Effects of Doubling the Portion Size of Fruit and Vegetable Side Dishes on Children's Intake at a Meal

Increasing the portion size of energy‐dense entrées has been shown to increase children's energy intake during a meal. It remains to be investigated whether serving larger portions to children can be used to promote intake of more healthful foods, such as fruits and vegetables (F&V). The aim of the present study was to examine the effects of increasing the portion size of F&V side dishes on children's intake. Forty‐three children (22 boys, 21 girls), aged 5–6 years, were served dinner once a week for 2 weeks. Each dinner consisted of pasta with tomato sauce, three F&V side dishes (broccoli, carrots, and applesauce), and milk. The portion size of the F&V was doubled between experimental conditions whereas the size of the pasta remained constant. Doubling the portion size of the side dishes resulted in a 43% increase in children's intake of the fruit side dish (P = 0.001), but did not affect children's intake of the two vegetable side dishes (P > 0.60). Further, when the portion size of F&V side dishes was doubled, children ate significantly less of the pasta (P = 0.04). The difference in meal energy intake between portion size conditions (19.5 ± 16.3 kcal) was not significant (P = 0.24). Although more studies are needed to understand whether increases in portion size can influence vegetable intake, children did eat more in response to a large quantity of a preferred low energy‐dense fruit side dish at meals. Thus variations in portion size can be used strategically to help children achieve the recommended intake of fruits.     

Bone Mineral Density of the Spine in 11,898 Chinese Infants and Young Children: A Cross-Sectional Study

Background

Bone mineral density (BMD) increases progressively during childhood and adolescence and is affected by various genetic and environmental factors. The aim of this study was to establish reference values for lumbar BMD in healthy Chinese infants and young children and investigate its influencing factors.

Methods and Findings

Healthy children aged 0 to 3 years who underwent regular physical examinations at the Child Health Care Clinic of Hubei Maternal and Child Health Hospital (N = 11,898) were recruited for this study. We also chose 379 preterm infants aged 0 to 1 years to preliminarily explore the development of BMD in this special population. BMD (g/cm²) measurements of the lumbar spine (L2–L4) were carried out with dual-energy X-ray absorptiometry and a questionnaire was administered to full-term children''s parents to gather information on various nutritional and lifestyle factors as well as mothers'' nutritional supplement use during pregnancy. Lumbar BMD significantly increased with age among both boys and girls (p<0.05), with fastest growth observed during the first postnatal year. There was no significant difference in lumbar BMD between boys and girls of similar age (p>0.05), either among healthy reference children or preterm infants. However, BMD values in preterm infants were significantly lower than those in term infants 3 to 8 months old (p<0.05) after adjustment for gestational age. Multivariable linear regression analysis indicated significant positive associations between lumbar BMD of healthy children and the child''s age and current weight, mother''s weight gain during pregnancy, birth weight, children''s outdoor activity duration and children''s physical activity duration.

Conclusion

Our study provides reference values of lumbar BMD for healthy Chinese children aged 0 to 3 years and identifies several influencing factors.     

Acute Increase of Children's Conjunctivitis Clinic Visits by Asian Dust Storms Exposure - A Spatiotemporal Study in Taipei,Taiwan

Adverse health impacts of Asian dust storms (ADS) have been widely investigated and discussed in respiratory disease, but no study has examined the association between ADS events and their impact on eye diseases, especially in children. The impact of ADS events on the incidence of children''s conjunctivitis is examined by analyzing the data from children''s clinic visits registered in the 41 districts of Taipei area in Taiwan during the period 2002–2007. The structural additive regression modeling approach was used to assess the association between ADS events and clinic visits for conjunctivitis in children with consideration of day-of-the-week effects, temperature, and air quality levels. This study identifies an acute increase in the relative rate for children''s conjunctivitis clinic visits during ADS periods with 1.48% (95% CI = 0.79, 2.17) for preschool children (aged <6 years old) and 9.48% (95% CI = 9.03, 9.93) for schoolchildren (aged ≥6 years old), respectively. The relative rates during post-ADS periods were still statistically significant, but much lower than those during ADS periods. The spatial analysis presents geographic heterogeneity of children''s conjunctivitis clinic visits where higher relative rates were more likely observed in the most populated districts Compared to previous ADS studies related to respiratory diseases, our results reveals significantly acute impacts on children''s conjunctivitis during ADS periods, and much influence on schoolchildren. Vulnerable areas were also identified in high density population.     

