Associations between predictors of children's dietary intake and socioeconomic position: a systematic review of the literature

Socioeconomically disadvantaged children are at higher risk of consuming poor diets, in particular less fruits and vegetables and more non‐core foods and sweetened beverages. Currently the drivers of socioeconomically related differences in children's dietary intake are not well understood. This systematic review explored whether dietary predictors vary for children of different socioeconomic circumstances. Seven databases and reference lists of included material were searched for studies investigating predictors of 9–13‐year‐old children's diet in relation to socioeconomic position. Individual‐ and population‐based cross‐sectional, cohort and epidemiological studies published in English and conducted in developed countries were included. Twenty‐eight studies were included in this review; most were conducted in Europe (n = 12) or North America (n = 10). The most frequently used indicators of socioeconomic position were parent education and occupation. Predictors of children's dietary intake varied among children of different socioeconomic circumstances. Socioeconomic position was consistently associated with children's nutrition knowledge, parent modelling, home food availability and accessibility. Indeterminate associations with socioeconomic position were observed for parent feeding practices and food environment near school. Differences in the determinants of eating between socioeconomic groups provide a better understanding of the drivers of socioeconomic disparities in dietary intake, and how to develop targeted intervention strategies.     

Complementary feeding and non communicable diseases: Current knowledge and future research needs

Early diet and nutrition may set in place growth patterns and/or metabolic pathways that promote risk factors for later NCDs. Most relevant studies so far available have a cross-sectional or retrospective design and are thus of limited validity for evaluating the impact of early feeding on later disease. Standardised protocols for prospective research should be developed. The contribution of protein intake in early life to later NCD development has been the object of several studies; however future research should specifically target the effects of early protein intake on (a) how protein intake influences body composition, (b) how different body composition in infancy contributes to later NCDs, (c) whether there is an age ‘window’ when high protein intake is particularly associated with later overweight and obesity, (d) what levels of protein intake may protect against later overweight/obesity, (e) what level of cow milk intake in the first years of life minimises risk-inducing growth whilst meeting recommended calcium intakes. The role of the quality of fat and carbohydrate intakes at early ages should be better investigated. There is a dearth of data from many communities about the foods introduced as complementary feeds, the ages at which they are introduced and why mothers use these foods. Definitely more information is needed on how and to what extent mothers' behaviour is influenced by media, advertising and other commercial pressures and why formula fed infants are started on other foods much earlier than breast fed infants. Standardized protocols are needed to develop more data on complementary feeding in different regions, different countries and different socio-economic environments.     

Influence of food companies' brand mascots and entertainment companies' cartoon media characters on children's diet and health: a systematic review and research needs

Reducing the extent and persuasive power of marketing unhealthy foods to children worldwide are important obesity prevention goals. Research is limited to understand how brand mascots and cartoon media characters influence children's diet. We conducted a systematic review of five electronic databases (2000–2014) to identify experimental studies that measured how food companies' mascots and entertainment companies' media characters influence up to 12 diet‐related cognitive, behavioural and health outcomes for children under 12 years. Eleven studies met the inclusion criteria. Studies used 21 unique popular media characters, but no brand mascots. Results suggest that cartoon media character branding can positively increase children's fruit or vegetable intake compared with no character branding. However, familiar media character branding is a more powerful influence on children's food preferences, choices and intake, especially for energy‐dense and nutrient‐poor foods (e.g. cookies, candy or chocolate) compared with fruits or vegetables. Future research should use a theoretically grounded conceptual model and larger and more diverse samples across settings to produce stronger findings for mediating and moderating factors. Future research can be used to inform the deliberations of policymakers, practitioners and advocates regarding how media character marketing should be used to support healthy food environments for children.     

