Farm to Elementary School Programming Increases Access to Fruits and Vegetables and Increases Their Consumption Among Those With Low Intake

ObjectiveTo assess the effectiveness of Wisconsin Farm to School (F2S) programs in increasing students' fruit and vegetable (FV) intake.DesignQuasi-experimental baseline and follow-up assessments: knowledge and attitudes survey, food frequency questionnaire (FFQ), and lunch tray photo observation.SettingWisconsin elementary schools: 1 urban and 8 rural.ParticipantsChildren, grades 3–5 (n = 1,117; 53% male, 19% non-Caucasian).Intervention(s)Farm to School programming ranging from Harvest of the Month alone to comprehensive, including school garden, locally sourced produce in school meals, and classroom lessons.Main Outcome MeasuresKnowledge, attitudes, exposure, liking, willingness; FFQ-derived (total), and photo-derived school lunch FV intake.Analysist tests and mixed modeling to assess baseline differences and academic-year change.ResultsHigher willingness to try FV (+1%; P < .001) and knowledge of nutrition/agriculture (+1%; P < .001) (n = 888), and lunch FV availability (+6% to 17%; P ≤ .001) (n = 4,451 trays), both with increasing prior F2S program exposure and across the year. There was no effect on overall dietary patterns (FFQ; n = 305) but FV consumption increased among those with the lowest intakes (FFQ, baseline very low fruit intake, +135%, P < .001; photos: percentage of trays with no FV consumption for continuing programs decreased 3% to 10%, P ≤ .05).Conclusions and ImplicationsFarm to School programming improved mediators of FV consumption and decreased the proportion of children with unfavorable FV behaviors at school lunch. Longer-term data are needed to further assess F2S programs.     

Reliability and Validity of Digital Images to Assess Child Dietary Intake in a Quick-Service Restaurant Setting

BackgroundDevelopment of methods to accurately measure dietary intake in free-living situations—restaurants or otherwise—is critically needed to understand overall dietary patterns.ObjectiveThis study aimed to develop and test reliability and validity of digital images (DI) for measuring children’s dietary intake in quick-service restaurants (QSRs), validating against weighed plate waste (PW) and bomb calorimetry (BC).DesignIn 2016, cross-sectional data were collected at two time points within a randomized controlled trial assessing children’s leftovers in QSRs from parents of 4- to 12-year-old children.Participants/settingParents (n = 640; mean age = 35.9 y; 70.8% female) consented and agreed to provide their child’s PW for digital imaging, across 11 QSRs in Massachusetts in areas with low socioeconomic status and ethnically diverse populations.Outcome measuresOutcome measures were interrater reliability for DIs, correspondence between methods for energy consumed and left over, and correspondence between methods across varying quantities of PW.Analyses performedIntraclass correlations, percent agreement, Spearman correlations, Wilcoxon signed rank tests, and Bland-Altman plots were used.ResultsInterrater reliability ratings for DIs had substantial intraclass correlations (ICC = 0.94) but not acceptable exact percent agreement (80.2%); DI and PW energy consumed were significantly correlated (r = 0.96, P < 0.001); DI slightly underestimated energy consumed compared with PW (Mdiff = ?1.61 kcals, P < 0.001). Bland-Altman plots showed high DI–PW correspondence across various energy amounts and revealed few outliers. Energy left over by BC was highly correlated with DI (r = 0.87, P < 0.001) and PW (r = 0.90, P < 0.001); and mean differences were not significantly different from DI (Mdiff = 9.77 kcal, P = 0.06) or PW (Mdiff = ?2.84 kcal, P = 0.20).ConclusionsCorrespondence was high between PW and DI assessments of energy consumed, and high with BC energy left over. Results demonstrate reliability and practical validity of digital images for assessing child meal consumption in QSR settings.     

