Jillian J. Haszard

Factor analysis of the Comprehensive Feeding Practices Questionnaire in a large sample of children.

How parents feed their children may impact on their weight and eating behaviours, both now and in the future. The Comprehensive Feeding Practices Questionnaire (CFPQ) proposes to measure parental feeding practices and was originally developed using 12 factors in relatively small, homogenous samples. In contrast the present study used a large, diverse sample (n=1013) of children aged 4-8years. A confirmatory factor analysis showed that the original 12-factor model was not a good fit and that several factors were strongly inter-correlated. A subsequent exploratory factor analysis yielded five scales of interest: Healthy Eating Guidance, Monitoring, Parent Pressure, Restriction and Child Control. These scales were largely supported by further analyses in these data. Parents who were concerned about their child being overweight reported more Healthy Eating Guidance and Restriction and less Parent Pressure, whereas parents concerned about their child being underweight used more Parent Pressure and less Healthy Eating Guidance. Parents who rated a healthy diet for their child as very important undertook more Healthy Eating Guidance and Monitoring of food intake and less Child Control. These five factors from the CFPQ provide a well-supported and useful set of feeding practices that could be applicable to a wide variety of population groups.

Associations between parental feeding practices, problem food behaviours and dietary intake in New Zealand overweight children aged 4–8 years

OBJECTIVE Parents report that childrens eating behaviours are a major barrier to providing them with a healthy diet. Links between problem eating behaviours and parental feeding practices are not well established and have not previously been examined in overweight children. The aim of the present study was to assess associations between problem food behaviours, dietary intake and parental feeding practices of overweight children aged 4-8 years. DESIGN Participants were recruited for a lifestyle intervention (n 203). At baseline, childrens BMI was measured and parents completed comprehensive questionnaires about the feeding practices they used, the problem food behaviours their children exhibited and the foods their child consumed. A fussy eating scale was developed and associations were determined using correlations and regression analysis, including interactions. SETTING Dunedin, New Zealand. SUBJECTS Overweight children aged 4-8 years. RESULTS Healthy eating guidance and monitoring by parents were related to the consumption of fewer unhealthy foods (B=-0·4, P=0·001 and B=-0·4, P<0·001). Conversely, a lack of parental control (child control) was related to a higher intake of unhealthy foods (B = 0·5, P<0·001). Parents of children who were fussy eaters monitored their childs food intake less (P<0·001) and allowed the child more freedom over what he/she ate (P<0·001). These children consumed fewer fruit and vegetables than those who were not fussy eaters (P<0·001). However, fussy eaters with food-restrictive parents ate more fruit and vegetables (B=2·9, P<0·001). CONCLUSIONS These results suggest that a more structured food environment might be beneficial for the diet and food behaviours of young overweight children.

A Tailored Family-Based Obesity Intervention: A Randomized Trial

OBJECTIVE: To determine whether a 2-year family-based intervention using frequent contact and limited expert involvement was effective in reducing excessive weight compared with usual care. METHODS: Two hundred and six overweight and obese (BMI ≥85th percentile) children aged 4 to 8 years were randomized to usual care (UC) or tailored package (TP) sessions at university research rooms. UC families received personalized feedback and generalized advice regarding healthy lifestyles at baseline and 6 months. TP families attended a single multidisciplinary session to develop specific goals suitable for each family, then met with a mentor each month for 12 months, and every third month for another 12 months to discuss progress and provide support. Outcome measurements (anthropometry, questionnaires, dietary intake, accelerometry) were obtained at 0, 12, and 24 months. RESULTS: BMI at 24 months was significantly lower in TP compared with UC children (difference, 95% confidence interval: –0.34, –0.65 to –0.02), as was BMI z score (–0.12, –0.20 to –0.04) and waist circumference (–1.5, –2.5 to –0.5 cm). TP children consumed more fruit and vegetables (P = .038) and fewer noncore foods (P = .020) than UC children, and fewer noncore foods were available in the home (P = .002). TP children were also more physically active (P = .035). No differences in parental feeding practices, parenting, quality of life, child sleep, or behavior were observed. CONCLUSIONS: Frequent, low-dose support was effective for reducing excessive weight in predominantly mild to moderately overweight children over a 2-year period. Such initiatives could feasibly be incorporated into primary care.

