview survey was used to collect data from a random sample of parents or guardians with at least one child under the age of 18 in Ontario (n = 3,206). Three multivariable logistic regression models were built to predict whether or not parents reported their child was meeting guidelines. Independent variables included parent and child age and gender, multiple indicators of parental support behaviours, and socio-demographic characteristics. Parental support behaviours were categorized post-hoc as motivational, instrumental, regulatory, and conditional based on an adapted framework. Results Controlling for all other factors in the model, several parental support behaviours were found to be significant predictors of children meeting established health guidelines. For example, conditional support behaviours including taking the child to places where they can be active (OR: 2.06; 95 % CI: 1.32-3.21), and eating meals as a family away from the TV (95 % CI: 1.15-2.41) were significant positive predictors of children meeting physical activity and fruit and vegetable guidelines, respectively. Conclusions Health promotion efforts aimed at improving particular parent support behaviours could be effective levers for mitigating the burden of excess body weight in childhood. As such, the influence of support behaviours should be fully considered in any comprehensive approach to prevention and reduction of childhood overweight and obesity.
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Family meal frequency has been shown to be strongly associated with better dietary intake; however, associations with weight status have been mixed. Family meals-focused randomized controlled trials with weight outcomes have not been previously conducted. Therefore, this study purpose was to describe weight-related outcomes of the HOME Plus study, the first family meals-focused randomized controlled trial to prevent excess weight gain among youth. Families (n = 160 8-12-year-old children and their parents/guardians) were randomized to intervention (n = 81) or control (n = 79) groups. Data were collected at baseline (2011–2012), post-intervention (12-months post-baseline) and follow-up (21-months post-baseline). The intervention included ten monthly group sessions (nutrition education; hands-on meal and snack planning, preparation, and skill development; screen time reductions) and five motivational, goal-setting phone calls. The main outcome was child body mass index (BMI) z-score. General linear models, adjusted for baseline values and demographics, showed no significant treatment group differences in BMI z-scores at post-intervention or follow-up; however, a promising reduction in excess weight gain was observed. Post-hoc stratification by pubertal onset indicated prepubescent children in the intervention group had significantly lower BMI z-scores than their control group counterparts. The study used a strong theoretical framework, rigorous design, quality measurement and a program with high fidelity to test a family meals-focused obesity prevention intervention. It showed a modest decrease in excess weight gain. The significant intervention effect among prepubescent children suggests the intervention may be more efficacious among relatively young children, although more research with appropriately powered samples are needed to replicate this finding. Trial registration This study is registered at www.clinicaltrials.gov NCT01538615. Registered 01/17/2012.
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Recently, there has been an increased interest in the importance of family meals on children's health and nutrition. This study aims to examine if the eating habits and eating behaviors of children are different according to the frequency of family dinners. The subjects were third-grade students from 70 elementary schools in 17 cities nationwide. A two-stage stratified cluster sampling was employed. The survey questionnaire was composed of items that examined the general characteristics, family meals, eating habits, eating behaviors, and environmental influence on children's eating. The subjects responded to a self-reported questionnaire. Excluding the incomplete responses, the data (n = 3,435) were analyzed using χ(2)-test or t-test. The group that had more frequent family dinners (≥ 5 days/week, 63.4%), compared to those that had less (≤ 4 days/week, 36.6%), showed better eating habits, such as eating meals regularly, performing desirable behaviors during meals, having breakfast frequently, having breakfast with family members (P < 0.001), and not eating only what he or she likes (P < 0.05). Those who had more frequent family dinners also consumed healthy foods with more frequency, including protein foods, dairy products, grains, vegetables, seaweeds (P < 0.001), and fruits (P < 0.01). However, unhealthy eating behaviors (e.g., eating fatty foods, salty foods, sweets, etc.) were not significantly different by the frequency of family dinners. Having dinner frequently with family members was associated with more desirable eating habits and with healthy eating behaviors in young children. Thus nutrition education might be planned to promote family dinners, by emphasizing the benefits of having family meals on children's health and nutrition and making more opportunities for family meals.
