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The cornerstone of obesity treatment is behavioural weight management, resulting in significant improvements in cardio-metabolic and psychosocial health. However, there is ongoing concern that dietary interventions used for weight management may precipitate the development of eating disorders. Systematic reviews demonstrate that, while for most participants medically supervised obesity treatment improves risk scores related to eating disorders, a subset of people who undergo obesity treatment may have poor outcomes for eating disorders. This review summarises the background and rationale for the formation of the Eating Disorders In weight-related Therapy (EDIT) Collaboration. The EDIT Collaboration will explore the complex risk factor interactions that precede changes to eating disorder risk following weight management. In this review, we also outline the programme of work and design of studies for the EDIT Collaboration, including expected knowledge gains. The EDIT studies explore risk factors and the interactions between them using individual-level data from international weight management trials. Combining all available data on eating disorder risk from weight management trials will allow sufficient sample size to interrogate our hypothesis: that individuals undertaking weight management interventions will vary in their eating disorder risk profile, on the basis of personal characteristics and intervention strategies available to them. The collaboration includes the integration of health consumers in project development and translation. An important knowledge gain from this project is a comprehensive understanding of the impact of weight management interventions on eating disorder risk.
Inflammatory diets are increasingly recognised as a modifiable determinant of mental illness. However, there is a dearth of studies in early life and across the full mental well-being spectrum (mental illness to positive well-being) at the population level. This is a critical gap given that inflammatory diet patterns and mental well-being trajectories typically establish by adolescence. We examined the associations of inflammatory diet scores with mental well-being in 11–12-year-olds and mid-life adults. Throughout Australia, 1759 11–12-year-olds (49 % girls) and 1812 parents (88 % mothers) contributed cross-sectional population-based data. Alternate inflammatory diet scores were calculated from a twenty-six-item FFQ, based on the prior literature and prediction of inflammatory markers. Participants reported negatively and positively framed mental well-being via psychosocial health, quality of life and life satisfaction surveys. We used causal inference modelling techniques via generalised linear regression models (mean differences and risk ratios (RR)) to examine how inflammatory diets might influence mental well-being. In children and adults, respectively, a 1 sd higher literature-derived inflammatory diet score conferred between a 44 % (RR 95 % CI 1·2, 1·8) to 57 % (RR 95 % CI 1·3, 2·0) and 54 % (95 % CI 1·2, 2·0) to 86 % (RR 95 % CI 1·4, 2·4) higher risk of being in the worst mental well-being category (i.e. <16th percentile) across outcome measures. Results for inflammation-derived scores were similar. BMI mediated effects (21–39 %) in adults. Inflammatory diet patterns were cross-sectionally associated with mental well-being at age 11–12 years, with similar effects observed in mid-adulthood. Reducing inflammatory dietary components in childhood could improve population-level mental well-being across the life course.
Nutritional geometry (NG) is a novel dietary analysis approach that considers nutrient balance, rather than single nutrient effects, on health and behaviour. Through NG, recent animal experiments have found that lifespan and reproduction are differentially altered by dietary macronutrient distribution. Epidemiological research using NG reports similar findings for human ageing. Yet, the relation of macronutrient balance to human reproduction, especially reproductive maturation, remains undefined. We studied the impact of childhood macronutrient intake on pubertal maturation, by applying NG to an Australian longitudinal adolescent dataset. Food records, collected at age 8 years from 142 pre-pubertal children (females, 92; males, 50), were analysed for absolute energy, percentage energy and energy-adjusted residuals from protein, carbohydrate and fat. Pubertal stage change (assessed at 8, 13 and 15 years) was modelled to obtain individual mathematical estimates of pubertal timing and tempo. Timing of menarche was recorded. The association of macronutrients to pubertal timing/tempo was assessed via NG, involving generalised additive models and heat maps to aid interpretation. Results showed lower dietary protein (relative to carbohydrate and fat) in girls consistently predicted earlier pubertal timing and menarche, and was related to faster pubertal tempo (all P < 0·05). No significant associations were identified in boys for both timing and tempo. Results suggest a role of non-protein macronutrients in facilitating female maturation; corroborating feeding and reproductive behaviour patterns observed in earlier NG studies of primates. Application of NG to other adolescent datasets is required to confirm the present findings. Such work would advance understanding of how nutrient balance shapes human development and health.
