Rebecca Byrne

Food and beverage intake in Australian children aged 12-16 months participating in the NOURISH and SAIDI studies.

Objective: To describe the quantity and diversity of food and beverage intake in Australian children aged 12–16 months and to determine if the amount and type of milk intake is associated with dietary diversity.

Child dietary and eating behavior outcomes up to 3.5 years after an early feeding intervention: The NOURISH RCT.

To evaluate dietary intake impact outcomes up to 3.5 years after the NOURISH early feeding intervention (concealed allocation, assessor masked randomized controlled trial).

Breastfeeding Duration and Authoritative Feeding Practices in First-Time Mothers.

Background: Longer breastfeeding duration appears to have a protective effect against childhood obesity. This effect may be partially mediated by maternal feeding practices during the first years of life. However, the few studies that have examined links between breastfeeding duration and subsequent feeding practices have yielded conflicting results. Objective: Using a large sample of first-time mothers and a newly validated, comprehensive measure of maternal feeding (the Feeding Practices and Structure Questionnaire), this study examined associations between breastfeeding duration and maternal feeding practices at child age 24 months. Methods: Mothers (n = 458) enrolled in the NOURISH trial provided data on breastfeeding at child age 4, 14, and 24 months, and on feeding practices at 24 months. Structural equation modeling was used to examine associations between breastfeeding duration and 5 nonresponsive and 4 structure-related “authoritative” feeding practices, adjusting for a range of maternal and child characteristics. Results: The model showed acceptable fit (χ2/df = 1.68; root mean square error of approximation = .04, comparative fit index = .91, and Tucker-Lewis index = .89) and longer breastfeeding duration was negatively associated with 4 out of 5 nonresponsive feeding practices and positively associated with 3 out of 4 structure-related feeding practices. Overall, these results suggest that mothers who breastfeed longer reported using more appropriate feeding practices. Conclusion: These data demonstrate an association between longer breastfeeding duration and authoritative feeding practices characterized by responsiveness and structure, which may partly account for the apparent protective effect of breastfeeding on childhood obesity.

Beverage intake of Australian children and relationship with intake of fruit, vegetables, milk and body weight at 2, 3.7 and 5 years of age: Beverage intake of Australian children aged two to five years

AIM Describe the type and amount of beverages consumed by Australian children at age 2, 3.7 and 5; investigate the longitudinal relationship between intake of sweet beverages with fruits and vegetables or milk/alternatives, and body mass index (BMI) z-score. METHODS Mothers in the NOURISH trial completed a single 24-hour recall of their childs intake, at age 2 (n = 515), 3.7 (n = 426) and 5 (n = 405). Anthropometry was measured by study staff. At each time point, proportion of children consuming at least one beverage on 24-hour recall from the following groups was determined; essential-cows milk/alternatives, breast milk; non-essential-formula, sweet beverages. For consumers, intake (grams) of each beverage and proportion total estimated energy intake was calculated. The longitudinal relationship between intake of sweet beverages, and fruit and vegetable intake (g/kg body weight), with BMI z-score at 2, 3.7 and 5 years was examined using structural equation modelling. A second model investigated relationship with intake of milk/alternatives. RESULTS Sweet beverages were consumed by 38, 55 and 47% of children at each time point. Intake of sweet beverages strongly correlated between two and five years; however, intake was not associated with BMIz and did not appear to displace fruit and vegetable intake. Intake of cows milk declined over time and was negatively associated with intake of sweet beverages at two and five years. CONCLUSIONS Tracking of intake over time supports the notion that childrens early experience of sweet tastes is a strong predictor of future intake. Limiting exposure to sweet beverages in early childhood remains an important strategy in the development of healthy food preferences and promotion of dietary quality.

Assessing Dietary Intake and Growth of Infants

Objective: Early cessation of breastfeeding and introduction of solids is common in Australia, which may have implications for child growth and obesity risk. This study aimed to contrast usual energy and macronutrient intake of infants against requirements according to feeding modality (n=670) and determine whether early introduction of solids and cessation of breastfeeding were independently associated with rapid growth (weight gain z-score ≥ 0.67) between birth to age six months (n=220). Methods: An analysis of data from mothers and infants participating in the NOURISH and South Australian Infant Dietary Intake (SAIDI) studies was undertaken. Both studies enrolled mothers on the postnatal wards from 11 large hospitals in South Australia and Brisbane consecutively. Anthropometric data, infant feeding practices and three days of infant dietary intake data were collected at birth and again when infants were aged 4-8 months. Results: Usual energy intakes were above estimated requirements for infants aged 4-

Serve sizes and frequency of food consumption in Australian children aged 14 and 24 months

Objective: To describe the dietary intake of a sample of Australian children.

