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Comparison of diet quality between young children and adolescents in the Mediterranean basin and the influence of life habits
Abstract
Introduction:
Introduction: the dietary intake patterns of children should be monitored because of their influence on health in adulthood. It is now widely accepted that childhood nutrition is linked to specific diseases such as obesity and to risk factors for cardiovascular disease in adulthood. Therefore, knowledge of dietary intake during childhood may be useful to identify possible risk factors for disease in adulthood. The main focus of research into children's diets has been the contribution of macronutrients and micronutrients. Objective: several indices have been developed for assessing the diet quality of previously defined population groups. The aim of the present study was to compare the nutritional status of Andalusian children and adolescents and examine the relationship between their diet quality and socio-demographic or lifestyle factors. Results and conclusions: the food intake of the younger children in this study was closer to RDIs compared with the adolescents, who generally reported a lower energy supply in their diet than the recommended. The mean (SD) diet quality score was 12.1 (1.9) for the younger children (6-9 years) and 9.4 (3.2) for the older group (10-17 years), a statistically significant difference. A good correlation was found between energy intake (MJ/kg body weight) and estimated energy (MET MJ/kg body weight).
... As a source of protein, the Mediterranean pattern defends animal protein, but prioritising fish and eggs over meat. The MD not only focuses on food, but also defends a healthy lifestyle, which is why it emphasises the need to perform physical activity every day adapted to our abilities to maintain good health (6,7). ...
... Therefore, once the scientific literature has been reviewed, and the insufficiency of studies and the inconsistency of results have been proven, the main objective of this applied research work is to provide the population with information of general interest on the promotion of a healthy diet through social media and analyse the impact of its dissemination, in the form of a longitudinal intervention study of the Spanish nutritional evolution during confinement. In a daily survey format, designed and validated by authors (3,6,7,(11)(12)(13)(14), it is intended to assess food consumption during the quarantine period. Databases and information achieved through this new format of study could be useful to inform the population through social media about forms of healthy eating based on the MD, publicise not so widespread foods or different ways of consuming them and also their benefits in the body, describe possible mood changes during confinement and how to cope with them through diet, explain different aspects related to a healthy life style and physical activity practise, carry out daily surveys to assess the way the population feeds during quarantine and also making an assessment of the declared daily mood and body perception of the participants, and analysing how all of the above is disseminated through something newer than paper format (magazines, newspapers, and television) such as social media and how it this new format impacts the population. ...
... We also used the official social media (Instagram) of scientific knowledge transfer academic platform designed by our nutritional research group in the Department of Nutrition and Food Science of the University of Granada, Spain call MM Health Science (@mmhealthscience) [section: "#lasaludnutricionalnoseconfina" (#nutritionalhealthisnotconfined)] (3) with more than 820 followers. The validity and reliability of this tool used in this study were obtained through the research work published by Mariscal-Arcas (3,6,7,(11)(12)(13)(14). The age of the subjects who voluntarily participated in the study was between 17 and 65 years, excluding any subject under 17 years of age from the study. ...
Introduction: In Spain, on 14 March 2020, a state of alarm is declared to face the health emergency situation caused by the COVID-19 coronavirus, limiting the freedom of movement of people. The Spanish population is confined.
Objective: With this situation, “NUTRITIONAL HEALTH IS NOT CONFINED” arises a research project that seeks to promote nutritional education based on the pattern of the Mediterranean diet (MD) using new computer technologies. It is about providing the population with the information of general interest about the promotion of a healthy diet through social networks and analysing the impact of its dissemination, in the form of a longitudinal intervention study of the Spanish nutritional evolution during confinement, with a daily survey format, and it is intended to assess food consumption during the period of confinement. Materials and methods: In total, 936 participants were asked every day. Short publications were published every day based on the scientific evidence (FAO, WHO, AECOSAN) through social media such as Instagram, accompanied by a questionnaire of 11 questions (yes/no) where it was intended to assess the evolution of daily consumption.
Results and Discussion: The diffusion through social media has allowed to have a greater reach of the population. We observed that mood throughout confinement generally improves. There are certain eating habits from the MD that are well established in the daily diet of our population, such as the consumption of fruits, vegetables, legumes, dairy products, and eggs. It seems that enjoying good health is a growing concern in pandemic situations, which is why inappropriate behaviours such as “snacking” between meals or the consumption of processed foods such as snacks, industrial pastries, soft drinks, and sweets are avoided, increasing the amount of healthy food such as meat and fish. This study opens up future avenues of research promoting MD and implements new cohort nutritional databases, especially about young adult people, who are adept at navigating digital spaces and therefore using social media.
... Understanding socio-economic disparities in diet can inform nutrition policy and population-based interventions [7]. Socio-demographic differences in diet quality have been described in adults [8][9][10], older children, and adolescents [11][12][13]. However, less is known about socio-demographic differences in diet quality among Canadian preschool children. ...
Purpose: To examine associations between preschoolers’ diet quality
and parent and child socio-demographic variables. Methods: Cross-sectional analysis with 117 preschoolers. Parents reported socio-demographics and their children’s diet using 3-day food records. Diet quality was assessed using the Healthy Eating Index (HEI)
2015. Linear regression models were used to analyze associations between socio-demographics and HEI scores.Results: Approximately 86% of children had an HEI-2015 score in the “needs improvement” category (51–80 out of a maximum of 100).
Children’s overall HEI-2015 score was inversely associated with children’s
age (β = −0.19, 95% CI −0.37, −0.02). Parental education was positively
associated with children’s overall HEI score (β = 9.58, 95% CI 3.81,
15.35) and with scores for total fruit (β = 1.00, 95% CI 0.39, 1.76), vegetables
(β = 1.11, 95% CI 0.03, 2.18), total protein (β = 1.06, 95% CI 0.28,
1.84), and seafood/plant protein (β = 1.67, 95% CI 0.43, 2.89) components.
Children who identified as Caucasian (β = 4.29, 95% CI 2.46,
6.14), had a Caucasian parent (β = 3.01, 95% CI 0.78, 5.25), or parents
who were born in Canada (β = 2.32, 95% CI 0.53, 4.1) had higher scores
for dairy. Conclusion: Our results suggest that preschoolers’ diet quality needs
improvement and that children’s diet quality varies by children’s age
and parental education level
Background:
As part of efforts to prevent childhood overweight and obesity, we need to understand the relationship between total fat intake and body fatness in generally healthy children.
Objectives:
To assess the effects and associations of total fat intake on measures of weight and body fatness in children and young people not aiming to lose weight.
Search methods:
For this update we revised the previous search strategy and ran it over all years in the Cochrane Library, MEDLINE (Ovid), MEDLINE (PubMed), and Embase (Ovid) (current to 23 May 2017). No language and publication status limits were applied. We searched the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov for ongoing and unpublished studies (5 June 2017).
Selection criteria:
We included randomised controlled trials (RCTs) in children aged 24 months to 18 years, with or without risk factors for cardiovascular disease, randomised to a lower fat (30% or less of total energy (TE)) versus usual or moderate-fat diet (greater than 30%TE), without the intention to reduce weight, and assessed a measure of weight or body fatness after at least six months. We included prospective cohort studies if they related baseline total fat intake to weight or body fatness at least 12 months later.
Data collection and analysis:
We extracted data on participants, interventions or exposures, controls and outcomes, and trial or cohort quality characteristics, as well as data on potential effect modifiers, and assessed risk of bias for all included studies. We extracted body weight and blood lipid levels outcomes at six months, six to 12 months, one to two years, two to five years and more than five years for RCTs; and for cohort studies, at baseline to one year, one to two years, two to five years, five to 10 years and more than 10 years. We planned to perform random-effects meta-analyses with relevant subgrouping, and sensitivity and funnel plot analyses where data allowed.
