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Mediators of the effectiveness of a kindergarten-based, family-involved intervention on pre-schoolers' snacking behaviour: the ToyBox-study.
Lambrinou, CP, van Stralen, MM, Androutsos, O, Cardon, G, De Craemer, M, Iotova, V, Socha, P, Koletzko, B, Moreno, LA, Manios, Y
Public health nutrition. 2019;(1):157-163
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Abstract
OBJECTIVE The present study aimed to explore the mediating role of family-related determinants on the effects of the ToyBox-intervention on pre-school children's consumption of healthy and unhealthy snacks. DESIGN The ToyBox-intervention was a kindergarten-based, family-involved intervention with a cluster-randomized design, aiming to promote healthy lifestyle behaviours to prevent obesity at pre-school age. SETTING Kindergartens (n 309) in six European countries. SUBJECTS A total of 6290 pre-schoolers and their families participated in the ToyBox-intervention in 2012-2013 and data from 5212 pre-schoolers/families were included in the current analyses. RESULTS Even though the total effect of the ToyBox-intervention on healthy and unhealthy snacking was not significant, the ToyBox-intervention significantly improved parental rule setting on children's unhealthy snack consumption (i.e. restriction of snacking while watching television and permission only at certain occasions) and parental consumption of unhealthy snacks, while it increased parental knowledge on snacking recommendations. Regarding healthy snacking, the ToyBox-intervention improved children's attitude towards fruit and vegetables (F&V). All previously mentioned family-related determinants mediated the intervention effects on pre-schoolers' consumption of healthy and unhealthy snacks. Almost all family-related determinants examined in the study were independently associated with pre-schoolers' consumption of healthy and unhealthy snacks. CONCLUSIONS The intervention was effective in improving relevant family-related determinants. Interventions aiming to promote F&V consumption and limit the consumption of unhealthy snacks in pre-schoolers should target on these mediators, but also identify new family-, school- or peer-related determinants, to enhance their effectiveness.
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A review of methods to assess parental feeding practices and preschool children's eating behavior: the need for further development of tools.
de Lauzon-Guillain, B, Oliveira, A, Charles, MA, Grammatikaki, E, Jones, L, Rigal, N, Lopes, C, Manios, Y, Moreira, P, Emmett, P, et al
Journal of the Academy of Nutrition and Dietetics. 2012;(10):1578-602, 1602.e1-8
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Abstract
We reviewed tools developed to measure parental feeding practices and eating behavior and food intake or preferences of children aged 0 to 5 years. Two electronic literature databases (Medline and Psycinfo) were used to search for both observational and experimental studies in human beings. The articles selected for review were those presenting tools with data on internal consistency and/or test-retest reliability and/or construct validity. A total of 3,445 articles were retrieved, and further searching of reference lists and contact with experts produced an additional 18 articles. We identified three tools on the qualitative dimension of children's eating behavior, two tools on food intake or preferences, and one tool on parental feeding practices with rigorous testing of internal consistency, construct validity, and test-retest reliability. All other tools presented in this review need further evaluation of their validity or reliability. Because major gaps exist, we highlight the need for more tools on parental attention to children's hunger and satiety cues, and the need to evaluate the degree of control allowed to children younger than age 2 years in feeding events. Food avoidance (ie, behaviors or strategies to take away and to reject food) and food approach (ie, attractiveness for food stimuli) have not been assessed in children aged 12 to 24 months. Food preference tests based on sensory aspects rather than nutritional quality may be worth investigating. We identified a need for further evaluation of quality, especially test-retest reliability and construct validity, for most tools developed for use in studying children aged 0 to 5 years.