Search

Background: The Children’s Body Image Scale (CBIS) is a measure of body perception and satisfaction. Obesity has a negative impact on children’s body satisfaction. This study aimed to (1) determine the construct validity of the CBIS in a purely overweight/obese sample, and (2) explore longitudinal changes in body perception and satisfaction in overweight/obese children participating in a six month weight management program delivered to parents. Datawere self-reported by overweight/obese 5 to 9 year old children (n = 127) over a 36 month period. Findings: The CBIS demonstrated good construct validity (Rho: range 0.38 to 0.71, p < 0.05). Accuracy in body size perception did not alter significantly over time (Rho: range 0.45 to 0.59, p < 0.001). No consistent differences in body satisfaction by age or sex were observed. Body satisfaction improved after the six month weight management intervention (mean difference = 0.74, 95% CI 0.15–1.26) which was maintained at 36 month follow up. Conclusion: The CBIS is a useful measure to monitor overweight/obese children’s body satisfaction. In this cohort, it is suggestive that the child weight management program delivered to parents did not impact negatively on children’s body satisfaction. Refereed/Peer-reviewed

Background: Excessive consumption of discretionary choices (nutrient-poor foods and beverages) negatively impacts on children's diet quality and increases the risk of obesity and related chronic conditions. Dietary guidelines are complex, and simple messages based on effective dietary strategies are needed to improve population compliance with dietary guidelines. Objective: This study aimed to quantify the theoretical nutritional impact of dietary strategies targeting a reduction in discretionary choice intake in Australian children aged 2 to 18 years. Design: This study was a computer simulation dietary modeling design. Participants/setting: Participants were Australian children aged 2 to 18 years (n=2,812, population weighted N=4,770,094) from the National Nutrition and Physical Activity Survey 2011-2012. Intervention: Simulations were performed on 24-hour recall dietary intake data to model theoretical impact on nutrient profile of moderating (50% reduction), substituting (replacing 50% of discretionary choices for core foods), and reformulating (reducing target nutrients within products) mean population intake of all discretionary choices. Main outcome measures: The main outcome measures were absolute and percentage change in nutrient profile (energy, saturated fat, added sugars, sodium). Statistical analyses performed: Simulations were performed using percent adjustment calculations and “What If” analyses. Sensitivity analyses were performed adjusting parameter uncertainties. Results: Moderation (energy −4.8% to −19.3%, saturated fat −10.2% to −24.5%, added sugars −24.3% to −43.1%, sodium −6.4% to −20.3%) and substitution (energy −9.4% to −15.4%, saturated fat −7.6% to −22.5%, added sugars −39.2% to −42.7%, sodium −10.8% to −19.0%) scenarios saw the greatest reductions across energy and target nutrients, with substitution scenarios modeling a smaller impact on protein, fiber, and micronutrients compared with the moderation strategy. The reformulation scenarios showed less theoretical reductions in energy intake (−1.1% to −12.8%), despite the differences in saturated fat (−27.5%), added sugars (−25.5%), and sodium (−9.1%), between the primary scenarios compared with base case. Conclusions: Dietary strategies to reduce discretionary choices (moderation) or replace them with core (healthy) food group choices (substitution) show good theoretical improvements in energy intake and nutritional profile. Multinutrient reformulation approaches achieve reductions in saturated fat, added sugar, and sodium. To reduce population discretionary choices intake, the dietary strategies can inform policy and food industry and consumer education action. Refereed/Peer-reviewed

Whereas the influence of pregnancy diet and milk feeding on children’s health and development is well characterized, the role of early food intake and eating behaviors is largely unexplored. This study aimed to determine whether the degree of adherence to complementary feeding guidelines was associated with dietary, obesity, cardiovascular, and cognitive outcomes at 7–8 y of age. Data were analyzed from the Avon Longitudinal Study of Parents and Children using parent-completed dietary questionnaires at 6 mo of age to calculate a Complementary Feeding Utility Index score. Regression analysis was used to explore associations between the index score and dietary patterns derived via principal component analysis (n = 4326), body-mass index (BMI) (n = 4801), waist circumference (n = 4798), blood pressure (n = 4685), and lipids (n = 3232) measured at age 7 y; and intelligence quotient (IQ) measured at age 8 y (n = 4429) after adjustment for covariates. The index score was negatively associated with a “processed” dietary pattern [β = −0.16 (95% CI: −0.20, −0.13); P < 0.001] but positively associated with a “health conscious” dietary pattern [β = 0.18 (95% CI: 0.14, 0.21); P < 0.001]. A higher index score was also positively associated with total, verbal, and performance IQ scores at 8 y of age [β = 1.92 (95%CI: 1.38, 2.47); P < 0.001 for total IQ). The index score was weakly associated with waist circumference [β = −0.15 (95%CI: −0.31, −0.002); P = 0.046] and diastolic blood pressure [β = −0.24 (95%CI: −0.47, −0.01); P = 0.043] at 7 y of age but was not associated with BMI or other cardiovascular risk factors. These findings suggest that adherence to current complementary feeding guidelines may have implications for some, but not all, health and development outcomes in childhood Refereed/Peer-reviewed

