To describe nutrition environments in formal child care for 3- and 4-year-olds.

Cross-sectional online survey of nutrition-related child-care policy and practice. Written nutrition policies were analysed using the Wellness Child Care Assessment Tool.

Licensed child-care services in the Auckland, Counties Manukau and Waikato regions of New Zealand.

Eight hundred and forty-seven services (private and community day care, kindergartens and playcentres).

Managers/head teachers of 257 child-care services completed the survey. Of services, 82·4 % had a written food, nutrition or wellness policy. Most policies did not refer to the national Food and Nutrition Guidelines and lacked directives for staff regarding recommended behaviours to promote healthy eating. Food was provided daily to children in 56·4 % of child-care services, including 33·5 % that provided lunch and at least two other meals/snacks every day. Teachers talked to children about food, and cooked with children, at least weekly in 60 % of child-care services. Nearly all services had an edible garden (89·5 %). Foods/beverages were sold for fundraising in the past 12 months by 37·2 % of services. The most commonly reported barrier to promoting nutrition was a lack of support from families (20·6 %).

Although the majority of child-care services had a written nutrition policy, these were not comprehensive and contained weak statements that could be difficult to action. Foods served at celebrations and for fundraising were largely high in sugar, salt and/or saturated fat. Most services promoted some healthy eating behaviours but other widespread practices encouraged children to overeat or form unhealthy food preferences.

Many dietary assessment methods attempt to estimate total food and nutrient intake. If the intention is simply to determine whether participants achieve dietary recommendations, this leads to much redundant data. We used data mining techniques to explore the number of foods that intake information was required on to accurately predict achievement, or not, of key dietary recommendations.

We built decision trees for achievement of recommendations for fruit and vegetables, sodium, fat, saturated fat and free sugars using data from a national dietary surveillance data set. Decision trees describe complex relationships between potential predictor variables (age, sex and all foods listed in the database) and outcome variables (achievement of each of the recommendations).

UK National Diet and Nutrition Survey (NDNS, 2008–12).

The analysis included 4156 individuals.

Information on consumption of 113 out of 3911 (3 %) foods, plus age and sex was required to accurately categorize individuals according to all five recommendations. The best trade-off between decision tree accuracy and number of foods included occurred at between eleven (for fruit and vegetables) and thirty-two (for fat, plus age) foods, achieving an accuracy of 72 % (for fat) to 83 % (for fruit and vegetables), with similar values for sensitivity and specificity.

Using information on intake of 113 foods, it is possible to predict with 72–83 % accuracy whether individuals achieve key dietary recommendations. Substantial further research is required to make use of these findings for dietary assessment.

To investigate (i) associations between adolescents’ frequency of breakfast and family functioning (close relations to parents, quality of family communication and family support) and (ii) if any observed associations between breakfast frequency and family functioning vary by sociodemographic factors.

School-based cross-sectional study. Students completed a web-based questionnaire. Associations were estimated by multilevel multivariate logistic regression.

Danish arm of the Health Behaviour in School-aged Children study, 2014.

Adolescents aged 13 and 15 years (n 3054) from a random sample of forty-one schools.

Nearly one-quarter of the adolescents had low breakfast frequency. Low breakfast frequency was associated with low family functioning measured by three dimensions. The OR (95 % CI) of low breakfast frequency was 1·81 (1·40, 2·33) for adolescents who reported no close relations to parents, 2·28 (1·61, 3·22) for adolescents who reported low level of quality of family communication and 2·09 (1·39, 3·15) for adolescents who reported low level of family support. Joint effect analyses suggested that the odds of low breakfast frequency among adolescents with low family functioning compared with high family functioning were highest among adolescents being girls, immigrants and living in other than a traditional family structure.

Low breakfast frequency was associated with low family functioning measured by close relations to parents, quality of family communication and family support. Further, analyses suggested that the associations were more pronounced among girls, immigrants and adolescents from other family structure than traditional. The study highlights the importance of the family setting in promoting regular breakfast frequency among adolescents.

Although existing evidence links breakfast frequency to better dietary quality, little is known specifically in regard to the benefits associated with eating breakfast together with one’s family. The present study describes the prevalence and experience of having family meals at breakfast among rural families and examines associations between meal frequency and adolescent diet quality.