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Background: The home food environment influences children's eating behaviors and potentially affects overall diet quality. The aim of the present study was to evaluate the relationship between the home food environment and Hispanic children's diet quality. Methods: Hispanic children, 10-14 years of age (n=187), and their parents participated in this cross-sectional study. The Healthy Eating Index (HEI) was used to determine diet quality based on reported dietary intake obtained through a food frequency questionnaire administered to the children. Parents self-reported home food availability, familial eating habits, and their own habitual diet through a home environment survey. Results: The children's HEI total score was 59.4±8.8. Reported diets did not adhere to the dietary recommendations for total vegetables, greens and beans, whole grains, seafood and plant proteins, fatty acids, refined grains, sodium, solid fats, and added sugars. None of the participants had "good" scores (HEI, >80), 86% had scores that "need improvement" (HEI, 51-80), and 14% had "poor" scores (HEI, <50). Children with lower HEI scores had sugar-sweetened beverages available at home and participated in family meals while watching television more frequently, when compared with children with higher HEI scores. Conclusions: Home food availability, parental diet, and familial eating habits seem to play an important role in the diet quality of children. Interventions targeting family education on healthful dietary habits at home could have a positive impact on children's diet quality and overall health.
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Most Americans, including children, continue to eat fewer fruit and vegetables than is recommended, putting themselves at increased risk of various health conditions. The aim of this study was to evaluate the relative importance of several family environment variables (food availability and accessibility, modelling of food consumption, parenting style, and family mealtime environment) in predicting children’s consumption of fruit and vegetables in a sample of pre-school children from low income, predominantly ethnic minority families. Two hundred and twenty-nine primary caregivers and their pre-school children were recruited from Head Start programmes in New York and New Jersey. Caregivers gave their consent to the study, completed a series of paper and pencil questionnaires, and had both their height and weight and their children’s height and weight measured. Higher availability, accessibility, and parental modelling were associated with higher consumption of fruit and vegetables in children. Availability and Accessibility were the best predictors, but Parental Modelling significantly enhanced prediction over the other variables. Public health interventions should be geared toward helping poorer families increase the availability of fruit and vegetables in their homes, advising parents on how to make them accessible, and encouraging parents to model their consumption. Funding RLG receives research funding from Covidien.
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Objective: To explore the association of social-environment (SE) factors and diet quality (DQ) with weight status in a group of children in Puerto Rico (PR). Methods: A cross-sectional study in a sample of 114 12-year-old children enrolled in 4 public schools in the San Juan Metropolitan area in Puerto Rico (PR) during the 2012- 2013 school year. These children completed a self-administered questionnaire on socio-demographic characteristics and SE, with information on family meal patterns; parental feeding styles; parental, peer, and school support for healthy eating; physical activity (PA); and frequency of PA and sedentary times. The participants also completed at 24-hour dietary recall interview to determine DQ. This was assessed with the Healthy Eating Index (HIE)-2010, an instrument that evaluates compliance with the Dietary Guidelines for Americans. Body mass index (BMI) was calculated and categorized as healthy weight, overweight, or obese. Results: 36% of participants were overweight/obese. In terms of DQ, 55% had “poor” DQ, 45% had diets that “need improvement”, and none had “good” DQ. Children of healthy weight (75.0%) reported more frequent family meals than did overweight/obese children (57.5%; p = 0.05). No other significant associations were found between SE factors and DQ or body weight status. Conclusion: Most of the participants were of healthy weight but had poor quality diets. Having a healthy weight was positively associated with frequent family meals.
