Socio-cognitive and nutritional factors associated with body mass index in children and adolescents: possibilities for childhood obesity prevention

A large national study of schoolchildren aged 6-18 years was conducted to assess nutritional and socio-cognitive factors associated with body mass index (BMI). A questionnaire was used to assess nutritional quality of breakfast, importance of physical activity and food variety score, among 4441 students from randomly selected schools in all states and territories of Australia between September and December 2000. Height and weight were measured. Nutritional knowledge, dietary self-efficacy and dietary locus of control were also assessed among adolescents. School socio-economic status (SES) was derived from parental income. The factors were modelled using multiple linear regression to determine significant predictors of BMI. Dietary self-efficacy, nutritional quality of breakfast and SES were found to be the principal predictors of BMI in addition to the expected biological factors of age, gender and height. Furthermore, low SES was found to contribute to high BMI, mediated by the low nutritional quality of breakfast. Food variety was positively associated with high BMI and this was mediated by dietary self-efficacy. Nutrition knowledge and dietary locus of control were not associated with BMI. These results suggest that breakfast programmes for low-income children may be an effective measure in the prevention of childhood obesity.     

Changing children's diets: developing methods and messages

With an increasing prevalence of childhood overweight and obesity within the UK ( Chinn & Rona, 2001 ) and the emergence of type II diabetes as a childhood condition ( Kaufman, 2002 ), primary school children represent an important target group for health promotion. However, the increasing social and financial freedom enjoyed by this population is unlikely to be matched by an increase in their food control, cognitive abilities or the perceived need required to facilitate healthy behaviours, especially food choice. Thus, indirect attempts at behavioural modification are needed, with parents indicated as potentially powerful education intermediaries. This presentation will summarize the key findings of a 3‐year research project which aimed to investigate the current motivators and reinforcers for behaviour change within the families of primary school children in the UK. Three separate studies, utilizing both qualitative and quantitative methodologies, were undertaken with a total of 253 parents of primary school children, recruited from locations within the south east and the north west of the UK. Using focus groups and a questionnaire developed to assess the key constructs of the Theory of Planned Behaviour ( Ajzen, 1988 ), the barriers and benefits perceived by parents to be associated with the provision of a healthy diet were identified and quantified. These results were used to inform the development of a parental education programme, which was subsequently pilot tested and evaluated in order to highlight the practical implications for intervention delivery within this population. Results indicated a general rejection by parents of traditional nutritional messages and sources in favour of a more concrete but flexible approach with a short‐term health focus delivered by neutral agencies. Although healthy eating was viewed positively, parents tended to set themselves unrealistic targets and to have suboptimal nutritional knowledge and an inadequate awareness of their own influence as a model for their child's behaviour. Negative approaches to food control were frequently observed along with practical barriers to education uptake. Results would suggest that behavioural techniques should be promoted in preference to simple fact acquisition and novel, possibly ‘virtual’ approaches to parent–educator contact are worthy of further investigation. Differences in parental attitudes and behaviour were observed between families of different socio‐economic status (SES). Parents also appeared to reinforce inappropriate gender stereotypes in relationship to food and exercise behaviour. Social support was shown to positively impact on parental intention to provide a healthy diet. Although tailored nutrition education programmes are required which promote behavioural techniques via SES sensitive approaches, this research has confirmed the overarching role of environmental support. By nurturing family and community cohesiveness, the potential for long‐term behavioural change and health improvements in primary school‐aged population may be realized.     

Nutrition knowledge, attitude, and behavior of Taiwanese elementary school children