Family Influence: Key to Fruit and Vegetable Consumption among Fourth- and Fifth-grade Students

ObjectiveTo assess social and familial environmental influences on fruit and vegetable (FV) consumption of fourth- and fifth-graders living in a culturally diverse, urban setting.DesignIn 2006, students from 9 fourth- and fifth-grade classrooms from a public school in the Washington-Baltimore Metropolitan Region were recruited as part of the Food Stamp Nutrition Education's initiative to increase FV consumption among school-aged children in low-income schools. This intervention was conducted in partnership with the school.ParticipantsNinety-three fourth- and fifth-grade students and their parents.Main Outcome MeasureThe average daily FV consumption of elementary school students was the dependent variable. Home engagement (eg, student participation in menu planning and food selection at home), parental modeling, school environment, peer influences, and individual characteristics were the independent variables.AnalysisMultiple regression analysis.ResultsFamily and home environment factors explained more than 50% of the variance in students' FV consumption.Conclusions and ImplicationsInterventions designed to influence school-aged children's FV consumption should target family members and consider incorporating strategies to reach families and promote meal planning activities with the children in their homes.     

The association between family meals, TV viewing during meals, and fruit, vegetables, soda, and chips intake among Latino children

ObjectiveExamine the relationship of family meals to children's consumption of fruit and vegetables as well as soda and chips. Additionally, to assess the relationship between viewing TV during family meals and children's diet.DesignCross-sectional study that used a questionnaire completed by parents.SettingThirteen schools in San Diego, California.ParticipantsSeven hundred ninety-four children and their parents.AnalysisOrdinal regression assessed associations between children's intake of fruit, vegetables, soda, and chips with family meal frequency and TV viewing during family meals.ResultsChildren who consumed breakfast, lunch, or dinner with their family at least 4 days per week ate fruit and vegetables 5 or more times a week 84%, 85%, and 80%, respectively. Of those children who ate breakfast, lunch, or dinner with their family at least 4 days per week, 40%, 44%, and 43% consumed soda and chips 5 or more times a week, respectively. Children who ate breakfast with their families at least 4 times a week were more likely to consume fruit and vegetables, and children whose TV was never or rarely on during family meals were less likely to consume soda and chips (P = .04 and P < .001, respectively).ConclusionsInterventions geared at increasing the frequency of eating breakfast as a family and decreasing the amount of TV watched during family meals are needed, especially among acculturating Latino families.     

Fruit and Vegetable Preparation Changes During and After Cost-Offset Community-Supported Agriculture Plus Nutrition Education

ObjectiveInadequate consumption of fruits and vegetables (FV) can negatively impact health. Cost-offset, or subsidized, community-supported agriculture (CO-CSA) may change FV preparation behaviors among caregivers in low-income households. We assessed changes in FV preparation frequency and methods during and after participation in a CO-CSA plus tailored nutrition education intervention.DesignLongitudinal comparison of outcomes at baseline, end of CO-CSA season, and 1 year later.ParticipantsCaregivers of children aged 2–12 years from households with low income in rural areas of 4 US states (n = 148).InterventionSummer season, half-price CO-CSA share plus tailored nutrition education classes. Comparison to a control group not included in this analysis.Variables MeasuredMonthly frequency of preparing 9 FV for children's snacks and 5 vegetables for dinner; use of healthy preparation methods for dinner.AnalysisRepeated measures ANCOVA including state with Bonferroni correction and 95% confidence.ResultsAt baseline, caregivers prepared fruit for children's snacks and vegetables for dinner almost daily and vegetables for children's snacks every other day. The frequency of total FV preparation and most vegetable varieties increased during the intervention. Increases in total vegetables for snacks, dinner, and leafy greens were maintained 1 year later (n = 107).Conclusions and ImplicationsCommunity-supported agriculture plus education is a promising approach to sustained increases in vegetable preparation for children's snacks and dinner meals.     