Socioeconomic Predictors of Cognition in Ugandan Children: Implications for Community Interventions

Background

Several interventions to improve cognition in at risk children have been suggested. Identification of key variables predicting cognition is necessary to guide these interventions. This study was conducted to identify these variables in Ugandan children and guide such interventions.

Methods

A cohort of 89 healthy children (45 females) aged 5 to 12 years old were followed over 24 months and had cognitive tests measuring visual spatial processing, memory, attention and spatial learning administered at baseline, 6 months and 24 months. Nutritional status, child''s educational level, maternal education, socioeconomic status and quality of the home environment were also measured at baseline. A multivariate, longitudinal model was then used to identify predictors of cognition over the 24 months.

Results

A higher child''s education level was associated with better memory (p = 0.03), attention (p = 0.005) and spatial learning scores over the 24 months (p = 0.05); higher nutrition scores predicted better visual spatial processing (p = 0.002) and spatial learning scores (p = 0.008); and a higher home environment score predicted a better memory score (p = 0.03).

Conclusion

Cognition in Ugandan children is predicted by child''s education, nutritional status and the home environment. Community interventions to improve cognition may be effective if they target multiple socioeconomic variables.     

Augmented Reality for the Assessment of Children's Spatial Memory in Real Settings

Short-term memory can be defined as the capacity for holding a small amount of information in mind in an active state for a short period of time. Although some instruments have been developed to study spatial short-term memory in real environments, there are no instruments that are specifically designed to assess visuospatial short-term memory in an attractive way to children. In this paper, we present the ARSM (Augmented Reality Spatial Memory) task, the first Augmented Reality task that involves a user''s movement to assess spatial short-term memory in healthy children. The experimental procedure of the ARSM task was designed to assess the children''s skill to retain visuospatial information. They were individually asked to remember the real place where augmented reality objects were located. The children (N = 76) were divided into two groups: preschool (5–6 year olds) and primary school (7–8 year olds). We found a significant improvement in ARSM task performance in the older group. The correlations between scores for the ARSM task and traditional procedures were significant. These traditional procedures were the Dot Matrix subtest for the assessment of visuospatial short-term memory of the computerized AWMA-2 battery and a parent''s questionnaire about a child''s everyday spatial memory. Hence, we suggest that the ARSM task has high verisimilitude with spatial short-term memory skills in real life. In addition, we evaluated the ARSM task''s usability and perceived satisfaction. The study revealed that the younger children were more satisfied with the ARSM task. This novel instrument could be useful in detecting visuospatial short-term difficulties that affect specific developmental navigational disorders and/or school academic achievement.     

Screening for Autism Spectrum Disorders with the Brief Infant-Toddler Social and Emotional Assessment

Objective

Using parent-completed questionnaires in (preventive) child health care can facilitate the early detection of psychosocial problems and psychopathology, including autism spectrum disorders (ASD). A promising questionnaire for this purpose is the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). The screening accuracy with regard to ASD of the BITSEA Problem and Competence scales and a newly calculated Autism score were evaluated.

Method

Data, that was collected between April 2010 and April 2011, from a community sample of 2-year-olds (N = 3127), was combined with a sample of preschool children diagnosed with ASD (N = 159). For the total population and for subgroups by child''s gender, area under the Receiver Operating Characteristic (ROC) curve was examined, and across a range of BITSEA Problem, Competence and Autism scores, sensitivity, specificity, positive and negative likelihood ratio''s, diagnostic odds ratio and Youden''s index were reported.