Few studies have investigated the effect of maternal factors on child eating practices. Our study aimed to explore mother–child dietary behaviours and their associations with socio-demographic factors. A cross-sectional analysis was conducted using data from control participants (n 243) in the Healthy Beginnings Trial, which involved first-time mothers and their 2-year-old children. Mother–child dietary behaviours were assessed using short dietary questions (short FFQ) and their associations with socio-demographic factors were examined using binary logistic regression. The dietary intake of 2-year-old children was characterised by low vegetable consumption and high discretionary food intake. In multivariate analysis, lower-income mothers (<Australian $40 000 per annum) reported their child was more likely to consume less fruit (<1 serve/d) (adjusted OR (AOR): 5·83; 95 % CI 1·49, 22·80) and ate hot chips more frequently (≥2 times/week) (AOR: 4·80; 95 % CI 1·28, 18·04), compared with higher-income mothers (≥Australian $40 000 per annum). Younger mothers (<25 years) reported their child consumed more sugary drinks and soft drink (>0·5 cups/d) AOR 2·93 (95 % CI 1·03, 8·35), compared with older mothers (≥25 years). Non-Australian-born mothers reported their child consumed more fruit juice (>0·5 cups/d) AOR 2·04 (95 % CI 1·02, 4·05), sweet snacks AOR 1·96 (95 % CI 1·02, 3·76) and fast food (≥2 times/week) AOR 3·67 (95 % CI 1·29, 10·43) compared with Australian-born mothers. Significant positive correlations between maternal and child dietary intake were observed for all dietary variables except milk, with the largest association for fast foods (Pearson’s r 0·52, P<0·001). This study shows that maternal factors are associated with child dietary behaviours. Targeting young mothers (<25 years) of potential disadvantage, before commencement of early feeding practices, has the potential to improve children’s diets.
The formation of food brand associations and attachment is fundamental to brand preferences, which influence purchases and consumption. Food promotions operate through a cascade of links, from brand recognition, to affect, and on to consumption. Frequent exposures to product promotions may establish social norms for products, reinforcing brand affect. These pathways signify potential mechanisms for how children’s exposure to unhealthy food promotions can contribute to poor diets. The present study explored children’s brand associations and attachments for major food brands.
A cross-sectional online survey was conducted. Fourteen study brands were used, with each child viewing a set of seven logos. The questionnaire assessed perceptions of food brands and perceptions of users of brands, using semantic differential scales, and perceived brand ‘personalities’, using Likert scales.
New South Wales, Australia, October–November 2014.
Children aged 10–16 years (n 417).
Children demonstrated strong positive affect to certain brands, perceiving some unhealthy food brands to have positive attributes, desirable user traits and alignment to their own personality. Brand personality traits of ‘smart’ and ‘sporty’ were viewed as indicators of healthiness. Brands with these traits were ranked lower for popularity.
Children’s brand associations and attachments indicate the potential normative social influences of promotions. While children are aware of brand healthiness as an attribute, this competes with other brand associations, highlighting the challenge of health/nutrition messaging to counter unhealthy food marketing. Restricting children’s exposure to unhealthy food marketing and the persuasive nature of marketing is an important part of efforts to improve children’s diet-related health.
The persistence of undernutrition, along with overweight and obesity, constitute the double burden of malnutrition. The present study aimed to: (i) describe the prevalence and trends of concurrent stunting and overweight in Indonesian children; (ii) identify potentially associated risk factors; and (iii) determine whether stunted children are at greater risk of overweight compared with those of healthy height.
A secondary data analysis of children aged 2·0–4·9 years in four cross-sectional studies of the Indonesian Family Life Survey. Children’s height and BMI Z-scores were calculated based on the WHO Child Growth Standards (2006). We defined ‘concurrent stunting and overweight’ as height-for-age Z-score <−2 and BMI Z-score >+1. Multivariate generalised linear latent and mixed models were used to determine associated risk factors.
Thirteen out of twenty-seven provinces in Indonesia.
Children (n 4101) from four waves of the Indonesian Family Life Survey (1993–2007).
There were inconsistent trends in the prevalence of concurrent stunting and overweight from waves 1 to 4. Children were more likely to be stunted and overweight when they were in the youngest age group (2·0–2·9 years), were weaned after the age of 6 months, had short-statured mothers or lived in rural areas. Stunted children were significantly more likely to be overweight than healthy-height children (OR>1) but did not differ significantly different across each wave (OR=1·34–2·01).
