Journal of the Academy of Nutrition and Dietetics最新文献

Background: Parents are important conduits of weight- and health-related messaging. Weight-related communication and approaches to child feeding used by parents may reflect their past experiences with weight stigma and are understudied pathways through which intergenerational weight stigma may be transmitted.

Objective: The aim of this study was to examine how experienced and internalized weight stigma among parents of children with higher weights are associated with weight-related communication and the feeding practices they use.

Design: The Listening to Parents study is a cross-sectional study of 103 parent-child dyads who completed in-person study visits at the University of Michigan in Ann Arbor between November 2022 through June 2023.

Participants/setting: Participants were parents of children (ages 6 through 14 years, identified by parents as "heavier or overweight") who completed the Stigmatizing Situations Inventory Brief and Weight Bias Internalization Scale-Modified, as well as questions about weight-related communication and the Comprehensive Feeding Practices Questionnaire.

Main outcome measures: Outcomes included 5 items corresponding to parental weight-related communication (ie, self-directed, other-directed, and child-directed weight talk, child-directed weight teasing, and child-directed encouragement to lose weight) and 3 Comprehensive Feeding Practices Questionnaire subscales (ie, Monitoring, Restriction for Health, and Restriction for Weight Control).

Statistical analyses performed: Linear regression models were used to examine associations between mean scored parent-experienced and parent-internalized weight stigma and weight-related communication and feeding practices. Models were adjusted for child gender, parent-perceived child weight status, parental race and ethnicity, parental body mass index, and household income-to-needs ratio.

Results: In covariate-adjusted models, parent-internalized weight stigma was positively associated with self-directed weight talk (β = .20, SE = .078; P = .01) and greater use of health-related restrictive child feeding practices (β = .16, SE = .070; P = .02). No other significant associations in covariate-adjusted models were observed.

Conclusions: Although parents with greater internalized weight stigma may engage in more self-directed weight talk, they may also be more attuned to the harms of weight stigma and seek to minimize child-directed weight talk and weight teasing.

Background: Emerging evidence indicates water insecurity (WI) is detrimental to nutritional outcomes and dietary choices.

Objective: WI experiences were measured alongside market and traditional sugar-sweetened beverage (SSB) consumption in a small-scale society experiencing the early stages of a nutrition transition (ie, lifestyle and dietary changes away from traditional foods) to test how they are associated.

Design: The 12-item Household Water Insecurity Experiences (HWISE) scale was implemented along with a cross-sectional retrospective survey of beverage intake and sociodemographic characteristics across 5 communities at varying distances from a market town.

Participants/setting: Participants were Tsimané forager-horticulturalist adults aged 16 years and older (n = 455; 47% were women) in lowland Bolivia from April through May 2019.

Main outcome measure: Sugar-sweetened beverage consumption and traditional beverage consumption were measured.

Statistical analyses performed: Multivariate logistic and Poisson regressions were performed, adjusting for possible confounding variables, including age, gender, income, household water needs, and community residence.

Results: Using logistic regressions, each point higher WI (HWISE) score was associated with 23% (95% CI 1.01 to 1.50; P = .035) and 27% (95% CI 1.06 to 1.52; P = .008) higher odds of consuming an SSB in the past week for men and women, respectively. For men, each point higher HWISE score was associated with 13% (95% CI 1.10 to 1.16; P < .001) higher odds of drinking chicha fuerte (ie, a traditional, homemade fermented beverage with antibacterial properties) and 16% (95% CI 1.02 to 1.32; P = .022) higher odds of consuming liquor. SSB consumption was highest in the closest communities to the market town and declined significantly with distance; and traditional beverages, such as chicha dulce (a sugar-sweetened, unfermented homemade chicha), were lowest in the close communities and increased with distance to the market town.

Conclusions: Among Tsimané adults living in the Bolivian Amazon experiencing the nutrition transition, WI was associated with greater SSB intake. Distance to the main market town shaped access and preferences, as it was associated with SSB and traditional beverage consumption.

Background: Children's consumption of ultra-processed food (UPF) may contribute to inequalities in obesity and wider health. Socioeconomic patterning in younger UK children's UPF intake is unknown.

Objective: The aim of this study was to investigate socioeconomic patterning of UK toddlers' (aged 21 months) and children's (aged 7 years) UPF intake across several household and neighborhood indicators.

Design: Secondary analysis of data from a prospective longitudinal cohort study using parent-reported sociodemographic data and 3-day diet diaries.

Participants/setting: Participants were children from the UK Gemini study of 4804 twins born in 2007. At ages 21 months and 7 years, 2591 and 592 children, respectively, had at least 2 days of dietary data.

