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1.
Portion size selection in children: Effect of sensory imagery for snacks varying in energy density.
Lange, C, Schwartz, C, Hachefa, C, Cornil, Y, Nicklaus, S, Chandon, P
Appetite. 2020;:104656
Abstract
Food sensory imagery - creating a vivid mental image of the sensory experience of eating - can lead to the selection of smaller portions because it serves as a reminder that eating enjoyment does not necessarily increase with portion size. The evidence is mostly limited to adults and to energy-dense foods for which it is particularly difficult to predict the satiating effects of consumption quantity. The objective was to study how food sensory imagery influences portion size selection of foods varying in energy density (brownie and applesauce) by 7- to 11-year-old children. During after-school time, 171 children were randomized into two conditions. Children in the food sensory imagery condition were asked to imagine the taste, smell, and texture of eating palatable foods, i.e., chocolate cereal, chocolate waffle, and chocolate candies. Children in the control condition performed a similar sensory imagery task for non-food-related activities. Children were then asked to choose between the recommended serving size, a 50% larger portion, and a 125% larger portion of either brownie or applesauce. One week later, they were placed in the same condition for the other food. Compared to the control condition, food sensory imagery led children to choose 7.1% less brownie but had no effect on applesauce portion selection. Exploratory findings showed that the food sensory imagery intervention was especially effective at reducing brownie portion size selection among children who were moderately hungry, who usually eat fast, and whose parents pressure them to eat. In conclusion, food sensory imagery may be a useful intervention to nudge children towards healthier portion size choices because it reduces the selected portion size of an energy-dense snack without reducing the selected portion size of a healthier snack.
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Effect of Family-Based REDUCE Intervention Program on Children Eating Behavior and Dietary Intake: Randomized Controlled Field Trial.
Ahmad, N, Shariff, ZM, Mukhtar, F, Lye, MS
Nutrients. 2020;(10)
Abstract
The objective of this study was to evaluate the effect of a family-based intervention program (REDUCE) on children's eating behaviors and dietary intake. A two-arm randomized controlled field trial was conducted among parents and children of 7 to 10 years old who were either overweight or obese. The intervention was conducted via face-to-face sessions and social media. The child eating behaviors were assessed using the child eating behaviors questionnaire (CEBQ), while their dietary consumption of vegetables and unhealthy snacks was assessed using a parental report of three days unweighted food. The generalized linear mixed modelling adjusted for covariates was used to estimate the intervention effects with alpha of 0.05. A total of 122 parents (91% response rate) completed this study. At the six-month post-training, there were statistically significant mean differences in the enjoyment of food (F(6481) = 4.653, p < 0.001), fruit and vegetable intake (F(6480) = 4.165, p < 0.001) and unhealthy snack intake (F(6480) = 5.062, p < 0.001) between the intervention and wait-list groups; however, it was not clinically meaningful. This study added to the body of knowledge of family-based intervention that utilized social media and assessed the effect in children's eating behavior using the CEBQ and children's dietary intake.
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Advertising Placement in Digital Game Design Influences Children's Choices of Advertised Snacks: A Randomized Trial.
Smith, R, Kelly, B, Yeatman, H, Moore, C, Baur, L, King, L, Boyland, E, Chapman, K, Hughes, C, Bauman, A
Journal of the Academy of Nutrition and Dietetics. 2020;(3):404-413
Abstract
BACKGROUND Children are inhabitants of a media-rich environment rife in extensive, sophisticated, and persistent techniques that are used to market unhealthy food. Exposure is known to influence children's attitudes, choices, and consumption, yet further research is required to explore the influence of contemporary techniques within online games. OBJECTIVE To explore the influence of modern advertising on children's attitudes, choices, and consumption, techniques (ie, banner advertising, advergame, and rewarded video advertising) were used to promote an unfamiliar confectionery brand within an online game. DESIGN A between-subjects randomized experimental study. PARTICIPANTS/SETTING Children (aged 7 to 12 years [n=156]) were recruited in New South Wales, Australia, between September and November 2017. INTERVENTION Children were required to play a 4-minute online game, complete some questionnaires, and choose one snack to consume afterward. Children were randomly assigned to one of four conditions: a control group with no advertising, and three experimental conditions that promoted an unfamiliar confectionery brand via a banner advertisement, advergame, or rewarded video advertisement. MAIN OUTCOME MEASURES Questionnaires included the assessment of attitudes to the test brand before and after the game, enjoyment of the game, and children's awareness of advertising. Food choice was recorded and food consumption was measured by weighing the snack in grams, which was translated into kilocalories. STATISTICAL ANALYSES PERFORMED Statistical tests included analyses of variance, Kruskal-Wallis test, and χ2 test. RESULTS Attitudes toward the perception of fun (P=0.06) and taste (P=0.21) of the test brand were not influenced by condition. Children who were exposed to the rewarded video advertising chose the test brand significantly more than children in the other three conditions (P<0.002). Condition did not influence overall energy intake measured in grams (P=0.78) or kilocalories (P=0.46). CONCLUSIONS Children's choice of the test brand was significantly influenced by the rewarded video advertising condition (compared with control, banner advertising, and advergame conditions). This technique is prevalent across online and application games that children play yet the effects of using rewarded video advertising to promote food brands have not been explored from a public health perspective. This study contributes to the understanding of modern strategies used to market unhealthy foods to children.