Data were drawn from Project BreakFAST, a group-randomized trial aimed at increasing school breakfast participation in rural Minnesota high schools, USA. Linear mixed models were used to examine associations between student reports of family breakfast frequency and Healthy Eating Index 2010 (HEI-2010) scores while accounting for clustering within schools, demographics and household food security.

Adolescent students from sixteen schools completed online surveys, height and weight measurements, and dietary recalls at baseline in 2012–2014.

The sample included 827 adolescents (55·1 % girls) in grades 9–10 who reported eating breakfast on at most three days per school week.

On average, adolescents reported eating breakfast with their family 1·3 (sd 1·9) times in the past week. Family breakfast meals occurred most frequently in the homes of adolescents who reported a race other than white (P=0·002) or Hispanic ethnicity (P=0·02). Family breakfast frequency was directly associated with adolescent involvement in preparing breakfast meals (P<0·001) and positive attitudes (P≤0·01) about mealtime importance, interactions and structure. Family breakfast frequency was unrelated to most diet quality markers.

Family meals may be one important context of opportunity for promoting healthy food patterns at breakfast. Additional research is needed to better inform and evaluate strategies.

Breakfast consumption has been consistently associated with health outcomes and cognitive functioning in schoolchildren. Evidence of direct links with educational outcomes remains equivocal. We aimed to examine the link between breakfast consumption in 9–11-year-old children and educational outcomes obtained 6–18 months later.

Data on individual-level free school meal entitlement and educational outcomes (Statutory Assessment Tests (SATs) at Key Stage 2) were obtained via the SAIL databank and linked to earlier data collected on breakfast consumption. Multilevel modelling assessed associations between breakfast consumption and SATs.

Trial of the Primary School Free Breakfast Initiative in Wales.

Year 5 and 6 students, n 3093 (baseline) and n 3055 (follow-up).

Significant associations were found between all dietary behaviours and better performance in SATs, adjusted for gender and individual- and school-level free school meal entitlement (OR=1·95; CI 1·58, 2·40 for breakfast, OR=1·08; CI 1·04, 1·13 for healthy breakfast items). No association was observed between number of unhealthy breakfast items consumed and educational performance. Association of breakfast consumption with educational performance was stronger where the measure of breakfast consumption was more proximal to SATs tests (OR=2·02 measured 6 months prior to SATs, OR=1·61 measured 18 months prior).

Significant positive associations between self-reported breakfast consumption and educational outcomes were observed. Future research should aim to explore the mechanisms by which breakfast consumption and educational outcomes are linked, and understand how to promote breakfast consumption among schoolchildren. Communicating findings of educational benefits to schools may help to enhance buy-in to efforts to improve health behaviours of pupils.

Employing Rothschild’s Motivation–Opportunity–Ability framework, the present study examines the extent to which heterogeneity in barriers regarding the motivation, the perceived opportunity and the perceived ability to choose low-calorie over high-calorie snacks is associated with the proportion of low-calorie snack choices in real life. Furthermore, the study investigates which dominant barrier profiles can be discerned.

Data were obtained from a survey about participants’ motivation, opportunity and ability to choose low-calorie over high-calorie snacks and an FFQ that measured habitual consumption of snack foods and beverages. Data were analysed using R packages lavaan and NbClust, and IBM SPSS Statistics.

A representative sample (n 1318) of the Dutch population based on gender (686 women), age and education level.

For both snack foods and beverages, motivation to choose low-calorie over high-calorie snacks was associated strongest with proportions of low-calorie choices. The perceived ability and perceived opportunity were also associated with proportions of low-calorie choices, albeit to a lesser extent. Furthermore, three dominant profiles of barriers were identified: the no-barrier profile, the lack-of-opportunity profile and the lack-of-motivation profile. These profiles differed significantly on proportions of low-calorie snack choices, daily meal consumption and sociodemographic characteristics.

Heterogeneity in barriers regarding the motivation, the perceived opportunity and the perceived ability to choose low-calorie over high-calorie snacks is associated with the proportion of low-calorie snack choices in real life. By identifying and appreciating heterogeneity in barriers, the present study provides further incentives for the tailoring of intervention strategies.