Results

The area under the ROC curve (95% confidence interval, [95%CI]) of the Problem scale was 0.90(0.87–0.92), of the Competence scale 0.93(0.91–0.95), and of the Autism score 0.95(0.93–0.97). For the total population, the screening accuracy of the Autism score was significantly better, compared to the Problem scale. The screening accuracy of the Competence scale was significantly better for girls (AUC = 0.97; 95%CI = 0.95–0.98) than for boys (AUC = 0.91; 95%CI = 0.88–0.94).

Conclusion

The results indicate that the BITSEA scales and newly calculated Autism score have good discriminative power to differentiate children with and without ASD. Therefore, the BITSEA may be helpful in the early detection of ASD, which could have beneficial effects on the child''s development.     

Ability to taste 6-n-propylthiouracil and BMI in low-income preschool-aged children

Background: Sensitivity to the bitter compound 6‐n‐propylthiouracil (PROP) is genetically mediated. Sensitivity to PROP has been associated with weight status in both adults and children. Objective: To determine whether there is an association between PROP sensitivity and BMI in low‐income children of diverse race/ethnicity, among whom there is a high prevalence of obesity. Methods and Procedures: Eighty‐one preschool‐aged children attending Head Start tasted a solution of 560 μmol/l PROP and reported whether it tasted “like water” or “like something else”. Mothers reported child's race, age, maternal education, maternal weight and height, child's reluctance to sample new foods via the Food Neophobia Scale (FNS), and child's dietary intake using a food frequency questionnaire. Child weight and height were measured. BMI was calculated and for children, expressed in z‐scores. Regression analyses were used to evaluate the relationship between child's PROP taster status and BMI z‐score, testing covariates child's age, gender, race, maternal education and BMI, and child's FNS score. Children's dietary intake was compared by PROP taster status. Results: PROP tasters, compared with nontasters, had significantly higher BMI z‐scores (0.99 (s.d. 1.24) vs. 0.03 (1.12), P = 0.004) and had a significantly higher prevalence of overweight (31.8% vs. 5.6%, P = 0.025), but demonstrated no differences in reported dietary intake. The most parsimonious model predicting the child's BMI z‐score included only maternal BMI and the child's PROP taster status (R ² = 22.3%). Discussion: A genetically mediated ability to taste bitter may contribute to obesity risk in low‐income, preschool‐aged children.     

The association of television and video viewing with fast food intake by preschool-age children

Objective: To examine the extent to which television (TV) and video viewing is associated with consumption of fast food by preschool‐age children. Research Methods and Procedures: In a cross‐sectional study of 240 parents of children ages 2.0 to 5.9 years, parents reported the number of hours their child watched TV/videos on an average weekday and weekend day in the past month; a daily, weighted average of TV/video viewing was then calculated. The main outcome was parents’ report of their children's fast food intake, using the question, “How many times a week does your child eat at fast food restaurants such as McDonald's, Burger King, or Kentucky Fried Chicken?” dichotomized to (never/<1 vs. ≥1 time/wk). The association of TV/video viewing with fast food intake was evaluated by multiple logistic regression before and after adjusting for several potential confounders. Results: Twenty‐two percent of parents reported that their child ate at fast food restaurants at least once per week. After adjusting for parents’ age, race/ethnicity, and household income as well as child's age and sex, for each 1‐hour increase of TV/video watched per day, the odds ratio (OR) for consuming fast food ≥1 time per week was 1.60 (95% confidence interval, 1.03 to 2.49). After further adjustment for socio‐environmental factors that might serve as proxies for the availability of healthy food options, such as parental time constraints and the availability and high cost of fresh fruits and vegetables in their neighborhoods, the OR for consuming fast food ≥1 time per week was minimally attenuated (OR, 1.55; 95% confidence interval, 1.04 to 2.31). Discussion: TV/video viewing was correlated with fast food consumption among preschool children in this study. Our findings raise the possibility that greater exposure to TV and videos may influence preschool children's consumption of unhealthful foods.     