Main results:
We included 24 studies comprising three parallel-group RCTs (n = 1054 randomised) and 21 prospective analytical cohort studies (about 25,059 children completed). Twenty-three studies were conducted in high-income countries. No meta-analyses were possible, since only one RCT reported the same outcome at each time point range for all outcomes, and cohort studies were too heterogeneous to combine.Effects of dietary counselling to reduce total fat intake from RCTsTwo studies recruited children aged between 4 and 11 years and a third recruited children aged 12 to 13 years. Interventions were combinations of individual and group counselling, and education sessions in clinics, schools and homes, delivered by dieticians, nutritionists, behaviourists or trained, supervised teachers. Concerns about imprecision and poor reporting limited our confidence in our findings. In addition, the inclusion of hypercholesteraemic children in two trials raised concerns about applicability.One study of dietary counselling to lower total fat intake found that the intervention may make little or no difference to weight compared with usual diet at 12 months (mean difference (MD) -0.50 kg, 95% confidence interval (CI) -1.78 to 0.78; n = 620; low-quality evidence) and at three years (MD -0.60 kg, 95% CI -2.39 to 1.19; n = 612; low-quality evidence). Education delivered as a classroom curriculum probably decreased BMI in children at 17 months (MD -1.5 kg/m2, 95% CI -2.45 to -0.55; 1 RCT; n = 191; moderate-quality evidence). The effects were smaller at longer term follow-up (five years: MD 0 kg/m2, 95% CI -0.63 to 0.63; n = 541; seven years; MD -0.10 kg/m2, 95% CI -0.75 to 0.55; n = 576; low-quality evidence).Dietary counselling probably slightly reduced total cholesterol at 12 months compared to controls (MD -0.15 mmol/L, 95% CI -0.24 to -0.06; 1 RCT; n = 618; moderate-quality evidence), but may make little or no difference over longer time periods. Dietary counselling probably slightly decreased low-density lipoprotein (LDL) cholesterol at 12 months (MD -0.12 mmol/L, 95% CI -0.20 to -0.04; 1 RCT; n = 618, moderate-quality evidence) and at five years (MD -0.09, 95% CI -0.17 to -0.01; 1 RCT; n = 623; moderate-quality evidence), compared to controls. Dietary counselling probably made little or no difference to HDL-C at 12 months (MD -0.03 mmol/L, 95% CI -0.08 to 0.02; 1 RCT; n = 618; moderate-quality evidence), and at five years (MD -0.01 mmol/L, 95% CI -0.06 to 0.04; 1 RCT; n = 522; moderate-quality evidence). Likewise, counselling probably made little or no difference to triglycerides in children at 12 months (MD -0.01 mmol/L, 95% CI -0.08 to 0.06; 1 RCT; n = 618; moderate-quality evidence). Lower versus usual or modified fat intake may make little or no difference to height at seven years (MD -0.60 cm, 95% CI -2.06 to 0.86; 1 RCT; n = 577; low-quality evidence).Associations between total fat intake, weight and body fatness from cohort studiesOver half the cohort analyses that reported on primary outcomes suggested that as total fat intake increases, body fatness measures may move in the same direction. However, heterogeneous methods and reporting across cohort studies, and predominantly very low-quality evidence, made it difficult to draw firm conclusions and true relationships may be substantially different.
Authors' conclusions:
We were unable to reach firm conclusions. Limited evidence from three trials that randomised children to dietary counselling or education to lower total fat intake (30% or less TE) versus usual or modified fat intake, but with no intention to reduce weight, showed small reductions in body mass index, total- and LDL-cholesterol at some time points with lower fat intake compared to controls. There were no consistent effects on weight, high-density lipoprotein (HDL) cholesterol or height. Associations in cohort studies that related total fat intake to later measures of body fatness in children were inconsistent and the quality of this evidence was mostly very low. Most studies were conducted in high-income countries, and may not be applicable in low- and middle-income settings. High-quality, longer-term studies are needed, that include low- and middle-income settings to look at both possible benefits and harms.
Objectives:
To describe the nutritional profile and assess the National Dietary Survey on the Child and Adolescent Population project in Spain (ENALIA) regarding usual total energy and macronutrient intake.
Methods:
A cross-sectional nationally representative sample of 1862 children and adolescents (age 6 months to 17) was surveyed between 2013 and 2014 following European methodology recommendations. Dietary information was collected using two methods, dietary records (for children from age 6 months to 9 years) and 24-h dietary recall (participants age 10 and older). Usual intake was estimated by correcting for within-person intake variance using the Iowa State University (ISU) method. A probability analysis was used to assess compliance with dietary reference intakes in the target population.
Results:
Protein consumption in the age 1-3 group as a percentage of total energy exceeded the upper limit of the Acceptable Macronutrient Distribution Range (AMDR) by 4.7% for boys and 12.1% for girls. 42.9% of girls age 4-8 were under the lower limit of the AMDR for carbohydrates. 43.4% of boys and 46.9% of girls between 4 and 17 exceeded the AMDR in total fat intake, saturated fatty acids (SFAs) accounting for 12.3% of total energy.
Conclusions:
The results suggest that Spanish children and adolescents could improve macronutrient distribution by reducing fat and increasing carbohydrate intake across all age groups, and decreasing protein intake, especially in young children.
Nonalcoholic fatty liver disease (NAFLD) is emerging as the most common chronic liver disease, and is characterized by a wide spectrum of fat-liver disorders that can result in severe liver disease and cirrhosis. Inflammation and oxidative stress are the major risk factors involved in the pathogenesis of NAFLD. Currently, there is no consensus concerning the pharmacological treatment of NAFLD. However, lifestyle interventions based on exercise and a balanced diet for quality and quantity, are considered the cornerstone of NAFLD management. Mediterranean diet (MD), rich in polyunsaturated fats, polyphenols, vitamins and carotenoids, with their anti-inflammatory and anti-oxidant effects, has been suggested to be effective in preventing cardiovascular risk factors. In adults, MD has also been demonstrated to be efficacious in reducing the risk of metabolic syndrome. However, few studies are available on the effects of the MD in both adult and pediatric subjects with NAFLD. Thus, the aims of the present narrative review are to analyze the current clinical evidence on the impact of MD in patients with NAFLD, and to summarize the main mechanisms of action of MD components on this condition.
This paper reviews information on why the nutrition of older children (5-9 years) and adolescents (10-19 years) is important and the consequences that it can have over generations. Developing countries still face a high burden of undernutrition and anemia, while the burden of overweight and obesity is on the rise in both developing and developed countries. There are evidence-based interventions which can improve the nutritional status and these include interventions for a balanced and diverse diet and micronutrient supplementation, especially iron and multiple micronutrient supplementation where there is sufficient evidence to reduce anemia. There is mixed evidence for the effective strategies to prevent and control obesity and a dearth of evidence from developing countries. Adolescent pregnancy also poses greater challenges to the health of mother and child, and advocacy should be rampant to delay the age of marriage and pregnancy. Interventions targeted to improving the nutritional status among "pregnant adolescents" have shown improvement in birth weight and a reduction in low birth weight and preterm delivery. Traditional platforms including school-based and community-based approaches offer a mixed picture of effectiveness, but emerging avenues of mHealth and social media could also be channelized to reach this population. The population of this age group is on the rise globally, and failure to invest in improving the nutrition of older children and adolescents will further increase the number of dependents in coming generations and negatively influence the health of future generations and progress of nations.
Objective
Carbohydrate staples such as pasta have been implicated in the obesity epidemic. It is unclear whether pasta contributes to weight gain or like other low-glycaemic index (GI) foods contributes to weight loss. We synthesised the evidence of the effect of pasta on measures of adiposity.
Design
Systematic review and meta-analysis using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
Data sources
MEDLINE, Embase, CINAHL and the Cochrane Library were searched through 7 February 2017.
Eligibility criteria for selecting studies
We included randomised controlled trials ≥3 weeks assessing the effect of pasta alone or in the context of low-GI dietary patterns on measures of global (body weight, body mass index (BMI), body fat) and regional (waist circumference (WC), waist-to-hip ratio (WHR), sagittal abdominal diameter (SAD)) adiposity in adults.
Data extraction and synthesis
Two independent reviewers extracted data and assessed risk of bias. Data were pooled using the generic inverse-variance method and expressed as mean differences (MDs) with 95% CIs. Heterogeneity was assessed (Cochran Q statistic) and quantified (I² statistic). GRADE assessed the certainty of the evidence.
Results
We identified no trial comparisons of the effect of pasta alone and 32 trial comparisons (n=2448 participants) of the effect of pasta in the context of low-GI dietary patterns. Pasta in the context of low-GI dietary patterns significantly reduced body weight (MD=−0.63 kg; 95% CI −0.84 to –0.42 kg) and BMI (MD=−0.26 kg/m²; 95% CI −0.36 to –0.16 kg/m²) compared with higher-GI dietary patterns. There was no effect on other measures of adiposity. The certainty of the evidence was graded as moderate for body weight, BMI, WHR and SAD and low for WC and body fat.
Conclusions
Pasta in the context of low-GI dietary patterns does not adversely affect adiposity and even reduces body weight and BMI compared with higher-GI dietary patterns. Future trials should assess the effect of pasta in the context of other ‘healthy’ dietary patterns.
Trial registration number
NCT02961088; Results.
