Beliefs and advice‐seeking behaviours for fertility and pregnancy: a cross‐sectional study of a global sample

Background

Pregnancy can motivate individuals to adopt lifestyle behaviours that protect the health of their offspring. The aims of the present study were to explore men's and women's beliefs about lifestyle, fertility and pregnancy, as well as where they seek advice.

Methods

Participants (2185 women and 221 men, six unspecified) from 104 countries completed a questionnaire that explored their beliefs about what was important for a healthy pregnancy and their advice‐seeking behaviours. Recruitment was via a Massive Open Online Course entitled ‘Food as Medicine’, with food, nutrient and health content. Comparisons of categorical data were performed using a chi‐squared test (P = 0.05).

Results

Eating a variety of fruits and vegetables and not smoking (both 93.7%) were the most frequently and equally ranked in the top‐five factors for a healthy pregnancy. Taking prenatal supplements (26.8%) was considered to be less important. Participants in Westernised countries ranked not smoking or drinking alcohol as being significantly more important than those in other countries. Overall, doctors (47.7%) were the most common source of fertility and pregnancy advice. Larger proportions of those aged <40 years used the Internet (<40 years 44.1%, >40 years 18.2% χ² = 152.7, P < 0.01) and social media (<40 years 16.1%, >40 years 3.6%; χ² = 110.18, P < 0.01) for health information.

Conclusions

There is disconnection between beliefs and actions regarding the lifestyle behaviours considered to be important for a healthy pregnancy, particularly nutrition. Pregnancy advice‐seeking has evolved, with younger men and women utilising the Internet and social media. Health professionals must consider new communication strategies to deliver evidence‐based lifestyle advice, particularly for younger men and women and where access to healthcare is limited.

     

Reducing the maternal dietary intake of indigestible and slowly absorbed short‐chain carbohydrates is associated with improved infantile colic: a proof‐of‐concept study

Background

To investigate if a low fermentable oligo‐, di‐ and mono‐saccharides and polyols (FODMAP) diet consumed by breastfeeding mothers may be associated with reduced symptoms of infantile colic.

Methods

Exclusively breastfeeding mothers and their typically‐developing healthy infants who met the Wessel Criteria for infantile colic were recruited from the community, to this single‐blind, open‐label, interventional study. After a 3‐day qualifying period, mothers were provided a low FODMAP 7‐day diet. On days 5, 6 and 7 mothers completed a Baby Day Diary. At baseline and at the end of the 7‐day dietary intervention, breast milk was analysed for FODMAP content and infant faecal samples for pH .

Results

Eighteen breastfeeding mothers (aged 27–40 years) adhered (100%) to the low FODMAP diet. Infants were of gestational age 37–40.3 weeks and aged 2–17 weeks. At entry, crying durations were a mean [95% CI ] of 142 [106–61] min and fell by 52 [178–120] min (P = 0.005; ancova ). Combined crying‐fussing durations fell by 73 [301–223] min (n = 13; P = 0.007), as did crying episodes (P = 0.01) and fussing durations (P = 0.011). Infant sleeping, feeding, or awake‐and‐content durations did not change. Infant faecal pH did not change. Breast milk lactose content was stable and other known FODMAP s were not detected. At end of study, mothers reported their baby ‘is much more content’ and ‘can be put down without crying’.

Conclusions

Maternal low FODMAP diet may be associated with a reduction in infant colic symptoms. A randomized controlled study is warranted to determine if a maternal low FODMAP diet is effective in reducing symptoms.

     

VITAL change for mums: a feasibility study investigating tailored nutrition and exercise care delivered by video‐consultations for women 3–12 months postpartum

Background

A tailored approach to nutrition and physical activity advice can support women following childbirth in managing barriers (i.e. time and childcare) to making healthy lifestyle changes. The aim of the present study was to evaluate the implementation, acceptability and preliminary efficacy of a personally tailored nutrition and exercise programme for postpartum women delivered via video‐consultations by an accredited practising dietitian (APD ) and accredited exercise physiologist (AEP ).