Good for the heart,good for the Earth: proposal of a dietary pattern able to optimize cardiovascular disease prevention and mitigate climate change

Background and aimsHuman and planetary health are inextricably interconnected through food systems. Food choices account for 50% of all deaths for cardiovascular diseases (CVD) – the leading cause of death in Europe – and food systems generate up to 37% of total greenhouse gas (GHG) emissions.Methods and resultsBased on a systematic revision of meta-analyses of prospective studies exploring the association between individual foods/food groups and the incidence of CVD, we identified a dietary pattern able to optimize CVD prevention.. This dietary pattern was compared to the current diet of the European population. The nutritional adequacy of both diets was evaluated according to the European Food Safety Authority (EFSA) recommended nutrient intake for the adult population, and their environmental impact was evaluated in terms of carbon footprint (CF).As compared to the current diet, the desirable diet includes higher intakes of fruit, vegetables, wholegrains, low glycemic index (GI) cereals, nuts, legumes and fish, and lower amounts of beef, butter, high GI cereals or potatoes and sugar. The diet here identified provides appropriate intakes of all nutrients and matches better than the current Europeans' one the EFSA requirements. Furthermore, the CF of the proposed diet is 48.6% lower than that of the current Europeans’ diet.ConclusionThe transition toward a dietary pattern designed to optimize CVD prevention would improve the nutritional profile of the habitual diet in Europe and, at the same time, contribute to mitigate climate change by reducing the GHG emissions linked to food consumption almost by half.     

Developing a methodology for assigning glycaemic index values to foods consumed across Europe

There is growing evidence that the glycaemic index (GI) of the diet is important with respect to body weight and metabolic disease risk. However, research is limited by the paucity of GI values for commonly consumed carbohydrate‐rich foods in European countries. A new methodology has been developed for consistent assignment of GI values to foods across five European databases used in the Diogenes intervention study. GI values were assigned according to five decreasing levels of confidence (1) Measured values for specific foods; (2) Published values from published sources; (3) Equivalent values where published values for similar foods existed; (4) Estimated values assigned as one of three values representing low/medium/high GI ranges and (5) Nominal values assigned as 70, where no other value could be assigned with sufficient confidence. GI values were assigned to 5105 foods. In food records collected at baseline, the contribution to carbohydrate intake of foods assigned levels 1–2 ranged from 16% to 43% depending on country, and this increased to 53–81% including level 3 foods. The degree of confidence to assigned GI values differed across Europe. This standardized approach of assigning GI values will be made available to other researchers to facilitate further investigation into the effects of dietary GI on health.     

Food and nutrition studies in Mexico: a gender perspective

The present paper reflects on utilization of the gender category in food and nutrition studies in Mexico. It highlights women's important role as caretakers of family health and nutrition. Briefly the authors review how women have been analysed in the different food an nutrition surveys; how gender has been effaced in the "mean per capita", and how women have been taken into account only as far as their reproductive role. This paper also outlines the importance of including the gender category and gender approach in food and nutrition studies; in order to clearly visualize the feeding inequities among men and women throughout the stages of the feeding process, i.e. decision, provision, preparation, distribution and intake. Moreover, improved understanding of women's nutrition practices and meanings that foods convey to women is advocated. In the conclusion the absolute need to articulate the gender issue in nutrition, nursing and medical academic curricula is stated.     

The impact of initiatives to limit the advertising of food and beverage products to children: a systematic review

In response to increasing evidence that advertising of foods and beverages affects children's food choices and food intake, several national governments and many of the world's larger food and beverage manufacturers have acted to restrict the marketing of their products to children or to advertise only ‘better for you’ products or ‘healthier dietary choices’ to children. Independent assessment of the impact of these pledges has been difficult due to the different criteria being used in regulatory and self‐regulatory regimes. In this paper, we undertook a systematic review to examine the data available on levels of exposure of children to the advertising of less healthy foods since the introduction of the statutory and voluntary codes. The results indicate a sharp division in the evidence, with scientific, peer‐reviewed papers showing that high levels of such advertising of less healthy foods continue to be found in several different countries worldwide. In contrast, the evidence provided in industry‐sponsored reports indicates a remarkably high adherence to voluntary codes. We conclude that adherence to voluntary codes may not sufficiently reduce the advertising of foods which undermine healthy diets, or reduce children's exposure to this advertising.     

