Kirsty Kiezebrink

Maternal feeding behaviour and young children's dietary quality: A cross-sectional study of socially disadvantaged mothers of two-year old children using the Theory of Planned Behaviour

BackgroundHaving breakfast, eating food cooked from scratch and eating together as a family have health and psychosocial benefits for young children. This study investigates how these parentally determined behaviours relate to childrens dietary quality and uses a psychological model, the Theory of Planned Behaviour (TPB), to investigate socio-cognitive predictors of these behaviours in socially disadvantaged mothers of young children in Scotland.MethodThree hundred mothers of children aged 2 years (from 372 invited to participate, 81% response rate), recruited via General Practitioners, took part in home-based semi-structured interviews in a cross-sectional survey of maternal psychological factors related to their childrens dietary quality. Regression analyses examined statistical predictors of maternal intentions and feeding behaviours.ResultsMothers of children with poorer quality diets were less likely than others to provide breakfast every day, cook from scratch and provide proper sit-down meals. TPB socio-cognitive factors (intentions, perceived behavioural control) significantly predicted these three behaviours, and attitudes, norms, and perceived behavioural control significantly predicted mothers intentions, with medium to large effect sizes.ConclusionsInterventions to improve young childrens dietary health could benefit from a focus on modifying maternal motivations and attitudes in attempts to improve feeding behaviours.

What maternal factors influence the diet of 2-year-old children living in deprived areas? A cross-sectional survey

OBJECTIVEnTo investigate the maternal factors associated with poor diet among disadvantaged children.nnnDESIGNnSurvey of 300 mothers of 2-year-old children from areas of high deprivation in Scotland (response rate 81 %). A diet quality score was derived from reported consumption of carbohydrates, protein, fruit and vegetables, dairy products and restriction of sugary fatty foods.nnnRESULTSnMost children (85 %) were classified as having a poor quality diet (low diet quality score). Mothers general knowledge about healthy eating was high, but did not predict the quality of the childrens diet. Lower frequencies of food preparation and serving, such as cooking with raw ingredients, providing breakfast daily and the family eating together, were also associated with a poorer diet. Regression modelling identified five significant factors. An increased risk of a poor diet was associated with mothers being unlikely to restrict sweets (OR = 21.63, 95 % CI 2.70, 173.30) or finding it difficult to provide 2-3 portions of fruit daily (OR = 2.94, 95 % CI 1.09, 7.95). Concern that the child did not eat enough increased the risk of a poor diet (OR = 2.37, 95 % CI 1.09, 5.16). Believing a healthy diet would help the child eat more reduced the risk of having a poor diet (OR = 0.28, 95 % CI 0.11, 0.74), as did providing breakfast daily (OR = 0.22, 95 % CI 0.05, 0.99).nnnCONCLUSIONSnInterventions to improve childrens diet could promote more positive intentions about preparing and serving of foods, particularly of specific meals at which the family eats together. The benefits of these behaviours to the child (improved diet, weight control) should be emphasised.

Interaction between Disinhibition and restraint: Implications for body weight and eating disturbance

An increase in obesity is usually accompanied by an increase in eating disturbances. Susceptibility to these states may arise from different combinations of underlying traits: Three Factor Eating Questionnaire (TFEQ) Restraint and Disinhibition. Two studies were conducted to examine the interaction between these traits; one on-line study (n=351) and one laboratory-based study (n=120). Participants completed a battery of questionnaires and provided self-report measures of body weight and physical activity. A combination of high Disinhibition and high Restraint was associated with a problematic eating behaviour profile (EAT-26), and a higher rate of smoking and alcohol consumption. A combination of high Disinhibition and low Restraint was associated with a higher susceptibility to weight gain and a higher sedentary behaviour. These data show that different combinations of Disinhibition and Restraint are associated with distinct weight and behaviour outcomes.