Methods

In this feasibility study (VITAL change for mums), postpartum (3–12 months) women (body mass index ≥25 or >2 kg above pre‐pregnancy weight) who were seeking to achieve a healthy weight participated in a single‐arm intervention. Participants received up to five real‐time personalised video‐consultations (2 × APD , 2 × AEP , 1 × either) over the 8‐week intervention period. Implementation (recruitment, retention, utilisation), acceptability (participant satisfaction) and preliminary efficacy (anthropometry, dietary intake, cardiovascular fitness, physical activity level, psychological wellbeing) were assessed.

Results

Thirty women [mean (SD) age 31.6 (3.1) years, body mass index 29.0 (4.0) kg m^?2, 100% married/de facto , 80% university level education] were recruited within 10 days and 27 completed the study. Women's mean (SD) ratings (out of a score of 5) indicated satisfaction with the video‐consultations [4.4 (0.9)] and the online setting [4.5 (0.8)]. Women agreed that accessing an APD [4.4 (0.8)] and AEP [4.3 (0.9)] was easier using video‐consultations than attending an in‐person consultation. Statistically significant improvements in waist circumference, body composition, cardiorespiratory fitness, dietary intake and physical activity were observed from baseline to 8 weeks.

Conclusions

The findings of the present study suggest that a nutrition and exercise intervention delivered by qualified health professionals via video‐consultations is feasible, acceptable and achieves positive outcomes for women following childbirth.

     

Fifteen years of using a second stage protein substitute for weaning in phenylketonuria: a retrospective study

Background

In phenylketonuria (PKU), during weaning, it is necessary to introduce a second stage phenylalanine (Phe)‐free protein substitute (PS) to help meet non‐Phe protein requirements. Semi‐solid weaning Phe‐free PS have been available for >15 years, although no long‐term studies have reported their efficacy.

Methods

Retrospective data from 31 children with PKU who commenced a weaning PS were collected from clinical records from age of weaning to 2 years, on: gender; birth order; weaning age; anthropometry; blood Phe levels; age commenced and dosage of weaning PS and Phe‐free infant L‐amino acid formula; natural protein intake; and issues with administration of PS or food.

Results

Median commencement age for weaning was 17 weeks (range 12–25 weeks) and, for weaning PS, 20 weeks (range 13–37 weeks). Median natural protein was 4 g day^?1 (range 3–11 g day^?1) and total protein intake was >2 g kg^?1 day^?1 from weaning to 2 years of age. Children started on 2–4 g day^?1 protein equivalent (5–10 g day^?1 of powder) from weaning PS, increasing by 0.2 g kg^?1 day^?1 (2 g day^?1) monthly to 12 months of age. Teething and illness adversely affected the administration of weaning PS and the acceptance of solid foods. Altogether, 32% of children had delayed introduction of more textured foods, associated with birth order (firstborn 80% versus 38%; P = 0.05) and food refusal when teething (80% versus 29%; P = 0.02).

Conclusions

Timing of introduction of solid foods and weaning PS, progression onto more textured foods and consistent feeding routines were important in aiding their acceptance. Any negative behaviour with weaning PS was mainly associated with food refusal, teething and illness. Parental approach influenced the acceptance of weaning PS.

     

Dietary patterns and risk of ulcerative colitis: a case–control study

Background

Recent evidence indicates a role for dietary factors in the pathogenesis of ulcerative colitis (UC ). The aim of the present study was to investigate the relationship between dietary patterns and UC risk.

Methods

Sixty‐two newly diagnosed cases of UC and 124 healthy age and sex‐matched controls were studied. Data on diet was measured using a validated country‐specific food frequency questionnaire. Factor analysis was used to define major dietary patterns based on 28 food groups and nutrient content.

Results

After adjustment for confounding factors, subjects who were in the highest tertile of the healthy dietary pattern had a 79% lower risk of UC (odds ratio = 0.21, 95% confidence interval = 0.07–0.59, P  =  0.003), whereas the consumption of an unhealthy dietary pattern was associated with a significantly increased risk of UC (odds ratio = 3.39, 95% 95% confidence interval = 1.16–9.90, P  =  0.027).

Conclusions

The findings of the present study suggest that dietary patterns are associated with UC risk.

     

The effect of pre‐pregnancy lifestyle counselling on food intakes and association between food intakes and gestational diabetes in high‐risk women: results from a randomised controlled trial

Background

Healthy diets before and during pregnancy have been suggested to reduce the risk of gestational diabetes (GDM ). Several lifestyle intervention studies for pregnant women have reported dietary improvements after counselling. However, evidence concerning the effect of counselling initiated before pregnancy on diets is limited.