There are few dietary assessment tools that are scientifically developed and freely available online. The Commonwealth Scientific and Industrial Research Organisation (CSIRO) Healthy Diet Score survey asks questions about the quantity, quality, and variety of foods consumed. On completion, individuals receive a personalised Diet Score-reflecting their overall compliance with the Australian Dietary Guidelines. Over 145,000 Australians have completed the survey since it was launched in May 2015. The average Diet Score was 58.8 out of a possible 100 (SD = 12.9). Women scored higher than men; older adults higher than younger adults; and normal weight adults higher than obese adults. It was most common to receive feedback about discretionary foods (73.8% of the sample), followed by dairy foods (55.5%) and healthy fats (47.0%). Results suggest that Australians’ diets are not consistent with the recommendations in the guidelines. The combination of using technology and providing the tool free of charge has attracted a lot of traffic to the website, providing valuable insights into what Australians’ report to be eating. The use of technology has also enhanced the user experience, with individuals receiving immediate and personalised feedback. This survey tool will be useful to monitor population diet quality and understand the degree to Australians’ diets comply with dietary guidelines. Refereed/Peer-reviewed

Population surveys have rarely identified dietary patterns associated with excess energy intake in relation to risk of obesity. This study uses self-reported food intake data from the validated Commonwealth Scientific and Industrial Research Organisation (CSIRO) Healthy Diet Score survey to examine whether apparent compliance with dietary guidelines varies by weight status. The sample of 185,951 Australian adults were majority female (71.8%), with 30.2%, 35.3% and 31.0% aged between 18-30, 31-50 and 51-70 years respectively. Using multinomial regression, in the adjusted model controlling for gender and age, individuals in the lowest quintile of diet quality were almost three times more likely to be obese than those in the highest quintile (OR 2.99, CI: 2.88:3.11; p < 0.001). The differential components of diet quality between normal and obese adults were fruit (difference in compliance score 12.9 points out of a possible 100, CI: 12.3:13.5; p < 0.001), discretionary foods (8.7 points, CI: 8.1:9.2; p < 0.001), and healthy fats (7.7 points, CI: 7.2:8.1; p < 0.001). Discretionary foods was the lowest scoring component across all gender and weight status groups, and are an important intervention target to improve diet quality. This study contributes to the evidence that diet quality is associated with health outcomes, including weight status, and will be useful in framing recommendations for obesity prevention and management. Refereed/Peer-reviewed

Aims: There is increasing interest in the use of smartphone applications (apps) for delivering child obesity management interventions and supporting lifestyle behaviour change; however, there has been very little academic research on their development. Our aim is to review nutrition-related apps designed for children currently available in Australia for their usefulness in education or support behavioural interventions for child obesity. Methods: Apps available for download in iTunes Australia between 2 April and 3 June 2013 which were suitable for children >12 years were identified. Key words were chosen to identify apps applicable to children, focusing on nutrition. Results: A total of 27 apps were included. Most apps (24/27) were not based on evidence-informed recommendations. A third of apps were developed in the USA (n = 10; 37%) and were free (67%), nine apps required upfront payment, with a mean cost of $A2.80 (range $A0.99-$A7.49). The most common nutrition features were the promotion of energy balance (n = 12 apps) and guidance on appropriate portion size (n = 15). The most common behaviour change feature was goal setting (n = 15). The five apps that scored most highly against the characteristics reviewed were: Calorie Counter Pro by My Net Diary, Weight Watchers, Swap It Don't Stop It, Control My Weight by Calorie King and Rate What I Ate-Photo Diet Tracker. Conclusions: Very few apps were identified that could be used in education or support behavioural interventions for child obesity. There is a need to harness this technology and evaluate the applicability and use within childhood obesity research interventions Refereed/Peer-reviewed