Background
In the United Kingdom, the Food Standards Agency-Ofcom nutrient profiling model (FSA-Ofcom model) is used to define less-healthy foods that cannot be advertised to children. However, there has been limited investigation of whether less-healthy foods defined by this model are associated with prospective health outcomes. The objective of this study was to test whether consumption of less-healthy food as defined by the FSA-Ofcom model is associated with cardiovascular disease (CVD).
Methods and findings
We used data from the European Prospective Investigation of Cancer (EPIC)-Norfolk cohort study in adults (n = 25,639) aged 40–79 years who completed a 7-day diet diary between 1993 and 1997. Incident CVD (primary outcome), cardiovascular mortality, and all-cause mortality (secondary outcomes) were identified using record linkage to hospital admissions data and death certificates up to 31 March 2015. Each food and beverage item reported was coded and given a continuous score, using the FSA-Ofcom model, based on the consumption of energy; saturated fat; total sugar; sodium; nonsoluble fibre; protein; and fruits, vegetables, and nuts. Items were classified as less-healthy using Ofcom regulation thresholds. We used Cox proportional hazards regression to test for an association between consumption of less-healthy food and incident CVD. Sensitivity analyses explored whether the results differed based on the definition of the exposure. Analyses were adjusted for age, sex, behavioural risk factors, clinical risk factors, and socioeconomic status. Participants were followed up for a mean of 16.4 years. During follow-up, there were 4,965 incident cases of CVD (1,524 fatal within 30 days). In the unadjusted analyses, we observed an association between consumption of less-healthy food and incident CVD (test for linear trend over quintile groups, p < 0.01). After adjustment for covariates (sociodemographic, behavioural, and indices of cardiovascular risk), we found no association between consumption of less-healthy food and incident CVD (p = 0.84) or cardiovascular mortality (p = 0.90), but there was an association between consumption of less-healthy food and all-cause mortality (test for linear trend, p = 0.006; quintile group 5, highest consumption of less-healthy food, versus quintile group 1, HR = 1.11, 95% CI 1.02–1.20). Sensitivity analyses produced similar results. The study is observational and relies on self-report of dietary consumption. Despite adjustment for known and reported confounders, residual confounding is possible.
Conclusions
After adjustment for potential confounding factors, no significant association between consumption of less-healthy food (as classified by the FSA-Ofcom model) and CVD was observed in this study. This suggests, in the UK setting, that the FSA-Ofcom model is not consistently discriminating among foods with respect to their association with CVD. More studies are needed to understand better the relationship between consumption of less-healthy food, defined by the FSA-Ofcom model, and indices of health.
Energy balance-related behaviours (EBRB) are established in childhood and seem to persist through to adulthood. A lower parental educational level was associated with unhealthy behavioural patterns. The aim of the study is to identify clusters of EBRB and examine their association with preschool children’s BMI and maternal, paternal and parental education. A subsample of the ToyBox study ( n 5387) conducted in six European countries was used. Six behavioural clusters (‘healthy diet and low activity’, ‘active’, ‘healthy lifestyle’, ‘high water and screen time; low fruits and vegetables (F&V) and physical activity (PA)’, ‘unhealthy lifestyle’ and ‘high F&V consumers’) emerged. The healthiest group characterised by high water and F&V consumption and high PA z scores (‘healthy lifestyle’) was more prevalent among preschool children with at least one medium- or higher-educated parent and showed markedly healthier trends for all the included EBRB. In the opposite, the ‘unhealthy lifestyle’ cluster (characterised by high soft drinks and screen time z scores, and low water, F&V and PA z scores) was more prevalent among children with lower parental, paternal and maternal education levels. OR identified that children with lower maternal, paternal and parental education levels were less likely to be allocated in the ‘healthy lifestyle’ cluster and more likely to be allocated in the ‘unhealthy lifestyle’ cluster. The ‘unhealthy lifestyle’ cluster was more prevalent among children with parents in lower parental educational levels and children who were obese. Therefore, parental educational level is one of the key factors that should be considered when developing childhood obesity prevention interventions.
Background:
The aim of this study was to increase the knowledge of healthy eating, to encourage change in nutritional behavior in accordance with the Mediterranean diet and to promote physical activity in children aged 7 to 9 years and their parents in a school setting through the use of cards and board games of the project Giochiamo (Let us play).
Methods:
This experimental randomized field trial enrolled children in a school setting. The trial consisted of two phases. The first phase, including both intervention and control groups, encompassed a informative session about the food pyramid and physical activity (PA) by experts of public health and preventive medicine. The second phase, including only the experimental groups, involved games focusing on the main concepts of the food pyramid and PA. A questionnaire was administered before the intervention and after one month in order to assess changing in knowledge and behavior scores.
Results:
Eighty-nine children were randomly allocated in the intervention (22 children of the fourth year, 22 children of the second year) and the control group (23 children of the fourth year, 22 children of the second year). The univariate analyses showed significant differences (p = 0,004) between intervention and control groups for behavior score after the intervention. In particular, in a stratified analysis classes of the second year showed significant differences for knowledge score (p = 0,005) and for behavior score (p = 0,002), resulting higher among the intervention group. No significant differences resulted in classes of the fourth year for both scores.
Conclusions:
The results of the Giochiamo project clearly demonstrate that the lecture and the games were effective to improve knowledge and behavior habits on the Mediterranean diet and PA. Second year students showed significant differences for knowledge and behavior score in comparison to fourth year students suggesting that, the earlier the intervention occurs, the better are the results in terms of improvement of knowledge and eating habits and PA behaviors.
Background:
More than 14 million children in the United States attend summer camp annually, yet little is known about the food environment in day camps.
Objective:
Our aim was to describe the nutritional quality of meals served to, brought by, and consumed by children attending summer day camps serving meals and snacks, and to describe camp water access.
Design:
We conducted a cross-sectional study.
Participants/settings:
Participants were 149 children attending five summer camps in Boston, MA, in 2013.
Main outcome measures:
Foods and beverages served were observed for 5 consecutive days. For 2 days, children's dietary intake was directly observed using a validated protocol. Outcome measures included total energy (kilocalories) and servings of different types of foods and beverages served and consumed during breakfast, lunch, and snack.
Statistical analyses performed:
Mean total energy, trans fats, sodium, sugar, and fiber served per meal were calculated across the camps, as were mean weekly frequencies of serving fruits, vegetables, meat/meat alternates, grains, milk, 100% juice, sugar-sweetened beverages, whole grains, red/highly processed meats, grain-based desserts, and salty snacks. Mean consumption was calculated per camper per day.
Results:
Camps served a mean (standard deviation) of 647.7 (134.3) kcal for lunch, 401.8 (149.6) kcal for breakfast, and 266.4 (150.8) kcal for snack. Most camps served red/highly processed meats, salty snacks, and grain-based desserts frequently, and rarely served vegetables or water. Children consumed little (eg, at lunch, 36.5% of fruit portions, 35.0% of meat/meat alternative portions, and 37.6% of milk portions served) except for salty snacks (66.9% of portions) and grain-based desserts (64.1% of portions). Sugar-sweetened beverages and salty snacks were frequently brought to camp. One-quarter of campers drank nothing throughout the entire camp day.
Conclusions:
The nutritional quality of foods and beverages served at summer day camps could be improved. Future studies should assess barriers to consumption of healthy foods and beverages in these settings.
It is well known that cardiovascular disease is the leading cause of mortality in the western societies. A number of risk factors such as family history, diabetes, hypertension, obesity, diabetes, smoking and physical inactivity are responsible for a significant proportion of the overall cardiovascular risk. Interestingly, recent data suggest there is a gradient in the incidence, morbidity and mortality of cardiovascular disease across the spectrum of socioeconomic status, as this is defined by educational level, occupation or income. Additionally, dietary mediators seem to play significant role in the pathogenesis of cardiovascular disease, mediating some of the discrepancies in atherosclerosis among different socioeconomic layers. Therefore, in the present article, we aim to review the association between socioeconomic status and cardiovascular disease risk factors and the role of different dietary mediators.
Background:
The frequency of intake of food and beverages depends on a number of ill-defined behaviour patterns. The objectives of this study were to evaluate the effects of screen time and sleep duration on food consumption frequency, and to describe frequencies and types of food consumption according to BMI category and parents' level of education.