Concurrent stunting and overweight occurs in Indonesian children aged 2·0–4·9 years. Current policies and programmes need to be tailored for the management of this phenomenon.
We prospectively assessed the (1) frequency and socio-economic correlates of takeaway food consumption during adolescence; and (2) association between frequent takeaway food consumption with intakes of major food groups and anthropometric measures and blood pressure (BP). In total, 699 Sydney schoolchildren (380 girls and 319 boys) who had dietary data at both 12 and 17 years of age were included for analyses. Takeaway food consumption was self-reported and based on a single question. Anthropometric measures and BP were collected. The proportion of participants who ate takeaway foods once per week or more increased significantly over 5 years from the age of 12 to 17 years: 35·5–44·1 % (P<0·0001). In total, 12-year-old girls compared with boys had reduced odds of takeaway foods once per week or more at the age of 17 years (P=0·01), multivariable-adjusted OR 0·63 (95 % CI 0·44, 0·90). In total, 12-year-old children who ate takeaway foods once per week or more had significantly lower mean fruit (220·3 v. 253·0 g/d; P=0·03) and vegetable consumption (213·2 v. 247·7 g/d; P=0·004), 5 years later (at 17 years of age). Frequent takeaway food consumption at the age of 12 years was not associated with anthropometric indices and BP at the age of 17 years. Consumption of takeaway foods became more frequent during adolescence, particularly among boys, and it was associated with reduced intake of fruits and vegetables.
To examine demographic and behavioural correlates of unhealthy snack-food consumption among Australian secondary-school students and the association between their perceptions of availability, convenience and intake with consumption.
Cross-sectional survey of students’ eating, physical activity and sedentary behaviours using validated instruments administered via an online questionnaire.
Australian secondary schools across all states/territories.
Secondary-school students aged 12–17 years participating in the 2009–10 National Secondary Students’ Diet and Activity (NaSSDA) survey (n 12 188).
Approximately one in five students (21 %) reported consuming unhealthy snack foods ≥14 times/week (‘frequent snackers’). After adjusting for all covariates, older students and those with a BMI of ≥25 kg/m2 were less likely to be frequent snackers, while students who reported high fast-food and high sugar-sweetened beverage consumption and those who watched television for >2 h/d were more likely to snack frequently. Furthermore, after adjusting for all covariates and demographic factors, students who agreed that snack foods are usually available at home, convenient to buy and that they eat too many snack foods were more likely to be snacking frequently. Conversely, students who agreed that fruit is a convenient snack were less likely to be frequent snackers.
Frequent unhealthy snack-food consumption appears to cluster with other poor health behaviours. Perceptions of availability and convenience are factors most readily amenable to change, and findings suggest interventions should focus on decreasing the availability of unhealthy snack foods in the home and promoting healthier options such as fruit as convenient snacks.
To conduct a critical review of recent empirical research regarding mood, behaviour and nutrition factors including essential fatty acids, macronutrients, micronutrients and food additives.
A literature search of databases Medline, PsycInfo, CINAHL and Embase up to October 2008. The search emphasised empirical research published in the last 10 years and also included older literature. Studies in both adults and children were addressed.
Research into omega-3 fatty acids has been substantial but evidence for their potential in treating mood and behaviour is modest. In comparison, there has been much less research into carbohydrate and protein intakes and little evidence for their ability to influence mood and behaviour. Recent trials with food additives suggest their removal from the diet may benefit susceptible children with hyperactivity disorders. Micronutrient supplementation appears to improve mood only in those who were initially deficient in micronutrients.
More stringent research designs such as longitudinal studies and the use of biologically inert placebos within randomised controlled trials are needed before supplemental use of omega-3 fatty acids to treat disorders of mood and behaviour can be recommended. Caution is advised regarding the indiscriminate use of diets free of artificial food additives in managing hyperactivity disorders, as they may place an undue burden on individuals and their families. Should omega-3 fatty acid supplementation or the elimination of certain food additives be established as effective, they may provide cost-effective, accessible and well-tolerated adjuncts to standard psychiatric treatments for mood and behavioural disturbances.
To assess the association between socio-economic position (SEP) and poor eating behaviours in a large representative sample of Australian secondary-school students.