Growth and complementary feeding in the Americas

Background and aimsTo describe growth patterns of young children in Latin America and the Caribbean, the types of nationally representative data available on complementary feeding practices and complementary feeding practices.Methods and resultsData on growth, timing of introduction of liquids and foods, and complementary feeding practices were abstracted from nationally representative surveys. The high prevalence of stunting relative to the low prevalence of underweight is striking, with the “average” child in the region, with the exception of the Haitian child, short and chubby. The focus of the demographic and health surveys continues to be on undernutrition with only one question, intake of sugary foods, related foods that may have consequences for adult health. The United States has more comprehensive information; Mexico has information on beverage consumption and Brazil on soft drink and biscuit or snack consumption. In 14 of 19 countries, fewer than half of infants are exclusively breastfed for the first 6 months of life, indicating an early introduction of liquids and complementary foods. Among the 5 countries with data on the intake of sugary foods, intake in the previous 24 h among children 6–23 months of age ranged from 14% to 79%.ConclusionsThe absence of data to characterize complementary feeding diets as they relate to risk of overweight and chronic diseases in the Region of the Americas calls attention to the need to improve data collection frameworks and methods to address this important gap in knowledge.     

On the role and fate of sugars in human nutrition and health. Introduction

The recently implemented European Regulation (EC) No. 1924/2006 on nutrition and health claims made on foods is fuelling scientific research efforts in the food and health arena. Essentially, it is now established that only claims that are scientifically substantiated will be allowed. Because this new legislation covers the idea that foods with health or nutritional claims might be perceived by consumers as having a health advantage over products without claims, it introduces a further requirement (enclosing the new concept of 'nutrient profile') to avoid a situation where claims could mislead consumers when trying to make healthy choices in the context of a balanced diet. Thus, only those foods having an appropriate nutrition profile (composition of different nutrients such as sugars and other substances with particularly relevant nutritional or physiological effects) will be allowed to bear claims. A scientific expert workshop was organized to critically review the available evidence behind current intake recommendations for sugars, focusing on the strength/gaps of the scientific evidence available and the identification of those fields where further research is needed. Work was distributed in the following topics covering potential effects of dietary sugars on (i) body weight control; (ii) diabetes-insulin resistance; (iii) dental health and (iv) micronutrient dilution. New approaches, including intervention studies and the application of nutrigenomic technologies, should be undertaken and interpreted bearing in mind that foods, food components and their combinations can have both positive and negative effects on health, thus requiring benefit–risk analysis.     

Evidence of a possible link between obesogenic food advertising and child overweight

A recent review of the literature concluded that advertising of foods on television may influence children's food choices and encourage unhealthy diets, but the review acknowledged there was a lack of clear evidence in coming to this conclusion. The present paper examines ecological evidence for a link between advertising to children and the risk of overweight using data from surveys of advertising on children's television and estimates of the prevalence of overweight among children, in the USA, Australia and eight European countries. A significant association was found between the proportion of children overweight and the numbers of advertisements per hour on children's television, especially those advertisements that encourage the consumption of energy‐dense, micronutrient‐poor foods (r = 0.81, P < 0.005). A weaker, negative association was found between the proportion of children overweight and the number of advertisements encouraging healthier diets (r = ?0.56, P < 0.10). The quantity of advertising on children's television appears to be related to the prevalence of excess body weight among children. Furthermore, the content of the advertising appears to have a specific effect. The findings justify the need for taking precautionary measures to reduce children's exposure to obesogenic marketing practices.     