Main outcome measures: This study measured percentage energy from UPF at 21 months and 7 years of age, classified using the NOVA system.

Statistical analyses performed: Unadjusted linear regression models were run for household socioeconomic position (SEP) composite score; index of multiple deprivation decile; income; occupation level; mother's age; education of mother and partner; and child's ethnicity, sex, and age. Adjusted multivariable linear regression models were adjusted for ethnicity and all SEP indicators except SEP composite score (adjusted 1), in addition to child sex and age (adjusted 2). Missing data were addressed with multiple imputation and inverse probability weighting. CIs and P values were adjusted to account for clustering within families.

Results: Children of lower SEP had higher UPF intake across several indicators. Mother's education was the strongest predictor; postgraduate education was associated with 8.64% (95% CI -12.08% to -5.20%; P < .001) and 10.12% (95% CI, -15.68% to -4.56%; P < .001) less energy from UPF at 21 months and 7 years, respectively, compared with no educational qualifications in adjusted model 2.

Conclusions: UK children from more disadvantaged backgrounds consumed a greater proportion of their energy from UPF. Mother's education seemed to be the most influential factor. Socioeconomic inequalities, particularly in maternal education, may drive disparities in diet quality and associated health outcomes. Addressing these gaps is essential to reduce childhood obesity and improve long-term health in socioeconomically disadvantaged populations.

Background: Home visitation programs are uniquely positioned to reach young children during the first 2000 days of life (ages 0 to 5 years), a critical time period to prevent childhood obesity.

Objective: This scoping review aimed to identify early childhood obesity prevention interventions implemented within home visitation during the first 2000 days of life, summarize outcomes assessed, and examine if and how nonmaternal caregivers and technology were included.

Methods: Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, 3 databases (PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature) were searched from January 1980 to June 2023 for obesity prevention interventions that utilized home visitation as a treatment modality, targeted children aged 5 years or younger, reported on child weight outcomes, were experimental or quasiexperimental designs with a control or comparison arm, and had full-text available in English. The quality and risk of bias of included studies were rated using the Academy of Nutrition and Dietetics' Quality Criteria Checklist for Primary Research.

Results: Of the 871 identified articles, 21 met inclusion criteria, and all reported at least 1 obesogenic behavioral outcome in the intervention group compared with the control group. Intervention duration ranged from 4 months to 3 years, and frequency of home visits varied from weekly, biweekly, monthly, or a designated number of home visits within a defined time frame. Three interventions partnered with an established home visiting program, but home visits in all interventions were conducted by either professional or paraprofessional individuals. Nine of the 21 studies targeted other caregivers in addition to the mother, and 12 of 21 incorporated a form of technology.

Conclusions: Several different early childhood obesity prevention interventions have been implemented within home visitation during the first 2000 days of life. Future research is needed to investigate the effectiveness of these interventions on weight- and behavior-related outcomes, as well as explore the influences of the interventionist type, program duration, inclusion of nonmaternal caregivers, and use of technology on childhood obesity-related outcomes.

Background: Although the Dietary Guidelines for Americans recommend that individuals drink water instead of sugar-sweetened beverages (SSBs), this behavior is influenced and reinforced by a complex network of structures and systems.

Objective: The objectives of this study were to develop a shared understanding among multiple stakeholders about the structural and underlying, interconnected drivers of SSB and water consumption in the Washington, DC, metro area and to have them identify feasible and influential policy levers.

Design: A community-based system dynamics approach was used during a 2-day group model building workshop where stakeholders engaged to develop a shared visual representation of the underlying, interconnected drivers of SSB and water intake and to identify what they believed were influential and feasible policy levers.

Participants/setting: Stakeholders were purposively recruited from diverse sectors (early childhood education [n = 6], nutrition assistance programs [n = 2], food policy council and advocacy groups [n =4], city government officials including municipal water [n = 4], and food and beverage retail [n = 1]) to participate in a group model building workshop during July 2022 in Washington, DC.

Statistical analysis: Using member checking and iterative feedback, the research team synthesized the outputs from the workshop into 1 causal loop diagram and ranked policy levers.

Results: Stakeholders visualized 7 subsystems that drive water and SSB consumption, then identified and ranked 5 policy levers by potential impact and ease of implementation, including increase public health spending (high impact/hard to do); invest in new and updated infrastructure for public water (high impact/hard to do); implement coordinated public health campaigns to promote drinking safe, palatable water as an alternative to SSB (low impact/easy to do); provision of tap water filters (low impact/easy to do); and limits on SSB marketing (high impact/debated easy or hard to do).

Conclusions: This participatory approach allowed stakeholders to envision multiple places to intervene in the system simultaneously to both decrease SSB and increase water consumption in the specific context of their community.