Strategies for achieving a high response rate in a home interview survey

BackgroundResponse rates in surveys have been falling over the last 20 years, leading to the need for novel approaches to enhance recruitment. This study describes strategies used to maximise recruitment to a home interview survey of mothers with young children living in areas of high deprivation.MethodsMothers of two year old children received a letter from their GP inviting them to take part in a survey on diet. Participants were subsequently recruited by a researcher. The researcher first tried to contact potential participants by telephone, to discuss the study and make an appointment to conduct a home interview. Where telephone numbers for women could not be obtained from GP records, web searches of publicly available databases were conducted. After obtaining correct telephone numbers, up to six attempts were made to establish contact by telephone. If this was unsuccessful, a postal request for telephone contact was made. Where no telephone contact was achieved, the researcher sent up to two appointments by post to conduct a home interview.ResultsParticipating GPs invited 372 women to take part in a home based interview study. GP practices provided telephone numbers for 162 women, of which 134 were valid numbers. The researcher identified a further 187 numbers from electronic directories. Further searches of GP records by practice staff yielded another 38 telephone numbers. Thus, telephone numbers were obtained for 99% of potential participants.The recruitment rate from telephone contacts was 77%. Most of the gain was achieved within four calls. For the remaining women, contact by post and home visits resulted in 18 further interviews, corresponding to 35% of the women not recruited by telephone. The final interview rate was 82%. This was possible because personal contact was established with 95% of potential participants.ConclusionThis study achieved a high response rate in a hard to reach group. This was mainly achieved by first establishing contact by telephone. The use of multiple sources identified the telephone numbers of almost all the sample. Multiple attempts at telephone contact followed by postal approaches led to a high home interview rate.

Evidence of complex involvement of serotonergic genes with restrictive and binge purge subtypes of anorexia nervosa

Abstract Objectives. There is mixed evidence of association of serotoninergic genes with anorexia nervosa (AN), but substantial evidence for the involvement of serotonergic mechanisms in appetite control. This study was designed to investigate possible associations between the two subtypes of AN (Restricting-RAN, and Binge-purging–BPAN) and polymorphisms within five genes encoding for proteins involved in the serotoninergic system. Methods. In order to carry out this investigation we have conducted a case–control association study on 226 females meeting the criteria for AN, and 678 matched healthy females. Results. Our data show a significant association between polymorphisms with the gene encoding HTR2A with both AN subtypes, an association between polymorphisms within the genes encoding HTR1D and HTR1B with RAN, and an association between polymorphisms within the gene encoding HTR2C with BPAN. No associations were found for any polymorphisms of the serotonin transporter gene. This outcome indicates a substantial and complex inter-relationship between serotoninergic genes and AN. Conclusions. Given these data we hypothesis that the expression or control of expression of several genes of the serotoninergic system, and interactions between these genes, could exert considerable influence over the specific symptomatology of the subtypes of AN.

Similarities and differences between excessive exercising anorexia nervosa patients compared with DSM-IV defined anorexia nervosa subtypes

This study describes anorexia nervosa (AN) patients who use excessive exercise for weight management and how this behaviour relates to the classical Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) sub-grouping of AN. The study compared 428 clinical AN patients with 119 age and gender-matched controls. The AN cases were initially dichotomised according to DSM-IV subtype criteria into restricting (RAN; N=198) and binge-purge (BPAN; N=230) anorexia. The psychometric instruments were chosen to reflect key features concerning the diagnosis of eating disorders and characteristics of eating and food behaviour and included the 26-item Eating Attitude Test (EAT-26), Three Factor Eating Questionnaire (TFEQ), Dutch Eating Behaviour Questionnaire (DEBQ), Eysenck Personality Inventory (EPI) and Rosenberg Self-Esteem scale (RSE). Structured clinical interviews (1) were carried out in order to identify the subgroup of patients who use excessive exercise in order to facilitate weight control (EAN). The three groups (RAN, BPAN, EAN) did not differ in measures of current age, current body mass index, age of onset of AN and measures of restrained eating. However, significant differences were observed on EAT-26, DEBQ emotional and external factors, TFEQ disinhibition and hunger factors, EPI extraversion and neuroticism, and self-esteem. The EAN were similar to the RAN on the majority of variables but showed significant differences on extraversion, neuroticism, self-esteem and disease pathology (EAT-26). Compared with BPAN, EAN had lower disease pathology (EAT-26 scores), scored higher on the EPI extraversion scale, lower on the neuroticism scale and had greater self-esteem. The EAN also displayed significantly lower emotional and external eating (DEBQ) than BPAN and significantly lower disinhibition and hunger scores (TFEQ). These data suggest that EAN group display a mixed profile of characteristics resembling both BPAN and RAN. When EAN are defined as a separate group they appear to be phenotypically more similar to RAN than BPAN on this particular profile of variables. However when DSM-IV criteria are applied they are almost exclusively classified as BPAN. This outcome suggests that EAN do constitute an identifiable group that can be distinguished from RAN and BPAN. Consequently it is likely that the behaviour of excessive exercising should be considered as clinically relevant on the outcome of treatment.