Global benchmarking of children's exposure to television advertising of unhealthy foods and beverages across 22 countries

Restricting children's exposures to marketing of unhealthy foods and beverages is a global obesity prevention priority. Monitoring marketing exposures supports informed policymaking. This study presents a global overview of children's television advertising exposure to healthy and unhealthy products. Twenty‐two countries contributed data, captured between 2008 and 2017. Advertisements were coded for the nature of foods and beverages, using the 2015 World Health Organization (WHO) Europe Nutrient Profile Model (should be permitted/not‐permitted to be advertised). Peak viewing times were defined as the top five hour timeslots for children. On average, there were four times more advertisements for foods/beverages that should not be permitted than for permitted foods/beverages. The frequency of food/beverages advertisements that should not be permitted per hour was higher during peak viewing times compared with other times (P < 0.001). During peak viewing times, food and beverage advertisements that should not be permitted were higher in countries with industry self‐regulatory programmes for responsible advertising compared with countries with no policies. Globally, children are exposed to a large volume of television advertisements for unhealthy foods and beverages, despite the implementation of food industry programmes. Governments should enact regulation to protect children from television advertising of unhealthy products that undermine their health.     

Complementary feeding patterns in India

There are far too many children in the world who suffer from under-nutrition and growth faltering, with life time consequences such as reduced work capacity, increased infections, impaired intellectual performance and an increased risk of non communicable diseases later in life. These changes occur early in life, and consequently, complementary feeding has been receiving increased attention in the international nutrition community. In India, common problems relate not only to insufficient breastfeeding, but also to detrimental feeding practices. Only about 20% of children aged 6–23 months were fed according to the three recommended Infant and Child Feeding practices [1]. The most common types of solid or semi-solid foods fed to both breastfeeding and non-breastfeeding children under 3 years of age were foods made from grains and roots. These complementary feeding practices were found to be significantly associated with poor socioeconomic status, undesirable socio-cultural beliefs, maternal illiteracy, and ignorance.Although many initiatives have been carried out in India to promote Infant and Young Child Feeding, the progress in reducing the number of undernourished children in India over the last decade has been slow and modest. Equally, with the growing evidence and interest in the role of infant nutrition in the development of over nutrition and non-communicable disease, it is important to plan appropriate complementary feeding interventions that result in optimal growth. Contact opportunities with parents, specifically mothers, must be used for counseling through multiple communication channels such as local media, in order to constantly educate the population with consistent and simple messages on child feeding.     

Faim et satiété, contrôle de la prise alimentaire

Food intake is a complex periodical behaviour through which a living organism can extract vital nutrient and energy substances from the environment. Hunger and satiety are psycho-physiological states that, respectively, elicit or inhibit food intake. Homeostatic (glucostatic or lipostatic) and non-homeostatic (environmental conditions) mechanisms contribute to the periodic initiation of food intake. Once a meal has started, the stimulation to eat is progressively antagonized by the cumulative effects of the ingested foods. This satiation process brings the eating episode to an end before the ingested nutrients have been absorbed. Meal size is determined by an interaction of sensory (food quality and variety), gastro-intestinal, and neuroendocrine responses. A Pavlovian learning mechanism allows the metabolic consequences of ingesting a particular food to become associated with the sensory characteristics of the food; as a consequence, a unique repertoire of food acceptance and rejection responses is shaped for each individual eater. Satiety, the post-meal phase of inhibition of eating, depends on the nutrient composition of the meal and, mainly, on its energy density. The selection of high energy-density foods induces little satiety and favours “passive over-consumption”. In humans, culture, socio-economical status, family context, and even the physical characteristics of the environment affect food choices and energy intake. The mechanisms selected by Evolution in order to allow survival under environmental conditions of food shortage seem more efficient at correcting for energy needs than excesses. In the present context of food plethora, the obesity epidemic reflects both a biological bias and the potent stimulation from the environment.     