Methods:
We studied 6287 and 2806 children drawn from the 2011 and 2013 cross-sectional ALADINO studies respectively. Data were collected on number of hours of sleep, screen time, and weekly frequency of consumption of 17 food groups. Weight status was measured, and information was also collected on parents' educational level. Average food consumption frequencies were calculated by reference to hours of sleep and hours of screen time, and were defined as ≥4 times or <4 times per week (once per week for soft drinks and diet soft drinks). Differences in frequency were evaluated for screen times of more and less than 2 h per day, and for sleep durations longer or shorter than the daily average. We fitted logistic regression models to evaluate the independent association between screen exposure and hours of sleep on the one hand, and food consumption frequency on the other.
Results:
Consumption of fruit and vegetables was lower among children who had parents with no formal or only primary school education. High levels of screen time were associated with a greater frequency of consumption of energy-dense, micronutrient-poor products and a lower frequency of consumption of fruit and vegetables. Sleeping a sufficient number of hours was associated with a higher consumption of fruit and vegetables. The results for 2011 were concordant with those for 2013.
Conclusions:
If efforts to ensure healthier eating habits among children are to be at all successful, they should focus on promoting a sufficient amount of sleep for children, limiting the time they spend watching television and/or playing with computers or video games, and educating parents accordingly.
IntroductionChildren who frequently eat family meals are less likely to develop risk- and behavior-related outcomes, such as substance misuse, sexual risk, and obesity. Few studies have examined sociodemographic characteristics associated with both meal frequency (i.e., number of meals) and duration (i.e., number of minutes spent at mealtimes). Methods
We examine the association between sociodemographics and family meal frequency and duration among a sample of 85 parents in a large New England city that was recruited through the public-school system. Additionally, we examined differences in family meals by race/ethnicity and parental nativity. Unadjusted ANOVA and adjusted ANCOVA models were used to assess the associations between sociodemographic characteristics and frequency and duration of meals. ResultsSociodemographic characteristics were not significantly associated with the frequency of family meals; however, in the adjusted models, differences were associated with duration of meals. Parents who were born outside the U.S. spent an average of 135.0 min eating meals per day with their children compared to 76.2 for parents who were born in the U.S. (p < 0.01). Additionally, parents who reported being single, divorced, or separated on average, spent significantly more time per day eating family meals (126.7 min) compared to parents who reported being married or partnered (84.4; p = 0.02). Differences existed in meal duration by parental nativity and race/ethnicity, ranging from 63.7 min among multi-racial/other parents born in the U.S. to 182.8 min among black parents born outside the U.S. DiscussionThis study builds a foundation for focused research into the mechanisms of family meals. Future longitudinal epidemiologic research on family meals may help to delineate targets for prevention of maladaptive behaviors, which could affect family-based practices, interventions, and policies.
The lifestyle is defined as the set of behavioral patterns and daily habits of a person, which maintained over time may become dimensions of risk or safety depending on their nature. The aim of this study was to know the lifestyles of university students in the following dimensions: diet, exercise, consumption of tobacco, alcohol and other drugs, sex and road safety. We made a literature review in electronic databases: PubMed, SCIELO and CUIDEN, between 2002-2014; using as keywords habits, lifestyle, health behaviors, young adult and university students. From articles found, stand out as most relevant data that university students have a high presence of favorable beliefs about healthy lifestyles and nevertheless not put into practice. We could conclude that according to different authors, university students in general have not a good eating habits, eating unbalanced diets high in calories. Besides the physical exercise is null, knowing that a good diet and doing exercise have beneficial effects on health. To this must be added the high consumption of alcohol, tobacco and marijuana among university students.
Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.
Background: Increasing obesity among adolescents in the industrialized world may result from poor nutritional habits and inadequate exercise. Aim: To determine differences in food intake, nutritional habits, and body mass index between Spanish adolescents who engage in ski activity and those who do not. Methods: A socio-demographic survey, food frequency questionnaire, 24-hr dietary recall, and physical activity questionnaire were completed by 300 Spanish schoolchildren aged 10 to 18 yrs. Results were compared (Student's t, chi-square and Fisher's exact test) between adolescents engaged (SP) and not engaged (N-SP) in skiing according to their sex. Results: SP adolescents devoted > 4 h/day to physical activity versus < 1 h for N-SP adolescents. No significant differences were found in nutrient intake or nutritional habits between SP and N-SP adolescents. Protein and fat intakes of both groups were above recommended levels. A higher proportion of N-SP than SP males were overweight. Logistic regression analysis showed that the maintenance of a normal weight was favored by the practice of skiing, the consumption of sugar-free drinks, and supplementation with vitamins/mineral salts and was negatively associated with body weight dissatisfaction, intake of nutritional supplements other than vitamins or minerals, and the consumption of snacks. Conclusions: The diet of this adolescent population was poorly balanced. Engagement in physical activity appears to be a key factor in maintaining a healthy body mass index.
Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.
The Mediterranean diet has been linked to a number of health benefits, including reduced mortality risk and lower incidence of cardiovascular disease. Definitions of the Mediterranean diet vary across some settings, and scores are increasingly being employed to define Mediterranean diet adherence in epidemiological studies. Some components of the Mediterranean diet overlap with other healthy dietary patterns, whereas other aspects are unique to the Mediterranean diet. In this forum article, we asked clinicians and researchers with an interest in the effect of diet on health to describe what constitutes a Mediterranean diet in different geographical settings, and how we can study the health benefits of this dietary pattern.
Objective:
To propose and apply an instrument to assess the breakfast quality of children and adolescents in the Mediterranean area.
Design:
Randomized, cross-sectional survey of breakfast consumption using a validated semi-quantitative FFQ administered at school by trained dietitians between Tuesday and Friday. A Breakfast Quality Index (BQI) score was developed, assigning a positive value to the consumption of cereals, fruit, vegetables, dairy products, MUFA, Ca and compliance with energy recommendations, and to the absence of SFA and trans-rich fats. Data were analysed by Student's t test and ANOVA.
Setting:
Schools in Granada and Balearic Islands (Spain).
Subjects:
All schoolchildren (n 4332) aged 8-17 years at randomly selected and representative schools between 2006 and 2008, stratified by age and sex.
Results:
Breakfast was not consumed by 6·5 % of participants. BQI score was highest for children aged 7-9 years and decreased with age (P = 0·001). Females scored higher in all age groups. The lowest score was in males aged 14-17 years and the highest in females aged 7-9 years (P = 0·006).
Conclusions:
The proposed BQI appears useful to estimate the breakfast quality of schoolchildren and to form a basis for nutrition education.
Background
Speed of eating, an important aspect of eating behaviour, has recently been related to loss of control of food intake and obesity. Very little time is allocated for lunch at school and thus children may consume food more quickly and food intake may therefore be affected. Study 1 measured the time spent eating lunch in a large group of students eating together for school meals. Study 2 measured the speed of eating and the amount of food eaten in individual school children during normal school lunches and then examined the effect of experimentally increasing or decreasing the speed of eating on total food intake.
Methods
The time spent eating lunch was measured with a stop watch in 100 children in secondary school. A more detailed study of eating behaviour was then undertaken in 30 secondary school children (18 girls). The amount of food eaten at lunch was recorded by a hidden scale when the children ate amongst their peers and by a scale connected to a computer when they ate individually. When eating individually, feedback on how quickly to eat was visible on the computer screen. The speed of eating could therefore be increased or decreased experimentally using this visual feedback and the total amount of food eaten measured.
Results
In general, the children spent very little time eating their lunch. The 100 children in Study 1 spent on average (SD) just 7 (0.8) minutes eating lunch. The girls in Study 2 consumed their lunch in 5.6 (1.2) minutes and the boys ate theirs in only 6.8 (1.3) minutes. Eating with peers markedly distorted the amount of food eaten for lunch; only two girls and one boy maintained their food intake at the level observed when the children ate individually without external influences (258 (38) g in girls and 289 (73) g in boys). Nine girls ate on average 33% less food and seven girls ate 23% more food whilst the remaining boys ate 26% more food. The average speed of eating during school lunches amongst groups increased to 183 (53)% in the girls and to 166 (47)% in the boys compared to the speed of eating in the unrestricted condition. These apparent changes in food intake during school lunches could be replicated by experimentally increasing the speed of eating when the children were eating individually.
Conclusions
If insufficient time is allocated for consuming school lunches, compensatory increased speed of eating puts children at risk of losing control over food intake and in many cases over-eating. Public health initiatives to increase the time available for school meals might prove a relatively easy way to reduce excess food intake at school and enable children to eat more healthily.
The purpose of the present study was to evaluate the changes in the availability of the most important food components of the traditional Mediterranean diet and other food groups in five geographical areas during a 43-year period.
Ecological study with food availability data obtained from FAO food balance sheets in forty-one countries for the period 1961-1965 and 2000-2004.