Variable Food-Specific IgG Antibody Levels in Healthy and Symptomatic Chinese Adults

Background

The presence of food-specific IgG antibodies in human serum may be useful for diagnosis of adverse food reactions. However, the clinical utility of tesing for such antibodies remains very controversial. The aim of this study was to evaluate the serum levels and population distribution of food-specific IgGs and their association with chronic symptoms in a large-scale Chinese population.

Methodology/Principal Findings

A total of 21305 adult participants from different regions of China had 14 type of food-specific serum IgG antibodies that were measured by enzyme-linked immunosorbent assay. Amongthese, 5,394 participants were randomly chosen to complete follow-up questionnaire surveys on their dietary characteristics and chronic symptoms. The concentrations of food-specific IgGs against 14 foods ranged from a median (interquartile range) of 7.3 (3.8, 12.6) U/mL of pork-specfic IgG to 42.3 (28.8, 60.2) U/mL of crab-specific IgG. The concentration of food-specific IgGs was closely related to gender; after adjustment for region and age, women had higher concentrations of food-specific IgGs against all of the 14 foods except chicken (regression coefficient (95% CI): 0.01 (−0.003, 0.023); P = 0.129) and corn (0.002 (−0.013, 0.016); P = 0.825). Similar results were also found in the relationship of geographic region to the food-specific IgG concentrations for the 14 foods. Chronic symptoms were negatively associated with the concentrations of a few food-specific IgGs, and were positively associated with the concentrations of other food-specific IgGs.

Conclusions

The levels of food-specific IgGs were variable both in healthy and in symptomatic Chinese adults. These findings raise awareness that demographic factors, the type of food and specific chronic symptoms should be considered before food elimination treatment based on IgG testing in patients with chronic symptoms is used in clinical practice.     

Risk of Childhood Overweight after Exposure to Tobacco Smoking in Prenatal and Early Postnatal Life

Objective

To investigate the association between exposure to mothers smoking during prenatal and early postnatal life and risk of overweight at age 7 years, while taking birth weight into account.

Methods

From the Danish National Birth Cohort a total of 32,747 families were identified with available information on maternal smoking status in child''s pre- and postnatal life and child''s birth weight, and weight and height at age 7 years. Outcome was overweight according to the International Obesity Task Force gender and age specific body mass index. Smoking exposure was categorized into four groups: no exposure (n = 25,076); exposure only during pregnancy (n = 3,343); exposure only postnatally (n = 140); and exposure during pregnancy and postnatally (n = 4,188). Risk of overweight according to smoking status as well as dose-response relationships were estimated by crude and adjusted odds ratios using logistic regression models.

Results

Exposure to smoking only during pregnancy, or both during pregnancy and postnatally were both significantly associated with overweight at 7 years of age (OR: 1.31, 95% CI: 1.15–1.48, and OR: 1.76, 95% CI: 1.58–1.97, respectively). Analyses excluding children with low birth weight (<2,500 gram) revealed similar results. A significant prenatal dose-response relationship was found. Per one additional cigarette smoked per day an increase in risk of overweight was observed (OR: 1.02, 95% CI: 1.01–1.03). When adjusting for quantity of smoking during pregnancy, prolonged exposure after birth further increased the risk of later overweight in the children (OR 1.28, 95% CI:1.09–1.50) compared with exposure only in the prenatal period.

Conclusions

Mother''s perinatal smoking increased child''s OR of overweight at age 7 years irrespective of birth weight, and with higher OR if exposed both during pregnancy and in early postnatal life. Clear dose-response relationships were observed, which emphasizes the need for prevention of any tobacco exposure of infants.     