Although television (TV) viewing is frequently paired with snacking among young children, little is known about the environment in which caregivers promote this behaviour. We describe low-income pre-schoolers’ snacking and TV viewing habits as reported by their primary caregivers, including social/physical snacking contexts, types of snacks and caregiver rationales for offering snacks. These findings may support the development of effective messages to promote healthy child snacking.

Semi-structured interviews assessed caregiver conceptualizations of pre-schoolers’ snacks, purpose of snacks, snack context and snack frequency.

Interviews occurred in Boston, Massachusetts and Philadelphia, Pennsylvania, USA.

Forty-seven low-income multi-ethnic primary caregivers of children aged 3–5 years (92 % female, 32 % Hispanic/Latino, 34 % African American) described their child’s snacking in the context of TV viewing.

TV viewing and child snacking themes were described consistently across racial/ethnic groups. Caregivers described snacks offered during TV viewing as largely unhealthy. Labels for TV snacks indicated non-nutritive purposes, such as ‘time out’, ‘enjoyment’ or ‘quiet.’ Caregivers’ primary reasons for providing snacks included child’s expectations, behaviour management (e.g. to occupy child) and social time (e.g. family bonding). Some caregivers used TV to distract picky children to eat more food. Child snacking and TV viewing were contextually paired by providing child-sized furniture (‘TV table’) specifically for snacking.

Low-income caregivers facilitate pre-schoolers’ snacking and TV viewing, which are described as routine, positive and useful for non-nutritive purposes. Messages to caregivers should encourage ‘snack-free’ TV viewing, healthy snack options and guidance for managing children’s behaviour without snacks or TV.

Despite the importance of cooking in modern life, public perceptions about what it means to cook are unknown. We aimed to examine perceptions of cooking and their association with cooking confidence, attitudes and behaviours in the USA.

We designed and fielded a nationally representative survey among US adults (n 1112) in April 2015. We used factor analysis to identify perceptions about cooking and multivariate ordered logit and Poisson models to explore associations between those perceptions and cooking confidence, attitudes and behaviours.

Nationally representative web-based survey of US adults.

US adults aged ≥18 years.

Americans conceptualized cooking in three ways: the use of scratch ingredients, convenience foods and not using heat. Respondents who perceived cooking as including convenience foods were less confident in their ability to cook from scratch (OR=0·52, P<0·001) and less likely to enjoy cooking (OR=0·68, P=0·01) than those who did not. Although individuals who perceived cooking as including only scratch ingredients reported cooking dinner (4·31 times/week) and using packaged/boxed products (0·95 times/week) the least frequently, few notable differences in the frequency of cooking meals were observed.

Cooking frequency is similar among US adults regardless of how they perceive cooking, but cooking confidence and enjoyment are lowest among Americans who perceive cooking as including the use of convenience foods. These insights should inform the development of more specific measures of cooking behaviour as well as meaningful and targeted public health messages to encourage healthier cooking.

To assess the prevalence of and explanations for the avoidance of dairy foods, including symptoms attributed to their consumption, diagnoses and psychological predictors of avoidance. Also considered were comparisons with symptom-related avoidance of wheat in the same sample.

Cross-sectional population survey.

The study was conducted in Australia using a national postal omnibus survey.

Adults aged 18 years and over (n 1184; 52·9 % female) selected at random from the Australian Electoral Roll.

Despite few claims of formally diagnosed allergy or intolerance, 11·8 % of the sample reported avoiding dairy products because of adverse physiological effects, which commonly included gastrointestinal symptoms. Unlike wheat (3·5 %) or wheat-and-dairy (3·6 %) avoidance, dairy avoidance (8·2 %) was predicted by age (negatively) and worry about illness (positively).

The findings are further evidence of a widespread tendency for consumers to exercise control over their health by eliminating dietary factors considered suspect without medical evidence or oversight. Unanswered questions include the decision processes underlying dairy avoidance, whether symptoms are attributed correctly, the agents and physiological mechanism(s) involved, the relative contributions of symptom severity and vigilance to the association with illness worry, and the nutritional adequacy of dairy avoiders’ diets. Irrespective of the accuracy of self-diagnoses, if the elimination of suspect foods is an end in itself the paradoxical possibility for nutritional imbalances may have significant public health implications.