Changes in Fruit and Vegetable Consumption of Third-Grade Students in Body Quest: Food of the Warrior,a 17-Class Childhood Obesity Prevention Program

ObjectiveTo increase fruit and vegetable (FV) consumption of youth in Body Quest: Food of the Warrior (BQ), a childhood obesity prevention program.DesignQuasi-experimental.SettingSupplemental Nutrition Assistance Program–Education eligible schools (n = 60).ParticipantsThird-grade students (n = 2,477).InterventionTreatment groups (n = 1,674) self-reported foods consumed through the School Lunch Program for 17 weekly assessments; they participated in BQ curriculum, iPad app education, and weekly FV tastings. Control groups (n = 803) completed only pre- and post-assessments.Main Outcome MeasureWeekly FV consumed through School Lunch Program.AnalysisANCOVA and growth modeling.ResultsFrom before to after the program, the treatment group demonstrated significant, moderate increases in fruit (P < .01) and vegetable (P < .001) consumptions, increasing from 7 to 8 weekly FV servings. After the program, the treatment group consumed significantly (P < .001) more FV than the control group. Fruit and vegetable consumption increased to class 10 and then stabilized. From before to after the program, all FV predictors were significantly higher and included gender (vegetables), race (FV), and free/reduced lunch (fruit).Conclusions and ImplicationsNutrition programs can increase FV intake. Even moderate increases in FV intake can be an initial step for the prevention of chronic disease.     

Fruit and Vegetable Snack Consumption Among Children With a Body Mass Index at or Above the 75th Percentile

ObjectiveTo describe fruit and vegetable (FV) consumption as snacks and the association with diet quality and compare the snacking environment and child and parent characteristics between children who consumed FV as snacks and those who did not.MethodsThis secondary analysis study used baseline data from a healthy weight management study with 8- to 12-year-old children with a body mass index ≥75th percentile. Data collection included 24-hour dietary recalls, measured height/weight, and child and parent surveys.ResultsChildren (n = 119) consumed 0.1 cup equivalent per 1,000 kcal of FV as snacks, the equivalent of 16.9% of their daily FV consumption. More FV consumption as snacks occurred at home when a parent was present and was associated with higher parent support for FV consumption as snacks (P = 0.03).Conclusions and ImplicationsRenewed attention to strategies to promote FV consumption as snacks, especially at away-from-home locations, is merited.     

Misclassification of Fourth-Grade Children's Participation in School-Provided Meals Based on Parental Responses Relative to Administrative Daily Records

Although many studies have relied on parental responses concerning children's school-meal participation, few studies have evaluated parental response accuracy. We investigated misclassification of fourth-grade children's participation in school-meal programs based on parental responses relative to administrative daily records using cross-sectional study data collected for 3 school years (2004-05, 2005-06, and 2006-07) for 1,100 fourth-grade children (87% black; 52% girls) from 18 schools total in one district. Parents reported children's usual school-meal participation on paper consent forms. The district provided administrative daily records of individual children's school-meal participation. Researchers measured children's weight and height. “Usual participation” in breakfast/lunch was defined as ≥50% of days. Parental responses misclassified 16.3%, 12.8%, 19.8%, and 4.7% of children for participation in breakfast, classroom breakfast, cafeteria breakfast, and lunch, respectively. Parental responses misclassified more children for participation in cafeteria than classroom breakfast (P=0.0008); usual-participant misclassification probabilities were less than nonusual-participant misclassification probabilities for classroom breakfast, cafeteria breakfast, and lunch (P<0.0001 for each) (two-proportion z tests). Parental responses concerning children's participation were more accurate for lunch than breakfast; parents overstated breakfast participation (both classroom and cafeteria) and lunch participation. Breakfast participation misclassification was not related to body mass index (P=0.41), sex (P=0.40), age (P=0.63), or socioeconomic status (P=0.21) (multicategory logistic regression controlling for school year, breakfast location, and school). Relying on parental responses concerning children's school-meal participation may hamper researchers' abilities to detect relationships that have policy implications for the child nutrition community. The use of administrative daily records of children's school-meal participation is recommended.     