Mediterranean, Northern and Central Europe, Other Mediterranean countries and Other Countries of the World were the studied areas.
The main changes since the 1960s, at an availability level, were found in European areas and in Other Mediterranean countries. The greatest changes were found in Mediterranean Europe, recording high availability of non-Mediterranean food groups (animal fats, vegetable oils, sugar and meat), whereas the availability of alcoholic beverages, including wine, and legumes decreased. Despite having lost some of its typical characteristics, Mediterranean Europe has more olive oil, vegetables, fruits and fish available than other areas. Although Northern Europe has a greater availability of non-Mediterranean foods, there has been a tendency towards a decrease in availability of some of these foods and to increase Mediterranean food such as olive oil and fruits.
The present study suggests that European countries, especially those in the Mediterranean area, have experienced a 'westernisation' process of food habits, and have increasingly similar patterns of food availability (mainly non-Mediterranean food groups) among them. Measures must be taken to counteract these tendencies and to avoid their possible negative consequences. It is also crucial to find ways to promote and preserve the Mediterranean diet and its lifestyle in modern societies.
The Mediterranean diet is considered one of the healthiest dietary models. Recent changes in the actual Mediterranean diet include a reduction in energy intake and a higher consumption of foods with low nutrient density (e.g. soft drinks, candy, sweets, etc.). In Spain, in association with cultural and lifestyle changes, there has been a reduction in the intake of antioxidants and vitamins, an increase in the proportion of SFA and a decrease in the consumption of fibre, among other changes. Children and adolescents may be the age groups with the most deteriorated Mediterranean diet. The current paper presents the results of applying the Mediterranean Diet Quality Index for children and adolescents (KIDMED) to a large sample of Spanish schoolchildren.
Data from questionnaires were used to calculate the KIDMED index.
Granada, Southern Spain.
Schoolchildren (n 3190) aged 8-16 years.
Among the 8-10-year-olds, the KIDMED index classification was 'good' in 48.6% of the population, 'average' in 49.5% and 'poor' in 1.6%. Among the 10-16-year-olds, the KIDMED index classification was good in 46.9% of the population, average in 51.1% and poor in 2.0%.
The nutritional behaviour of the present population of schoolchildren is similar to that found in the earlier KIDMED study.
We provide an updated version of the Compendium of Physical Activities, a coding scheme that classifies specific physical activity (PA) by rate of energy expenditure. It was developed to enhance the comparability of results across studies using self-reports of PA. The Compendium coding scheme links a five-digit code that describes physical activities by major headings (e.g., occupation, transportation, etc.) and specific activities within each major heading with its intensity, defined as the ratio of work metabolic rate to a standard resting metabolic rate (MET). Energy expenditure in MET-minutes, MET-hours, kcal, or kcal per kilogram body weight can be estimated for specific activities by type or MET intensity. Additions to the Compendium were obtained from studies describing daily PA patterns of adults and studies measuring the energy cost of specific physical activities in field settings. The updated version includes two new major headings of volunteer and religious activities, extends the number of specific activities from 477 to 605, and provides updated MET intensity levels for selected activities.
To evaluate the consumption of energy and nutrients and to identify the risk of inadequate intakes in the Canary Island population (1997-98).
Cross-sectional epidemiological study.
A dietary survey was conducted in a representative sample of the Canary Island population (n = 1747; 821 men and 926 women) aged 6 to 75 years. Two 24-hour recalls were utilised as the dietary survey instrument, carried out over non-consecutive days. Spanish Food Composition Tables were used and data was adjusted for intraindividual variability.
The mean daily intakes were 1760 kcal for energy, 73 g for protein, 228 g for carbohydrates, 15 g for fibre and 62 g for fat (24 g SFA, 25 g MUFA and 8 g PUFA). Energy and nutrient consumption decreased with age excluding vitamins A. C and folate. Nutrient density increased with age, with the lowest intakes seen in children and adolescents. As for social class, decreased calorie intake was observed in the lowest category, with the highest income level showing the greatest intakes for vitamin A, B12, niacin and folate. Noteworthy findings include an overall low calorie intake, and elevated risks of inadequate intakes (percentages of the population with intakes below 2/3 of the RDI) for vitamins D (92.5%), E(87.4%), A(74%), folate(44.7%), iron(30.1%) magnesium (14.9%) and vitamin C (5.4%). Risk for inadequate protein intake was not observed.
To describe vitamin intakes in Spanish food patterns, identify groups at risk for inadequacy and determine conditioning factors that may influence this situation.
Pooled-analysis of eight cross-sectional regional nutrition surveys.
Ten thousand two hundred and eight free-living subjects (4728 men, 5480 women) aged 25-60 years. Respondents of population nutritional surveys carried out in eight Spanish regions (Alicante, Andalucia, Balearic Islands, Canary Islands, Catalunya, Galicia, Madrid and Basque Country) from 1990 to 1998. The samples were pooled together and weighted to build a national random sample.
Dietary assessment by means of repeated 24-hour recall using photograph models to estimate portion size. Adjusted data for intra-individual variation were used to estimate the prevalence of inadequate intake. A Diet Quality Score (DQS) was computed considering the risk for inadequate intake for folate, vitamin C, vitamin A and vitamin E. DQS scores vary between 0 (good) and 4 (very poor). Influence of lifestyle (smoking, alcohol consumption and physical activity) was considered as well.
Inadequate intakes (<2/3 Recommended Dietary Intake) were estimated in more than 10% of the sample for riboflavin (in men), folate (in women), vitamin C, vitamin A, vitamin D and vitamin E. More than 35% of the sample had diets classified as poor quality or very poor quality. Factors identified to have an influence on a poor-quality diet were old age, low education level and low socio-economical level. A sedentary lifestyle, smoking, usual consumption of alcohol and being overweight were conditioning factors for a poor-quality diet as well.
Results from The eVe Study suggest that a high proportion of the Spanish population has inadequate intakes for at least one nutrient and nearly 50% should adjust their usual food pattern towards a more nutrient-dense, healthier diet.
The objective of this paper is to present the development of the Nutritional Objectives for the Spanish Population. Preparation of draft documents contributed by different working groups was followed by a consensus meeting held in Bilbao on 5-7 October 2000, hosted by the Spanish Society of Community Nutrition and sponsored by the World Health Organisation. Establishing nutritional guidelines was conducted by: (1) analysing current food and nutritional data from nutritional surveys, for intermediate objectives; and (2) reviewing current scientific knowledge for final objectives. The objectives include intermediate and ultimate figures, and comprise percentage of energy from macronutrients and fatty acids, fruit and vegetable consumption, frequency of sweets, physical activity and body mass index, folate, calcium, sodium, fluoride and iodine intake, dietary fibre, cholesterol, alcohol and duration of breast-feeding. The nutritional objectives for the Spanish population create a rational framework for the development of dietary guidelines and nutritional policies in Spain, within a Mediterranean context.
The aim of this study was to assess whether the recently developed Diet Quality Index-International (DQI-I) could be used to evaluate diet quality of a Mediterranean population. A cross-sectional nutritional survey was carried out in the Balearic Islands (Spain) between 1999 and 2000. Dietary information (replicated 24 h recall and a food frequency questionnaire), and socio-demographic and lifestyle data were collected from a representative sample of the population (n 1200: 498 males and 702 females) aged 16-65 years (response rate 77.22 %). The DQI-I was developed according to the method defined by Kim et al. (2003), and focused on four major aspects of a high-quality diet (variety, adequacy, moderation and overall balance). The percentage of adherence to the Mediterranean dietary pattern (MDP) was also calculated and correlation analysis was carried out between the DQI-I score and the percentage of adherence to the MDP. The total score of the DQI-I reached 43 % of the possible score, indicating that the Balearic diet was a poor-quality diet. Correlation analysis between the DQI-I scores and adherence to the MDP showed that the DQI-I subcategories protein, iron and calcium adequacy were negatively correlated with the MDP. Furthermore, moderation in empty calorie food consumption and overall balance subcategories were not significantly correlated with the MDP. Due to some methodological factors and cultural biases, the proposed DQI-I scoring system is not useful to evaluate the quality of this Mediterranean-type diet. Further research is needed to develop a new diet quality index adapted to the MDP.