Methods

This randomised controlled study explored whether pre‐pregnancy lifestyle counselling influenced food intakes, as well as whether changes in food intakes were associated with GDM . The participants comprised 75 women with prior GDM and/or a body mass index ≥ 30 kg m^–2. Women were randomised into a control or an intervention group, and their food intakes were followed from pre‐pregnancy to early pregnancy using a food frequency questionnaire. The control and intervention groups were combined to assess the association between changes in food intakes and GDM . The diagnosis of GDM was based on a 75‐g oral glucose tolerance test conducted in the first and second trimester of pregnancy.

Results

Pre‐pregnancy lifestyle counselling showed no major overall effect on food intakes. The intake of low‐fat cheese increased significantly in women who did not develop GDM compared to women who did after adjusting for potential confounders (P = 0.028). This association was not observed for regular‐fat cheese.

Conclusions

The findings obtained in the present study suggest that an increased intake of low‐fat but not regular‐fat cheese between pre‐pregnancy and early pregnancy is associated with a lower risk of GDM in high‐risk women.

     

Comparing the effectiveness of a multi‐component weight loss intervention in adults with and without intellectual disabilities

Background

The prevalence of obesity in adults with intellectual disabilities (ID) is rising, although the evidence base for its treatment in this population group is minimal. Weight management interventions that are accessible to adults with ID will reduce the inequalities that they frequently experience in health services. This short report compared the effectiveness of weight management in those with and without ID who completed nine sessions of a multi‐component weight management programme.

Methods

TAKE 5 is a 16‐week multi‐component weight management intervention for adults with ID and obesity [body mass index (BMI) ≥30 kg m^–2]. This intervention is an adaption of the weight management programme provided by the Glasgow & Clyde Weight Management Service (GCWMS) for adults without ID and obesity (National Health Service based). Fifty‐two participants of the TAKE 5 programme were individually matched by baseline characteristics (sex, age and BMI) with two participants without ID of the GCWMS programme. Comparisons in terms of weight and BMI change and rate of weight loss were made for those who attended all nine sessions.

Results

There were no significant differences between the groups in the amount of weight loss (median: ?3.6 versus ?3.8 kg, respectively, P = 0.4), change in BMI (median: ?1.5 versus ?1.4 kg m^–2, P = 0.9), success of achieving 5% weight loss (41.3% versus 36.8%, P = 0.9) and rate of weight loss across the 16‐week intervention.

Conclusions

A multi‐component weight loss intervention can be equally effective for adults with and without ID and obesity.

     

Fermentable short chain carbohydrate (FODMAP) content of common plant‐based foods and processed foods suitable for vegetarian‐ and vegan‐based eating patterns

Background

The low FODMAP (fermentable, oligo‐, di‐, mono‐saccharides and polyols) diet is an effective strategy to improve symptoms of irritable bowel syndrome. However, combining the low FODMAP diet with another dietary restriction such as vegetarianism/veganism is challenging. Greater knowledge about the FODMAP composition of plant‐based foods and food processing practices common to vegetarian/vegan eating patterns would assist in the implementation of the diet in this patient population. The present study aimed to quantify the FODMAP content of plant‐based foods common in vegetarian/vegan diets and to investigate whether food processing can impact FODMAP levels.

Methods

Total FODMAP content was quantified in 35 foods, including fructose‐in‐excess‐of‐glucose, lactose, sorbitol, mannitol, galacto‐oligosaccharide and total fructan, using high‐performance‐liquid‐chromatography and enzymatic assays. The effects of cooking, sprouting, pickling, fermentation, activation and canning on FODMAP content were assessed. The Monash University criteria to classify foods as low FODMAP was used.

Results

Of the 35 foods, 20 were classified as low FODMAP , including canned coconut milk (0.24 g serve^–1), dulse (0.02 serve^–1), nutritional yeast (0.01 serve^–1), soy cheese (0.03 serve^–1), tempeh (0.26 serve^–1), wheat gluten (0.13 serve^–1) and wheat grass (0.05 serve^–1). No FODMAP s were detected in agar‐agar, egg replacer, vegan egg yolk, kelp noodles and spirulina. Food processing techniques that produced the greatest reduction in FODMAP content included pickling and canning.