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Obesity is a growing public health concern in Canada. Excess weight is particularly a concern among youth given that obesity in youth predicts obesity in adulthood. Eating behaviors, both inside and outside the home have been associated with increased risk of obesity; however, there is little data among Canadian youth to monitor trends. The School Health Action, Planning and Evaluation Surveys (SHAPES) were administered in schools. Our study examined 20, 923 students (grades 5-12) from four regions in Canada. The regions were Hamilton and Thunder Bay (both in Ontario), the Province of Prince Edward Island, and the Province of Quebec. Consuming breakfast daily was reported by 70% of grade 5-8 students, and 51% of grade 9-12's. Among students in grade 9-12, 52% reported eating with family members daily, compared with 68% in grade 5-8. Just over half of students in grade 5-8, and 70% in grade 9-12 reported eating at a fast-food place once a week or more. Among grade 5-8 students 68% reported eating in front of the television at least once per week, compared to 76% in grade 9-12. Obese students were more likely to watch TV while eating, and less likely to eat with a family member and eat breakfast. The findings suggest that only a modest proportion of youth report dietary patterns that have previously been associated with healthy eating and reduced risk of obesity. Later adolescence may be a critical time for intervention in health-related behaviors.
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Family meals have been negatively associated with overweight in children, while television (TV) viewing during meals has been associated with a poorer diet. The aim of the present study was to assess the association of eating family breakfast and dinner, and having a TV on during dinner, with overweight in nine European countries and whether these associations differed between Northern and Southern & Eastern Europe. Cross-sectional data. Schoolchildren reported family meals and TV viewing. BMI was based on parental reports on height and weight of their children. Cut-off points for overweight by the International Obesity Task Force were used. Logistic regressions were performed adjusted by age, gender and parental education. Schools in Northern European (Sweden, the Netherlands, Iceland, Germany and Finland) and Southern & Eastern European (Portugal, Greece, Bulgaria and Slovenia) countries, participating in the PRO GREENS project. Children aged 10-12 years in (n 6316). In the sample, 21 % of the children were overweight, from 35 % in Greece to 10 % in the Netherlands. Only a few associations were found between family meals and TV viewing during dinner with overweight in the nine countries. Northern European children, compared with other regions, were significantly more likely to be overweight if they had fewer family breakfasts and more often viewed TV during dinner. The associations between family meals and TV viewing during dinner with overweight were few and showed significance only in Northern Europe. Differences in foods consumed during family meals and in health-related lifestyles between Northern and Southern & Eastern Europe may explain these discrepancies.
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Frequent family meals and home food preparation are considered important for children's nutritional health and weight maintenance. This cross-sectional study tested whether these parent-driven behaviors are related to the availability of food preparation supplies in low-income urban households. Caregivers of children ages 6 to 13 provided information on family meal frequency, child consumption of home-prepared dinners, household food insecurity, and attitudes towards cooking. Researchers used a newly developed Food Preparation Checklist (FPC) to assess the availability of 41 food preparation supplies during a physical audit of the home environment. Caregivers and children provided anthropometric measurements and jointly reported on child dietary intake. In ordinal logistic regression models, greater home availability of food preparation supplies was associated with more frequent family meals and child consumption of home-prepared dinners. Associations were independent of household financial strain, food insecurity, caregiver attitudes toward cooking, and sociodemographic characteristics. Fewer food preparation supplies were available in households characterized by greater food insecurity, lower income, and negative caregiver attitudes towards cooking, but did not differ by child or caregiver weight status. As in prior studies, more frequent family meals and consumption of home-prepared dinners were associated with healthier child dietary intake in several areas. We conclude that food preparation supplies are often limited in the most socioeconomically disadvantaged households, and their availability is related to the frequency with which children consume family meals and home-prepared dinners. The potential role of food preparation supplies as contributors to socioeconomic disparities in child nutritional health and obesity deserves further study.