Prevalence estimates of obesity in a national random sample of Spanish children and young people are presented in this paper, defined by age- and sex-specific BMI national reference standards for the 85th percentile (overweight) and 97th percentile (obesity), as well as by Cole et al. criteria. A random sample of 3534 people, aged 2-24 years, was interviewed between 1998 and 2000. The study protocol included personal data, data on education and socioeconomic status (SES) for the family, dietary assessment, anthropometric measurements and physical activity. The prevalence of obesity was 13.9 % (95 % CI 12.7, 15.1) considering Spanish reference standards as cut-offs. Obesity was significantly higher in boys (15.6 %) than in girls (12 %). The highest values were observed between 6 and 13 years of age. Using Cole's cut-offs, the estimated prevalence of obesity was 6.3 % (95 % CI 5.4, 7.5) with a similar pattern to that previously described by sex. Regarding sociodemographic factors, sex, age group, region, size of locality of residence, mother's level of education and family SES level were significant predictors for obesity in children and adolescents under 14 years. Among young people, the main sociodemographic predictors for obesity were geographical region and family SES level. Odds ratio for obesity was 1.27 for those with a more frequent consumption of buns, cakes and snacks, and 1.71 for those with more frequent consumption of sugared drinks. Adequate consumption of fruit and vegetables, usually having breakfast and regular sports practice had a protective effect. The available data show that obesity in Spain is a public health issue given its magnitude and increasing trends. Among Spanish children and young people, those at prepubertal age, particularly boys, can be identified as a group at higher risk for overweight and obesity, particularly children from lower SES families.
We examined associations between two Mediterranean diet (MD) adherence indexes (the MD index, MDI, and the MD score, MDS) and several blood biomarkers of diet and disease.
We studied 328 individuals from Catalonia (Northeastern Spain), ages 18-75, who provided fasting blood samples, a subset of the 2346 individuals as part of a larger representative and random sample from the 1992-1993 Catalan Nutritional Survey.
Diet was measured using 24-h recalls. Biomarkers studied were plasma levels of beta-carotene, alpha-tocopherol, retinol, vitamins B12, C and folates as well as serum total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides. Multivariate linear regression was used to analyse associations of the nutrient biomarkers with the dietary pattern indexes, adjusting for potential confounders.
Subjects with higher MD adherence, as measured by the two dietary indexes, had significantly higher plasma concentrations of beta-carotene, folates, vitamin C, alpha-tocopherol and HDL cholesterol. The most highly significant relationship was that between folates and the adherence to the MD Pattern, as determined by both indexes. These research findings suggest the potential usefulness of biomarkers as complementary tools for assessing adherence to a dietary pattern. This type of data not only informs the development of robust dietary adherence indexes, but it also provides specific clues about the potential physiological mechanisms that explain the beneficial effects of the MD pattern on chronic disease risk.
To examine whether there is an association between individual and family eating patterns during childhood and the likelihood of developing an eating disorder (ED) later in life. The sample comprised 261 eating disorder patients [33.5% [N=88] anorexia nervosa (AN), 47.2% [N=123] with bulimia nervosa (BN) and 19.3% [N=50] with Eating Disorders Not Otherwise Specified (EDNOS)] and 160 healthy controls from the Province of Catalonia, Spain, who were matched for age and education. All patients were consecutively admitted to our Psychiatry Department and were diagnosed according to DSM-IV criteria. Participants completed the Early Eating Environmental Subscale of the Cross-Cultural (Environmental) Questionnaire (CCQ), a retrospective measure of childhood eating attitudes and behaviours. In the control group, also the General Health Questionnaire-28 (GHQ-28) was used. During childhood and early adolescence, the following main factors were identified to be linked to eating disorders: eating excessive sweets and snacks and consuming food specially prepared for the respondent. Conversely, regular breakfast consumption was negatively associated with an eating disorder. Compared to healthy controls, eating disorder patients report unfavourable eating patterns early in life, which in conjunction with an excessive importance given to food by the individual and the family may increase the likelihood for developing a subsequent eating disorder.
The aim of this study was to assess whether the recently developed Diet Quality Index-International (DQI-I) was useful to evaluate the diet quality of a young Mediterranean population. A cross-sectional nutritional survey was carried out in southern Spain (Granada-Andalucia) from 2002 to 2005. Dietary information (24 h recall and FFQ) and socio-demographic and lifestyle data were collected from a representative sample of the population (n 288, 44.1 % females and 55.9 % males) aged 6-18 years (mean 12.88 (sd 2.78) years). DQI-I was designed according to the method of Kim et al. modified by Tur et al. for Mediterranean populations. It focused on four main characteristics of a high-quality diet (variety, adequacy, moderation and overall balance). This young population from southern Spain obtained 56.31 % of the total DQI-I score, indicating a poor-quality diet. A higher score was associated with a longer breakfast and greater physical activity. The DQI-I may require further modification for application in Mediterranean populations, differentiating between olive oil and saturated fats, among other changes. Further research is needed to develop a new diet quality index adapted to the Mediterranean diet.
Background:
Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden.
Objectives:
To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under.
Search methods:
We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2018. We searched Proquest Dissertations and Theses in November 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials.
Selection criteria:
We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements.
Data collection and analysis:
Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures.
Main results:
We included 63 trials with 178 trial arms and 11,698 participants. Thirty-nine trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fourteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Nine studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake.We judged 14 of the 63 included trials as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining studies.There is very low quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 3.50 g as-desired consumption of vegetables (SMD 0.33, 95% CI 0.13 to 0.54; participants = 1741; studies = 13). Multicomponent interventions versus no intervention may have a very small effect on child consumption of fruit and vegetables (SMD 0.35, 95% CI 0.04 to 0.66; participants = 2009; studies = 5; low-quality evidence), equivalent to an increase of 0.37 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; participants = 3078; studies = 11; very low-quality evidence).Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions. Studies reported receiving governmental or charitable funds, except for four studies reporting industry funding.
Authors' conclusions:
Despite identifying 63 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low- and low-quality evidence respectively that child-feeding practice and multicomponent interventions may lead to very small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up is required and future research should adopt more rigorous methods to advance the field.This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
Aim
Children with obesity have a greater risk of adverse social and physical health outcomes. We examined temporal changes in body mass index (BMI) z‐scores and the prevalence obesity and morbid obesity in children from 1985 to 2014.
Methods
Secondary data analysis of BMI data for children aged 7–15 years from five cross‐sectional Australian datasets. Changes in age‐ and gender‐adjusted BMI (BMI z‐scores) and nutritional status were categorised using the International Obesity Task Force cut‐off points.
Results
The percentage of children who were obese tripled between 1985 and 1995 from 1.6 to 4.7%, before plateauing between 1995 and 2014. The percentage of morbidly obese children was <1% in 1985 and 1995, increasing to 2% between 1995 and 2007, with no further increase between 2007 and 2014. The proportion of obese children classified as morbidly obese was 12% in 1985–1995, 24% in 2007–2012 and 28% in 2014. Between 1985 and 2012, the mean BMI z‐score increased in children categorised as obese from 1.94 (standard deviation 0.15) to 2.03 (0.22), and then plateaued. For morbidly obese children, the mean BMI z‐score was 2.4 (0.13) and remained similar over the study period.
Conclusions
Our findings suggest that the relative fatness of children with morbid obesity, as measured by BMI z‐score, has remained stable. The proportion of obese and morbidly obese children has also plateaued between 2007 and 2014. However, the prevalence of obesity remains high, and more dedicated resources are required to treat children with obesity to reduce the short‐ and long‐term health impact.
Background:
Insufficient consumption of fruits and vegetables in childhood increases the risk of future chronic diseases, including cardiovascular disease.
Objectives:
To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under.
Search methods:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE and Embase to identify eligible trials on 25 September 2017. We searched Proquest Dissertations and Theses and two clinical trial registers in November 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials.
Selection criteria:
We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements.
Data collection and analysis:
Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures.
Main results:
We included 55 trials with 154 trial arms and 11,108 participants. Thirty-three trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Thirteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Eight studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition intervention delivered to children in increasing child fruit and vegetable intake.We judged 14 of the 55 included trials as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining studies.Meta-analysis of trials examining child-feeding practices versus no intervention revealed a positive effect on child vegetable consumption (SMD 0.38, 95% confidence interval (CI) 0.15 to 0.61; n = 1509; 11 studies; very low-quality evidence), equivalent to a mean difference of 4.03 g of vegetables. There were no short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.11, 95% CI -0.05 to 0.28; n = 3023; 10 studies; very low-quality evidence) or multicomponent interventions versus no intervention (SMD 0.28, 95% CI -0.06 to 0.63; n = 1861; 4 studies; very low-quality evidence).Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions. Studies reported receiving governmental or charitable funds, except for three studies reporting industry funding.