Conclusions

The present study provides a greater FODMAP composition knowledge of plant‐based foods that can now be applied to the dietetic management of vegetarians/vegans requiring a low FODMAP diet. Food processing lowered the FODMAP content of foods, thereby increasing options for patients following a low FODMAP diet.

     

Efficacy of vitamin D supplementation in combination with conventional antiviral therapy in patients with chronic hepatitis C infection: a meta‐analysis of randomised controlled trials

Background

Although a contributory role of vitamin D levels for the development of chronic hepatitis C has been suggested, the efficacy of vitamin D supplementation in combination with conventional antiviral therapy consisting of pegylated interferon‐α (Peg‐IFN ‐α) injection and oral ribavirin (RBV ) remains unclear. We investigated its efficacy in the treatment of chronic hepatitis C via a meta‐analysis of randomised controlled trials.

Methods

We searched PubMed, EMBASE , the Cochrane Library, ClinicalTrials.gov and the bibliographies of relevant articles to locate additional publications in September 2016. Three evaluators independently reviewed and selected eligible studies based on predetermined selection criteria.

Results

Of 522 articles meeting our initial criteria, a total of seven open‐label, randomised controlled trials involving 548 participants, were included in the final analysis. Vitamin D supplementation in combination with Peg‐IFN ‐α injection and oral RBV significantly increased the rate of viral response for hepatitis C at 24 weeks after treatment in a random‐effects meta‐analysis (relative risk = 1.30; 95% confidence interval = 1.04–1.62; I ² = 75.9%). Also, its significant efficacy was observed in patients with hepatitis C virus genotype 1, which is known to be refractory to antiviral therapy.

Conclusions

In summary, we observed that additional use of vitamin D has a positive effect on sustained viral response rates of patients with chronic hepatitis C infection. However, we cannot establish the efficacy because of substantial heterogeneity, a small sample size and a low methodological quality.

     

Food addiction and associations with mental health symptoms: a systematic review with meta‐analysis

Background

The present study systematically reviewed the literature aiming to determine the relationships between food addiction, as measured by the Yale Food Addiction Scale (YFAS ), and mental health symptoms.

Methods

Nine databases were searched using keywords. Studies were included if they reported: (i) YFAS diagnosis or symptom score and (ii) a mental health outcome, as well as the association between (i) and (ii). In total, 51 studies were included.

Results

Through meta‐analysis, the mean prevalence of food addiction diagnosis was 16.2%, with an average of 3.3 (range 2.85–3.92) food addiction symptoms being reported. Subanalyses revealed that the mean number of food addiction symptoms in populations seeking treatment for weight loss was 3.01 (range 2.65–3.37) and this was higher in groups with disordered eating (mean 5.2 3.6–6.7). Significant positive correlations were found between food addiction and binge eating [mean r  = 0.602 (0.557–0.643), P  < 0.05], depression, anxiety and food addiction [mean r  = 0.459 (0.358–0.550), r  = 0.483 (0.228–0.676), P  < 0.05, respectively].

Conclusions

A significant, positive relationship exists between food addiction and mental health symptoms, although the results of the present study highlight the complexity of this relationship.

     

Identification of factors contributing to successful self‐directed weight loss: a qualitative study

Background

Despite the number of weight management programmes and their wide promotion, most overweight and obese individuals tend to lose weight on their own. The present study aimed to understand the characteristics and strategies of those who successfully engage in self‐directed weight loss, which could empower other overweight and obese individuals with information and strategies to manage their weight on their own.

Methods

Men and women who had lost at least 5% of their body weight without direct interaction with professionals or weight management programmes were recruited. Demographic data were collected by questionnaire and participants' weight‐loss experiences were explored using semi‐ structured interviews to elicit in‐depth individual experiences and perspectives. Iterative thematic method data analysis was used to generate themes describing contributing factors to the success of self‐directed weight loss identified by participants.

Results

Most characteristics of those who successfully self‐managed their weight loss were in line with those reported by successful weight losers participating in professional‐led projects. However, strategies such as early embedding of new lifestyle behaviours into daily routine, the ability to learn from previous weight‐loss experiences, and not requiring social support were identified as distinctive factors that contributed to the success of self‐directed weight loss by participants of the present study.