Poor Nutrition Status and Associated Feeding Practices among HIV-Positive Children in a Food Secure Region in Tanzania: A Call for Tailored Nutrition Training

Undernutrition among HIV-positive children can be ameliorated if they are given adequate foods in the right frequency and diversity. Food insecurity is known to undermine such efforts, but even in food rich areas, people have undernutrition. As yet no study has examined feeding practices and their associations with nutrition status among as HIV-positive children in regions with high food production. We therefore examined the magnitude of undernutrition and its association with feeding practices among HIV-positive children in a high food production region in Tanzania.

Methods

We conducted this mixed-method study among 748 children aged 6 months-14 years attending 9 of a total of 32 care and treatment centers in Tanga region, Tanzania. We collected quantitative data using a standard questionnaire and qualitative data through seven focus group discussions (FGDs).

Results

HIV-positive children had high magnitudes of undernutrition. Stunting, underweight, wasting, and thinness were prevalent among 61.9%, 38.7%, 26.0%, and 21.1% of HIV-positive children, respectively. They also had poor feeding practices: 88.1% were fed at a frequency below the recommendations, and 62.3% had a low level of dietary diversity. Lower feeding frequency was associated with stunting (β = 0.11, p = 0.016); underweight (β = 0.12, p = 0.029); and thinness (β = 0.11, p = 0.026). Lower feeding frequency was associated with low wealth index (β = 0.06, p<0.001), food insecurity (β = −0.05, p<0.001), and caregiver''s education. In the FGDs, participants discussed the causal relationships among the key associations; undernutrition was mainly due to low feeding frequency and dietary diversity. Such poor feeding practices resulted from poor nutrition knowledge, food insecurity, low income, and poverty.

Conclusion

Feeding practices and nutrition status were poor among HIV-positive children even in food rich areas. Improving feeding frequency may help to ameliorate undernutrition. To improve it, tailored interventions should target children of poor households, the food insecure, and caregivers who have received only a low level of education.     

Away-from-home food intake and risk for obesity: examining the influence of context

Objective: This study examined sociodemographic and cultural determinants of away‐from‐home food consumption in two contexts and the influence of frequency of away‐from‐home food consumption on children's dietary intake and parent and child weight status. Methods and Procedures: Parents of children (N = 708) in grades K‐2 were recruited from 13 elementary schools in Southern California. Parents were asked through a questionnaire the frequency with which they eat meals away from home and the restaurant they frequented most often. The height and weight of the parents and their children were measured to calculate BMI. Results: Consuming foods at least once a week from relatives/neighbors/friends (RNF) homes was associated with children's dietary intake and children's risk for obesity. For example, children of parents with weekly or greater RNF food consumption drank more sugar‐sweetened beverages. Parents of families who ate at restaurants at least weekly reported that their children consumed more sugar‐sweetened beverages, more sweet/savory snacks, and less water compared with families who did not frequent restaurants this often. The type of restaurant visited did not affect diet intake or obesity. More acculturated families exhibited less healthy dietary behaviors than less acculturated families. Discussion: Restaurants remain an important setting for preventing child and adult obesity, but other settings outside the home need to be considered in future intervention research. This may especially involve eating in the homes of RNF.     

Dietary Adequacy of Vitamin D and Calcium among Inuit and Inuvialuit Women of Child-Bearing Age in Arctic Canada: A Growing Concern

Background

Arctic populations are at an increased risk of vitamin D inadequacy due to geographic latitude and a nutrition transition. This study aimed to assess the adequacy of dietary vitamin D and calcium among women of child-bearing age in Arctic Canada.

Methods

This study collected data from 203 randomly selected women of child-bearing age (19-44 years) in Nunavut and the Northwest Territories of Arctic Canada. Cross-sectional surveys using a validated quantitative food frequency questionnaire were analysed to determine the dietary adequacy of vitamin D and calcium and summarize the top foods contributing to vitamin D and calcium intake among traditional food eaters (TFE) and non-traditional food eaters (NTFE).