How different are baby-led weaning and conventional complementary feeding? A cross-sectional study of infants aged 6–8 months

Objectives To compare the food, nutrient and ‘family meal’ intakes of infants following baby-led weaning (BLW) with those of infants following a more traditional spoon-feeding (TSF) approach to complementary feeding. Study design and participants Cross-sectional study of dietary intake and feeding behaviours in 51 age-matched and sex-matched infants (n=25 BLW, 26 TSF) 6–8 months of age. Methods Parents completed a questionnaire, and weighed diet records (WDRs) on 1–3 non-consecutive days, to investigate food and nutrient intakes, the extent to which infants were self-fed or parent-fed, and infant involvement in ‘family meals’. Results BLW infants were more likely than TSF infants to have fed themselves all or most of their food when starting complementary feeding (67% vs 8%, p<0.001). Although there was no statistically significant difference in the large number of infants consuming foods thought to pose a choking risk during the WDR (78% vs 58%, p=0.172), the CI was wide, so we cannot rule out increased odds with BLW (OR, 95% CI: 2.57, 0.63 to 10.44). No difference was observed in energy intake, but BLW infants appeared to consume more total (48% vs 42% energy, p<0.001) and saturated (22% vs 18% energy, p<0.001) fat, and less iron (1.6 vs 3.6 mg, p<0.001), zinc (3.0 vs 3.7 mg, p=0.001) and vitamin B12 (0.2 vs 0.5 μg, p<0.001) than TSF infants. BLW infants were more likely to eat with their family at lunch and at the evening meal (both p≤0.020). Conclusions Infants following BLW had similar energy intakes to those following TSF and were eating family meals more regularly, but appeared to have higher intakes of fat and saturated fat, and lower intakes of iron, zinc and vitamin B12. A high proportion of both groups were offered foods thought to pose a choking risk.

Consumption of fortified infant foods reduces dietary diversity but has a positive effect on subsequent growth in infants from Sumedang district, Indonesia

Stunting and underweight among under-five children in Indonesia are common, raising public health concerns. Whether inappropriate complementary feeding (CF) practices compromise optimal growth during late infancy in Indonesia is uncertain. Therefore we characterized and evaluated CF practices in Indonesian infants and investigated their relationship with subsequent growth. We enrolled breastfed infants at 6 months of age (n = 230); and followed them at 9 (n = 202) and 12 months of age (n = 190). We collected socio-demographic and anthropometric data and two-day in-home weighed food records. Relations between WHO CF indicators, sentinel foods, and energy and micronutrient intakes at 9 months and growth at 12 months were explored using multiple linear regression. Stunting and underweight increased from 15.8% and 4.4% at 6 months to 22.6% and 10.5% at 12 months, respectively. Median intakes of calcium, iron, zinc, and riboflavin were below WHO recommendations. Infants consuming fortified infant foods (FIFs) at 9 months had diets with a lower dietary diversity (DD) score (2.3 vs.3.0), energy density, median energy (250 vs. 310 kcal/d) and protein (6.5 vs. 9.1 g/d) intake than non-consumers (p<0.01), despite higher intakes of calcium, iron, and vitamins A and C (p<0.001). Positive relations existed for 9-month consumption of iron-rich/iron fortified infant foods with length-for-age Z-score (LAZ) at 12 months (β = 0.22; 95% CI: 0.01, 0.44; P = 0.04), and for fortified infant foods alone with both LAZ (β = 0.29; 95% CI: 0.09, 0.48; P = 0.04) and weight-for-age Z-score (β = 0.14; 95% CI: 0.02, 0.26; P = 0.02) at 12 months. The positive association of FIFs with subsequent growth may be attributed to their content of both powdered cow’s milk and multi-micronutrient fortificants. Nonetheless, mothers should not be encouraged to over-rely on FIFs as they reduce DD.

Knowledge and attitudes to vitamin D and sun exposure in elite New Zealand athletes: a cross-sectional study

BackgroundSun safety and vitamin D status are important for prolonged health. They are of particular interest to those working with athletes for whom for whom safe sun practices maybe limited.The aim of this cross-sectional study was to describe the attitudes of elite New Zealand athletes to both vitamin D and sun exposure.Methods110 elite New Zealand outdoor athletes volunteered to participate in an interview with a trained interviewer. The interviewer asked the athletes questions on their Vitamin D knowledge, attitudes and practices regarding sun exposure as well as their concerns about skin cancer.ResultsAthletes were more concerned about their risk of skin cancer (66%) than their vitamin D status (6%). Although the majority (97%) were aware of Vitamin D and could identify the sun as a source (76%) only 17% could name another source of Vitamin D.Only 10 (9%) reported always applying sunscreen before going out in the sun. No athlete reported reapplying sunscreen every hour and 25 suggesting that they never reapply sunscreen.ConclusionsAthletes are concerned about skin cancer however, their use of sunscreen is not optimal suggesting reapplication of sunscreen could be targeted in order to reduce the risk of sun cancer. Awareness of sources of Vitamin D other than the sun may also need to be improved potentially through educational interventions and possibly in conjunction with sun smart messages.