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There is mounting evidence that family functioning is linked to childhood overweight and obesity, and that both of these are associated with health-related behaviours and adverse health outcomes in children and adolescents. This paper systematically examines the peer-reviewed evidence regarding the relationship between child and adolescent overweight and obesity and family functioning. Peer-reviewed literature published between 1990 and 2011 hosted in Scopus, Pub Med or Psyc INFO were searched, in addition to the reference lists of included papers. Twenty-one studies met the selection criteria. Of the 17 identified cross-sectional and longitudinal studies, 12 reported significant associations between family functioning and childhood overweight and obesity. The instruments used to measure family functioning in the identified studies were heterogeneous. Poor family functioning was associated with increased risk of obesity and overweight in children and adolescents, and obese children and adolescents were more likely to come from families with poor family functioning. Aspects of family functioning which were associated with increased risk of child and adolescent obesity included poor communication, poor behaviour control, high levels of family conflict and low family hierarchy values. Half (2/4) of the identified intervention studies showed a significant relationship between family functioning and changes in child weight. The results demonstrate that family functioning is linked to obesity; however, higher level evidence and greater understanding of the mechanisms behind this relationship are required. The results indicate a need for a standardised family functioning measure applicable across populations. The results provide evidence of the value of considering family functioning in childhood obesity research and intervention.
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Background This study aims to explore how the home food environment and parental attitudes and values affect children's fruit and vegetable (F&V) intake. Methods The sample consists of 2383 children with a mean age of 8.3 years (95% CI 8.2 to 8.3) attending 52 primary schools in London. These children are taking part in two randomised controlled trials to evaluate a school gardening programme. Diet was assessed using a validated 24-h food tick list, the Child And Diet Evaluation Tool (CADET). Results The CADET tool found that children consumed on average 293 g F&V (95% CI 287 to 303) per day. Clustered (by school) multilevel regression models with total F&V as the primary outcome were conducted to explore how the home environment affects children's F&V intake. Children of families who reported ‘always’ eating a family meal together at a table had 125 g (95% CI 92 to 157; p=<0.001) more F&V than families who never ate a meal together. Daily consumption of F&V by parents was associated with higher F&V (88 g, 95% CI 37 to 138) intake in children compared with rarely/never consumption of F&V by parents. Cutting up fruit and vegetables for children was associated with higher consumption. Families who reported always cutting up F&V for their children had 44 g (95% CI 18 to 71) more F&V than families who never cut up F&V. Conclusions This study identified that cutting up F&V and family consumption of F&V facilitates children's intake. Eating a family meal together regularly could increase children's F&V intake and help them achieve the recommended intake. Trial registration ISRCTN11396528.
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Objective: During the early years, parents have a major influence on children’s diets and developing food choices. We investigated parenting styles as predictors of 2–5-year-old children’s diets and whether general nutrition knowledge (GNK) mediated these influences. Design: Cross-sectional research. Questionnaires measured demographic and lifestyle variables, family environment, parenting styles and feeding practices, child diet and GNK. Regression models tested GNK as a mediator of relationships between parenting variables and child diet (fruit/vegetable and non-core food consumption), controlling for confounders and family environment. Setting: Questionnaires were completed by main caregivers at home. Subjects: Parents of children aged 2–5 years (n 269). Results: Higher child fruit/vegetable consumption was associated with lower overreactive parenting and restriction, higher authoritative parenting and dining together as a family; with lax parenting approaching statistical significance (P50?083) and 19% of variance explained by the model. GNK was not a significant predictor. Conversely, non-core food consumption was associated with higher over-reactive and lax parenting as well as child age, increased takeaway food consumption and higher television viewing; GNK had a small effect (P = 0.043) and 28% of variance was explained by the model. GNK was a significant mediator only for authoritative parenting on non-core food (effect = -0.005). Conclusions: These findings highlight that young children’s diets may be improved by interventions targeting a range of positive and supportive parenting practices in conjunction with nutrition knowledge education for parents of young children. Further insights will come from closer attention to the nature and role of restrictive feeding practices v. laxness and longitudinal research.