Seafood inclusion in commercial main meal early years' food products

Seafood consumption is recommended as part of a healthy, balanced diet. Under-exposure to seafood during early years feeding, when taste and food acceptance is developed, may impact on the future development of a varied diet. This study aimed to investigate the availability and nutritional content of seafood in commercial infant meals compared to the other food types. A survey was conducted of all commercial infant main meal products available for purchase in supermarkets, high street retailers and online stores within the United Kingdom. The primary food type (seafood, poultry, meat and vegetables) within each product, nutritional composition per 100u2009g, and ingredient contribution were assessed. Of the original 341 main meal products seafood (nu2009=u200913; 3.8%) was underrepresented compared to poultry (103; 30.2%), meat (121; 35.5%) and vegetables (104; 30.5%). The number of the seafood meals increased three years later (nu2009=u200920; 6.3%) vegetable meals remained the largest contributor to the market (115; 36.4%) with meat (99; 31.3%) and poultry (82; 26.0%) both contributing slightly less than previously. Seafood-based meals provided significantly higher energy (83.0 kcal), protein (4.6u2009g), and total fat (3.2u2009g) than vegetable (68u2009kcal, 2.7u2009g, 1.9u2009g), meat (66u2009kcal, 3.0u2009g, 2.1u2009g) and poultry-based meals (66u2009kcal, 3.0u2009g, 2.1u2009g) and higher saturated fat (1.3u2009g) than poultry (0.4u2009g) and vegetable-based (0.6u2009g) meals (all per 100u2009g) which may be attributed to additional dairy ingredients. Parents who predominantly use commercial products to wean their infant may face challenges in sourcing a range of seafood products to enable the introduction of this food into the diet of their infant.

A comparison of preprepared commercial infant feeding meals with home-cooked recipes

Objectives To compare the cost, nutritional and food variety contents of commercial meals and published infant and young child feeding (IYCF) home-cooked recipes, and to compare nutritional contents to age-specific recommendations. Design Cross-sectional study. Setting Full range of preprepared main meals available within the UK market. Main-meal recipes identified from a survey of Amazons top 20 best-sellers and IYCF cookbooks available from local libraries. Samples 278 commercial IYCF savoury meals from UK market and 408 home-cooked recipes from best-selling IYCF published cookbooks. Main outcome measures Cost and nutritional content per 100u2005g and food variety per meal for both commercial meals and home-cooked recipes. Results Commercial products provided more ‘vegetable’ variety per meal (median=3.0; r=−0.33) than home-cooked recipes (2.0). Home-cooked recipes provided 26% more energy and 44% more protein and total fat than commercial products (r=−0.40, −0.31, −0.40, respectively) while costing less (£0.33/100u2005g and £0.68/100u2005g, respectively). The majority of commercial products (65%) met energy density recommendations but 50% of home-cooked recipes exceeded the maximum range. Conclusions The majority of commercial meals provided an energy-dense meal with greater vegetable variety per meal to their home-cooked counterparts. Home-cooked recipes provided a cheaper meal option, however the majority exceeded recommendations for energy and fats.

Intervention vignettes as a qualitative tool to refine complex intervention design

Background In trial design, decisions are made about which intervention components/processes to standardise and which remain flexible to maximise utility and/or effectiveness. The intervention-context-system fit for complex interventions impacts on trial recruitment, delivery and outcomes. Survey vignettes and discrete choice experiments are quantitative researcher led approaches which focus on a few measurable attributes. Our aim was to explore the utility of qualitative vignettes as a methodological tool allowing service users/providers to contribute to intervention design.

Effects of workplace-based dietary and/or physical activity interventions for weight management targeting healthcare professionals: a systematic review of randomised controlled trials

BackgroundThe prevalence of overweight and obesity is high amongst healthcare professionals and there is growing interest in delivering weight loss interventions in the workplace. We conducted a systematic review to (i) examine the effectiveness of workplace-based diet and/or physical activity interventions aimed at healthcare professionals and to (ii) identify and describe key components of effective interventions. Seven electronic databases were systematically searched.ResultsThirteen randomised controlled trials met the inclusion criteria, of which seven had data available for meta-analysis. Where meta-analysis was possible, studies were grouped according to length of follow-up (<12 months and ≥12 months) and behavioural target (diet only, physical activity only or diet and physical activity), with outcome data pooled using a weighted random effects model. Nine studies reported statistically significant (between-group) differences. Four studies reported being informed by a behaviour change theory. Meta-analysis of all trials reporting weight data demonstrated healthcare professionals allocated to dietary and physical activity interventions lost significantly more body weight (−3.95 Kg, [95% CI −4.96 to- 2.95 Kg]) than controls up to 12 months follow up.ConclusionsWorkplace diet and/or physical activity interventions targeting healthcare professionals are limited in number and are heterogeneous. To improve the evidence base, we recommend additional evaluations of theory-based interventions and adequate reporting of intervention content.