Cross-sectional survey of students’ vegetable, fruit, sugar-sweetened beverage and fast-food consumption assessed using validated instruments and collected via a web-based self-report format.
Secondary schools across all Australian states and territories.
Secondary-school students (n 12 188; response rate: 54 %) aged 12–17 years participating in the 2009–10 National Secondary Students’ Diet and Activity (NaSSDA) survey.
Overall, 25 % of students reported consuming ≤1 serving of vegetables/d and 29 % reported eating ≤1 serving of fruit/d. Fourteen per cent of students reported drinking at least 1–2 cups of sugar-sweetened beverages/d while 9 % reported eating fast food ≥3 times/week. After adjusting for other demographic factors, students of lower-SEP areas were more likely to report low intake of vegetables (F(4, 231) = 3·61, P = 0·007) and high frequency of consumption of sugar-sweetened beverages (F(4, 231) = 8·41, P < 0·001) and fast food (F(4, 231) = 4·59, P = 0·001) compared with students of high-SEP neighbourhoods. A positive SEP association was found for fruit consumption among female students only (F(4, 231) = 4·20, P = 0·003). Those from lower-SEP areas were also more likely to engage in multiple poor eating behaviours (F(4, 231)=5·80, P < 0·001).
Results suggest that socio-economic disparities in Australian adolescents’ eating behaviours do exist, with students residing in lower-SEP neighbourhoods faring less well than those from high-SEP neighbourhoods. Reducing social inequalities in eating behaviours among young people should be a key consideration of future preventive strategies.
A simple FFQ which ranks young children's dietary habits is necessary for population-based monitoring and intervention programmes. The aim of the present study was to determine the reliability and validity of a short FFQ to assess the dietary habits of young children aged 2–5 years.
Parents completed a seventeen-item FFQ for their children by telephone on two occasions, two weeks apart. Sixty-four parents also completed 3 d food records for their children. The FFQ included daily servings of fruit and vegetables, frequency of eating lean meat, processed meats, take-away food, snack foods (biscuits, cakes, doughnuts, muesli bars), potato crisps and confectionery, and cups of soft drinks/cordials, juice, milk and water. Weighted kappa and intra-class correlation coefficients were used to assess FFQ reliability and the Bland–Altman method was used to assess validity of the FFQ compared with the 3 d food record.
Seven pre-school centres in metropolitan Sydney, Australia.
Seventy-seven children aged 2–5 years.
The majority of questions had moderate to good reliability: κw ranged from 0·37 (lean meat) to 0·85 (take-away food consumption). Validity analysis showed a significant increase in mean values from the food record with increasing ordered categories from the FFQ for servings of vegetables and fruit and cups of drinks (all trend P ≤ 0·01). Spearman rank correlation coefficient was >0·5 for vegetables, fruit, diet soft drinks and fruit juice.
The FFQ provides reliable and moderately valid information about the dietary intakes and habits of children aged 2–5 years, in particular for fruit, vegetables and beverages.
To determine parents’ and children's attitudes towards food, beverage and alcohol sponsorship of elite and children's sports and the acceptability of policies and alternative funding models to limit this sponsorship.
Telephone surveys were conducted with parents in February–May 2011. One child from each household was invited to complete an online survey. Surveys assessed parents’ perceptions about the influence of sponsorship on children and support for limiting sponsorship, and children's awareness of and attitudes towards sponsors.
Randomly sampled households in New South Wales, Australia.
Parents (n 825) and children aged 10–16 years (n 243).
Three-quarters of parents supported the introduction of policies to restrict unhealthy food, beverage and alcohol sponsorship of children's and elite sports. More parents (81 %) supported the introduction of alternative funding models to allow these companies to sponsor sport provided there was no visible branding. Two-thirds of children recalled sponsors of their favourite elite sports team/athlete, with 428 sponsors recalled. Of these, 11 % were food/beverage companies and 3 % were alcohol-related. For 39 % of sponsors, children reported feeling better about the company after it had sponsored a team/athlete.
Australian parents support restrictions on unhealthy food, beverage and alcohol sport sponsorship. Children's positive associations regarding sponsors are likely to be linked to brand preferences and usage.
We aimed to establish associations of duration of breast-feeding with mean BMI and waist circumference, as well as the likelihood of being overweight/obese, during early childhood.
Cross-sectional, population-based study. Height, weight and waist circumference were measured and BMI calculated. Interviewer-administered questionnaire determined whether the child was ever breast-fed and the duration of breast-feeding.
