Sweetened Food Purchases and Indulgent Feeding Are Associated With Increased Toddler Anthropometry

ObjectiveTo explore the role of feeding practices and food purchases in toddler dietary intake and anthropometry.MethodsA convenience sample of Latino mother and toddler pairs were interviewed at baseline and at 6-month follow-up. Data on feeding practices, toddler dietary intake, anthropometry, and food purchases were collected using the Toddler-Feeding Questionnaire; 24-hour recalls; measurements of weight, height, and/or length; and food purchase receipts.ResultsIndulgent feeding scores and high intake of sweetened beverage were associated with a 0.52 increase (P = .03) and 0.46 increase in toddler weight-for-height z-score (P = .05), respectively. Households with 10 percentage points of more sweetened food and beverage expenditures were associated with increases in weight indicator z-scores.Conclusions and ImplicationsIndulgent feeding, high intake, and purchase of sweetened beverage are associated with weight gain in Latino toddlers. Programs should target food purchasing decisions and provide concrete guidance for the division of responsibility around feeding.     

Child Feeding Style and Dietary Outcomes in a Cohort of Latino Farmworker Families

Background

The high level of obesity in Latino children, especially in farmworker families, may be partly attributed to feeding styles of parents. Feeding styles used in Latino farmworker families have not been well characterized.

Toddler-feeding practices among Mexican American mothers. A qualitative study

Little is known about toddler feeding practices, particularly among Mexican American mothers. A convenience sample of 18 Mexican-American mothers with toddlers participated in individual in-depth interviews. In determining what to feed her child, mothers tended to cater to the child's preferences rather than exposing the child to different foods or repeating attempts to feed previously unaccepted foods. In deciding when to feed food or beverage, more than half said the child's cue was primary. Findings indicate that an indulgent feeding style may dominate compared to other styles in the toddler developmental stage in Mexican-American mothers.     

Moderating Effects of Parental Feeding Practices and Emotional Eating on Dietary Intake among Overweight African American Adolescents

This study examined the effects of parental feeding practices and adolescent emotional eating (EE) on dietary outcomes among overweight African American adolescents. Based on Family Systems Theory, it was hypothesized that parental feeding practices, such as parental monitoring and responsibility, would buffer the effects of EE on poor dietary quality, whereas practices such as concern about a child’s weight, restriction, and pressure-to-eat would exacerbate this relationship. Adolescents (N = 127; Mage = 12.83 ± 1.74; MBMI% = 96.61 ± 4.14) provided baseline data from the Families Improving Together (FIT) for Weight Loss trial and an ancillary study. Dietary outcomes (fruit and vegetables (F&Vs), energy intake, sweetened beverage, total fat, and saturated fat) were assessed using random 24-h dietary recalls. Validated surveys were used to assess adolescent-reported EE and parental feeding practices. Results demonstrated a significant interaction between EE and parental monitoring (adjusted analyses; B = 0.524, SE = 0.176, p = 0.004), restriction (B = −0.331, SE = 0.162, p = 0.043), and concern (B = −0.602, SE = 0.171, p = 0.001) on F&V intake; under high monitoring, low restriction, and low concern, EE was positively associated with F&V intake. There were no significant effects for the other dietary outcomes. These findings indicate that parental feeding practices and EE may be important factors to consider for dietary interventions, specifically for F&V intake, among overweight African American adolescents.     