Estimating Free and Added Sugar Intakes in New Zealand

The reduction of free or added sugar intake (sugars added to food and drinks as a sweetener) is almost universally recommended to reduce the risk of obesity-related diseases and dental caries. The World Health Organisation recommends intakes of free sugars of less than 10% of energy intake. However, estimating and monitoring intakes at the population level is challenging because free sugars cannot be analytically distinguished from naturally occurring sugars and most national food composition databases do not include data on free or added sugars. We developed free and added sugar estimates for the New Zealand (NZ) food composition database (FOODfiles 2010) by adapting a method developed for Australia. We reanalyzed the 24 h recall dietary data collected for 4721 adults aged 15 years and over participating in the nationally representative 2008/09 New Zealand Adult Nutrition Survey to estimate free and added sugar intakes. The median estimated intake of free and added sugars was 57 and 49 g/day respectively and 42% of adults consumed less than 10% of their energy intake from free sugars. This approach provides more direct estimates of the free and added sugar contents of New Zealand foods than previously available and will enable monitoring of adherence to free sugar intake guidelines in future.

The Association between Parent Diet Quality and Child Dietary Patterns in Nine- to Eleven-Year-Old Children from Dunedin, New Zealand

Previous research investigating the relationship between parents’ and children’s diets has focused on single foods or nutrients, and not on global diet, which may be more important for good health. The aim of the study was to investigate the relationship between parental diet quality and child dietary patterns. A cross-sectional survey was conducted in 17 primary schools in Dunedin, New Zealand. Information on food consumption and related factors in children and their primary caregiver/parent were collected. Principal component analysis (PCA) was used to investigate dietary patterns in children and diet quality index (DQI) scores were calculated in parents. Relationships between parental DQI and child dietary patterns were examined in 401 child-parent pairs using mixed regression models. PCA generated two patterns; ‘Fruit and Vegetables’ and ‘Snacks’. A one unit higher parental DQI score was associated with a 0.03SD (CI: 0.02, 0.04) lower child ‘Snacks’ score. There was no significant relationship between ‘Fruit and Vegetables’ score and parental diet quality. Higher parental diet quality was associated with a lower dietary pattern score in children that was characterised by a lower consumption frequency of confectionery, chocolate, cakes, biscuits and savoury snacks. These results highlight the importance of parental modelling, in terms of their dietary choices, on the diet of children.

Parental motivation to change body weight in young overweight children.

OBJECTIVE To determine what factors are associated with parental motivation to change body weight in overweight children. DESIGN Cross-sectional study. SETTING Dunedin, New Zealand. SUBJECTS Two hundred and seventy-one children aged 4-8 years, recruited in primary and secondary care, were identified as overweight (BMI ≥ 85th percentile) after screening. Parents completed questionnaires on demographics; motivation to improve diet, physical activity and weight; perception and concern about weight; parenting; and social desirability, prior to being informed that their child was overweight. Additional measures of physical activity (accelerometry), dietary intake and child behaviour (questionnaire) were obtained after feedback. RESULTS Although all children were overweight, only 42% of parents perceived their child to be so, with 36% indicating any concern. Very few parents (n 25, 8%) were actively trying to change the childs weight. Greater motivation to change weight was observed for girls compared with boys (P = 0.001), despite no sex difference in BMI Z-score (P = 0.374). Motivation was not associated with most demographic variables, social desirability, dietary intake, parenting or child behaviour. Increased motivation to change the childs weight was observed for heavier children (P < 0.001), those who were less physically active (P = 0.002) and more sedentary (P < 0.001), and in parents who were more concerned about their childs weight (P < 0.001) or who used greater food restriction (P < 0.001). CONCLUSIONS Low levels of parental motivation to change overweight in young children highlight the urgent need to determine how best to improve motivation to initiate change.

Wanting to and Doing So: Parental Intent to Change Weight Does Not TranslateInto Behavior

Abstract Objective: Because poor parental recognition of overweight is so common in young children, we sought to determine whether demographics or family behaviors differed in children whose parents were actively trying to reduce excess weight in their child compared with those who were unaware there was an issue. Methods: Parents of 271 overweight (body mass index≥85th) children aged 4-8 years completed questionnaires on demographics, weight, feeding practices, social desirability, dietary intake, and home food availability. Children wore accelerometers over 7 days to measure physical activity/inactivity. Results: 113 parents (41.7%) classified their child as overweight, 96 (35.4%) indicated at least some concern, but only 66 (24.4%) parents were trying to (probably or definitely) change their child’s weight. In total, 56 children met all three criteria. These children were older, heavier and more likely to be female (P<0.001), but did not differ in socioeconomic status (P=0.614), maternal education (P=0.615), or ethnicity (P=0.051), compared to the remaining children. Few differences in feeding practices were observed, except for higher food restriction in those trying to change their child’s weight (P<0.001). These children were significantly less physically active (P=0.033) and more sedentary (P=0.002) than the other children. Despite strong intent to change the diet (P<0.001), this did not translate to differences in home food availability or dietary intake. Social desirability was also not related to efforts to change. Conclusion: Parental awareness of excess weight in young children and attempts to address the issue do not appear to translate into healthier behaviors in the home.