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Using repeated visual exposure, rewards and modelling in a mobile application to increase vegetable acceptance in children.
Farrow, C, Belcher, E, Coulthard, H, Thomas, JM, Lumsden, J, Hakobyan, L, Haycraft, E
Appetite. 2019;:104327
Abstract
Children are not consuming the recommended amounts of fruit and vegetables. Repeated visual exposure, modelling, and rewards have been shown to be effective at increasing vegetable acceptance in young children. The aim of this study was to assess the effectiveness of an evidence-based mobile application (Vegetable Maths Masters) which builds on these principles to increase children's liking and acceptance of vegetables. Seventy-four children (37 male, 37 female) aged 3-6 years old were randomised to play with either the vegetable app or a similar control app that did not include any foods. Children played their allocated game for 10 min. Liking and acceptance of the vegetables used in Vegetable Maths Masters (carrot and sweetcorn) and other vegetables which were not used in the game (yellow pepper and tomato) were measured pre- and post-play in both groups. Parents provided data about their child's food fussiness and previous exposure to the foods being used. Children who played with the Vegetable Maths Masters app consumed significantly more vegetables after playing with the app and reported significant increases in their liking of vegetables, relative to the control group. The effect of the Vegetable Maths Masters app on the change in consumption of vegetables was mediated by the change in liking of vegetables. These findings suggest that evidence-based mobile apps can provide an effective tool for increasing children's liking and consumption of vegetables in the short-term. Further work is now required to establish whether these effects are maintained over time.
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Development of the DAGIS intervention study: a preschool-based family-involving study promoting preschoolers' energy balance-related behaviours and self-regulation skills.
Ray, C, Kaukonen, R, Lehto, E, Vepsäläinen, H, Sajaniemi, N, Erkkola, M, Roos, E
BMC public health. 2019;(1):1670
Abstract
BACKGROUND Preschoolers' energy balance-related behaviours (EBRBs) and self-regulation skills are important for their later health. Few preschool-based interventions aiming to promote preschoolers' EBRBs and self-regulation skills, simultaneously reducing differences in EBRBs, due to children's socio-economic status (SES) background, have been conducted. This study will present the Increased Health and Wellbeing in Preschools (DAGIS) intervention development process applying the Intervention Mapping (IM) framework. METHODS The development of the DAGIS intervention study, a preschool level clustered randomized controlled trial (RCT), was based on the IM framework. The protocol in IM guides the development process of an intervention through six steps: needs assessment and logic model of the problem, programme outcomes and objectives, design of the programme, production, implementation plan, and evaluation plan. RESULTS The needs assessment, part of the step 1 in IM, yielded the base for the DAGIS logic model of change. The model includes objectives related to changes in children's EBRBs, self-regulation skills, and in psychosocial and physical environment that is determined by parents and early educators. A 22-week programme was developed, and materials for preschools and families were produced. A feasibility study of the recruitment processes, acceptability of the materials and methods, and implementation was conducted. The DAGIS intervention study was conducted September 2017-May 2018 as a clustered RCT including a comprehensive effectiveness and process evaluation. The process evaluation was run throughout the intervention targeting preschools and families. CONCLUSION A preschool-based family-involving programme was developed in the DAGIS intervention study by applying the IM protocol. It was a time- and resource-consuming process. However, the systematic planning, development, and running of the programme have reinforced a comprehensive evaluation, which is a strength in the intervention. The results from the evaluation will enhance the knowledge of how to promote EBRBs and self-regulation skills among preschoolers, and diminish SES differences in them. TRIAL REGISTRATION ISRCTN57165350 (Prospectively registered January the 8th, 2015).