Infants and pre-school children (n 2092) aged 1–6 years were examined in the Sydney Paediatric Eye Disease Study during 2007–2009.
Of the children aged 1–6 years, 1270 had been breast-fed compared with 822 who were never breast-fed. After multivariable adjustment, 1–6-year-old children who were ever breast-fed compared with those who were not had significantly lower BMI, 16·7 (se 0·1) kg/m2v. 17·1 (se 0·2) kg/m2 (P = 0·01). Decreasing BMI was associated with increasing duration of breast-feeding (Ptrend = 0·002). After multivariable adjustment, each month increase in breast-feeding was associated with an average BMI decrease of 0·04 kg/m2 (P = 0·002) and 0·03 kg/m2 (P = 0·03) among children aged 1–2 years and 3–4 years, respectively. In 1–2-year-old children, each month increase in breast-feeding duration was associated with a 0·06 cm decrease in waist circumference (P = 0·04). Significant associations were not observed among 5–6-year-old children. Children who were ever breast-fed v. those never breast-fed were less likely to be overweight/obese (multivariable-adjusted OR = 0·54; 95 % CI 0·36, 0·83).
We demonstrated a modest influence of breast-feeding on children's BMI during early childhood, particularly among those aged less than 5 years.
A detailed understanding of the underlying drivers of obesity-risk behaviours is needed to inform prevention initiatives, particularly for individuals of low socioeconomic position who are at increased risk of unhealthy weight gain. However, few studies have concurrently considered factors in the home and local neighbourhood environments, and little research has examined determinants among children from low socioeconomic backgrounds. The present study examined home, social and neighbourhood correlates of BMI (kg/m2) in children living in disadvantaged neighbourhoods. Cross-sectional data were collected from 491 women with children aged 5–12 years living in forty urban and forty rural socioeconomically disadvantaged areas (suburbs) of Victoria, Australia in 2007 and 2008. Mothers completed questionnaires about the home environment (maternal efficacy, perceived importance/beliefs, rewards, rules and access to equipment), social norms and perceived neighbourhood environment in relation to physical activity, healthy eating and sedentary behaviour. Children's height and weight were measured at school or home. Linear regression analyses controlled for child sex and age. In multivariable analyses, children whose mothers had higher efficacy for them doing physical activity tended to have lower BMI z scores (B = − 0·04, 95 % CI − 0·06, − 0·02), and children who had a television (TV) in their bedroom (B = 0·24, 95 % CI 0·04, 0·44) and whose mothers made greater use of food as a reward for good behaviour (B = 0·05, 95 % CI 0·01, 0·09) tended to have higher BMI z scores. Increasing efficacy among mothers to promote physical activity, limiting use of food as a reward and not placing TV in children's bedrooms may be important targets for future obesity prevention initiatives in disadvantaged communities.
A set of seven principles (the ‘Sydney Principles’) was developed by an International Obesity Taskforce (IOTF) Working Group to guide action on changing food and beverage marketing practices that target children. The aim of the present communication is to present the Sydney Principles and report on feedback received from a global consultation (November 2006 to April 2007) on the Principles.
The Principles state that actions to reduce marketing to children should: (i) support the rights of children; (ii) afford substantial protection to children; (iii) be statutory in nature; (iv) take a wide definition of commercial promotions; (v) guarantee commercial-free childhood settings; (vi) include cross-border media; and (vii) be evaluated, monitored and enforced.
The draft principles were widely disseminated and 220 responses were received from professional and scientific associations, consumer bodies, industry bodies, health professionals and others. There was virtually universal agreement on the need to have a set of principles to guide action in this contentious area of marketing to children. Apart from industry opposition to the third principle calling for a statutory approach and several comments about the implementation challenges, there was strong support for each of the Sydney Principles. Feedback on two specific issues of contention related to the age range to which restrictions should apply (most nominating age 16 or 18 years) and the types of products to be included (31 % nominating all products, 24 % all food and beverages, and 45 % energy-dense, nutrient-poor foods and beverages).
The Sydney Principles, which took a children’s rights-based approach, should be used to benchmark action to reduce marketing to children. The age definition for a child and the types of products which should have marketing restrictions may better suit a risk-based approach at this stage. The Sydney Principles should guide the formation of an International Code on Food and Beverage Marketing to Children.
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