Preliminary Exploration of Obesity-Related Eating Behaviour Patterns in a Sample of Saudi Preschoolers Aged 2–6 Years through the Children’s Eating Behaviour Questionnaire

Background: The Children’s Eating Behaviour Questionnaire (CEBQ) is used with parents to determine the characteristics of eating behaviour of their children and, consequently, children’s propensity to become obese. It has been successfully used mainly in Western countries, but not in Saudi Arabia. In this pilot study, we explored the use of the Saudi version of the CEBQ for preschool children aged 2–6 years in Saudi Arabia, and assessed the associations between eating behaviours and children’s age, gender and relative weight and parental weight. Methods: Parents of 200 Saudi preschool children in Riyadh completed the Saudi version of the CEBQ. Factor analyses on all CEBQ items were performed and differences between genders and age groups were examined. Correlations between children’s BMI z-scores and eating behaviours were analysed using linear regression. Results: The factor analysis revealed an eight-factor solution similar to the theoretical factor structure, with good internal reliability and acceptable correlations between subscales. Boys scored higher than girls on food responsiveness; no difference between age groups was found. Positive associations between BMI z-scores and ‘food approach’ subscales, food responsiveness, enjoyment of food and emotional overeating were found, while ‘food avoidant’ subscales, satiety responsiveness and slowness in eating had inverse relationships with BMI z-scores. Maternal BMI had a positive association with BMI z-scores and food responsiveness. Conclusion: The CEBQ is a valid psychometric tool that can be reliably used to assess eating behaviour characteristics in Saudi preschool children.     

Translation of Two Healthy Eating and Active Living Support Programs for Parents of 2–6-Year-Old Children: Outcomes of the ‘Time for Healthy Habits’ Parallel Partially Randomised Preference Trial

This translation study assessed the effectiveness of two remotely delivered healthy eating and active living interventions for parents of 2- to 6-year-old children in improving child fruit and vegetable intake, non-core food intake, body mass index (BMI), physical activity, screen time, and sleep. Parents (n = 458) were recruited to a partially randomised preference trial comprising three intervention groups. Healthy Habits Plus comprised six telephone calls, Time2bHealthy comprised six online modules, and the active control comprised ten information sheets and a summary booklet. Data were collected from parents via a telephone questionnaire at baseline and nine months post-baseline. Data were analysed for randomised participants alone (n = 240), preference participants alone (n = 218), and all participants combined (n = 458). There was no significant improvement in fruit and vegetable intake (primary outcome) when comparing the telephone and online interventions to the control. In both the randomised only and all participants combined analyses, there was a significant improvement in non-core food intake for the telephone intervention compared to the control (p < 0.001). Differences between interventions for other outcomes were small. In conclusion, the telephone and online interventions did not improve child fruit and vegetable intake relative to written materials, but the telephone intervention did improve non-core food intake.     

Increasing Fruit and Vegetable Variety over Time Is Associated with Lower 15-Year Healthcare Costs: Results from the Australian Longitudinal Study on Women’s Health

Healthcare costs are lower for adults who consume more vegetables; however, the association between healthcare costs and fruit and vegetable varieties is unclear. Our aim was to investigate the association between (i) baseline fruit and vegetable (F&V) varieties, and (ii) changes in F&V varieties over time with 15-year healthcare costs in an Australian Longitudinal Study on Women’s Health. The data for Survey 3 (n = 8833 women, aged 50–55 years) and Survey 7 (n = 6955, aged 62–67 years) of the 1946–1951 cohort were used. The F&V variety was assessed using the Fruit and Vegetable Variety (FAVVA) index calculated from the Cancer Council of Victoria’s Dietary Questionnaire for Epidemiological Studies food frequency questionnaire. The baseline FAVVA and change in FAVVA were analysed as continuous predictors of Medicare claims/costs by using multiple regression analyses. Healthy weight women made, on average, 4.3 (95% confidence interval (CI) 1.7–6.8) fewer claims for every 10-point-higher FAVVA. Healthy weight women with higher fruit varieties incurred fewer charges; however, this was reversed for women overweight/obese. Across the sample, for every 10-point increase in FAVVA over time, women made 4.3 (95% CI 1.9–6.8) fewer claims and incurred $309.1 (95% CI $129.3–488.8) less in charges over 15 years. A higher F&V variety is associated with a small reduction in healthcare claims for healthy weight women only. An increasing F&V variety over time is associated with lower healthcare costs.     