Dietary indices evaluate diet quality, usually based on current dietary guidelines. Indices can therefore contribute to our understanding of early-life obesity-risk dietary behaviours. Yet indices are commonly applied to dietary data collected by onerous methods (e.g., recalls or records). Short dietary assessment instruments are an attractive alternative to collect data from which to derive an index score. A systematic review of studies published before April 2013 was conducted to identify short (≤50 items) tools that measure whole-of-diet intake of young children (birth-five years) and are applicable to dietary indices, in particular screening obesogenic dietary behaviours. The search identified 3686 papers of which 16, reporting on 15 tools (n=7, infants and toddlers birth-24 months;n=8, preschoolers 2–5 years), met the inclusion criteria. Most tools were food frequency questionnaires (n=14), with one innovative dietary questionnaire identified. Seven were tested for validity or reliability, and one was tested for both. Six tools (n=2, infants and toddlers;n=4, preschoolers) are applicable for use with current dietary indices, five of which screen obesogenic dietary behaviours. Given the limited number of brief, valid and reliable dietary assessment tools for young children to which an index can be applied, future short tool development is warranted, particularly for screening obesogenic dietary behaviours.

Objective: To determine whether sleep timing behaviour is associated with energy intake and diet quality in children and adolescents. Conclusion: Late bedtimes and late wake up times are associated with poorer diet quality, independent of sleep duration, PAL and child and sociodemographic characteristics. Design: Cross-sectional analysis of nationally representative survey data. Results: In adjusted multivariate regression models with sleep timing behaviour group as the independent variable, the 'LL' category compared with the 'EE' category had a higher BMI z-score (β=0.20, 95% confidence interval (CI) 0.06 to 0.34, P=0.007), and lower diet quality (β=−4.0, 95% CI −5.7 to −2.3, P

Objective : To describe the impact of a parent-led, family-focused child weight management program on the food intake and activity patterns of pre-pubertal children. Methods : An assessor-blinded, randomized controlled trial involving 111 (64% female) overweight, pre-pubertal children 6-9 years of age randomly assigned to parenting-skills training plus intensive diet and activity education (P + DA), parenting-skills training alone (P), or a 12-month wait-listed control (WLC). Study outcomes were assessed at baseline, 6 months, and 12 months. This paper presents data on food intake assessed via a validated 54-item parent-completed dietary questionnaire and activity behaviours assessed via a parent-report 20-item activity questionnaire. Results : Intake of energy-dense nutrient-poor foods was lower in both intervention groups at 6 months (mean difference, P + DA - 1.5 serves [CI - 2.0; - 1.0]; P - 1.0 serves [- 2.0; - 0.5]) and 12 months (mean difference P + DA - 1.0 serves [CI - 2.0; - 0.5]; P - 1.0 serves [- 1.5; 0.0]) compared to baseline. Intake of vegetables, fruit, breads and cereals, meat and alternatives and dairy foods remained unchanged. Regardless of study group there were significant reductions over time in the reported time spent engaged in small screen activities and an increase in the time reported spent in active play. Conclusion : A child weight management intervention that promotes food intake in line with national dietary guidelines achieves a reduction in children's intake of energy-dense, nutrient-poor foods. This was achieved without compromising intake of nutrient-rich food and changes were maintained even once the intervention ceased. Refereed/Peer-reviewed

Diet quality indices reflect overall dietary patterns better than single nutrients or food groups. The study aims were to develop a measure of adherence with dietary guidelines applicable to child and adolescent populations in Australia and determine the association between index scores and food and nutrient intake, socio-demographic characteristics, and measures of adiposity. Data were analyzed from 4- to 16-y-old participants of the 2007 Australian Children’s Nutrition and Physical Activity Survey (n = 3416). The Dietary Guideline Index for Children and Adolescents (DGI-CA) comprises 11 components: 5 core food groups, wholegrain bread, reduced-fat dairy foods, extra foods (nutrient poor and high in fat, salt, and added sugar), healthy fats/oils, water, and diet variety (possible score of 100). The index criteria were age specific. The mean DGI-CA score was low (53.6 ± 0.4), similar between boys and girls, and differed by age; the youngest children scored higher than the oldest children (P < 0.0001). Higher DGI-CA scores were associated with lower energy intake, energy density, total and saturated fat, and sugar intake; higher protein, carbohydrate, fiber, calcium, iron, vitamin C, vitamin A, folate, phosphorous, magnesium, zinc, and iodine intakes; and a higher polyunsaturated:saturated fat ratio (P < 0.0001). DGI-CA scores were associated with socio-economic characteristics and measures of family circumstance. Weak positive associations were observed between DGI-CA score and BMI or waist circumference Z-scores in the 4- to 10-y and 12- to 16-y age groups only. This index is the first validated index in Australia and one of the few international indices to describe the diet quality of children and adolescents. Refereed/Peer-reviewed