Authors' conclusions:
Despite identifying 55 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains sparse. There was very low-quality evidence that child-feeding practice interventions are effective in increasing vegetable consumption in children aged five years and younger, however the effect size was very small and long-term follow-up is required. There was very low-quality evidence that parent nutrition education and multicomponent interventions are not effective in increasing fruit and vegetable consumption in children aged five years and younger. All findings should be considered with caution, given most included trials could not be combined in meta-analyses. Given the very low-quality evidence, future research will very likely change estimates and conclusions. Such research should adopt more rigorous methods to advance the field.This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
Background:
The Dietary Approaches to Stop Hypertension (DASH) diet is associated with lower blood pressure and reduced risk of cardiovascular disease among adults, but little is known about accordance with this dietary pattern or health benefits among children and adolescents.
Objective:
The objectives were to evaluate accordance with the DASH diet, differences over time, and the association with health attributes among a nationally representative sample of US children and adolescents.
Design:
Cross-sectional data from the 2003-2012 National Health and Nutrition Examination Surveys (NHANES) were analyzed.
Participants/setting:
Data from 9,793 individuals aged 8 to 18 years were examined.
Main outcome measures:
DASH accordance was estimated based on nine nutrient targets: total fat, saturated fat, protein, cholesterol, fiber, calcium, magnesium, potassium, and sodium; possible score range is 0 to 9.
Statistical analyses performed:
Accordance with the DASH diet across time was examined comparing the 2011-2012 to 2003-2004 NHANES surveys. The association between DASH score and weight status was examined using multinomial logistic regression, and the associations with waist circumference, systolic blood pressure, and diastolic blood pressure were examined using multivariable linear regression.
Results:
Accordance with the DASH diet was low across the age groups, with a range of mean DASH scores from 1.48 to 2.14. There were no significant changes across time. DASH score was inversely associated with systolic blood pressure (mm Hg) among 14- to 18-year-olds (β=-.46; 95% CI -.83 to -.09) among the larger sample of participants who completed at least one dietary recall, but no significant differences were seen in other age categories. In the subsample of participants with both dietary recalls, a significant inverse association was seen between DASH score and systolic blood pressure for 11- to 13-year-olds (β=-.57; 95% CI -1.02 to -.12). There were no significant associations between this dietary pattern and weight status, waist circumference, or diastolic blood pressure.
Conclusions:
Few US children and adolescents have diets that are in alignment with the DASH diet. Future research should explore strategies to encourage fruit, vegetable, and whole-grain consumption, as well as sodium reductions to help meet DASH nutrient targets in children and adolescents, as well as examine the potential benefits of this eating pattern on health in this population group.
Background: Whole-grain consumption seems to be cardioprotective in adults, but evidence in children is limited.
Objective: We investigated whether intakes of total whole grain and dietary fiber as well as specific whole grains were associated with fat mass and cardiometabolic risk profile in children.
Methods: We collected cross-sectional data on parental education, puberty, diet by 7-d records, and physical activity by accelerometry and measured anthropometry, fat mass index by dual-energy X-ray absorptiometry, and blood pressure in 713 Danish children aged 8–11 y. Fasting blood samples were obtained and analyzed for alkylresorcinols, biomarkers of whole-grain wheat and rye intake, HDL and LDL cholesterol, triacylglycerols, insulin, and glucose. Linear mixed models included puberty, parental education, physical activity, and intakes of energy, fruit and vegetables, saturated fat, and n–3 (ω-3) polyunsaturated fatty acids.
Results: Median (IQR) whole-grain and dietary fiber intakes were 52 g/d (35–72 g/d) and 17 g/d (14–22 g/d), respectively. Fourteen percent of children were overweight or obese and most had low-risk cardiometabolic profiles. Dietary whole-grain and fiber intakes were not associated with fat mass index but were inversely associated with serum insulin [both P < 0.01; e.g., with 0.68 pmol/L (95% CI: 0.26, 1.10 pmol/L) lower insulin · g whole grain⁻¹ · MJ⁻¹]. Whole-grain oat intake was inversely associated with fat mass index, systolic blood pressure, and LDL cholesterol (all P < 0.05) as well as insulin (P = 0.003), which also tended to be inversely associated with whole-grain rye intake (P = 0.11). Adjustment for fat mass index did not change the associations. The C17-to-C21 alkylresorcinol ratio, reflecting whole-grain rye to wheat intake, was inversely associated with insulin (P < 0.001).
Conclusions: Higher whole-grain intake was associated with lower serum insulin independently of fat mass in 8- to 11-y-old Danish children. Whole-grain oat intake was linked to an overall protective cardiometabolic profile, and whole-grain rye intake was marginally associated with lower serum insulin. This supports whole grains as healthy dietary components in childhood. This trial was registered at clinicaltrials.gov as NCT01577277.
Background and objectives:
The presence of metabolic syndrome (MetS) in childhood is a significant risk factor for later cardiovascular disease (CVD). Recent data showed temporal decreases in a sex- and race/ethnicity-specific MetS severity z-score among U.S. adolescents. Our goal was to characterize the relationship of this MetS z-score with other CVD risk indicators and assess their temporal trends and lifestyle influences.
Methods:
We analyzed 4837 participants aged 12-20years from the National Health and Nutrition Examination Survey by 2-year waves from 1999 to 2012. We used linear regression to compare MetS z-score and dietary factors with serum levels of low-density lipoprotein (LDL), apolipoprotein-B (ApoB), high-sensitivity C-reactive protein (hsCRP) and uric acid.
Results:
MetS severity z-score was positively correlated with LDL, ApoB, hsCRP, and uric acid measurements (p<0.0001 for all). These correlations held true among individual racial/ethnic groups. LDL, ApoB, and hsCRP measurements decreased over time among U.S. adolescents (p=0.002, p<0.0001, and p=0.024, respectively). Saturated fat consumption was positively correlated with LDL (p=0.005) and ApoB (p=0.012) and inversely related to serum uric acid (p=0.001). Total caloric intake was inversely related to LDL (p=0.003) and serum uric acid (p=0.003). Unsaturated fat, carbohydrate, and protein consumption were not related to LDL, ApoB, hsCRP, or serum uric acid.
Conclusions:
There is a positive correlation between MetS severity and all four CVD risk indicators studied. LDL, ApoB, and hsCRP showed favorable temporal trends, which could be related to similar trends in MetS z-score. These data support the importance of considering multiple inter-related factors in clinical CVD risk assessment.
Nutrition is a critical factor for appropriate child and adolescent development. Appropriate nutrition changes according to age. Nutrition is an important element for prevention of disease development, especially for chronic diseases. Many children and adolescents live in environments that do not promote optimum nutrition. Families must work to provide improved food environments to encourage optimum nutrition. Early primordial prevention of risk factors for chronic disease, such as cardiovascular disease, is important, and dietary habits established early may be carried through adult life.
An adequate folic acid intake has been related to female fertility. The recommended intake of this vitamin was recently increased to 400 ug/day, with an additional 200 ug/day during pregnancy. The Mediterranean Diet includes sources of folate such as pulses, green-leaf vegetables, fruit, cereals, and dried fruits; other foods of interest are liver and blue fish. The objectives were to determine the foods that contribute most to folate intake and analyze the factors that influence their consumption by three generations in a female population (n=898; age, 10-75 yrs) from Southern Spain: 230 adolescents (10-16yrs), 296 healthy pregnant women (19-45yrs), and 372 menopausal women (>45yrs). Participants completed a previously validated semi-quantitative food frequency questionnaire. Over 90% of their folate intake was supplied by cereals, fruit, natural juice, pulses, and cooked and raw vegetables. The mean (SD) daily intake of folate was 288.27(63.64) μg. A higher Mediterranean Diet Score (MDS) was significantly related to a greater folate intake. The daily folate intake was not significantly influenced by educational level, number of children, or place of residence (rural vs. urban). In logistic regression analysis, the factors related to an adequate folate intake (>2/3 of recommendations) were higher age, higher MDS, and lower BMI.
Objective:
To determine differences between children and their parents' perceptions regarding dietary behaviors, physical activity (PA), and screen time.
Study design:
This study included 292 children in the 3rd and 4th grades (mean age 8.48 years) and their parents/guardians. Eighty-eight parent/guardian-child pairs completed a modified version of the Centers for Disease Control and Prevention Youth Risk Behavior Survey that specifically asked parents about their child's health behaviors. A similar version of the survey was also given to their children to answer questions regarding their personal health behaviors. A paired t test was performed to assess the difference in parent-child responses. An independent t test was performed to assess the sex and age difference in nutritional habits, amount of screen time, and PA among children.