Results

The response rate was between 69-93% depending on the community sampled. Mean BMIs for both TFE and NTFE were above the normal range. Traditional food eaters had a significantly higher median vitamin D intake compared with non-traditional eaters (TFE = 5.13±5.34 µg/day; NTFE = 3.5±3.22 µg/day, p = 0·004). The majority of women (87%) were below the Estimated Average Requirements (EAR) for vitamin D. Despite adequate median daily calcium intake in both TFE (1299±798 mg/day) and NTFE (992±704 mg/day; p = 0.0005), 27% of the study population fell below the EAR for calcium. Dairy products contributed the most to intake of vitamin D (TFE = 30.7%; NTFE = 39.1%) and calcium (TFE = 25.5%; NTFE = 34.5%).

Conclusions

Inadequate dietary vitamin D intake is evident among Inuit and Inuvialuit women of child-bearing age in Arctic Canada. Promotion of nutrient-rich sources of traditional foods, supplementation protocols and/or expanded food fortification should be considered to address this nutrition concern.     

Maternal Prepregancy BMI and Lipid Profile during Early Pregnancy Are Independently Associated with Offspring's Body Composition at Age 5–6 Years: The ABCD Study

Background

There is growing evidence that disturbances in maternal metabolism and, subsequently, intrauterine conditions affect foetal metabolism. Whether this has metabolic consequences in offspring later in life is not fully elucidated. We investigated whether maternal pre-pregnancy body mass index (pBMI) is associated with offspring''s adiposity at age 5–6 years and whether this association is mediated by the mother''s lipid profile during early pregnancy.

Methods

Data were derived from a multi-ethnic birth cohort, the Amsterdam Born Children and their Development (ABCD) study (inclusion 2003–2004). During early gestation mothers completed a questionnaire during pregnancy (pBMI) and random non-fasting blood samples were analysed for total cholesterol (TC), triglycerides (TG), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB) and total free fatty acids (FFA) in early gestation. At age 5–6 years, child''s BMI, waist-to-height-ratio (WHtR) and fat% were assessed.

Results

Only non-diabetic mothers with at term-born children were included(n = 1727). Of all women, 15.1% were overweight(BMI: 25–29.9 kg/m2) and 4.3% were obese(BMI≥30 kg/m2). After adjustments for confounders, every unit increase in pBMI was linearly associated with various offspring variables: BMI(β 0.10; 95% CI 0.08–0.12), WHtR*100(β 0.13; 95% CI 0.09–0.17), fat%(β 0.21; 95% CI 0.13–0.29) and increased risk for overweight(OR:1.15; 95% CI 1.10–1.20). No convincing proof for mediation by maternal lipid profile during early gestation was found. Moreover, maternal FFA was associated with the child''s fat percentage, BMI and risk for overweight. Maternal ApoB and TC were positively associated with the offspring''s fat percentage and maternal TG was positively associated with their children''s WHtR.

Conclusions

Both pBMI and maternal lipids during early pregnancy are independently related to offspring adiposity.     

The Impact of Food Viscosity on Eating Rate,Subjective Appetite,Glycemic Response and Gastric Emptying Rate

Understanding the impact of rheological properties of food on postprandial appetite and glycemic response helps to design novel functional products. It has been shown that solid foods have a stronger satiating effect than their liquid equivalent. However, whether a subtle change in viscosity of a semi-solid food would have a similar effect on appetite is unknown. Fifteen healthy males participated in the randomized cross-over study. Each participant consumed a 1690 kJ portion of a standard viscosity (SV) and a high viscosity (HV) semi-solid meal with 1000 mg acetaminophen in two separate sessions. At regular intervals during the three hours following the meal, subjective appetite ratings were measured and blood samples collected. The plasma samples were assayed for insulin, glucose-dependent insulinotropic peptide (GIP), glucose and acetaminophen. After three hours, the participants were provided with an ad libitum pasta meal. Compared with the SV meal, HV was consumed at a slower eating rate (P = 0.020), with postprandial hunger and desire to eat being lower (P = 0.019 and P<0.001 respectively) while fullness was higher (P<0.001). In addition, consuming the HV resulted in lower plasma concentration of GIP (P<0.001), higher plasma concentration of glucose (P<0.001) and delayed gastric emptying as revealed by the acetaminophen absorption test (P<0.001). However, there was no effect of food viscosity on insulin or food intake at the subsequent meal. In conclusion, increasing the viscosity of a semi-solid food modulates glycemic response and suppresses postprandial satiety, although the effect may be short-lived. A slower eating rate and a delayed gastric emptying rate can partly explain for the stronger satiating properties of high viscous semi-solid foods.     