The purpose of this study is to understand nutrition knowledge, attitude, and behavior in Taiwanese elementary school children, and the relationship of these various components. The results indicated that children's knowledge was fair in nutrition basics, but poor in 'the physiological function of nutrients', 'relationships between diet/nutrients and disease', and 'the daily serving requirement for different food groups'. Children in general valued the importance of nutrition, but they did not concern the health benefit of foods in food selections. Their dietary quality was not satisfactory, and the diet of most children did not meet the recommended serving requirements for milk, vegetable, fruit, and cereals and grains groups. Positive relationships were found among nutrition knowledge, attitude, caring- about-nutrition behavior and dietary quality score. The restraint or disinhibited eating behavior of 4th to 6th graders was not serious, but a large number of children already performed some self-controlling practices to avoid obesity, but not frequently. One fourth of the students skipped meals, especially breakfast, and one quarter of 4th to 6th graders prepared their own breakfast; which may have some impact on children's diet quality. A gap was found between nutrition knowledge, attitude and eating behavior, especially vegetable and fruit consumption, indicating that the attitude toward eating for health was not strong in this age group. Future nutrition education for school children should not only include food serving requirements of food groups, but also apply appropriate theories to improve the motivation for healthy eating.     

家庭社会经济状况与3岁以内儿童生长发育及营养状况的关系

目的 探究家庭社会经济状况(SES)与3岁以内儿童生长发育及营养状况的关系,为我国儿童预防保健提供科学依据。方法 数据源于2015年中国九市7岁以下儿童体格发育调查的西安地区数据。研究共纳入父/母亲文化程度、父/母亲职业和家庭年收入5项指标因子,构建了SES综合指标作为自变量。结局变量为身长、体重和评估的营养状况结局。调整儿童性别和月龄后,分别建立线性回归和Logistic回归模型,分析SES与身长体重和营养结局的关系。结果 研究共纳入3岁以内儿童12 017人,经评估营养不良者281人(2.3%),营养过剩者531人(4.4%)。调整儿童性别和月龄后,与低水平SES儿童相比,中等水平SES儿童身长增加0.32 cm(95%CI:0.16~0.47),发生营养过剩的风险降低20%(OR =0.80, 95%CI:0.65~0.98);高水平儿童身长增加0.77 cm(95%CI:0.61~0.92),体重增加0.06 kg(95%CI:0.006~0.12),发生营养过剩的风险降低33%(OR=0.67, 95%CI:0.53~0.83)。结论 较好的社会经济状况可能降低营养过剩的风险,有助于儿童的发育与营养健康。应改善家庭育儿环境,加强对低SES家庭的儿保宣教,提高儿童的健康水平。     

Promoting healthy diet and exercise patterns amongst primary school children: a qualitative investigation of parental perspectives

Parents represent a potentially powerful intermediary in behaviour change strategies aimed at improving the lifestyle behaviours of young children. However, to fulfil this role, parents need to have the necessary knowledge and motivation to assimilate dietary guidelines. This study aimed to assess these psychosocial constructs, and subsequent parental receptiveness to nutrition education, through investigation of the barriers and benefits perceived by parents to the provision of a healthy diet and adequate exercise for their children. A qualitative methodology was employed and 41 parents took part in seven focus groups separated by socio‐economic status (SES). Across the groups, a combination of reported external barriers and unconscious internal barriers, stemming from high optimistic bias, low perceived control and unrealistic health expectations, were observed. SES differences were suggested in restrictive feeding practices, the responsibility attributed to the school and in the level and format of desired nutrition education. Overall a demand for interventions focusing on behavioural techniques rather than fact transmission was uncovered, in particular the promotion of parental self‐awareness to reduce negative influences within the family food environment. Providing realistic definitions of appropriate behaviour and empowering parents to tackle children's weight issues were indicated as important targets for future education programmes.     

Household food security and nutritional status of Hispanic children in the fifth grade

BACKGROUND: Food insecurity is a critical variable for understanding the nutritional status of low-income populations. However, limited research is available on the relation between household food insecurity and children's nutritional status. OBJECTIVE: Our objective was to examine the relations among household food insecurity, household food supplies, and school-age children's dietary intakes and body mass indexes (BMIs). DESIGN: A sample of 124 predominantly Hispanic, fifth-grade children and their mothers were surveyed as part of a school-based obesity-prevention program. Data on the children's weights and heights were collected and three 24-h dietary recalls were conducted. The mothers provided reports of household food insecurity and household food supplies. RESULTS: Food insecurity was negatively associated with the children's BMIs and household food supplies but not with the children's food intakes. However, a secondary analysis showed that as payday approached, children from the most food-insecure households had significant decreases in energy intakes and meat consumption. CONCLUSIONS: This is one of the first studies to report a significant association between food insecurity and children's nutritional status. The ages and sex-adjusted BMIs of the food-insecure children were lower than those of the food-secure children but were still within the normal range. The lower BMIs in the food-insecure children may have been due to short-term, yet periodic food restrictions that resulted as household food supplies diminished before payday. Future research is needed to assess the physiologic and psychological effects of periodic food restriction on children's health.     