To examine how different definitions of meals and snacks can affect the associations of meal frequency (MF) and snack frequency (SF) with dietary intake and adiposity measures.

Based on 7 d weighed dietary record data, all eating occasions providing ≥210 kJ of energy were divided into meals or snacks based on contribution to energy intake (≥15 % or <15 %) or time (06.00–10.00, 12.00–15.00 and 18.00–21.00 hours; other). Diet quality was assessed using the Healthy Diet Indicator (HDI) and Mediterranean Diet Score (MDS).

Great Britain.

British adults aged 19–64 years (n 1487).

MF based on energy contribution was associated with higher intake of dietary fibre, lower intakes of non-milk extrinsic sugars and alcohol, and higher HDI (only men) and MDS. MF based on time was associated with higher HDI and MDS in women only. Conversely, irrespective of the definition of snacks, SF was associated with higher intakes of confectionery and alcohol, lower intakes of cereals, protein, fat and dietary fibre, and lower HDI (except for SF based on energy contribution in women) and MDS. After adjustment for potential confounders, MF based on time, but not MF based on energy contribution, was positively associated with BMI and waist circumference in men only. SF was positively associated with BMI and waist circumference, irrespective of the definition of snacks.

Higher SF was consistently associated with lower diet quality and higher adiposity measures, while associations with MF varied depending on the definition of meals and sex.

To examine the associations of meal frequency (MF) and snack frequency (SF) with diet quality.

Dietary intake was assessed using two 24 h dietary recalls. All eating occasions providing ≥210 kJ of energy were divided into meals or snacks on the basis of contribution to energy intake (≥15 % or <15 %), self-report and time (06.00–09.00, 12.00–14.00 and 17.00–20.00 hours, or others). Diet quality was assessed using the Healthy Eating Index (HEI)-2010.

Nationally representative sample of the US population.

Children aged 6–11 years (n 4269) and adolescents aged 12–19 years (n 6193) in the National Health and Nutrition Examination Survey 2003–2012.

Irrespective of the definition of meals, higher MF was associated with higher HEI-2010 in both children and adolescents. One additional meal per day increased HEI-2010 by 1·45–3·59 points (all P<0·005). Conversely, the associations for SF were inconsistent. While SF based on energy contribution was positively associated with HEI-2010 in both children and adolescents (0·70 (P=0·001) and 1·00 (P<0·0001) point increase by one additional snack, respectively), there were no associations for SF based on self-report or time. In analyses in which only plausible energy reporters (3425 children and 3753 adolescents) were included, similar results were obtained.

In a representative sample of US children and adolescents, MF was associated with better diet quality, while the associations for SF varied depending on the definition of snacks. The findings highlight the importance of applying different definitions of meals and snacks when assessing the impact of dietary patterns on health.

Little is known about adolescents’ non-core food intake in the UK and the eating context in which they consume non-core foods. The present study aimed to describe types of non-core foods consumed by British adolescents in total and across different eating contexts.

A descriptive analysis, using cross-sectional data from food diaries. Non-core foods were classified based on cut-off points of fat and sugar from the Australian Guide to Healthy Eating. Eating context was defined as ‘where’ and ‘with whom’ adolescents consumed each food. Percentages of non-core energy were calculated for each food group in total and across eating contexts. A combined ranking was then created to account for each food’s contribution to non-core energy intake and its popularity of consumption (percentage of consumers).

The UK National Diet and Nutrition Survey 2008–2011.

Adolescents across the UK aged 11–18 years (n 666).

Non-core food comprised 39·5 % of total energy intake and was mostly ‘Regular soft drinks’, ‘Crisps & savoury snacks’, ‘Chips & potato products’, ‘Chocolate’ and ‘Biscuits’. Adolescents ate 57·0 % and 51·3 % of non-core food at ‘Eateries’ or with ‘Friends’, compared with 33·2 % and 32·1 % at ‘Home’ or with ‘Parents’. Persistent foods consumed across eating contexts were ‘Regular soft drinks’ and ‘Chips & potato products’.

Regular soft drinks contribute the most energy and are the most popular non-core food consumed by adolescents regardless of context, and represent a good target for interventions to reduce non-core food consumption.