Foods and Dietary Patterns That Are Healthy,Low-Cost,and Environmentally Sustainable: A Case Study of Optimization Modeling for New Zealand

Objective

Global health challenges include non-communicable disease burdens, ensuring food security in the context of rising food prices, and environmental constraints around food production, e.g., greenhouse gas [GHG] emissions. We therefore aimed to consider optimized solutions to the mix of food items in daily diets for a developed country population: New Zealand (NZ).

Methods

We conducted scenario development and linear programming to model 16 diets (some with uncertainty). Data inputs included nutrients in foods, food prices, food wastage and food-specific GHG emissions.

Findings

This study identified daily dietary patterns that met key nutrient requirements for as little as a median of NZ$ 3.17 per day (US$ 2.41/d) (95% simulation interval [SI] = NZ$ 2.86 to 3.50/d). Diets that included “more familiar meals” for New Zealanders, increased the cost. The optimized diets also had low GHG emission profiles compared with the estimate for the ‘typical NZ diet’ e.g., 1.62 kg CO₂e/d for one scenario (95%SI = 1.39 to 1.85 kg CO₂e) compared with 10.1 kg CO₂e/d, respectively. All of the optimized low-cost and low-GHG dietary patterns had likely health advantages over the current NZ dietary pattern, i.e., lower cardiovascular disease and cancer risk.

Conclusions

We identified optimal foods and dietary patterns that would lower the risk of non-communicable diseases at low cost and with low greenhouse gas emission profiles. These results could help guide central and local government decisions around which foods to focus policies on. That is which foods are most suitable for: food taxes (additions and exemptions); healthy food vouchers and subsidies; and for increased use by public institutions involved in food preparation.     

The Feasibility of Achieving Low-Sodium Intake in Diets That Are Also Nutritious,Low-Cost,and Have Familiar Meal Components

Objective

Given the importance of high sodium diets as a risk factor for disease burden (ranked 11^th in importance in the Global Burden of Disease Study 2010), we aimed to determine the feasibility of low-sodium diets that were also low-cost, nutritious and (for some scenarios) included familiar meals.

Methods

The mathematical technique of “linear programming” was used to model eight optimized daily diets (some with uncertainty), including some diets that contained “familiar meals” for New Zealanders or were Mediterranean-, Asian- and Pacific-style diets. Data inputs included nutrients in foods, food prices and food wastage.

Findings

Using nutrient recommendations for men and a cost constraint of <NZ$9/d (US$6.84), the sodium intake levels in the eight optimized daily diets were all well below the 2300 mg/d (5.8 g salt/d) recommended maximum. The only diet to not consistently fall below the recommended “target” upper limit of 1600 mg/d included an evening meal with sausages (median  = 1640 mg/d, 95% simulation interval: 1551–1735 mg/d). Many additional nutritional aspects of these optimized low-sodium diets suggest that they would reduce cardiovascular disease risk in other ways (e.g., improved polyunsaturated to saturated fat ratio) and also reduce risk of cancer and other chronic diseases (e.g., via higher intakes of vegetables, fruits and dietary fiber). Even healthier diets (e.g., with higher intakes of fruit) occurred when the cost constraint was relaxed to $NZ15/d (US$11.40). Similar results were obtained when the modeling considered diets for women.