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Objective: To examine the types of food served at family dinner in the homes of adolescents and correlations with parent and family sociodemographic characteristics, psychosocial factors and meal-specific variables. Design: A cross-sectional population-based survey completed by mail or telephone by parents participating in Project F-EAT (Families and Eating and Activity in Teens) in 2009-2010. Setting: Homes of families with adolescents in Minneapolis/St. Paul urban area, MN, USA. Subjects: Participants included 1923 parents/guardians (90·8% female; 68·5% from ethnic/racial minorities) of adolescents who participated in EAT 2010. Results: Less than a third (28%) of parents reported serving a green salad at family dinner on a regular basis, but 70% reported regularly serving vegetables (other than potatoes). About one-fifth (21%) of families had fast food at family dinners two or more times per week. Variables from within the sociodemographic domain (low educational attainment) psychosocial domain (high work-life stress, depressive symptoms, low family functioning) and meal-specific domain (low value of family meals, low enjoyment of cooking, low meal planning, high food purchasing barriers and fewer hours in food preparation) were associated with lower healthfulness of foods served at family dinners, in analyses adjusted for sociodemographic characteristics. Conclusions: There is a need for interventions to improve the healthfulness of food served at family meals. Interventions need to be suitable for parents with low levels of education; take parent and family psychosocial factors into account; promote more positive attitudes toward family meals; and provide skills to make it easier to plan and prepare healthful family meals.
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To evaluate shifts across BMI categories and associated changes in cardiometabolic risk factors over 2.5 years in an ethnically diverse middle school sample. As part of HEALTHY, a multisite school-based study designed to mitigate risk for type 2 diabetes, 3993 children participated in health screenings at the start of sixth and end of eighth grades. Assessments included anthropometric measures, blood pressure, and glucose, insulin, and lipids. Students were classified as underweight, healthy weight, overweight, obese, or severely obese. Mixed models controlling for school intervention status and covariates were used to evaluate shifts in BMI category over time and the relation between these shifts and changes in risk factors. At baseline, students averaged 11.3 (±0.6) years; 47.6% were boys, 59.6% were Hispanic, and 49.8% were overweight or obese. Shifts in BMI category over time were common. For example, 35.7% of youth who were overweight moved to the healthy weight range, but 13% in the healthy weight range became overweight. BMI shifts were not associated with school intervention condition, household education, or youth gender, race/ethnicity, pubertal status, or changes in height. Increases in BMI category were associated with worsening of cardiometabolic risk factors, and decreases were associated with improvements. Boys who increased BMI category were more vulnerable to negative risk factor changes than girls. There are substantial shifts across BMI categories during middle school that are associated with clinically meaningful changes in cardiometabolic risk factors. Programs to promote decreases in BMI and prevent increases are clearly warranted.
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Early childhood is critical to the development of lifelong food habits. Given the high proportion of children with inadequate fruit and vegetable consumption, identification of modifiable factors associated with higher consumption may be useful in developing interventions to address this public health issue. This study aimed to identify the characteristics of the home food environment that are associated with higher fruit and vegetable consumption in a sample of Australian preschool children. A cross-sectional telephone survey was conducted with 396 parents of 3 to 5 year-old children attending 30 preschools within the Hunter region, New South Wales, Australia. Children's fruit and vegetable consumption was measured using a valid and reliable subscale from the Children's Dietary Questionnaire. Associations were investigated between children's fruit and vegetable intake and characteristics of the home food environment including parental role-modeling, parental providing behaviour, fruit and vegetable availability, fruit and vegetable accessibility, pressure to eat, family eating policies and family mealtime practices. Characteristics of the home food environment that showed evidence of an association with children's fruit and vegetable consumption in simple regression models were entered into a backwards stepwise multiple regression analysis. The multiple regression analysis used generalised linear mixed models, controlled for parental education, household income and child gender, and was adjusted for the correlation between children's fruit and vegetable consumption within a preschool. The multiple regression analysis found positive associations between children's fruit and vegetable consumption and parental fruit and vegetable intake (p=0.005), fruit and vegetable availability (p=0.006) and accessibility (p=0.012), the number of occasions each day that parents provided their child with fruit and vegetables (p<0.001), and allowing children to eat only at set meal times all or most of the time (p=0.006). Combined, these characteristics of the home food environment accounted for 48% of the variation in the child's fruit and vegetable score. This study identified a range of modifiable characteristics within the home food environment that are associated with fruit and vegetable consumption among preschool children. Such characteristics could be considered potential targets for interventions to promote intake among children of this age.