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Caffeine affects children's ERPs and performance in an equiprobable go/no-go task: Testing a processing schema.
Barry, RJ, De Blasio, FM, Fogarty, JS
Psychophysiology. 2019;(5):e13330
Abstract
Caffeine's stimulant properties were used to test a proposed processing schema for children's processing stages in the equiprobable auditory go/no-go task. Active control-related ERP components were hypothesized to be differentially enhanced by caffeine. Caffeine (80 mg) was administered in a counterbalanced, randomized, double-blind, placebo-controlled, cross-over study of 24 children, aged 8-12 years. Four blocks of an equiprobable auditory go/no-go task were completed on each of two occasions, while on or off caffeine. ERP data sets from each condition (caffeine/go, placebo/go, caffeine/no-go, placebo/no-go) were subjected to separate temporal PCAs with extraction and varimax rotation of all components. Caffeine significantly reduced reaction time and go omission errors, and enhanced go PN, N2c, and P3b, and no-go N1-1 and N2b. This selective enhancement of different go/no-go components by caffeine matched the predicted amplification of biomarkers of children's active control processing in this task. Some unexpected findings also support further refinements in the child processing schema.
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The effect of mild sleep deprivation on diet and eating behaviour in children: protocol for the Daily Rest, Eating, and Activity Monitoring (DREAM) randomized cross-over trial.
Ward, AL, Galland, BC, Haszard, JJ, Meredith-Jones, K, Morrison, S, McIntosh, DR, Jackson, R, Beebe, DW, Fangupo, L, Richards, R, et al
BMC public health. 2019;(1):1347
Abstract
BACKGROUND Although insufficient sleep has emerged as a strong, independent risk factor for obesity in children, the mechanisms by which insufficient sleep leads to weight gain are uncertain. Observational research suggests that being tired influences what children eat more than how active they are, but only experimental research can determine causality. Few experimental studies have been undertaken to determine how reductions in sleep duration might affect indices of energy balance in children including food choice, appetite regulation, and sedentary time. The primary aim of this study is to objectively determine whether mild sleep deprivation increases energy intake in the absence of hunger. METHODS The Daily, Rest, Eating, and Activity Monitoring (DREAM) study is a randomized controlled trial investigating how mild sleep deprivation influences eating behaviour and activity patterns in children using a counterbalanced, cross-over design. One hundred and ten children aged 8-12 years, with normal reported sleep duration of 8-11 h per night will undergo 2 weeks of sleep manipulation; seven nights of sleep restriction by going to bed 1 hr later than usual, and seven nights of sleep extension going to bed 1 hr earlier than usual, separated by a washout week. During each experimental week, 24-h movement behaviours (sleep, physical activity, sedentary behaviour) will be measured via actigraphy; dietary intake and context of eating by multiple 24-h recalls and wearable camera images; and eating behaviours via objective and subjective methods. At the end of each experimental week a feeding experiment will determine energy intake from eating in the absence of hunger. Differences between sleep conditions will be determined to estimate the effects of reducing sleep duration by 1-2 h per night. DISCUSSION Determining how insufficient sleep predisposes children to weight gain should provide much-needed information for improving interventions for the effective prevention of obesity, thereby decreasing long-term morbidity and healthcare burden. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12618001671257 . Registered 10 October 2018.
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Parental support in promoting children's health behaviours and preventing overweight and obesity - a long-term follow-up of the cluster-randomised healthy school start study II trial.