海南贫困地区黎族中小学生营养知识状况及影响因素

了解海南省实施“学生营养改善计划”贫困地区黎族中小学生营养知识掌握情况,为制定有针对性的营养健康教育方案提供依据.方法 采用多阶段抽样的方法,随机抽取海南省实施“学生营养改善计划”贫困地区三至九年级黎族学生1 826名,进行营养知识问卷调查.结果 黎族中小学生营养知识平均得分为(3.15±1.71)分,不同性别、学段、供餐模式、营养知识获取途径数、是否住校、父母是否外出打工、不同地区学生营养知识得分差异均有统计学意义(t/F值分别为-4.676,-6.692,7.645,93.074,3.194,-3.348,6.014,P值均<0.05).多重线性回归分析结果显示,影响黎族学生营养知识得分的主要因素包括学段、供餐模式、性别、家庭人口数和地区(P值均<0.01).黎族学生营养知识平均知晓率为45.06%,知晓率较高的题目是“可预防贫血的食物”和“维生素和矿物质的食物来源”(60.4%,60.2%),知晓率最低的是“有利长个子的因素”(12.2%).学生获取营养知识的主要途径是校园宣传或课堂教学(42.7%)、父母或家人(41.2%)、课本(38.7%).结论 海南省实施“学生营养改善计划”贫困地区黎族学生营养知识的知晓水平较低,影响因素主要包括学段、供餐模式、性别、家庭人口数和地区等.应采取针对性的营养健康教育提高学生认知水平.     

Parental influence on food selection in young children and its relationships to childhood obesity

This investigation evaluated the impact of parental influences on children's food selections and the impact of childhood obesity on these food choices. Subjects were 53 young children of various weight status. Foods ranging widely in nutritional values were offered to each child for lunch. The children were again offered foods but were told that their mothers would be monitoring their selections. Finally, mothers were allowed to modify their children's last food choices. Results indicated that parental influences have a marked effect on food selection; both the threat of parental monitoring and actual parental monitoring lowered the number of nonnutritious foods chosen and total caloric content of the meal. The obesity status of the mothers and children had no impact on these results. The implication of these results for future intervention efforts are discussed.     

母亲的教育水平对学前儿童膳食与营养状况的影响——中国八省实例研究

利用１９９３年～１９９６年开展的中美长期合作课题“中国健康与营养调查”资料，选取中国八省城乡６岁以下儿童及其母亲１０９８对，采用分层分析的方法，初步分析了母亲的教育水平对学龄前儿童膳食与营养状况的影响。发现不论是否消除了家庭经济因素的干扰，母亲的教育水平在高中以上，其儿童体重不足率和生长迟缓率均最低，其次是母亲教育水平为初中的儿童；而母亲的教育水平在小学或小学以下者，其孩子的体重不足率和生长迟缓率最高，但母亲的教育水平与儿童消瘦率的关系不明显。分析还发现母亲的教育水平对儿童膳食的影响主要表现在对儿童动物性食物的摄入上。说明大力发展妇女教育，提高妇女素质，是改善我国儿童健康与营养状况的重要措施     

Association between socioeconomic status, weight, age and gender, and the body image and weight control practices of 6- to 19-year-old children and adolescents.

