The Frequency and Context of Snacking among Children: An Objective Analysis Using Wearable Cameras

Snacking is a common eating behaviour, but there is little objective data about children’s snacking. We aimed to determine the frequency and context of children’s snacking (n = 158; mean age = 12.6 years) by ethnicity, gender, socioeconomic deprivation and body mass index (BMI) children. Participants wore wearable cameras that passively captured images of their surroundings every seven seconds. Images (n = 739,162) were coded for snacking episodes, defined as eating occasions in between main meals. Contextual factors analysed included: snacking location, food source, timing, social contact and screen use. Rates of total, discretionary (not recommended for consumption) and healthful (recommended for consumption) snacking were calculated using negative binomial regression. On average, children consumed 8.2 (95%CI 7.4, 9.1) snacks per day, of which 5.2 (95%CI 4.6, 5.9) were discretionary foods/beverages. Children consumed more discretionary snacks than healthful snacks in each setting and at all times, including 15.0× more discretionary snacks in public spaces and 2.4× more discretionary snacks in schools. Most snacks (68.9%) were sourced from home. Girls consumed more total, discretionary and healthful snacks than boys, and Māori and Pacific consumed fewer healthful snacks than New Zealand (NZ) Europeans. Results show that children snack frequently, and that most snacking involves discretionary food items. Our findings suggest targeting home buying behaviour and environmental changes to support healthy snacking choices.     

Dietary factors are not associated with high levels of obesity in New Zealand Pacific preschool children

Pacific children living in New Zealand (NZ) are prone to excessive weight gain. In this study, we assessed the anthropometric status of 2- to 5-y-old Pacific children (n = 60) in relation to their macronutrient intakes. Measurements of height (n = 56), weight (n = 60), midarm circumference, and triceps skinfold thickness (n = 58), and 2-d weighed food records (n = 60) and demographic data were collected. Z-score results (mean +/- SD) showed that these children were tall (0.61 +/- 1.1) and heavy (1.67 +/- 1.1) for their age, and had high arm-muscle-area-for-height (geometric mean, 2.05). Over 64 and 45% of children were classified as overweight (including obesity) and obese, respectively. The percentage of energy contributed by fat in their diets met recommendations. In contrast, the percentage of energy contributed by sugar was high. The macronutrient intakes of children classified as obese (n = 32) compared with non-obese (n = 24) did not differ; however, their adjusted energy intakes were higher [5.79 (1.4) vs. 4.97 (1.4) MJ/d; P = 0.01]. Overweight and obesity were very common among very young NZ Pacific children, although the dietary etiology was not elucidated. These results emphasize the urgent need for obesity prevention for NZ Pacific children that begins early in life to avoid a future public health crisis.     

Diet, health and the nutrition transition: some impacts of economic and socio-economic factors on food consumption patterns in the Kingdom of Tonga

An essential element of the "health transition" is the emergence of disease patterns associated with changes in dietary regimes. The consumption of nutritionally poor (imported) foods in the Pacific is associated with increasing rates of diet related non-communicable diseases (NCDs). An oft-made assumption is that changes in consumption patterns are related to food preference (specifically preferences for high fat and/or dense carbohydrate foods). Recent work in the Kingdom of Tonga suggests that the "common-sense" association between food preference and food consumption is incorrect. The results of a large survey (n=430) indicate availability is the key factor in consumption, and that food preference, knowledge of the nutritional values of foods, and frequency of consumption are not correlated. Further analysis shows there are significant differences in consumption patterns between persons of higher and lower socio-economic status; perception of availability and frequency of consumption are a function of economic and social position--specifically access to cash. These results underline the salience of economic factors; the rise in NCDs is correlated with the increasing importance of the cash economy (not cultural values or ignorance of nutritional issues). In the absence of economic solutions, current consumption patterns will continue.     

CONSUMPTION OF TRADITIONAL VERSUS IMPORTED FOODS IN TONGA: IMPLICATIONS FOR PROGRAMS DESIGNED TO REDUCE DIET-RELATED NON-COMMUNICABLE DISEASES IN DEVELOPING COUNTRIES

In Tonga as elsewhere, consumption of inexpensive, high calorie, fatty foods are associated with increases in diet-related non-communicable diseases (NCDs). Programs have been designed to educate people about dangers associated with these foods, but if consumption has increased for economic reasons (e.g., price or availability), such programs may have minimal impact, and other policy options are warranted. A quantitative questionnaire study was conducted in Tonga using a broad sample from different areas (n = 430). The survey elicited information on: preferences for, frequency of consumption of, perception of nutritional value of, and (for a subset) the availability of, 36 traditional and imported foods. People prefer traditional foods and accurately perceive these as more nutritious. However, consumption patterns do not coincide with preference or nutritional value. Policy designed to improve NCDs should, therefore, address the general linkage between economic development and detrimental consumption patterns, and promote the availably and cost competitiveness of healthier, traditional foods.     

Hyperendemic subperiodic Bancroftian filariasis: a search for clinical and immunological correlates of microfilaraemia

A study was carried out in the Kingdom of Tonga, an area of hyperendemic Bancroftian filariasis, to determine whether correlations could be made between microfilaraemia, as diagnosed by membrane filter concentration, and immunological (skin test, immunoglobulin levels) or clinical findings. There was no relationship between the presence or degree of microfilaraemia and any clinical manifestation or skin test reaction. The skin test positivity rate for microfilaraemic and amicrofilaraemic individuals was approximately the same for all age groups. Among those aged 0 to 4 years, 48% of microfilaria positives were negative in the skin test. The highest average IgG and IgE levels were found in the groups with the highest microfilarial densities, i.e., in children with a history of fever and in adults with a history of lymphangitis/lymphadenitis. Over a period of a year, the microfilarial density changed significantly in 18 (34%) of 53 adults.