Conceptual and Measurement Issues in Early Parenting Practices Research: An Epidemiologic Perspective

Early parenting practices are significant to public health because of their linkages to child health outcomes. This paper focuses on the current state of the science regarding conceptual frameworks that incorporate early parenting practices in epidemiologic research and evidence supporting reliability and validity of self-report measures of such practices. Guided by a provisional definition of early parenting practices, literature searches were conducted using PubMed and Sociological Abstracts. Twenty-five published studies that included parent-report measures of early parenting practices met inclusion criteria. Findings on conceptual frameworks were analyzed qualitatively, whereas evidence of reliability and validity were organized into four domains (safety, feeding and oral health, development promotion, and discipline) and summarized in tabular form. Quantitative estimates of measures of reliability and validity were extracted, where available. We found two frameworks incorporating early parenting: one a program theory and the other a predictive model. We found no reported evidence of the reliability or validity of parent-report measures of safety or feeding and oral health practices. Evidence for reliability and validity were reported with greater frequency for development promotion and discipline practices, but report of the most pertinent type of reliability estimation, test–retest reliability, was rare. Failure to examine associations of early parenting practices with any child outcomes within most studies resulted in missed opportunities to indirectly estimate validity of parenting practice measures. Stronger evidence concerning specific measurement properties of early parenting practices is important to advancing maternal-child research, surveillance, and practice.     

Developing a measure of behavior change in a program to help low-income parents prevent unhealthful weight gain in children

ObjectiveTo develop and test a brief measure of changes in eating, active play, and parenting practices after an intervention to help parents shape children’s choices and home environments.DesignSequential phases of development and testing: expert panel review, cognitive testing interviews, field testing, test-retest study, and assessment of convergence with detailed previously validated instruments.Setting and ParticipantsExpanded Food and Nutrition Education Program (EFNEP), New York State. Low-income parents of 3- to 11-year-old children; Cooperative Extension nutrition and parenting educators.Main Outcome MeasuresQuestionnaire reliability, validity, respondent comprehension, and feasibility of use in program contexts.AnalysisQualitative analysis of item comprehension. Correlational analysis of test-retest reliability and convergent validity.ResultsA behavior checklist was developed to assess change in parent-reported family eating, physical activity, and parenting practices addressed by an intervention. The checklist was feasible for use in EFNEP and questions were understood as intended. Test-retest reliability was good (r = 0.83) and scores correlated significantly (range, 0.25 to –0.60; P < .05) with detailed measures of dietary habits, parental modeling, physical activity, and home environment.Conclusions and ImplicationsDevelopment and testing in a program context produced a tool community nutritionists can use to evaluate educational interventions aimed at helping parents promote healthful eating and activity.     

Development and validation of the Infant Feeding Style Questionnaire

This study describes and validates the Infant Feeding Style Questionnaire (IFSQ), a self-report instrument designed to measure feeding beliefs and behaviors among mothers of infants and young children. Categorical confirmatory factor analysis was used to estimate latent factors for five feeding styles, laissez-faire, restrictive, pressuring, responsive and indulgent, and to validate that items hypothesized a priori as measures of each style yielded well-fitting models. Models were tested and iteratively modified to determine the best fitting model for each of 13 feeding style sub-constructs, using a sample of 154 low-income African-American mothers of infants aged 3–20 months in North Carolina. With minor changes, models were confirmed in an independent sample of 150 African-American first-time mothers, yielding a final instrument with 39 questions on maternal beliefs, 24 questions on behaviors and an additional 20 behavioral items pertaining to solid feeding for infants over 6 months of age. Internal reliability measures for the sub-constructs ranged from 0.75 to 0.95. Several sub-constructs, responsive to satiety cues, pressuring with cereal, indulgent pampering and indulgent soothing, were inversely related to infant weight-for-length z-score, providing initial support for the validity of this instrument for assessing maternal feeding beliefs and behaviors that may influence infant weight outcomes.     

Development and Evaluation of a Brief Questionnaire to Assess Dietary Fat Quality in Low-income Overweight Women in the Southern United States

ObjectiveTo develop a brief questionnaire to assess dietary fat quality, the Dietary Fat Quality Assessment (DFQA), for use in dietary counseling to reduce heart disease risk.MethodsA subsample of 120 underserved, midlife women enrolled in a randomized, controlled weight loss trial completed baseline and follow-up telephone surveys. Main outcome measures included dietary fat components (total fat, saturated fat, polyunsaturated fat, monounsaturated fat, omega-3 fatty acids, and cholesterol).ResultsAssessments of major dietary fat components using the DFQA and a food frequency questionnaire were significantly correlated, with correlation coefficients of 0.54–0.66 (P < .001). Intra-class correlation coefficients to assess reliability ranged from 0.48 to 0.59 for each of the fat components studied.Conclusions and ImplicationsThe DFQA provides a reasonable assessment of dietary fat quality associated with coronary heart disease risk and may prove useful as a brief assessment tool to guide dietary counseling given to reduce heart disease risk.     