Aging-related changes of food intake in elderly subjects living in an urban community and relation with vital prognosis: Results of an 8-year longitudinal study (TMIG-LISA)

Purpose:   We conducted an 8-year longitudinal study to investigate aging-related changes in food and nutrient intake in a cohort of elderly subjects living in an urban community, and attempted to relate food intake with vital prognosis.
Procedures:   The first (baseline) nutrition survey was conducted in 1991 on 161 subjects (72 males and 89 females; aged 65–79) living in Koganei City. The second nutrition survey was conducted 8 years later in 1999. Excluding death or illness, 98 subjects (61%) were available for follow-up. Nutrition survey was conducted by a three-day dietary record method with daily home visits by dieticians. Aging-related changes in physical attributes, food intake, nutrient intake, and intake adequacy were analyzed. The relationship between nutrition intake and mortality was analyzed by Cox proportional hazard model.
Results:   (i) Weight and body mass index in females decreased significantly accompanying aging. (ii) Among all food groups, consumption of fruits was significantly lowered in males and females. (iii) Significantly decreased intake of protein, fats, carbohydrate, iron, sodium was observed in females. (iv) No change in protein–fat–carbohydrate energy ratio was observed. (v) Nutrient intake was greater than the recommended dietary allowances at baseline and also eight years later. (vi) A significant correlation was observed between vegetable protein intake and vital prognosis in males.
Conclusion:   In the present cohort, although nutrient and food intake changed with aging, nutrient intake was higher than the recommended dietary allowances. These results show that a 'diet for healthy longevity' is achieved by continuing to maintain the recommended dietary allowances despite age advancement.     

Structural responses to the obesity and non‐communicable diseases epidemic: Update on the Chilean law of food labelling and advertising

Chile approved the law of food labelling and advertising in 2012; this law aims to address the obesity epidemic, particularly in children. The implementation details were published in 2015, and the law was implemented finally in 2016, as described in the current article. Regulated foods were defined based on a specially developed nutrient profiling, which considered natural foods as gold standard. For liquid foods, amounts of energy, sugars, saturated fats, and sodium in 100 mL of cow's milk were used as cut‐offs. For solid foods, values within the 90th ‐ 99th percentile range for energy and critical nutrients were selected as cut‐off within a list of natural foods. A stop sign stating “High in <nutrient>” was chosen as warning label for packaged regulated foods. Regulated foods were also forbidden to be sold or offered for free at kiosks, cafeterias, and feeding programme at schools and nurseries. Besides, regulated foods cannot be promoted to children under 14 years. A staggered implementation of the regulation was decided, with nutrients cut‐offs becoming increasingly stricter over a 3‐year period. These regulatory efforts are in the right direction but will have to be sustained and complemented with other actions to achieve their ultimate impact of halting the obesity epidemic.     

Timing of introduction of complementary food: short- and long-term health consequences

Complementary food is needed when breast milk (or infant formula) alone is no longer sufficient for both nutritional and developmental reasons. The timing of its introduction, therefore, is an individual decision, although 6 months of exclusive breastfeeding can be recommended for most healthy term infants. The new foods are intended to 'complement' ongoing breastfeeding with those dietary items whose intake has become marginal or insufficient. Both breastfeeding and complementary feeding can have direct or later consequences on health. The evaluation of consequences of both early and late introduction of complementary food can neither disregard the effect of breastfeeding compared to formula feeding nor the composition or quality of the complementary food. Possible short-term health effects concern growth velocity and infections, and possible long-term effects may relate to atopic diseases, type 1 and 2 diabetes, obesity and neuromuscular development. On the basis of the currently available evidence, it is impossible to exactly determine the age when risks related to the start of complementary feeding are lowest or highest for most of these effects, with the possible exception of infections and early growth velocity. The present knowledge on undesirable health effects, however, is mainly based on observational studies, and although some mechanisms have been proposed, further prospective studies have to clarify these unsolved issues. Even less evidence on the consequences of the timing of complementary food introduction is available for formula-fed infants.     

Dietary management of swallowing disorders

Two major concerns in the dietary management of the dysphagic patient are to maintain adequate nutrition and to ensure safety during oral feeding. Dysphagic patients require modifications of standard hospital diets. Kitchen or nursing staff must remove from standard diet trays solid foods and liquids that pose swallowing hazards. Training kitchen and nursing staff and removing food are time consuming. It is also hazardous if certain foods are served to dysphagic patients through error or lack of knowledge. In addition, there is risk of inadequate nutrition when food is removed from trays. This paper proposes a four-level diet plan for patients who have difficulty swallowing solids and liquids. These diets gradually advance for patients undergoing treatment to improve swallowing function. The proposed diets save time for kitchen and nursing staff, reduce the risk of aspiration among patients, and serve as models for families as they prepare for discharge and meal planning at home. Diet guidelines are based on recommendations of the American Dietetic Association.     