To investigate the reciprocal relationship between unhealthy eating behaviours and depressive symptoms from childhood to adolescence.

Unhealthy eating behaviours were measured by the frequencies of eating foods with excess salt, sugar or fat in the past week. Depressive symptoms in the past two weeks were measured using a seven-item scale. Hierarchical linear growth models were used to analyse longitudinal associations between unhealthy eating behaviours and depressive symptoms. Time-fixed variables (sex, parents’ education level and household monthly income) and time-varying variables (parents’ marital status, family activities, body weight, vegetable or fruit consumption, exercising and smoking) were controlled for.

The Child and Adolescent Behaviors in Long-Term Evolution study, which commenced in 2001 and has annual follow-up.

Students (n 2630) followed from 2nd grade (8 years old in 2002) to 11th grade.

The frequency of unhealthy eating behaviours in the previous year and the difference between the frequency in the previous and successive year were positively associated with the initiation and growth rate of depressive symptoms. Depressive symptoms in the previous year and the difference in depressive symptoms between the previous and successive year were positively associated with the initial state and growth rate of unhealthy eating behaviours.

Our results suggest a reciprocal relationship between depressive symptoms and unhealthy eating behaviours. This relationship should be considered when developing programmes targeting depressive symptoms and unhealthy diet in children and adolescents.

Relationships among race/ethnicity, individual socio-economic status (SES), neighbourhood SES and acculturation are complex. We sought to answer whether: (i) race/ethnicity, individual SES and neighbourhood SES have independent effects on women’s fruit and vegetable consumption (FVC); (ii) SES modifies the effects of race/ethnicity on FVC; and (iii) nativity modifies the effect of Latina ethnicity on FVC.

Cross-sectional surveys from the population-based Geographic Research on Wellbeing (GROW) Study were linked with census-tract level data. FVC was indicated by (i) consuming fruits and vegetables less often than daily (LOWFV) and (ii) not having fruits and vegetables in the home very often. Other variables included age, marital status, race/ethnicity, country of birth, educational attainment, family income and longitudinal neighbourhood poverty (based on latent class growth models). Weighted logistic regression models accounting for the complex sample design were constructed.

California, USA, 2012–2013.

Women (n 2669).

In adjusted models, race/ethnicity, education and income were independently associated with FVC, but not neighbourhood poverty. Women of colour, high-school graduates and women with incomes at 301–400 % of the federal poverty level were at higher odds of LOWFV compared with non-Hispanic Whites, college graduates and those with incomes >400 % of the federal poverty level. Little evidence for interactions between race/ethnicity and individual or neighbourhood SES was found; similar patterns were observed for immigrant and US-born Latinas.

Addressing the dietary needs of lower-SES communities requires multilevel interventions that simultaneously provide culturally tailored nutrition education and address the physical and economic accessibility of culturally acceptable fruits and vegetables.

To examine the associations of food consumption, serum vitamins and metabolic syndrome risk with physical activity level in middle-aged adults.

Cross-sectional.

National Health and Nutrition Examination Survey (NHANES) 2005–2006.

Adults aged 40–70 years were divided into three groups by tertile of accelerometer-determined steps/d (in men and women, respectively): tertile 1 (sedentary), <6802, <5785; tertile 2 (intermediate), 6802–10698, 5785–9225; tertile 3 (active), ≥10699, ≥9226.

The active men consumed more grain products, fruits and vegetables, whereas the active women consumed more legumes and vegetables, compared with the sedentary group. Serum vitamin concentrations were associated with daily steps in both men and women. Vitamin C, α-carotene, trans-β-carotene, cis-β-carotene, β-cryptoxanthin, lutein+zeaxanthin, lycopene, γ-tocopherol and vitamin D were significantly associated with daily steps. OR (P<0·05) for the sedentary group were 1·52 and 1·61 for low HDL cholesterol, 1·66 and 3·97 for hypertriacylglycerolaemia, 1·02 and 2·73 for abdominal obesity, 1·79 and 1·77 for hyperglycaemia, 1·59 and 1·60 for hypertension, and 1·85 and 2·47 for metabolic syndrome in men and women, respectively.

