How multiple threats to safety affects quality of life for picky eating adults: A new explanatory model.

Picky eating describes a pattern of eating characterised by a narrow dietary range with rejection of both novel and familiar foods. Research has suggested that picky eating in adulthood is associated with several negative psychosocial outcomes including impaired quality of life. This research aimed to build and test a model explaining the relationship between picky eating and quality of life. 230 participants were recruited via online support forums for picky eating, and an undergraduate research participation scheme. Participants completed self-report measures of picky eating, sensory sensitivity, disgust, anxiety, fear of negative evaluation and eating related quality of life. Regression analysis indicated that picky eating, disgust sensitivity, anxiety, and fear of negative evaluation were all associated with impaired eating-related quality of life. A theoretical model was then devised which aimed to explain the interactions between these factors, and Path Analysis indicated that this model was a good fit for the data. This Safety in Picky Eating and Quality of life (SPEQ) model suggests that threat perception and the drive for safety underlies the relationship between picky eating and impaired quality of life. The SPEQ model provides a preliminary basis for understanding how picky eating impacts quality of life in adulthood.

Music as an alternative self-regulation strategy to snack foods following a negative mood induction in 5-7-year-old children: Interactions with parental use of food as a reward.

This study aimed to extend studies that have looked at snack food consumption following a negative mood induction, and examine whether listening to a happy song would counteract these effects in children. A second aim was to examine whether parental feeding practices (use of food as a reward and the use of food to regulate emotions) and child Body Mass Index (BMI) would moderate any differences. Eighty 5-7-year-old children took part in a negative mood induction and were then assigned to either a happy music condition or a silent control condition. The weight (g) consumed of four snack foods was measured (fruit hearts, crisps, chocolate biscuits, and breadsticks). Parents filled in baseline measures of feeding practices. There were no significant differences in food consumption between conditions. There was, however, a significant interaction between the high use of food as a reward and the condition on the amount of food eaten. In particular, following a negative -mood induction, those children whose parents reported using food as a reward and who were in the silent condition ate significantly more snack foods. There were no significant interactions with child BMI or with parental use of food to regulate emotions. This research suggests that the use of certain parental strategies may influence how children respond to novel emotion regulation techniques. Further research is needed to evaluate the best types of music to regulate emotions in children, and whether parents can be encouraged to replace maladaptive feeding practices with more adaptive non-food practices.

Phase Ib study of eltrombopag and azacitidine in patients with high-risk myelodysplastic syndromes and related disorders (the ELASTIC study).

Treating adverse risk myelodysplastic syndromes with azacitidine exacerbates thrombocytopenia. We report a study of eltrombopag in combination with azacitidine using a 3 + 3 cohort design. Patients with baseline platelets of <150 × 109 /l received eltrombopag ranging from 25 to 300 mg. An 8-day pre-phase of eltrombopag was followed by two cycles of combined therapy. Amongst 31 patients, there were no dose-limiting toxicities. The maximum tolerated dose (MTD) was 300 mg. Transient increases in bone marrow blasts at day 8 were common but no patient had protocol-defined progression following eltrombopag monotherapy. Marrow response rates after three and six treatment cycles were 32% and 29% respectively. In all, 70% of patients treated below and 36% treated at the MTD achieved a modified International Working Group 2006 platelet response at the end of cycle two. Of the platelet transfusion independent patients at baseline, 67% treated at the MTD became transfusion dependent during the first two cycles of treatment. Apart from lack of disease progression, our findings concur with a previously reported Phase III study (A StUdy of eltromboPag in myelodysPlastic SyndrOmes Receiving azaciTidine [SUPPORT]). We conclude that eltrombopag/azacitidine is safe in terms of conventional measures defined by adverse-event reporting. However, in light of SUPPORT and our own descriptive findings regarding efficacy, further combination studies in high-risk disease should be considered with caution.

Food neophobia and the evaluation of novel foods in adults; the sensory, emotional, association (SEA) model of the decision to taste a novel food.