Dietary intake and food habits are important contributors to the obesity epidemic. They are highly modifiable components of energy balance and are usually targeted in both obesity prevention and treatment programs. However, measurement of total diet creates challenges and can convey a large burden in terms of cost, technical expertise, impact on respondents and time. It is not surprising therefore that comprehensive reports of dietary intake in children are uncommon and, when reported, have limitations. The aim of this paper is to guide researchers and practitioners in selecting the most appropriate dietary assessment method for situations involving children and adolescents. This paper presents a summary of the issues to consider when choosing a method, a description of some of the more commonly used dietary assessment methods for young people and a series of case-studies to illustrate the range of circumstances faced when measuring dietary intake. We recommend that researchers consider the specific components of dietary intake addressed in their research and practice, and whether diet should be reported comprehensively or as targeted components. Other considerations include age, cognitive ability, weight status, physical activity level, respondent burden, and reliability and validity in the context of program goals and research questions. A checklist for selecting the appropriate dietary methodology is provided. This guide aims to facilitate the reporting of dietary intake and food habits in the context of obesity using valid and reliable measures, thus contributing to the evidence-base for nutrition policies and programs relating to obesity. © 2011 Informa Healthcare.

This review identifies studies describing interventions delivered across both the home and school/community setting, which target obesity and weight-related nutrition and physical activity behaviors in children. Fifteen studies, published between 1998 and 2010, were included and evaluated for effectiveness, study quality, nutrition/activity content, behavior change techniques, and theoretical basis, using validated assessment tools/taxonomies. Seven studies were rated as effective. Behavior change techniques used to engage families, and techniques associated with intervention effectiveness were coded. Effective studies used about 10 behavior change techniques, compared with 6.5 in ineffective studies. Effective interventions used techniques including providing general information on behavior–health links, prompting practice of behavior, and planning for social support/social changes. Different behavior change techniques were applied in the home and school setting. The findings of this review provide novel insights into the techniques associated with intervention effectiveness that can inform the development of public health obesity prevention strategies. Refereed/Peer-reviewed

On a population level, dietary improvement strategies have had limited success in preventing the surge in overweight and obesity or reducing risk factors for chronic disease. While numerous multi-component studies have examined whole-of-diet strategies, and single component (i.e. discrete) dietary intervention strategies have targeted an increase in core foods (e.g. fruits, vegetables, dairy), there is a paucity of evidence on the effectiveness of dietary intervention strategies targeting a decrease in discretionary choices. The aim of this review was to identify dietary intervention strategies that are potentially relevant to reducing intake of discretionary choices in 2-65 year olds. A scoping review was carried out to map the literature on key discrete dietary intervention strategies that are potentially applicable to reducing discretionary choices, and to identify the targeted health/nutrition effects (e.g. improve nutrient intake, decrease sugar intake, and reduce body weight) of these strategies. Studies conducted in participants aged 2-65 years and published in English by July 20, 2015, were located through electronic searches including the Cochrane Library, Medline, Embase, CINAHL, and Scopus. Three thousand two hundred and eighty three studies were identified from the search, of which 44 met the selection criteria. The dietary intervention strategies included reformulation (n = 13), substitution (n = 5), restriction/elimination (n = 9), supplementation (n = 13), and nutrition education/messages (n = 4). The key findings of the review were: restricting portion size was consistently beneficial for reducing energy intake in the acute setting; reformulating foods from higher fat to lower fat could be useful to reduce saturated fat intake; substituting discretionary choices for high fibre snacks, fruit, or low/no-calorie beverages may be an effective strategy for reducing energy intake; supplementing nutrient dense foods such as nuts and wholegrain cereals supports an improved overall diet quality; and, a combination of permissive and restrictive nutrition messages may effectively modify behavior to reduce discretionary choices intake. Longer-term, well-controlled studies are required to assess the effectiveness of the identified dietary strategies as interventions to reduce discretionary choices intake. Refereed/Peer-reviewed