Consumption of, and factors influencing consumption of, fruit and vegetables among elderly Chinese people

ObjectiveThere is substantial evidence that the low intake of fruit and vegetables (FV) is a major risk factor for many nutrition-related non-communicable diseases. The purpose of our study was to assess FV consumption and the variables that influence FV consumption among Chinese people age 60 and older.MethodsTwenty-four-hour dietary recall data from the 1991, 1993, 1997, 2000, 2004, 2006, and 2009 China Health and Nutrition Surveys were used to collect the FV intake and sociodemographic variables examined in this article. Data were analyzed using t tests, χ² tests, and logistic regression.ResultsBetween 1991 and 2009, elderly Chinese adults experienced an improvement in dietary FV intake. The FV consumption increased from 325.7 g/d in 1991 to 379.0 g/d in 2009. During this 18-y period, the proportion of daily consumers increased from 11.0% to 32.5% for fruit and remained over 95% for vegetables. Age, gender, educational attainment, community, activity level, marital status, and drinking were significantly associated with FV consumption.ConclusionThe findings of this study indicated that FV intake among elderly adults in China was lower than the minimum of 400 g/d recommended by the World Health Organization. Greater public health efforts and approaches are needed to promote FV consumption in elderly Chinese adults.     

Child Involvement in Choosing a Recipe,Purchasing Ingredients,and Cooking at School Increases Willingness to Try New Foods and Reduces Food Neophobia

ObjectiveTo investigate the effect of involving children in their feeding process (choosing a recipe, purchasing the ingredients, and cooking) on their lunch food choice in a school environment.DesignQuasi-experimental.SettingTwo schools in Bilbao, Spain.ParticipantsA total of 202 children (aged 8–9 years) participated in the study (43% girls), with 99 in the nutrition education (NE) group and 103 in the hands-on (HO) group.InterventionThree 1-hour workshops (1 workshop/wk), different for each group: HO, cooking-related activities, and NE, healthy habits promotion through nutrition education activities.Main Outcome MeasuresFood neophobia, diet quality, cooking self-efficacy and attitudes toward cooking, and food intake and selection of the experimental lunches.AnalysisChi-square test of independence, ANCOVA, and t tests were performed.ResultsStudents from the HO group selected and ate more spinach/broccoli (P < 0.001 and P = 0.02, respectively) for the first lunch; and selected more spinach/broccoli (P = 0.04) for the second lunch. After the intervention, improvements were observed for spinach liking and neophobia for the HO group and cooking self-efficacy and KidMed score for both groups.Conclusions and ImplicationsBoth interventions succeeded in improving children's diet quality, but only the HO group reduced food neophobia levels. Therefore, involving children in choosing a recipe, purchasing ingredients, and cooking may promote changing eating behaviors toward healthy habits such as increasing vegetable consumption.     

Oregon Parents’ Perceptions of the Supportiveness of the School Environment for Their Children's Health Behaviors

ObjectiveTo describe Oregon parents’ perceptions of their children's school regarding health behaviors; examine how perceptions vary by parent, child, and community characteristics; and identify recommendations for improving school environments.MethodsOregon parents with an elementary school–aged child completed an electronic survey.ResultsOver 90% of parents (n = 814) described their child's school as supportive of healthy eating and physical activity. Parents who ate ≥5 fruits/vegetables per day more often perceived their children's school as unsupportive of healthy eating (P < 0.001) and physical activity (P < 0.05) relative to others. Parents of children eligible for free/reduced-price lunch more often perceived the school as unsupportive of physical activity (P < 0.05) relative to others. Parental recommendations included improving school meals and providing short physical activity breaks.Conclusions and ImplicationsParents’ suggested school improvements can inform school wellness committees’ and administrators’ quality-improvement efforts and, in turn, better support children's healthy behaviors.     