Results:
Of 88 parent-child dyads, there was no single dyad that provided the same answers to all the questions. There are differences between children's and parent's perception of average food consumption, amount of screen time, and PA. Fourth graders reported higher number of PA days than did 3rd graders (4.65 vs 5.57, P < .05).
Conclusions:
The discrepancies found between parents and their children concerning food choices, juice and soft drinks, screen time, and PA are all troubling, particularly in a community where obesity risk is high. The findings indicate a continued need for information about parent and child perceptions of diet behaviors and PA.
The international (International Obesity Task Force; IOTF) body mass index (BMI) cut-offs are widely used to assess the prevalence of child overweight, obesity and thinness. Based on data from six countries fitted by the LMS method, they link BMI values at 18 years (16, 17, 18.5, 25 and 30 kg m(-2)) to child centiles, which are averaged across the countries. Unlike other BMI references, e.g. the World Health Organization (WHO) standard, these cut-offs cannot be expressed as centiles (e.g. 85th).
To address this, we averaged the previously unpublished L, M and S curves for the six countries, and used them to derive new cut-offs defined in terms of the centiles at 18 years corresponding to each BMI value. These new cut-offs were compared with the originals, and with the WHO standard and reference, by measuring their prevalence rates based on US and Chinese data.
The new cut-offs were virtually identical to the originals, giving prevalence rates differing by < 0.2% on average. The discrepancies were smaller for overweight and obesity than for thinness. The international and WHO prevalences were systematically different before/after age 5.
Defining the international cut-offs in terms of the underlying LMS curves has several benefits. New cut-offs are easy to derive (e.g. BMI 35 for morbid obesity), and they can be expressed as BMI centiles (e.g. boys obesity = 98.9th centile), allowing them to be compared with other BMI references. For WHO, median BMI is relatively low in early life and high at older ages, probably due to its method of construction.
This paper uses fundamental principles of energy physiology to define minimum cut-off limits for energy intake below which a person of a given sex, age and body weight could not live a normal life-style. These have been derived from whole-body calorimeter and doubly-labelled water measurements in a wide range of healthy adults after due statistical allowance for intra- and interindividual variance. The tabulated cut-off limits, which depend on sample size and duration of measurements, identify minimum plausible levels of energy expenditure expressed as a multiple of basal metabolic rate (BMR). CUT-OFF 1 tests whether reported energy intake measurements can be representative of long-term habitual intake. It is set at 1.35 x BMR for cases where BMR has been measured rather than predicted. CUT-OFF 2 tests whether reported energy intakes are a plausible measure of the food consumed during the actual measurement period, and is always more liberal than CUT-OFF 1 since it has to allow for the known measurement imprecision arising from the high level of day-to-day variability in food intake. The cut-off limits can be used to evaluate energy intake data. Results falling below these limits must be recognized as being incompatible with long-term maintenance of energy balance and therefore with long-term survival.
To develop an index of overall diet quality.
The Healthy Eating Index (HEI) was developed based on a 10-component system of five food groups, four nutrients, and a measure of variety in food intake. Each of the 10 components has a score ranging from 0 to 10, so the total possible index score is 100.
Data from the 1989 and 1990 Continuing Survey of Food Intake by Individuals were used to analyze the HEI for a representative sample of the US population.
Frequencies, correlation coefficients, means.
The mean HEI was 63.9; most people scored neither very high nor very low. No one component of the index dominated the HEI score. People were most likely to do poorly in the fruit, saturated fat, grains, vegetable, and total fat categories. The HEI correlated positively and significantly with most nutrients; as the total HEI increased, intake for a range of nutrients also increased.
The HEI is a useful index of overall diet quality of the consumer. The US Department of Agriculture will use the HEI to monitor changes in dietary intake over time and as the basis of nutrition promotion activities for the population.
This article reviews the published indexes of overall diet quality. Approaches used for measuring overall diet quality include those based on examination of the intake of nutrients, food groups, or a combination of both. A majority of the indexes have been examined in relation to nutrient adequacy only; few have been evaluated for assessment of quality according to current dietary guidelines, namely, a diet relatively low in fat that meets energy and nutrient needs. The indexes of overall diet quality were related to the risk of disease more strongly than individual nutrients or foods.
We assessed associations between sociodemographic and lifestyle factors and dietary quality among adolescents.
Subjects were 445 adolescents (171 boys, 274 girls; 14 to 18 y old) selected from the Palma de Mallorca (Balearic Islands, Spain) school census (96% participation) using two-stage probability sampling. The study protocol included dietary intake by means of a validated semiquantitative food-frequency questionnaire; sociodemographic factors of sex, maternal level of education, parental occupational status, and maternal region of origin; physical activity; and body weight and height measurements. Body mass index was calculated and energy intake expressed as multiples of basal metabolic rate.
Mean daily energy intakes were 12.9 MJ for boys and 12.0 MJ for girls. Boys showed a higher percentage of energy from carbohydrates but a lower percentage from proteins and fat than did girls (44.9 versus 41.6, 18.8 versus 19.8, and 36.3 versus 38.5, respectively). Dietary fiber intake was within the recommended levels. Mineral and vitamin intakes generally met their estimated needs, except for vitamins A and D, which covered less than two-thirds of the recommended intake. Maternal educational level was positively correlated with dietary mineral and vitamin intakes. A positive relation between physical activity and dietary intakes of carbohydrate and of mineral and vitamin was found.
Maternal level of education and physical activity are associated to the quality of diet among adolescents in Palma de Mallorca.
The objective was to investigate relationships between family conflict and the perceived communication of negative messages regarding weight and shape from mothers to daughters, and daughters' disordered eating symptomatology. A correlational study was conducted in which a questionnaire was completed by 315 women aged between 14 and 28 years. The sample comprised both secondary school students (n=196) and university students (n=119). Disordered eating symptomatology was operationalised as drive for thinness, body dissatisfaction, and bulimic symptoms. Family conflict and the perceived frequency of negative messages regarding weight and shape communicated from mothers were also reported by participants. With current BMI treated as a covariate, support was provided for the proposition that frequency of negative messages is a more important contributor to disordered eating symptomatology than family conflict for both secondary school students and university students. However, for secondary students there was no relationship between family conflict and drive for thinness. Recommendations for future research are provided, including the possibility of considering the perception of both positive and negative weight-related messages, and the relative importance of such messages when conveyed by people other than the maternal figure, such as fathers, siblings and peers.
A composite measure of diet has been preferred to an index of a single nutrient or food in the area of dietary assessment. However, the lack of such a tool for cross-national comparisons has restricted the ability to compare diet quality between countries using an overall measure of diet. In this study, we created a tool called the Diet Quality Index-International (DQI-I) for global monitoring and exploration of diet quality across countries. The major categories of the index components are variety, adequacy, moderation and overall balance. Using the tool, this research presents a cross-national comparison of diet quality between China and the United States, incorporating comparable national in-depth diet data. The mean of the DQI-I score was slightly higher in China than in the United States. By major categories of the DQI-I, dietary variety was better achieved in the U.S. diet; moderation and overall balance of intakes were better accomplished in China. The DQI-I was successful in capturing variability in intakes of food and nutrients in both countries. Some distinct patterns of poor quality diet in each country were also identified. As demonstrated in this study, the DQI-I provides an effective means of cross-national comparative work for global understanding of diet quality. Furthermore, the dietary problem areas identified by the DQI-I may be useful in guiding the development of programs to improve public health.
Modifying the healthy eating index to assess diet quality in children and adolescents
- D Feskanich
- H R Rockett
- G A Colditz
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Programa DIAL software for assessing diets and food calculations (for Windows Copyright©
- R M Ortega Anta
- López Sobaler
- A M Carvajales
- Requejo Marcos
- Aparicio Vizuete
- Molinero Casares
Ortega Anta RM, López Sobaler AM, Carvajales PA, Requejo Marcos AM,
Aparicio Vizuete A, Molinero Casares LM, et al. Programa DIAL software for
assessing diets and food calculations (for Windows Copyright© 2015 Alce
Ingeniería). Available from: http://www.alceingenieria.net/nutricion/descarga.
htm
Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording
- R M Ortega Anta
- López Sobaler
- A M Carvajales
- Requejo Marcos
- Aparicio Vizuete
- Molinero Casares
Ortega Anta RM, López Sobaler AM, Carvajales PA, Requejo Marcos AM,
Aparicio Vizuete A, Molinero Casares LM, et al. Programa DIAL software for
assessing diets and food calculations (for Windows Copyright© 2015 Alce
Ingeniería). Available from: http://www.alceingenieria.net/nutricion/descarga.
htm
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