The aim of the study was to examine the effect of socioeconomic status (SES), age, weight and gender on the body image and weight control practices of children and adolescents, and to investigate whether health education about weight issues should target low socioeconomic groups. The study participants were a randomly selected group of school children who completed a questionnaire, and had their height and weight measured. Participants (n = 1131) were aged 6-19 years from 12 schools in New South Wales. SES, age, gender, body weight, body image, skipping breakfast, physical self-esteem, attempts to lose or gain weight, and dietary and weight control advice received from others were examined. Log-linear, chi 2 and MANOVA analyses were used to determine interactions between variables. Low SES children were more likely to be overweight, to skip breakfast, to perceive themselves as 'too thin', to be trying to gain weight and less likely to receive dietary or weight control advice. Physical self-esteem was lowest among overweight girls of middle/upper SES and greatest among boys of low SES, despite the latter being more likely to be overweight. Being overweight does not appear to adversely affect the physical self-esteem of children of low SES, particularly boys. Health educators should examine these issues with young people to help make health education and nutrition education most relevant and appropriate.     

The food–service industry, dietary guidelines and change

Abstract: The influence of the food–service industry on compliance with the Australian dietary guidelines was investigated through three separate methods of data collection and analysis: a telephone survey of 1683 randomly selected Brisbane residents; telephone interviews with 69 food–service–industry operators and 10 face–to–face interviews with key stakeholders in industry and government. Nearly 40 per cent of respondents had consumed foods prepared by the food–service industry at least once on the day before the interview, mainly from restaurants, cafes and takeaway shops, in the form of fast–food or snacks. Consumption of these foods declined with age. Those consuming foods prepared by the food–service industry ate significantly less fruit, vegetables and dairy food and were therefore less likely to comply with the dietary guidelines. Outcomes from interviews with operators in the food–service industry show that food choices offered to consumers were the result of a dynamic interaction between consumer demand and operators' own tastes and perceptions of food quality. Key informant interviews show that public health nutrition programs will have limited effect without supportive environmental changes in the food–service industry supply. An effective means of increasing the likelihood of compliance with the Australian dietary guidelines will be to encourage food suppliers in ways that address their core business concerns simultaneously with the goals of health professionals. ( Aust N Z J Public Health 1997; 21: 539–44)     

中国较贫困农村学前儿童膳食模式及其影响因素

用食物组成评分（ＦＧＳ）法［１］，分析我国贫困地区学龄前儿童的膳食模式和营养状况，显示出儿童的膳食模式能够反映其营养状况。对不同模式的儿童家庭背景进行分析表明，随着儿童家庭经济状况或父母的文化程度的提高，儿童膳食构成趋向于多样化，儿童的身高、体重状况也有明显好转。证明了经济收入、父母文化程度是通过膳食来影响儿童的营养状况。本文显示出食物组成评分法有其实用性。     

Nutritional practices in full‐day‐care pre‐schools

Background: Full‐day‐care pre‐schools contribute significantly to the nutritional intake and acquisition of dietary habits of the pre‐school child. The present study investigated nutritional practices in full‐day‐care pre‐schools in Dublin, Ireland, aiming to determine the nutritional support that pre‐school managers deem necessary, thereby facilitating the amelioration of existing pre‐school nutritional training and practices. Methods: A telephone questionnaire completed by pre‐school managers (n = 54) examined pre‐school dietary practices, food provision and the association between these and pre‐school size, nutritional training attendance, possession of the Food and Nutrition Guidelines for Pre‐school Services and having a healthy eating policy. Nutritional training needs were also investigated. Results: Twenty‐five pre‐schools provided all food for attending children; parents were sole providers in six. Thirty‐four pre‐schools had a written healthy eating policy. Attendance at nutritional training was reported by 40. Possession of the Guidelines (n = 40) did not consistently result in their use. Poor parental and staff involvement in policy and menu development was cited. Although the delayed introduction of iron‐containing foods and a feeding beaker in infants was clearly evident, inappropriate beverages and snacks were served to children aged 1–5 years in 43 and 37 pre‐schools, respectively. Training priorities cited by managers included parental education and the provision of information regarding menu planning and healthy food choices. Conclusions: Nutritional training should advocate whole staff familiarity with and use of current guidelines, in addition to encouraging nutritional policy development and enforcement. Parental education is warranted. Dietary education should focus specifically on appropriate weaning practices, healthy beverage and snack provision and menu planning.     