Fourth-Grade Cooking and Physical Activity Intervention Reveals Associations With Cooking Experience and Sex

ObjectiveExamine the impact of Fuel for Fun: Cooking with Kids Plus Parents and Play (FFF) on children's culinary self-efficacy, attitude, fruit and vegetable (FV) preferences, physical activity (PA), and body mass index.DesignRandomized controlled trial.SettingEight elementary schools in 2 Northern Colorado districts.ParticipantsFourth-grade students; 7-month interventions: school (S.FFF)—theory-based cooking + tasting lessons, active recess, lesson-driven cafeteria promotions; or school + family (S+F.FFF) with added family nights and home activities.Main Outcome Measure(s)Cooking self-efficacy and attitudes, FV preferences, PA, and measured height/weight.AnalysisIndividual outcomes nested by classroom, school, and district and assessed > 12 months with repeated measures controlled by sex and baseline cooking experience, with a significance level of P < 0.05.ResultsThe sample included 1,428 youth, 38 teachers, 4 cohorts, 50% boys, 75% White, and 15% Hispanic. No intervention effect was observed. Those who cooked retained higher self-efficacy, attitude, and FV preferences (P < 0.001). Girls reported higher self-efficacy and attitude than boys. Moderate-to-vigorous PA and metabolic equivalent minutes increased for all students; boys retained higher levels (P < 0.001). Body mass index percentile remained stable.Conclusions and ImplicationsCooking and sex were associated with all outcome measures and should be considered for intervention tailoring. Treatment impacts were not evident nesting by classroom, school, and district. Accurate assessment of school-based interventions requires rejecting student independence from group assignment assumptions.     

Social-Cognitive Correlates of Fruit and Vegetable Consumption in Minority and Non-Minority Youth

ObjectiveInadequate fruit and vegetable (FV) consumption signals a need for identifying predictors and correlates of intake, particularly in diverse adolescents.DesignParticipants completed an on-line assessment in early 2010.SettingComputer classrooms in 4 high schools.ParticipantsOne hundred twenty-two Caucasian and 125 minority (African American and Hispanic) high school students (mean age = 15.3 years, SD = 1.0) with parental consent. Response rate was 89%.Variables MeasuredSelf-efficacy as measured by confidence in goal setting and decision making about healthful eating; perceived benefits and barriers to eating FVs; healthful eating-related social support; body esteem; and FV intake.Analysist tests were used to examine group differences, and binary logistic regression analyses were conducted to explore the predictors of 5-A-Day FV consumption.ResultsThirty-four percent of the non-minority group and 28% of the minority group reported eating 5 or more portions of FVs a day (P = .34). Self-efficacy and perceived benefits predicted consumption in minority participants, whereas barriers and social support were significant predictors in the non-minority group.Conclusions and ImplicationsThese findings suggest different variables predict consumption for minority and non-minority groups and that self-efficacy is an important variable to consider in dietary change programs for minority adolescents.     

The Effect of Goal Setting on Fruit and Vegetable Consumption and Physical Activity Level in a Web-Based Intervention

ObjectiveTo explore the relationship between goal setting and fruit and vegetable (FV) consumption and physical activity (PA) in an intervention for college students.MethodsSecondary data analysis of intervention group participants from a 10-week online intervention with complete weekly data (n = 724). Outcomes (cups of FV per day and minutes of PA per week) and goals for both behaviors were reported online each week. Weekly differences between goals and behaviors were calculated, as well as the proportion meeting individual goals and meeting recommendations for behaviors.ResultsThere were significant (P < .05) effects of goal setting on both behaviors and of goal group (tertile of meeting weekly goals) on behavior, as well as meeting recommendations for both behaviors. There was an increase in FV consumption (P < .001) but no change in PA over time.Conclusions and ImplicationsGoal setting as part of a Web-based intervention for college students was effective, but results differed for FV and PA. Goal setting for maintaining behavior may need to differ from goal setting for changing behavior.     