Promoting healthy food preferences from the start: a narrative review of food preference learning from the prenatal period through early childhood

The palatable, energy‐dense foods that characterize modern environments can promote unhealthy eating habits, along with humans' predispositions to accept sweet tastes and reject those that are sour or bitter. Yet food preferences are malleable, and examining food preference learning during early life can highlight ways to promote acceptance of healthier foods. This narrative review describes research from the past 10 years focused on food preference learning from the prenatal period through early childhood (ages 2–5 years). Exposure to a variety of healthy foods from the start, including during the prenatal period, early milk‐feeding and the introduction to complementary foods and beverages, can support subsequent acceptance of those foods. Yet development is plastic, and healthier food preferences can still be promoted after infancy. In early childhood, research supports starting with the simplest strategies, such as repeated exposure and modelling, reserving other strategies for use when needed to motivate the initial tasting necessary for repeated exposure effects to begin. This review can help caregivers and practitioners to promote the development of healthy food preferences early in life. Specific implementation recommendations, the role of individual differences and next steps for research in this area are also discussed.     

Early nutrition patterns and diseases of adulthood: A plausible link?

In the last decades several studies tested the hypothesis that at early development stages certain foods or nutrients, in specific amounts, fed during limited sensitive periods, may determine an endocrine metabolic asset leading to clinical alterations that take place decades later (early nutritional programming of long term health). Evidence is mounting for programming effects of infant feeding. Observational studies indicate that breast feeding, relative to formula feeding, reduces the risk for obesity at school age by about 20% even after adjustment for biological and sociodemographic confounders. Moreover, breastfeeding is constantly associated with increased neurodevelopmental scores up to early adulthood, while its outcome in terms of delayed decay of brain function is still unknown. Besides the environment surrounding breastfeeding, specific nutrients within human milk may play a direct role. With the introduction of solids the major changes in diet are represented by the sudden decrease of fat intake from 50 to 30% of total energy. A protein excess, commonly found throughout all European Countries, has been associated to a higher risk of adiposity in early childhood, as confirmed by first reports from a large European trial. The amount of fat does not seem to be associated with later adiposity, while its quality may affect blood lipoproteins, blood pressure and neurodevelopmental performance. Early intake of dietary fibers might also have beneficial effects. Epidemiologic data show that episodes of rapid growth (growth acceleration hypothesis), whichever the dietary habits, are associated with later unfavorable health conditions and should be prevented.     

Systematic review of the association of mastication with food and nutrient intake in the independent elderly

Substantial number of elderly people suffer from poor mastication, which is considered to have a detrimental effect on their dietary habits. However, the association between mastication and diet is far from conclusive. The objective of this systematic review was to assess the association of mastication with food and nutrient intake in the community dwelling elderly. We searched the PubMed, Web of Science, Cochrane Library, and Scirus databases to obtain information on the epidemiological studies in this research area. The included publications were analyzed for study design, main conclusions, and strength of evidence. A comprehensive quality assessment of all the included studies (28 cross-sectional and 7 intervention studies) was performed. In 22 of the 28 cross-sectional studies, elderly persons with better mastication and dentition reported significantly higher consumption of foods and intake of some nutrients than those with poorer oral health; however, the remaining studies showed no such differences. Five of the 7 intervention studies with an intervention involving the provision of new prostheses did not show significant improvement in food and/or nutrient intake. These discrepant findings suggest that masticatory ability explains only part of the variance in food and nutrient intake of the elderly. Two intervention studies with the combination of prosthetic treatment and dietary intervention produced changes in intake of foods such as fruits and vegetables.