Evaluating Latino WIC Mothers’ Perceptions of Infant’s Healthy Growth: A Formative Assessment

Objectives This article reports on a formative assessment with Latino mothers in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) evaluating knowledge, attitudes and behaviors regarding healthy growth for infants and their understanding of infant growth monitoring. Further, we explored the acceptability and feasibility of mothers’ monitoring their infants’ growth. This assessment includes healthy growth perceptions from mothers, caregivers and from WIC staff. Methods Utilizing a mixed method approach, this assessment included qualitative focus groups with WIC mothers that included a growth chart plotting exercise and a quantitative survey. In-depth interviews with clinic staff discussing protocols used in assessing children’s growth were also conducted in one WIC clinic. Results Focus group participants included 34 mothers and 19 caregivers with a mean age of 32 years; 90 % identified as Latino. Themes included concern for underweight status, and reports of limited conversations between mothers and healthcare providers regarding overweight status, and infant feeding practices/beliefs that may contribute to feeding behaviors associated with risk for excess weight gain during infancy. Growth charts were well received, mothers were able to plot with modest accuracy; but effectiveness of growth plotting might be limited without refinement for health literacy and the provision of culturally-sensitive education in relation to feeding behaviors to support healthy infant growth. Conclusions This represents a first effort in evaluating Latino mothers’ perceptions of infants’ healthy growth and use growth charts as a potential tool that can help prevent excess weight gain in early infancy.     

Indulgent Feeding Style Moderates the Association of Food Responsiveness to Body Mass Index Z-scores of Preschoolers

ObjectiveTo investigate the moderating role of caregiver feeding styles in the association between preschool children's food-approaching eating behaviors and body mass index (BMI) z-scores.MethodsThis cross-sectional study examined 81 caregiver-preschooler dyads from low-income neighborhoods in Santiago, Chile. Moderated multiple linear regression analyses were used to determine the moderating effect of the indulgent feeding style in the relation between eating behaviors and BMI z-scores of preschool children.ResultsThe indulgent caregiver feeding style moderated the association between food responsiveness and BMI z-scores of preschoolers. In an indulgent feeding style, food responsiveness was associated with higher child BMI z-scores (β = 0.50; P < 0.001). There was no interaction between enjoyment of food and feeding styles in relation to children's BMI z-scores (β = 0.17; P = 0.58).Conclusions and ImplicationsAn indulgent feeding style can be a risk factor for unhealthy weight outcomes in food responsive preschoolers, but not in those who enjoy food. Educating indulgent parents in the feeding context, and prioritizing children with food-approaching behaviors who are sensitive to external food cues may be effective for approaching childhood obesity.     

Development and evaluation of the nutrition component of the Rapid Eating and Activity Assessment for Patients (REAP): a new tool for primary care providers