School lunch menus and 11 to 12 year old children's food choice in three secondary schools in England-are the nutritional standards being met?

OBJECTIVES: To determine if the lunchtime food provided to schoolchildren adheres to nutritional standards and to examine the influence of children's food choice on nutrient intake at lunchtime. SUBJECTS/SETTING: Seventy-four children aged 11-12 years were recruited from three secondary schools. The school populations spanned a spectrum of socio-economic deprivation. Lunchtime food and nutrient intake was assessed over a 5 day period. DESIGN: Cross-sectional study of menu composition and children's food choice in relation to nutrient intake. METHODS: Dietary recording was by an indirect weighing method of menu composition and nutrient intake over a 5 day period. Statistical analysis was carried out using general linear modelling techniques including: t-test, one-way ANOVA and ANCOVA. RESULTS: One school met the standards on food group provision. Intakes of total fat, saturated fatty acids and monounsaturated fatty acids were greater in boys. Intake of folate was greater in girls. There were between-school differences (independent of gender) for intake of fatty acids, starch, calcium and folate, with socio-economic deprivation associated with a lesser nutrient intake. Children could have chosen meals higher in calcium, iron, folate and zinc and lower in starch and fat, from the extensive cafeteria menu of between 26 and 42 food. For some nutrients, providing 'healthier' food influences intake of those nutrients whilst for other nutrients, children's food choice predominates. The majority of children did not meet the recommended targets for lunchtime nutrient intake, especially for micronutrients. CONCLUSIONS: Food provision in two out of three schools did not meet government guidelines and socio-economic deprivation was associated with worse food provision. Children from deprived areas were more likely to choose those foods of limited nutritional value than those from more privileged backgrounds. The statutory nutritional standards on their own, without a pricing policy to encourage healthier food choice or restrictions in food choice towards less healthy food are unlikely to catalyse the dietary changes that are so needed to ensure improved nutrient intakes amongst schoolchildren in England.     

Impact of of school children's nutrition education program on the knowledge and nutritional behavior of their parents

The aim of the work was to present the analysis of the influence of school children's nutrition education program on the knowledge and nutritional behavior of their parents (110 persons). The program was realized during 10 lessons. The interview with the parents concerning their knowledge and nutritional behavior was carried before and after realization of educational program at school. One can state that changes of parents nutritional behavior was connected with the educational materials getting by children, for example higher consumption of vegetables, fruits, milk and its products were observed. An increased level of knowledge especially on sources of selected nutrients: calcium, dietary fiber was found. Education of children and youth can be seen as one of the effective educational method of their parents.     

Chinese children at a crossroads: influence of family socioeconomic factors on diet patterns

This pilot study explores the roles of family socioeconomic status (SES) in influencing dietary consumption patterns in 60 Chinese elementary school-aged children (ages 6-11) in Chengdu, China. Two interviewer-administered questionnaires were specially developed to gather sociodemographic and food frequency data. Children from low SES families consumed rice and traditional staples, and high calcium drinks more frequently, and western fast food less frequently than children from higher SES families. After controlling for family SES, children who were primarily cared for by their mothers or grandparents consumed less healthy snacks less frequently than children who were primarily cared for by other adults (including fathers).     

Dietary intake and risk factors for poor diet quality among children in Nova Scotia

OBJECTIVE: Public health policies promote healthy nutrition but evaluations of children's adherence to dietary recommendations and studies of risk factors of poor nutrition are scarce, despite the importance of diet for the temporal increase in the prevalence of childhood obesity. Here we examine dietary intake and risk factors for poor diet quality among children in Nova Scotia to provide direction for health policies and prevention initiatives. METHODS: In 2003, we surveyed 5,200 grade five students from 282 public schools in Nova Scotia, as well as their parents. We assessed students' dietary intake (Harvard's Youth Adolescent Food Frequency Questionnaire) and compared this with Canadian food group and nutrient recommendations. We summarized diet quality using the Diet Quality Index International, and used multilevel regression methods to evaluate potential child, parental and school risk factors for poor diet quality. RESULTS: In Nova Scotia, 42.3% of children did not meet recommendations for milk products nor did they meet recommendations for the food groups 'Vegetables and fruit' (49.9%), 'Grain products' (54.4%) and 'Meat and alternatives' (73.7%). Children adequately met nutrient requirements with the exception of calcium and fibre, of which intakes were low, and dietary fat and sodium, of which intakes were high. Skipping meals and purchasing meals at school or fast-food restaurants were statistically significant determinants of poor diet. Parents' assessment of their own eating habits was positively associated with the quality of their children's diets. INTERPRETATION: Dietary intake among children in Nova Scotia is relatively poor. Explicit public health policies and prevention initiatives targeting children, their parents and schools may improve diet quality and prevent obesity.     