Conclusions

These results provide some reassurance for the feasibility of substantially reducing population sodium intake given currently available low-cost foods and while maintaining some level of familiar meals. Policy makers could consider ways to promote such optimized diets and foods, including regulations on maximum salt levels in processed foods, and taxes on alternative foods that are high in salt, sugar and saturated fat.     

Parents' perceptions of food intolerance in primary school children.

In a study of about 7000 children, parents'' perceptions were used to examine the prevalence of food intolerance, the types of food implicated, the association of intolerance with diseases, and the social background of those identified as being food intolerant. One hundred and ninety two children (3%) were perceived as being food intolerant, with a further 105 (2%) being classed as intolerant under a less stringent definition of intolerance. For 128 (67%) of these children a doctor was consulted. The pattern of food avoided was very similar in children for whom the decision to exclude certain foods was made by health staff and in those for whom the parents themselves made decisions about their child''s diet. A strong association was seen between the mother''s level of education and the child being perceived as being food intolerant. Between 20% and 30% of children with a disease associated with food intolerance--for example, eczema--had currently or previously avoided some types of food. The results of this study emphasise the need to develop criteria to tackle the growing demand for National Health Service treatment by parents who believe their child to be food intolerant.     

Methodology to Capture Children's Non-Dietary Ingestion Exposure Activities During Meal Events

During meal events, a child's food can be contaminated through contacts with objects and surfaces, and/or unwashed hands that have chemical residues, increasing ingestion exposure of contaminants for the child. This is not surprising, given that very young children eat more with the hands than adults, are active, and play with toys and objects while eating. In addition, children's unwashed hands and toys are commonly inserted into their mouths during meal events, increasing exposure. By observing children during their meal events, information can be gathered on the frequency and duration of contacts between objects, foods, and hands, and the sequence of events before the hands, foods, or objects are inserted into the mouth. This article describes the process of refining a videotaping and video-translation methodology to capture micro-level activity time series (MLATS), in order to better quantify total exposure for young children as a result of their behavior during meal events and cross-contamination of foods and hands. These MLATS can be seen as detailed activity patterns that provide useful data, along with transfer coefficients and environmental concentration to estimate exposures.     

A Prospective Cohort Study of the Effects of Adjuvant Breast Cancer Chemotherapy on Taste Function,Food Liking,Appetite and Associated Nutritional Outcomes

Background

‘Taste’ changes are commonly reported during chemotherapy. It is unclear to what extent this relates to actual changes in taste function or to changes in appetite and food liking and how these changes affect dietary intake and nutritional status.

Patients and methods

This prospective, repeated measures cohort study recruited participants from three oncology clinics. Women (n = 52) prescribed adjuvant chemotherapy underwent standardised testing of taste perception, appetite and food liking at six time points to measure change from baseline. Associations between taste and hedonic changes and nutritional outcomes were examined.

Results

Taste function was significantly reduced early in chemotherapy cycles (p<0.05) but showed recovery by late in the cycle. Ability to correctly identify salty, sour and umami tastants was reduced. Liking of sweet food decreased early and mid-cycle (p<0.01) but not late cycle. Liking of savory food was not significantly affected. Appetite decreased early in the cycle (p<0.001). Reduced taste function was associated with lowest kilojoule intake (r = 0.31; p = 0.008) as was appetite loss with reduced kilojoule (r = 0.34; p = 0.002) and protein intake (r = 0.36; p = 0.001) early in the third chemotherapy cycle. Decreased appetite early in the third and final chemotherapy cycles was associated with a decline in BMI (p = <0.0005) over the study period. Resolution of taste function, food liking and appetite was observed 8 weeks after chemotherapy completion. There was no association between taste change and dry mouth, oral mucositis or nausea.

Conclusion

The results reveal, for the first time, the cyclical yet transient effects of adjuvant chemotherapy on taste function and the link between taste and hedonic changes, dietary intake and nutritional outcomes. The results should be used to inform reliable pre-chemotherapy education.