OBJECTIVES: 1. To describe the development of a dietary assessment tool (Rapid Eating and Activity Assessment for Patients [REAP]) that quickly assesses a patient's diet and physical activity and facilitates brief counselling by a primary care provider, and 2. To describe the evaluation of the REAP in terms of its reliability, validity, and ease of use by primary care providers. DESIGN, SETTING AND PARTICIPANTS: The evaluation of REAP included: 1) an implementation feasibility study conducted with 61 medical students and practicing physicians in practice settings at various medical schools; 2) a calibration study with 44 Brown University Medical School students; 3) cognitive assessment testing with 31 consumers in Rhode Island; and 4) a reliability and calibration study of the revised tool with 94 consumers in Rhode Island and Massachusetts. RESULTS: The feasibility study revealed moderately high rankings on usefulness, ease, practicality, and helpfulness. The calibration studies demonstrated that REAP has excellent test-retest reliability (r = 0.86, P < .0001), is correlated with the Healthy Eating Index score (r = 0.49, P = .0007), and is significantly associated with intake of most nutrients studied. CONCLUSIONS AND IMPLICATIONS: REAP has adequate reliability and validity to be used in primary care practices for nutrition assessment and counselling, and is also user-friendly for providers.     

A Review of Methods to Assess Parental Feeding Practices and Preschool Children's Eating Behavior: The Need for Further Development of Tools

We reviewed tools developed to measure parental feeding practices and eating behavior and food intake or preferences of children aged 0 to 5 years. Two electronic literature databases (Medline and Psycinfo) were used to search for both observational and experimental studies in human beings. The articles selected for review were those presenting tools with data on internal consistency and/or test–retest reliability and/or construct validity. A total of 3,445 articles were retrieved, and further searching of reference lists and contact with experts produced an additional 18 articles. We identified three tools on the qualitative dimension of children's eating behavior, two tools on food intake or preferences, and one tool on parental feeding practices with rigorous testing of internal consistency, construct validity, and test–retest reliability. All other tools presented in this review need further evaluation of their validity or reliability. Because major gaps exist, we highlight the need for more tools on parental attention to children's hunger and satiety cues, and the need to evaluate the degree of control allowed to children younger than age 2 years in feeding events. Food avoidance (ie, behaviors or strategies to take away and to reject food) and food approach (ie, attractiveness for food stimuli) have not been assessed in children aged 12 to 24 months. Food preference tests based on sensory aspects rather than nutritional quality may be worth investigating. We identified a need for further evaluation of quality, especially test–retest reliability and construct validity, for most tools developed for use in studying children aged 0 to 5 years.     

Revisiting a neglected construct: parenting styles in a child-feeding context

The extent to which general parenting represents feeding styles in ethnically diverse populations is not well documented. Existing measures of child feeding have focused almost exclusively on specific behaviors of European-American parents. A valid and reliable instrument was developed to identify feeding styles in parents of low-income minority preschoolers. Two hundred thirty-one parents (130 Hispanic; 101 African-American) completed questionnaires on feeding practices and parenting styles. Based on self-reported feeding behavior, parents were assigned to four feeding styles (authoritarian, n=84; authoritative, n=34; indulgent, n=80; and uninvolved, n=33). Convergent validity was evaluated by relating feeding styles to independent measures of general parenting and authoritarian feeding practices. Authoritarian feeding styles were associated with higher levels of general parental control and authoritarian feeding practices. Alternatively, authoritative feeding styles were associated with higher levels of general parental responsiveness. Among the two permissive feeding styles, Hispanic parents were more likely to be indulgent, whereas African-American parents were more likely to be uninvolved. Further, differences were found among the feeding styles on an independent measure of child's body mass index.     