Children's food patterns--a review: I. Food preferences and feeding problems

Many studies of children's food preferences and feeding problems are limited by cultural definition of food preferences, feeding problems, and parental management (32, 40, 51, 59, 90). In general, most samples have been white middle class families with children in nursery school; nutritional adequacy has not been considered; food preferences and feeding problems have not been well defined; and poorly documented observations have been generalized to other or all populations. The results at this level of abstraction do not offer solutions to children's food behavior or begin to unravel the mystery of the role of preferences and problems in predicting food behavior and nutritional status. Although results of studies may vary because of methodology, the greatest problem is the level of abstraction. Some research is beginning to identify more rigorously attributes, dimensions, or factors involved in the formation of children's food patterns, using a broader theoretical framework (29, 33, 34, 47, 63, 64, 66, 68-70). Part II of this article examines food preferences by using a family point of view.     

The influence of parents' dietary beliefs and behaviours on children's dietary beliefs and behaviours. The CYKIDS study

We investigated the association between parental dietary beliefs and behaviours (DBB) and those of their children behaviours. Data were derived from a national cross-sectional study using multistage sampling design, among 1140 children (9-13 years). Principal component analysis was employed to extract the main factors out of eight variables assessing children's dietary beliefs and behaviours (N=991); those eight factors were then regressed, on 16 dependent variables, describing different parental dietary beliefs and behaviours, adjusted for potential confounders. Three factors emerged as important in explaining the variance in children's dietary beliefs and behaviours: "guilty about eating" (factor 1), "concerned about own body weight" (factor 2) and "eating all my food" (factor 3). Children with types 1-3 behaviour: were 30% more likely to have parents who did not control what and how much their child ate, have parents who are 40% more likely to think that their child is overweight/obese and seem to have more availability of high fat foods, respectively. Breastfeeding was associated with the acquisition of positive dietary beliefs and behaviours by children, independently of child's age, gender, place of residence, socio-economic status, diet quality, and child's and parents' obesity status. We propose that parents are likely to exert their influence in shaping eating habits and subsequently obesity development in their children, by influencing their children's dietary beliefs and behaviours.     

Does maternal knowledge and parent education affect blood phenylalanine control in phenylketonuria?

Background  Metabolic control in phenylketonuria (PKU) may be influenced by parental ability because dietary treatment involves complex food choices. This is an observational study to compare maternal carer (MC) knowledge and parental education with phenylalanine concentrations in children with PKU.
Methods  Children ( n  = 46; 26 boys) aged 1–10 years (median age 6 years) on dietary treatment were recruited. Their median lifetime and median phenylalanine concentrations in the year prior to study were estimated. MC completed a questionnaire to assess dietary knowledge.
Results  Overall maternal knowledge on most aspects of diet was good and there was a correlation between annual median blood phenylalanine concentrations, but at the age of 5–6 years of age only, and higher maternal carer scores on PKU knowledge ( r  = −0.646; P  < 0.0001). Three of only four children (12%) with median phenylalanine concentrations above 500 μmol L⁻¹ in the year prior to study had both parents leave school without educational qualifications. Children who had median phenylalanine concentrations ( n  = 3; 7%) over the recommended ranges at 3 years of age or earlier continued to have poor control.
Conclusions  Blood phenylalanine control within the first 3 years of age, poor parental educational achievement at school level, and unsatisfactory maternal dietary knowledge may all influence longer-term blood phenylalanine control in children.