Norman, Å, Zeebari, Z, Nyberg, G, Elinder, LS
BMC pediatrics. 2019;(1):104
Abstract
BACKGROUND Effects of obesity prevention interventions in early childhood are only meaningful if they are sustained over time, but long-term follow-up studies are rare. The school-based cluster-randomised Healthy School Start (HSS) trial aimed at child health promotion and obesity prevention through parental support was carried out in 31 pre-school classes (378 families) in disadvantaged areas in Sweden during 2012-2013. Post-intervention results showed intervention effects on intake of unhealthy foods and drinks, and lower BMI-sds in children with obesity at baseline. This study aimed to evaluate the long-term effectiveness 4 years post-intervention. METHODS Data were collected from 215 children in March-June 2017. Child dietary intake, screen time, and physical activity were measured through parental-proxy questionnaires. Child height and weight were measured by the research group. Group effects were examined using Poisson, linear, logistic, and quantile regression for data on different levels. Analyses were done by intention to treat, per protocol, and sensitivity analyses using multiple imputation. RESULTS No between-group effects on dietary intake, screen time, physical activity, or BMI-sds were found for the entire group at the four-year follow-up. In girls, a significant subgroup-effect was found favouring intervention compared to controls with a lower intake of unhealthy foods, but this was not sustained in the sensitivity analysis. In boys, a significant sub-group effect was found where the boys in the intervention group beyond the 95th percentile had significantly higher BMI-sds compared to boys in the control group. This effect was sustained in the sensitivity analysis. Analyses per protocol showed significant intervention effects regarding a lower intake of unhealthy foods and drinks in the children with a high intervention dose compared to controls. CONCLUSIONS Four years after the intervention, only sub-group effects were found, and it is unlikely that the HSS intervention had clinically meaningful effects on the children. These results suggest that school-based prevention programmes need to be extended for greater long-term effectiveness by e.g. integration into school routine practice. In addition, results showed that children with a high intervention dose had better long-term outcomes compared to controls, which emphasises the need for further work to increase family engagement in interventions. TRIAL REGISTRATION ISRCTN, ISRCTN39690370, retrospectively registered March 1, 2013, http://www.isrctn.com/ISRCTN39690370 .
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Featured Article: Bidirectional Effects of Sleep and Sedentary Behavior Among Toddlers: A Dynamic Multilevel Modeling Approach.
Armstrong, B, Covington, LB, Unick, GJ, Black, MM
Journal of pediatric psychology. 2019;(3):275-285
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Abstract
OBJECTIVE To examine the bidirectional effects of objectively measured nighttime sleep and sedentary activity among toddlers. METHOD Actical accelerometer data were analyzed for 195 toddlers participating in an obesity prevention trial (mean age = 27 months). Toddlers wore the accelerometers for up to 7 consecutive days. Nighttime sleep was defined as the number of minutes asleep between the hours of 8 pm and 8 am the following morning. Sedentary behavior (in minutes) was defined using previously established Actical cut points for toddlers. Variables were lagged and parsed into latent within- and between-person components, using dynamic structural equation modeling (DSEM). RESULTS Toddlers spent an average of 172 min (∼3 hr) in sedentary activity and slept an average of 460 min (∼8 hr) per night. An autoregressive cross-lagged multilevel model revealed significant autoregression for both sleep and sedentary activity. Cross-lagged values revealed that decreased sleep predicted increased next-day sedentary activity, and sedentary activity predicted that night's sleep. For 89% of the sample, the within-person standardized cross-lagged effects of sleep on sedentary were larger than the cross-lagged effects of sedentary on sleep. CONCLUSIONS Results suggest that, on average, nighttime sleep is a stronger predictor of subsequent sedentary behavior (compared with the reverse), and this is the case for the majority of toddlers. Findings highlight the importance of interindividual associations between sleep and sedentary activity. The present study is an example of how DSEM methods can be used to ask questions about Granger-causal cross-lagged relations between variables, both within and between individuals.
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Time spent looking at food during a delay of gratification task is positively associated with children's consumption at ad libitum laboratory meals.
Lundquist, E, Austen, M, Bermudez, M, Rubin, C, Bruce, AS, Masterson, TD, Keller, KL
Appetite. 2019;:104341
Abstract
Greater ability to delay gratification for an immediate food reward may protect against the development of obesity. However, it is not known if the behaviors children exhibit during a delay of gratification task are related to overeating in other contexts. The purpose of this analysis was to assess the relationship between observed child coping strategies during a delay of gratification task and laboratory intake from ad libitum test-meals. The sample consisted of 40, 7-9 year old children (40% (N = 16 with overweight/obesity). Across 5 laboratory visits, children consumed 3 identical test-meals presented after varying exposure conditions (i.e., no exposure, exposure to food commercials, exposure to toy commercials). On the first visit, children were recorded during a delay of gratification task which was coded for three behavioral themes: looking at vs. away from food, talking vs. staying silent, and fidgeting vs. sitting still. Pearson correlations and multiple regressions were run to look at the relationships between coping strategies and test-meal intake. Time spent looking away from food was negatively associated with ad libitum food consumption at the meals. Conversely, greater time spent looking at food was positively associated with ad libitum food consumption. These relationships were independent of covariates likely to influence intake (e.g., sex, age, weight status, parent income) and were more robust following food rather than toy commercial exposure. Children who spent more time looking at food and less time looking away during a delay of gratification task may be vulnerable to overeating in other contexts. Upon replication in larger samples, these behaviors could serve as modifiable targets in the development of childhood obesity prevention programs.