Those with the highest steps taken showed a more healthful eating profile and a better serum vitamin profile compared with less active adults. Those with the lowest steps taken had greater odds of having metabolic syndrome and its risk components. Probably, daily walking is a marker of a healthful eating profile and increasing daily walking is one of the healthful ways to decrease the metabolic syndrome and its risk components.

To systematically review the literature and map published studies on 4–8-year-olds’ intake of discretionary choices against an ecological framework (ANalysis Grid for Environments Linked to Obesity; ANGELO).

Articles were identified through database searches (PubMed, PyscINFO®, Web of Science) in February and March 2014 and hand-searching reference lists. Studies were assessed for methodological quality and mapped against the ANGELO framework by environment size (macro and micro setting) and type (physical, economic, policy and socio-cultural influences).

Studies were conducted in the USA (n 18), Australia (n 6), the UK (n 3), the Netherlands (n 3), Belgium (n 1), Germany (n 1) and Turkey (n 1).

Children aged 4–8 years, or parents/other caregivers.

Thirty-three studies met the review criteria (observational n 23, interventions n 10). Home was the most frequently studied setting (67 % of exposures/strategies), with the majority of these studies targeting family policy-type influences (e.g. child feeding practices, television regulation). Few studies were undertaken in government (5·5 %) or community (11 %) settings, or examined economic-type influences (0 %). Of the intervention studies only four were categorised as effective.

The present review is novel in its focus on mapping observational and intervention studies across a range of settings. It highlights the urgent need for high-quality research to inform interventions that directly tackle the factors influencing children’s excess intake of discretionary choices. Interventions that assist in optimising a range of environmental influences will enhance the impact of future public health interventions to improve child diet quality.

To understand perspectives of stakeholders during initial district-wide implementation of a Breakfast in the Classroom (BIC) model of the School Breakfast Program.

Qualitative data were collected from twenty-nine focus groups and twenty interviews with stakeholders in a school district early in the process of implementing a BIC model of the School Breakfast Program.

Ten elementary schools within a large, urban school district in the USA that served predominantly low-income, racial/ethnic minority students.

Purposively selected stakeholders in elementary schools that had implemented BIC for 3–6 months: students (n 85), parents/guardians (n 86), classroom teachers (n 44), cafeteria managers (n 10) and principals (n 10).

Four primary themes emerged, which were interpreted based on the Diffusion of Innovations model. School staff had changed their perceptions of both the relative disadvantages and costs related to time and effort of BIC over time; the majority of each stakeholder group expressed an appreciation for BIC; student breakfast consumption varied from day to day, related to compatibility of foods with child preferences; and stakeholders held mixed and various impressions of BIC’s potential impacts.

The study underscores the importance of engaging school staff and parents in discussions of BIC programming prior to its initiation to pre-emptively address concerns related to cost, relative disadvantages and compatibility with child preferences and school routines/workflow. Effectively communicating with stakeholders about positive impacts and nutritional value of the meals may improve support for BIC. These findings provide new information to policy makers, districts and practitioners that can be used to improve implementation efforts, model delivery and outcomes.

Finland is known for a sharp decrease in the intake of saturated fat and cardiovascular mortality. Since 2000, however, the consumption of butter-containing spreads – an important source of saturated fats – has increased. We examined social and health-related predictors of the increase among Finnish men and women.

An 11-year population follow-up.

A representative random sample of adult Finns, invited to a health survey in 2000.

Altogether 5414 persons aged 30–64 years at baseline in 2000 were re-invited in 2011. Of men 1529 (59 %) and of women 1853 (66 %) answered the questions on bread spreads at both time points. Respondents reported the use of bread spreads by choosing one of the following alternatives: no fat, soft margarine, butter–vegetable oil mixture and butter, which were later categorized into margarine/no spread and butter/butter–vegetable oil mixture (= butter). The predictors included gender, age, marital status, education, employment status, place of residence, health behaviours, BMI and health. Multinomial regression models were fitted.

Of the 2582 baseline margarine/no spread users, 24.6% shifted to butter. Only a few of the baseline sociodemographic or health-related determinants predicted the change. Finnish women were more likely to change to butter than men. Living with a spouse predicted the change among men.

The change from margarine to butter between 2000 and 2011 seemed not to be a matter of compliance with official nutrition recommendations. Further longitudinal studies on social, behavioural and motivational predictors of dietary changes are needed.