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The purpose of the present study was to investigate if the effects of the parental component of a school-based intervention on dietary fat intake from snacking were mediated by changes in home-related factors. A random sample of 10 schools with 2232 pupils aged 11-15 years was randomly assigned to one of two intervention groups [one with (n = 1226) and one without a parental component (n = 1006)]. Fat intake, home availability of low-fat foods and parental encouragement and support to eat a low-fat diet were assessed with validated self-administered questionnaires. Mediation was assessed with the product-of-coefficient test. Changes in home-related determinants were significantly related to changes in fat intake from snacks; therefore, school-based obesity programmes on adolescents should try to address these determinants. In the present study, one of the three investigated home-related factors, namely parental support, was affected by the parental component intervention. Decreases in parental support were prevented. These changes in parental support were found to mediate the parental intervention effects on changes in fat intake from snacks. Home-related factors appear to be related to changes in adolescents' snacking behaviours, therefore, school-based obesity programmes should target them. Nevertheless, more research is needed concerning effectively addressing the other determinants.
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Objective Although existing evidence links breakfast frequency to better dietary quality, little is known specifically in regard to the benefits associated with eating breakfast together with one’s family. The present study describes the prevalence and experience of having family meals at breakfast among rural families and examines associations between meal frequency and adolescent diet quality. Design Data were drawn from Project BreakFAST, a group-randomized trial aimed at increasing school breakfast participation in rural Minnesota high schools, USA. Linear mixed models were used to examine associations between student reports of family breakfast frequency and Healthy Eating Index 2010 (HEI-2010) scores while accounting for clustering within schools, demographics and household food security. Setting Adolescent students from sixteen schools completed online surveys, height and weight measurements, and dietary recalls at baseline in 2012–2014. Subjects The sample included 827 adolescents (55·1 % girls) in grades 9–10 who reported eating breakfast on at most three days per school week. Results On average, adolescents reported eating breakfast with their family 1·3 ( sd 1·9) times in the past week. Family breakfast meals occurred most frequently in the homes of adolescents who reported a race other than white ( P =0·002) or Hispanic ethnicity ( P =0·02). Family breakfast frequency was directly associated with adolescent involvement in preparing breakfast meals ( P <0·001) and positive attitudes ( P ≤0·01) about mealtime importance, interactions and structure. Family breakfast frequency was unrelated to most diet quality markers. Conclusions Family meals may be one important context of opportunity for promoting healthy food patterns at breakfast. Additional research is needed to better inform and evaluate strategies.
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Background: Family meal frequency has been consistently and significantly associated with positive youth dietary and psychosocial outcomes, but less consistently associated with weight outcomes. Family meal frequency measurement has varied widely and it is unclear how this variation might impact relationships with youth weight, dietary, and psychosocial outcomes. Objective: This study assesses how five parent/caregiver-reported and four child-reported family dinner frequency measures correlate with each other and are associated with health-related outcomes. Design/participants: This secondary, cross-sectional analysis uses baseline, parent/caregiver (n=160) and 8- to 12-year-old child (n=160) data from the Healthy Home Offerings via the Mealtime Environment (HOME) Plus trial (collected 2011 to 2012). Data were obtained from objective measurements, dietary recall interviews, and psychosocial surveys. Outcome measures: Outcomes included child body mass index z scores (BMIz); fruit, vegetable, and sugar-sweetened beverage intake; dietary quality (Healthy Eating Index-2010); family connectedness; and meal conversations. Statistical analyses performed: Pearson correlations and general linear models were used to assess associations between family dinner frequency measures and outcomes. Results: All family dinner frequency measures had comparable means and were correlated within and across parent/caregiver and child reporters (r=0.17 to 0.94; P<0.01). In unadjusted analyses, 78% of family dinner frequency measures were significantly associated with BMIz and 100% were significantly associated with fruit and vegetable intake and Healthy Eating Index-201