Acceptance of a Novel Food is Related to Caregiver Perceptions of Infant and Toddler Food-related Receptive Language

ObjectiveLanguage development, both what is understood (receptive language) and spoken (expressive language), is considered critical to a child's ability to understand and interact with their environment. However, little research has investigated the role children's early language skills might play in their food acceptance. The objective of this study was to explore the relationships between young children's food-related receptive language (FRL) and food-related expressive language (FEL) and acceptance of novel food.MethodsCaregivers (n = 54) reported their perceptions of children's (aged 7–24 months) FRL and FEL using the MacArthur-Bates Communicative Development Inventory. Novel food acceptance was observed (grams consumed) during a laboratory visit. Multivariable linear regression tested associations between FRL, FEL, and novel food acceptance, by child age (infants [aged from 7 to < 12 months], toddlers [aged 12–24 months]), and at a significance level of P < 0.1 for hypothesis-generating research.ResultsChildren's FRL and food acceptance differed by age (F = 8.08, P = 0.01). Among toddlers, greater FRL was associated with greater novel food acceptance (0.22 g [95% confidence interval, ?0.04 to 0.49]), P = 0.09). In infants, greater FRL was associated with lower novel food acceptance (?0.80 g [95% confidence interval, ?1.53 to ?0.07], P = 0.03). No association between FEL and novel food acceptance was noted in either group.Conclusions and ImplicationsToddlers’ understanding of food-related vocabulary may facilitate food acceptance; however, young infants may not yet have sufficient FRL to facilitate novel food acceptance.     

Impact of the National School Lunch Program on Fruit and Vegetable Selection in Northeastern Elementary Schoolchildren, 2012–2013

Increasing children''s fruit and vegetable (FV) consumption is an important goal of the U.S. Department of Agriculture''s (USDA''s) National School Lunch Program. Since 2012, the USDA''s requirement that children select FVs at lunch as part of the reimbursable school meal has been met with concern and evidence of food waste. We compared elementary schoolchildren''s FV selection, consumption, and waste before (10 school visits, 498 tray observations) and after (11 school visits, 944 tray observations) implementation of this requirement using validated dietary assessment measures. More children selected FVs in higher amounts when FVs were required compared with when they were optional (0.69 cups vs. 0.89 cups, p<0.001); however, consumption decreased slightly (0.51 cups vs. 0.45 cups, p=0.01) and waste increased (0.25 cups vs. 0.39 cups, p<0.001) when FVs were required compared with when they were optional. More exposure to FVs in schools through programmatic efforts and in the home environment may help familiarize children with FV offerings and encourage consumption.The majority of U.S. children do not consume recommended amounts of fruit and vegetables (FVs).¹ Increasing children''s consumption of FVs is an important goal of the National School Lunch Program, which feeds nearly 31 million children each school day.² As of the 2012 school year, the U.S. Department of Agriculture (USDA) requires schoolchildren to select either a fruit or a vegetable with a reimbursable meal.³ Implementation of this requirement raised concerns among school nutrition professionals surrounding operational challenges, FV waste, and increased costs.⁴ Two years later, school districts and states reported increased waste by students.^5,6 In a recent survey completed by 240 school nutrition directors, more than 80% subjectively reported an increase in the amount of FVs (especially vegetables) wasted by students.⁶ However, a limited number of studies exist that used rigorous, validated dietary assessment methods to measure schoolchildren''s FV selection, consumption, and waste.^7,8 Such studies are critical to inform and evaluate interventions aimed at increasing children''s FV consumption. We aimed to compare schoolchildren''s FV selection, consumption, and waste using validated dietary assessment methods when FVs were optional compared with when they were required with school lunch by the USDA.     

School Lunch Environmental Factors Impacting Fruit and Vegetable Consumption

Objective

Assess impact of school lunch environmental factors on fruit and vegetable (F&V) consumption in second and third grade students.