Conclusions

Overweight or obese individuals with strong internal motivation, problem‐solving skills and self‐reliance are more likely to be successful at achieving self‐directed weight loss. The patients identified with these characteristics could be encouraged to self‐manage their weight‐loss process, leaving the places available in more resource‐intensive professional‐led programmes to those individuals unlikely to succeed on their own.

     

Correlates of toenail selenium and its cross‐sectional association with metabolic syndrome

Background

The present study aimed to identify independent correlates of toenail selenium levels and to examine the association between toenail selenium levels and metabolic syndrome in Korean adults.

Methods

Cross‐sectional analysis was conducted using baseline data from the Trace Element Study of Korean Adults in the Yeungnam area, an ongoing cohort study of Korean adults over the age of 35 years. The baseline survey consisted of questionnaires on demographics, lifestyle characteristics and medical information. Dietary information was obtained through a validated semi‐quantitative food frequency questionnaire. Toenail selenium levels were quantified using neutron activation analysis. Biomarkers associated with metabolic syndrome were obtained from biennial medical check‐ups.

Results

In the multivariable‐adjusted analyses, independent lifestyle and dietary correlates of higher selenium levels were alcohol drinking (4.62% higher than nondrinking) and egg intake (0.43% higher per weekly serving), whereas current smoking (5.42% lower than nonsmoking) and vegetable consumption (0.05% lower per weekly serving) were associated with lower toenail selenium levels. In the multivariable adjusted logistic regression, no significant association was observed between toenail selenium levels and metabolic syndrome (odds ratio = 1.33, 95% confidence interval = 0.58–3.05).

Conclusions

Multiple lifestyle and dietary factors influenced toenail selenium levels, although no meaningful association was observed between toenail selenium levels and metabolic syndrome in Korean adults. Future prospective large‐scale cohort studies are required to determine whether there is a causal relationship between selenium levels and metabolic syndrome in Korean adults.

     

Diet quality and 10‐year healthcare costs by BMI categories in the mid‐age cohort of the Australian Longitudinal Study on Women's Health

Background

Better diets, as evaluated by diet quality indices, are associated with lower rates of morbidity and mortality. Although governments and researchers alike recognise the burden that obesity incurs for increased healthcare spending, there is insufficient evidence for the role of diet quality on healthcare costs.

Methods

Diet quality was assessed by the Australian Recommended Food Score (ARFS ) for 6328 women aged 50–55 years from the Australian Longitudinal Study on Women's Health. The ARFS was ranked by quintile, and 10‐year cumulative data on healthcare costs from Medicare (Australia's Universal healthcare cover) were reported by body mass index category, using generalised linear modelling.

Results

Healthy weight women with the highest diet quality were found to make significantly fewer Medicare claims (P = 0.012) compared to those with the lowest diet quality. In healthy weight and overweight women, the number of healthcare claims and charges was inversely associated with consuming a greater variety of vegetables. For every 1 point increase in the ARFS vegetable component score, healthy weight women made 1.9 fewer healthcare claims and were charged $139 less, whereas overweight women made 2.3 fewer claims and were charged $176 less for healthcare over 10 years.

Conclusions

The results of the present study support the need to prioritise an improved diet quality with the aim of reducing healthcare claims and overall costs in a population‐based sample of Australian females. As the burden of overweight and obesity on the healthcare system increases, strategies to improve diet quality may be of particular importance; however, more research is required to further establish this relationship.

     

Patients' perceptions and experiences of patient‐centred care in dietetic consultations

Background

Patient‐centred care (PCC ) is essential to quality healthcare. However, there is a paucity of research on PCC in dietetics, particularly regarding patients' experiences and perspectives of PCC . We aimed to enhance our understanding of PCC in dietetics by exploring patients' perceptions and experiences of PCC in individual dietetic consultations.

Methods

The present study used qualitative methods, situated in a constructivist–interpretivist paradigm. Maximum variation purposive sampling was used to recruit English speaking adult participants who had participated in ≥1 dietetic consultations for nutrition care. Individual semi‐structured interviews explored participants' perceptions and experiences of PCC in dietetic consultations. Data were analysed thematically.