Reliability and Validity of the SmartDiet Canadian Version Questionnaire

Measuring the outcomes of nutrition interventions in health promotion settings can be a challenge. Nutrition screening tools are often used to measure dietary patterns and nutrition intervention outcomes, but these tools may lack quantitative scoring methods. Using the SmartDiet questionnaire from Oslo, Norway, as a model, the SmartDiet Canadian Version questionnaire was developed to assess fiber and fat intake. The purpose of this study was to assess the reliability and validity of this new questionnaire. In 2007, 54 volunteer subjects (63% men, mean age 68.3±9.7 years) were recruited from the Cardiac Rehabilitation Program at Vancouver General Hospital, Vancouver, BC, Canada. Test-retest reliability was assessed by having subjects complete the questionnaire at recruitment and 1 month later. Intraclass correlation coefficients of reliability (ICC) for both fiber and fat intake were calculated. For fiber scores the ICC was 0.66 (95% confidence interval 0.48, 0.79) and for fat scores the intraclass correlation coefficient was 0.74 (95% confidence interval 0.59, 0.84). Validity was assessed by correlating the completed questionnaire at recruitment with a 3-day food diary. The daily fat and fiber scores from the questionnaire were correlated with the corresponding average daily fat and fiber scores from the 3-day food diary by means of the Spearman correlation coefficient. For fiber scores, Spearman rho was 0.53 (P<0.001), and for fat scores it was 0.48 (P<0.001). The SmartDiet Canadian Version questionnaire is a reliable and valid tool for assessing the daily fiber and fat intake of cardiac rehabilitation clients.     

Feasibility of a Multidisciplinary and Culturally Adapted Pediatric Weight Management Program for Latino Families: Results From the Vidas Activas y Familias Saludables Pilot Study

ObjectiveTo determine the feasibility of a pediatric weight management program for low-income Latino families.MethodsA pretest-posttest pilot study was conducted among 60 Latino children, aged 4–9, who were overweight/obese (body mass index-for-age ≥85th percentile). The 10-week group-based community program addressed diet, exercise, and behavior modification. Demand was assessed through recruitment and attendance, acceptability using postintervention surveys with participants, and limited efficacy testing of participant anthropometrics and cardiometabolic markers.ResultsOverall 65% of families were retained for follow-up. All families reported feeling more confident in making healthier food choices and would participate in the program again. Pre/post intervention testing found statistically significant decreases (P < .05) in body mass index for age z score, waist circumference, and % body fat.Conclusions and ImplicationsThis culturally adapted group intervention for Latino families was acceptable and shows promise for improved health status, although it needs to be replicated with a larger group and longer follow-up.     

Obesogenic Dietary Practices of Latino and Asian Subgroups of Children in California: An Analysis of the California Health Interview Survey, 2007–2012

Objectives. We examined obesogenic dietary practices among Latino and Asian subgroups of children living in California.Methods. We analyzed 2007, 2009, and 2011–2012 California Health Interview Survey data to examine the differences in dietary practices among Mexican and non-Mexican Latino children and 7 ethnic subgroups of Asian children. We used multivariable regression to examine the sociodemographic factors associated with specific dietary practices.Results. Latino subgroups of children had few differences in obesogenic dietary practices, whereas Asian subgroups of children exhibited significant differences in several obesogenic dietary practices. Korean and Filipino children were more likely than Chinese children to consume fast food and have low vegetable intake. Filipino children, followed by Japanese children, had the most obesogenic dietary practices compared with Chinese children, who along with South Asian children appeared to have the least obesogenic dietary practices. In general, income, education, and acculturation did not explain the dietary differences among Asian groups.Conclusions. Our findings suggest the need to disaggregate dietary profiles of Asian and Latino children and to consider nontraditional sociodemographic factors for messaging and counseling on healthy dietary practices among Asian populations.Dietary practices among pediatric racial and ethnic minority groups highlight possible contributions to the nation’s significant obesity disparities. High consumption of sugar- sweetened beverages (SSBs) and fast food and low consumption of fruits and vegetables have been found among Latino and African American children compared with White children.1–4 These dietary differences have been associated with environmental factors such as access to fresh foods and social factors such as family income, education level, and acculturation. Many of these factors have been understudied among Asian children. This gap in the literature is problematic given the emerging evidence that Asian children have notable differences in dietary practices compared with White children and that Asian Americans with the same body mass index (BMI; defined as weight in kilograms divided by the square of height in meters) are at a higher risk for cardiovascular diseases and type 2 diabetes than non-Hispanic Whites.5–8 Furthermore, children of various Asian and Latino ethnic groups with distinct historical, migration, and social contexts are generally grouped together in research analyses, making it difficult to understand the ethnicity-specific salient roles that education, income, and acculturation may play in specific dietary practices.9,10Acculturation has been described as both a protective factor and a risk factor for healthy dietary practices among immigrants. For example, acculturation among Latinos has been associated with higher consumption of fruits and vegetables but also with higher rates of fast food and sugary food consumption in both pediatric and adult Latino populations.11–13 Less is known about the role of acculturation in dietary practices among Asian and Latino ethnic subgroups.5,6,14,15 We examined dietary practices within ethnic subgroups of Latino and Asian children and the associated role of sociodemographic factors. On the basis of the thin literature that has examined dietary practices among Latino subgroups of children, we hypothesized that children of Mexican descent would have healthy dietary practices compared with other Latino groups and that Asian ethnic groups of children would show a wide variety of dietary practices. In addition, we hypothesized that acculturation, after controlling for education and income, would have an independent effect on dietary practices for all ethnic groups of children.     