Evaluation of a school-based multicomponent nutrition education program to improve young children's fruit and vegetable consumption

ObjectiveTo assess the impact of a multicomponent nutrition education program on student knowledge, attitudes, and behaviors related to consumption of fruits and vegetables (FVs).DesignQuasi-experimental pretest/posttest research design; 3 study conditions (Intervention+, Intervention, Comparison).SettingSix schools from the Los Angeles Unified School District (LAUSD).ParticipantsThree hundred ninety-nine low-income third-, fourth-, and fifth-grade students.InterventionThe Intervention+ condition included 4 components: traditional Network–LAUSD program, new standardized nutrition curriculum, teacher training workshops, and parent nutrition education workshops. The Intervention condition included 2 components: traditional Network–LAUSD program and teacher training workshops.Main Outcome MeasuresFruit and vegetable consumption, knowledge of food groups, attitudes and beliefs toward FVs, and parent/teacher influence on students’ attitudes toward FVs.AnalysisLinear mixed models.ResultsThe Intervention+ resulted in a positive change in knowledge (P < .05), attitudes and beliefs toward vegetables (P < .01), and teacher influence on students’ FV attitudes (P < .05).Conclusions and ImplicationsAlthough this study influenced knowledge and attitudes regarding FVs, a significant increase in students’ FV consumption was not observed. Given the ultimate aim of the LAUSD nutrition efforts is to increase FV consumption, future studies should consider adopting new intervention strategies, such as focusing on changing the school food environment.     

Parents' physical activity-related perceptions of their children with disabilities

BackgroundParental support of children's physical activity is important, especially for young children with disabilities, given their low rates of physical activity and dependence on parents.ObjectiveThe primary purpose of the current study was to examine multidimensional sources of parental support and whether these perceptions were related to parents’ perceptions of their children's physical ability.MethodsParents (N = 68) of children with disabilities completed scales assessing how much they role modeled, encouraged, and enjoyed physical activity in addition to their perceptions of their children's physical ability and peer relations in sport.ResultsParents were encouraging of their children's physical activity and sport participation. Although they did not view their children as being particularly skilled, they perceived that they enjoyed physical activity and sport. Parents also perceived their children's peer relations in physical activity and sport settings as being fairly neutral and to some extent contingent upon how physically capable they were seen by their peers.ConclusionsParents’ support of their children's sport and physical activity was not contingent on how physically capable they viewed their children, which is encouraging. Adult leaders of sports program should consider monitoring peer relations in their programs in order to teach appropriate helping and peer behaviors.     

Determinants of Healthy Diet Among Children Exposed and Unexposed to Gestational Diabetes

ObjectivesTo evaluate the association between individual and environmental determinants of diet quality with diet quality of children exposed to gestational diabetes mellitus (GDM+) and unexposed (GDM?); to study the association between mother and child vegetables and fruit (VF) intakes.DesignCross-sectional study.ParticipantsOne hundred forty-two children (104 GDM+; 38 GDM?) aged 6.2 ± 2.5 years.VariablesCanadian Healthy Eating Index 2007 (HEI-C) and VF were obtained with 2 24-hour dietary recall questionnaires in children. Maternal VF was obtained by a validated food frequency questionnaire, and weight and height were measured. Sociodemographic determinants were obtained by questionnaires.AnalysisLinear regression models were used to evaluate the association between individual and environmental determinants and the HEI-C score with interaction for GDM status.ResultsFamily meals were associated with HEI-C among GDM? but not GDM+ children (β = 9.97, P = 0.01 and β = ?0.41, P = 0.84, respectively; P for interaction = 0.02). Children's age (β = ?1.45; 95% confidence interval, ?2.19 to ?0.72; P < 0.001) was a determinant of HEI-C among all children. Maternal VF intakes were positively associated with children's VF intake (r = 0.30, P < 0.001, r² = 0.09), with association of larger variance among GDM? children (r = 0.38, r² = 0.14, P = 0.02) than GDM+ children (r = 0.23, r² = 0.05, P = 0.02).ConclusionsThe food environment at home was associated differently with the diet quality of GDM+ and GDM? children. Whether targeting family meals and maternal diet quality is a good strategy to improve children's diet quality among GDM+ children needs to be further investigated.