Results

Eleven patients were interviewed between September and November 2016. Four overarching themes emerged: (i) fostering and maintaining caring relationships; (ii) delivering individualised care; (iii) enabling patient involvement; and (iv) taking control of one's own health.

Conclusions

PCC is important to patients. Thus, there is opportunity for dietitians to enhance the care they provide by adopting patient‐centred practices. As the first study of its kind, these findings can inform future dietetic practice, education and research by contributing patients' perspectives of PCC . By understanding patients' unique needs and preferences, dietitians can better align their practice with a patient‐centred approach. Furthermore, these findings are useful for informing future dietetic research and education.

     

The nutrition impact symptoms (NIS) score detects malnutrition risk in patients admitted to nephrology wards

Background

Nutritional screening tools recommended for the general hospitalised population do not always adequately detect malnutrition risk in patients with kidney disease. The present study assessed the validity and reliability of the Nutrition Impact Symptoms (NIS ) score as a nutrition screening tool for hospitalised inpatients prefer in nephrology wards.

Methods

Nutritional status was classified using Subjective Global Assessment (SGA ). NIS scores were calculated from the total score of responses to questions assessing symptoms impacting upon nutritional status from the patient‐generated SGA . Concurrent validity of NIS score was assessed using a receiver operating characteristic curve to predict malnutrition risk against SGA . Predictive validity was examined against length of hospital stay (LOS ) and 30‐day re‐admission using Poisson and logistic regression, respectively. Inter‐rater reliability of NIS scoring between assessors was determined using intraclass correlation.

Results

In 143 patients [90 males; mean (SD ) age 57.8 (15.8) years], malnutrition prevalence was 38% (54/143) using SGA (rating B/C). Predicting malnutrition risk with an NIS score of ≥3 had a sensitivity of 0.89 and a specificity of 0.65 (area under the curve = 0.81 [95% confidence interval (CI ) = 0.74–0.88]). For each 1‐point increase in NIS score, the model predicted a 1.9% rise in the risk of an increased LOS (P = 0.002). Thirty‐day re‐admission was not associated with NIS score. Inter‐rater reliability was moderate (mean difference = 0.53; intraclass correlation coefficient = 0.74; 95% CI = 0.57–0.85).

Conclusions

Nutrition impact symptoms score is a valid stand‐alone nutrition screening tool for identifying malnutrition risk in nephrology inpatients and is associated with LOS.

     

Reduced 30‐day gastrostomy placement mortality following the introduction of a multidisciplinary nutrition support team: a cohort study

Background

Percutaneous endoscopic gastrostomy feeding allows patients with dysphagia to receive adequate nutritional support, although gastrostomy insertion is associated with mortality. A nutrition support team (NST ) may improve a gastrostomy service. The present study aimed to evaluate the introduction of a NST for assessment and follow‐up of patients referred for gastrostomy.

Methods

We included adult inpatients referred for gastrostomy insertion consecutively between 1 October 2010 and 31 March 2013. During the first 6 months, a multidisciplinary NST assessment service was implemented. Patient characteristics, clinical condition, referral appropriateness and follow‐up were documented prospectively. We compared the frequencies of appropriate referrals, 30‐day mortality and mental capacity/consent assessment time spent between the 6 months implementation phase and 2 years following establishment of the assessment service (‘established phase’).

Results

In total, 309 patients were referred for gastrostomy insertion and 199 (64%) gastrostomies placed. The percentage of appropriate referrals rose from 72% (61/85) during the implementation phase to 87% (194/224) during the established phase (P  = 0.002). Thirty‐day mortality reduced from 10% (5/52) to 2% (3/147) (P  = 0.01), whereas time allocated to assessment of mental capacity and attainment of informed consent rose from mean 3 days (limits of normal variation 0–7) to mean 6 (0–13) days.

Conclusions

The introduction of a NST to assess and select patients referred for gastrostomy placement was associated with a rise in the frequency of appropriate referrals and a decrease in 30‐day mortality following gastrostomy insertion. Concomitantly, time spent on patient assessment and attainment of informed consent increased.

     

Is frequency of family meals associated with fruit and vegetable intake among preschoolers? A logistic regression analysis

Background

The present study aimed to examine the associations between frequency of family meals and low fruit and vegetable intake in preschool children. Promoting healthy nutrition early in life is recommended for combating childhood obesity. Frequency of family meals is associated with fruit and vegetable intake in school‐age children and adolescents; the relationship in young children is less clear.