Parent use of food to soothe infant/toddler distress and child weight status. An exploratory study

The aim of the present study was to explore the parent feeding practice of using food to soothe infant/toddler distress and its relationship to child weight status. Seventy eight families with infants and toddlers (43 males) ranging in age from 3 to 34 months (M = 14 mos, SD = 9 mos) completed a survey which included questions on their use of food to soothe, questionnaires on parent feeding practices, parenting self-efficacy, child temperament and child's weight and length at the time of their last well-baby visit. Results revealed the use of food to soothe to be a valid construct. In addition, mothers who used food to soothe rated themselves lower in parenting self-efficacy and their children higher in temperamental negativity. Analyses examining weight status as the outcome variable revealed that mothers who reported the use of food to soothe had heavier children, however, this relationship was stronger for children rated as high in temperamental negativity.     

Influence of social context on eating, physical activity, and sedentary behaviors of Latina mothers and their preschool-age children

As more U.S. children grow up in Latino families, understanding how social class, culture, and environment influence feeding practices is key to preventing obesity. The authors conducted six focus groups and 20 in-depth interviews among immigrant, low-income Latina mothers in the Northeast United States and classified 17 emergent themes from content analysis according to ecologic frameworks for behavior change. Respondents related environmental influences to child feeding, diet, and activity, namely, supermarket proximity, food cost, access to recreational facilities, neighborhood safety, and weather. Television watching was seen as integral to family life, including watching during meals and using TV as babysitter and tool to learn English. Participation in the WIC program helped families address food insecurity, and child care provided healthy eating and physical activity opportunities. Health promotion efforts addressing obesity trends in Latino children must account for organizational and environmental influences on the day-to-day social context of young immigrant families.     

A Responsive Feeding Questionnaire Based on Self-Determination Theory for Caregivers of Chinese Toddlers

ObjectiveTo develop and test the psychometric properties of a responsive feeding questionnaire (RFQ) on the basis of Self-Determination Theory for caregivers of toddlers aged 12–24 months in China.DesignItem generation, preliminary evaluation items, refinement questionnaire, and psychometric properties testing.SettingToddlers’ caregivers from Shandong Province, China, were surveyed online between June 2021 and February 2022 (n = 616).Main Outcome MeasureContent, face, and construct validity and reliability of the RFQ.AnalysisContent validity was performed on the basis of expert panel feedback and cognitive interviews among caregivers. Construct validity was evaluated using principal component analysis with varimax rotation. Test-retest reliability was conducted with a sample of 105 caregivers.ResultsOver 3 phases of testing, a new instrument was developed to measure responsive feeding in toddler caregivers. The instrument was reliable, with an internal consistency of 0.87 and an intraclass correlation of 0.92. The principal component analysis identified a 3-factor solution (autonomy support, positive involvement, appropriate response) aligning with a theoretical framework from Self-Determination Theory. The final version of the instrument included 23 items.Conclusions and ImplicationsThe 23-item RFQ has been validated in a Chinese population. Future research needs to validate this instrument in other countries and with children of different ages.