Dietary Habits of a Group of Children with Crohn’s Disease Compared to Healthy Subjects: Assessment of Risk of Nutritional Deficiencies through a Bromatological Analysis

Diet is a matter of interest in the pathogenesis and management of Crohn’s Disease (CD). Little is known about CD children’s dietary habits. Our aim was assessing the quality and the amount of nutrient intake in a group of CD pediatric patients. Data were compared with those of healthy subjects (HS). In total, 20 patients (13 males) and 48 HS (24 males) aged 4–18 years were provided with a food diary to fill out for one week. Winfood software performed the bromatological analysis, providing data about intakes of proteins and amino acids, fatty acids, carbohydrates, cholesterol, fibers, minerals, vitamins, and polyphenols. Estimates of the antioxidant activity of foods and of the dietetic protein load were also calculated. The diet of CD patients was poorer in fibers, polyphenols, vitamin A, beta-carotene, and fatty acids, and richer in animal proteins, vitamin B12, and niacin. PRAL was higher in CD patients’ diets, while ORAC was higher in HS. No significant differences were observed in carbohydrate and other macro- and micronutrient consumptions. CD dietary habits seem to reflect the so-called Western diet, possibly involved in CD pathogenesis. Furthermore, analysis of dietary habits allows for prevention of nutritional deficiencies and timely correction through education and supplementation.     

Padres Preparados,Jóvenes Saludables: A Randomized Controlled Trial to Test Effects of a Community-Based Intervention on Latino Father’s Parenting Practices

Parenting practices have been associated with adolescent lifestyle behaviors and weight status. Evidence is limited regarding the efficacy of interventions to address father influences on adolescent lifestyle behaviors through availability and modeling practices. Therefore, the purpose of this study was to evaluate changes in father parenting practices after Latino families with adolescents participated in the Padres Preparados Jóvenes Saludables (Padres) program. Time-1 (baseline) and Time-2 (post-intervention) data were used from Latino father/adolescent (10–14 years) dyads enrolled in the Padres two-arm (intervention vs. delayed-treatment control group) randomized controlled trial in four community locations. The program had eight weekly, 2.5-h experiential learning sessions on food preparation, parenting practices, nutrition, and physical activity. Two types of parenting practices (role modeling and home food availability) were assessed by father report via questionnaire for each of 7 lifestyle behaviors, for a total of 14 parenting practices. Linear regression mixed models were used to evaluate the intervention effects. A total of 94 father/adolescent dyads completed both Time-1 and Time-2 evaluations. Significant positive intervention effects were found for frequencies of fruit modeling (p = 0.002) and screen time modeling (p = 0.039). Non-significant results were found for the other 12 father parenting practices.     

Insulin/IGF-1 Signaling Is Downregulated in Barrett’s Esophagus Patients Undergoing a Moderate Calorie and Protein Restriction Program: A Randomized 2-Year Trial

Obesity and associated insulin resistance (Ins-R) have been identified as important risk factors for esophageal adenocarcinoma development. Elevated calories and protein consumption are also associated with Ins-R and glucose intolerance. We investigated the effect of a 24-month moderate calorie and protein restriction program on overweight or obese patients affected by Barrett’s esophagus (BE), as no similar dietary approach has been attempted to date in this disease context. Anthropometric parameters, levels of serum analytes related to obesity and Ins-R, and the esophageal insulin/IGF-1 signaling pathway were analyzed. This study is registered with ClinicalTrials.gov, number {"type":"clinical-trial","attrs":{"text":"NCT03813381","term_id":"NCT03813381"}}NCT03813381. Insulin, C-peptide, IGF-1, IGF-binding protein 3 (IGFBP3), adipokines, and esophageal expression of the main proteins involved in insulin/IGF-1 signal transduction were quantified using Luminex-XMAP^® technology in 46 patients who followed the restriction program (IA) and in 54 controls (CA). Body mass index and waist circumference significantly decreased in 76.1% of IA and 35.2% of CA. IGF-1 levels were reduced in 71.7% of IA and 51.8% of CA. The simultaneous reduction of glycaemia, IGF-1, the IGF-1/IGFBP3 ratio, and the improvement in weight loss-dependent insulin sensitivity, were associated with the downregulation of the insulin/IGF-1 signal on BE tissue. The proposed intervention program was an effective approach to counteract obesity-associated cancer risk factors. The improvement in metabolic condition resulted in a downregulation of the ERK-mediated mitogenic signal in 43.5% of patients, probably affecting the molecular mechanism driving adenocarcinoma development in BE lesions.     