Methods

We completed a secondary analysis using data from the Early Childhood Longitudinal Study‐Birth Cohort. Participants included children, born in the year 2001, to mothers who were >15 years old (n = 8 950). Data were extracted from structured parent interviews during the year prior to kindergarten. We used hierarchical logistic regression to describe the relationships between frequency of family meals and low fruit and vegetable intake.

Results

Frequency of family meals was associated with low fruit and vegetable intake. The odds of low fruit and vegetable intake were greater for preschoolers who shared less than three evening family meals per week (odds ratio = 1.5, β = 0.376, P < 0.001) than preschoolers who shared the evening meal with family every night.

Conclusions

Fruit and vegetable intake is related to frequency of family meals in preschool‐age children. Educating parents about the potential benefits of frequent shared meals may lead to a higher fruit and vegetable consumption among preschoolers. Future studies should address other factors that likely contribute to eating patterns during the preschool years.

     

Theory‐informed nutrition education curriculum Tools For Feeling Good promotes healthy eating patterns among fifth grade pupils: cross‐sectional study

Background

The eating patterns of school‐aged children rarely meet recommendations: meal frequency is irregular and the consumption of vegetables is lower and sugar‐sweetened products higher than recommended. Although school is an excellent arena for nutrition education to support pupils eating patterns, teachers usually lack efficient tools. The present study aimed to develop a curriculum for nutrition education to be used by teachers and to examine its efficacy in the school environment with respect to the eating patterns of pupils.

Methods

The curriculum was developed in collaboration with school teachers using self‐determination theory as a theoretical standpoint. The Health at Every Size concept and sensory‐based food education were utilised in the curriculum. Self‐reported questionnaires were used to assess the feasibility and impact of the curriculum. Fourteen teachers implemented the curriculum during 2012–2013 with 194 pupils aged 10–13 years (fifth and sixth grades). The control schools included 140 pupils of the same age not following the curriculum.

Results

The teachers reported that the curriculum was easy to integrate in the school environment. The fifth graders improved their breakfast frequency, increased their consumption of vegetables and reduced their consumption of ice cream, sweets and sugar‐sweetened drinks. No improvement was found in the fifth graders at the control schools. In the sixth graders, no dietary changes were detected in the intervention or control schools.

Conclusions

The pupils in the fifth grade appeared to comprise a responsive target group for nutrition education at schools. The curriculum offers a promising approach for developing healthy eating patterns among fifth graders. Collaboration with teachers in developing the curriculum likely enhanced its feasibility and teacher commitment for implementation.

     

Significant differences in maternal child‐feeding style between ethnic groups in the UK: the role of deprivation and parenting styles

Background

Nonresponsive maternal child‐feeding interactions, such as restricting, pressurising and emotional feeding, can affect the ability of a child to self‐regulate intake and increase the risk of becoming overweight. However, despite findings that South Asian and Black children living in the UK are more likely to be overweight, UK research has not considered how maternal child‐feeding style might differ between ethnic groups. The present study aimed to explore variations in maternal child‐feeding style between ethnic groups in the UK , taking into account associated factors such as deprivation and parenting style.

Methods

Six hundred and fifty‐nine UK mothers with a child who was aged 5–11 years old completed a questionnaire. Items included ethnicity and demographic data, as well as copies of the Child Feeding Questionnaire, Parental Feeding Styles Questionnaire and Parenting Styles and Dimensions Questionnaire.

Results

Significant differences in perceived responsibility (P = 0.002), restriction (P = 0.026), pressure to eat (P = 0.045), instrumental feeding (P = 0.000) and emotional feeding (P = 0.000) were found between the groups. Mothers from South Asian backgrounds reported higher levels of pressure to eat, emotional feeding and indulgent feeding styles, whereas mothers from Chinese backgrounds reported greater perceived responsibility and restriction. Mothers from Black and White British backgrounds were not significantly higher with respect to any behaviour. Maternal child‐feeding style was also associated with deprivation and parenting style, although these did not fully explain the data.

Conclusions

Understanding cultural factors behind maternal child‐feeding style, particularly around pressurising and indulgent feeding behaviours, may play an important part in reducing levels of children who are overweight and obese in the UK .