Early maternal feeding practices: Associations with overweight later in childhood

BACKGROUND Current understanding of the impact of maternal feeding practices on weight outcomes in young children remains unclear given equivocal longitudinal study outcomes. OBJECTIVES To determine whether feeding practices used by mothers when their child was less than 2 years of age were related to overweight status at ages 3.5 and 5 years in a large cross-country sample; and investigate whether these associations were moderated by weight status in early life. DESIGN Data from mother-child dyads participating in four childhood obesity prevention trials across Australia and New Zealand were pooled (n = 723). Each trial administered items from the Comprehensive Feeding Practices Questionnaire (CFPQ) to mothers when infants were approximately 20 months of age, measuring food as a reward, modelling, restriction for health, pressure to eat, and emotion regulation. Poisson regression was used to determine risk ratios (RR) for overweight (BMI z-score ≥85th percentile) at 3.5 and 5 years by CFPQ scores. RESULTS Greater use of emotion regulation at 20 months of age predicted higher risk for overweight at 3.5 and 5 years (RR = 1.19 and 1.28, respectively), while restriction for health predicted lower risk for overweight at 5 years (RR = 0.88). Childs weight status at 20 months moderated the association between pressure to eat and overweight risk at 5 years, such that those who were not overweight at 20 months of age had reduced risk of overweight associated with the use of pressure to eat (RR = 0.68) but those who were overweight had an increased risk (RR = 1.09). CONCLUSION Early maternal feeding practices are related to a childs later risk of overweight.

The Relative Validity of the Menzies Remote Short-Item Dietary Assessment Tool (MRSDAT) in Aboriginal Australian Children Aged 6–36 Months

The Menzies Remote Short-item Dietary Assessment Tool (MRSDAT) can be used to derive a dietary index score, which measures the degree of compliance with the Australian Dietary Guidelines. This study aimed to determine the relative validity of a dietary index score for children aged 6–24 months, living in a Remote Aboriginal Community (RAC), derived using MRSDAT. This validation study compared dietary index scores derived using MRSDAT with those derived from the average of three 24-h recalls. Participants were aged 6–36 months at the first dietary assessment and were living in a RAC. The level of agreement between the two methods was explored using Lin’s concordance correlation coefficient (CCC), Bland-Altman plots, weighted Cohen’s kappa, and Fischer’s exact and paired t-tests. Forty participants were recruited. The CCC was poor between methods (R = 0.35, 95% CI 0.06, 0.58), with MRSDAT estimating higher dietary intake scores for all food groups except fruit, and higher dietary quality scores by an average of 4.78 points/100. Community-based Aboriginal researchers were central to this validation study. MRSDAT was within the performance range of other short-item dietary assessment tools developed for young children, and shows promise for use with very young children in RACs.

Consistency of Food Preferences in Australian Children from 2 to 5 Years of Age

While it is generally accepted that food habits established during infancy will track into later childhood, longitudinal analysis of children’s food preferences is rare. This paper examines whether maternal-reported child food preferences at five years of age are the same as that reported at two years; and identifies any patterns of change from twoto fiveyears. Mothers in the Australian NOURISH trial reported child food preferences at two and five years of age. A four point scale was utilised ‘like’, ‘neither like or dislike’, ‘dislike’, ‘never tried’. The proportion of children having the same preference at the two time points was calculated (95%CI) for 48 foods (cereals, 4; vegetables, 20; fruit, 14; meat/alternatives, 6; dairy, 4). For foods where ≤50% children had consistent preferences, the pattern of food preference change was determined. For 40/48 foods, more than half of the children were reported to have the same preference at two years of age, and three years later, at age five. Foods for which ≤50% children had the same preference at both ages were high-sugar breakfast cereals, zucchini, mushrooms, eggplant, spinach, lettuce, cabbage and celery. Findings reinforce the importance of promoting a consistent message regarding early and frequent exposure to a variety of healthy foods, particularly during the first 2 years of life, as the preferences established in these early years are likely to be maintained over time.