The Effect of Consumption of Animal Milk Compared to Infant Formula for Non-Breastfed/Mixed-Fed Infants 6–11 Months of Age: A Systematic Review and Meta-Analysis

Many infants do not receive breastmilk for the recommended 2-year duration. Instead, alternative milk beverages are often used, including infant formula and raw animal milk products. The purpose of this systematic review was to summarize the effect of animal milk consumption, compared to infant formula, on health outcomes in non-breastfed or mixed-fed infants aged 6–11 months. We searched multiple databases and followed Cochrane guidelines for conducting the review. The primary outcomes were anemia, gastrointestinal blood loss, weight-for-age, length-for-age, and weight-for-length. Nine studies were included: four randomized controlled trials (RCT) and five cohort studies. All studies, except one, were conducted in high income countries. There was a low certainty of evidence that cow’s milk increased the risk of anemia compared to formula milk (Cohort studies RR: 2.26, 95% CI: 1.15, 4.43, RCTs: RR: 4.03, 95% CI: 1.68, 9.65) and gastrointestinal blood loss (Cohort study RR: 1.52, 95% CI: 0.73, 3.16, RCTs: RR: 3.14, 95% CI: 0.98, 10.04). Additionally, there was low certainty evidence that animal milk consumption may not have a differential effect on weight and length-for-age compared to formula milk. Overall, the evidence was of low certainty and no solid conclusions can be drawn from this data. Further studies are needed from low- and middle-income countries to assess optimal milk type in non-breastfed infants aged 6–11 months.     

The application of an information support robot to reduce agitation in an older adult with Alzheimer’s disease living alone in a community dwelling: a case study

Objective/background:Agitation is a common behaviour of Alzheimer’s Disease (AD). Although healing robots have previously been used for alleviating agitation for people with dementia in hospitals and other healthcare facilities, its effects remain unclear whether an information-support robot capable of disseminating information with user needs may have similar effects when it is applied in community dwellings. This study was to investigate the effects of information-support robots for reducing agitation in older people with AD residing alone in community-dwellings.MethodsOne participant with AD who lived alone in a community-dwelling was recruited. Participant’s frequencies, durations, and time courses of four patterns of agitation at home at baseline and during intervention were analysed. In this study, agitation was defined as: (a) restlessness going to the corridor (RLtoC), (b) restlessness going to the toilet (RLtoT), (c) restlessness going to the entrance (RLtoE), and (d) restlessness going to multiple places (RLtoMP). In the intervention phase, the information-support robot disseminated daily schedule or date information to the participant.ResultsRLtoC and RLtoMP were significantly reduced in frequency during the intervention. The durations of each episode of RLtoT and RLtoMP in the intervention were slightly reduced than those at the baseline. There were no differences in time courses of episodes of RLtoC and RLtoMP after the intervention.ConclusionThis case study showed that information-support robot was useful to alleviate agitation of an older adult with AD living alone in a community-dwelling. Further study is warranted.     

The New Hybrid Nutrient Density Score NRFh 4:3:3 Tested in Relation to Affordable Nutrient Density and Healthy Eating Index 2015: Analyses of NHANES Data 2013–16

Background: Hybrid nutrient density scores are based on both nutrients and selected food groups. Objective: To compare the new hybrid nutrient-rich food NRFh 4:3:3 score to other nutrient-rich food (NRF) scores, energy density, and energy cost and to model the impact on the Healthy Eating Index (HEI-2015) of partially replacing less nutrient-rich with more nutrient-rich foods. Methods: Analyses were based on 5870 foods and beverages in the Food and Nutrient Database for Dietary Studies and on 24 h dietary recalls from the National Health and Nutrition Examination Survey (NHANES 2013–16). The NRFh 4:3:3 model was based on four nutrients to encourage (protein fiber, potassium, MUFA + PUFA); three food groups to encourage (dairy, fruit, whole grains); and three nutrients to limit (saturated fat, added sugar, sodium). Ratings generated by NRFh 4:3:3 and by other NRF models were correlated with score components, energy density (kcal/100 g), and energy cost (USD/100 kcal). The impact on HEI-2015 of replacing foods in the lowest nutrient density tertile (T1) with top tertile (T3) foods at 10%, 20%, 30%, and 100% equicaloric replacement was modeled using NHANES 2013–16 dietary data by population subgroups. Results: The NRFh 4:3:3 model awarded higher scores to foods containing dairy, fruit, and whole grains and proportionately lower scores to vegetables when compared to the NRF 9.3 model. Higher NRF and NRFh nutrient density scores were linked to lower energy density and higher energy cost; however, both correlations were lower for the NRFh 4:3:3. Isocaloric replacement of bottom tertile with top tertile foods as rated by both models led to significantly higher HEI-2105 values, based on complete (100%) and on partial (10–30%) replacement. Conclusion: The new NRFh 4:3:3 model provides the basis for developing new metrics of affordable nutrient density. The model identified “best value” food categories that were both affordable and nutrient-rich. Total and partial replacement of low nutrient density with high nutrient density foods was associated with higher HEI-2015 scores, suggesting that even partial inclusion of more nutrient dense foods in the diet may have an important impact on total diet quality.