Reluctance to eat new foods, known as food neophobia, is well researched in children but not adults. Two studies were carried out to understand the emotional, sensory, and cognitive factors associated with food neophobia in an adult sample, and to propose a preliminary explanation of the decision to taste a novel food named the SEA model (Sensory, Emotional, cognitive Association model). Participants were recruited through opportunity sampling of a university population in the Leicester region of the UK. Study one (n = 534) was a cross sectional study examining associations between self-report measures of food neophobia, emotional variables and sensory variables. In study two (n = 160), participants completed an online cognitive evaluation of 7 images of novel fruits and vegetables, rating perceived familiarity, categorisation as fruit or vegetable, cognitive associations based on appearance (what does the food look like), liking of any associated foods, and expected liking of the novel food. In study 1 it was found that tactile sensitivity and disgust sensitivity were the main sensory and emotional variables associated with food neophobia. In study 2, it was found that food neophobia and lower expected liking of novel foods were associated with disgust sensitivity, associating the novel foods with disliked foods, and lower perceived familiarity. The SEA model further proposes that underlying tendencies and automatic reactions to foods, combine with cognitive associations based on negative memories and negative beliefs about tasting new foods, to create expected disliking of a food and a decreased likelihood that it will be tried. Further work is needed to fully test the SEA model of the decision to taste a novel food, in particular to further examine how associations are formed.

Are music listening strategies associated with reduced food consumption following negative mood inductions; a series of three exploratory experimental studies.

Emotions play an important role in overeating, yet there is little research looking at practical strategies to reduce overeating in response to a negative mood. In three different experimental studies, we tested if exposure to music can reduce food consumption in a negative mood. Female undergraduates (N = 120-121 in each study) completed a measure of emotional eating and reported baseline hunger. Mood ratings were taken at baseline, post-mood induction and post-eating. All participants were given a mood induction (sadness for study 1, stress for studies 2 and 3) and allocated to one of three music conditions (self-chosen in study 3) or a silent (control) condition. Music was selected from three pieces reported by each participant as being listened to regularly when experiencing the negative mood being examined (sadness or stress) in order to provide solace (comforting music), diversion (distracting positive music), or discharge (angry and/or sad music). Participants were provided with several snack foods to consume whilst completing a mock taste test and intake (in grams) was compared between conditions. In study 1 participants in the music for discharge condition consumed less than those in the control condition. Moreover, participants with high levels of self-reported EE ate more crisps in the control than in the distraction condition. In study 2 participants in the solace condition consumed less than those in the control and discharge conditions. In study 3 most participants chose music for diversion; this did not, however, lead to lower consumption, despite a reduction in reported stress. Overall, the results of these studies indicate that listening to certain types of music might reduce emotion-related eating after controlling for hunger using a standardized pre-session snack.

The lived experience of parenting a child with sensory sensitivity and picky eating.

"Picky eating" is a common behaviour seen in childhood in both clinical and nonclinical populations. Sensory processing difficulties have been repeatedly associated with food refusal and picky eating behaviours. The aim of this study was to explore the lived experiences of parents/caregivers who have a child displaying both sensory processing differences and picky eating behaviours utilising Interpretative Phenomenological Analysis (IPA). Participants were recruited from social media support groups for parents of picky eating children. Pre-selection criteria utilised an adapted short sensory profile questionnaire to ensure the children displayed probable/definite taste-smell, audio-visual and tactile sensory sensitivities. Twelve participants fulfilling the required criteria were interviewed face to face utilising a semi-structured interview schedule. Interviews were transcribed and analysed following IPA guidelines and three common themes are presented here: Battling for control of the sensory environment, Living with stigma and, disapproval, and Staying positive and moving forward. The findings show the very considerable day-to-day challenges of parenting a child with sensory issues with food, including a lack of support and criticism from others. It was apparent that the parents in our study gradually adopted a positive and accepting attitude to their child's eating. This acceptance allowed them to have positive interactions around food with their child such as cooking and playing with food, suggesting that experiential activities serve an important purpose in this population. Further research should examine whether parental interventions based on acceptance of child eating behaviour, and commitment to gradual positive food interactions would be the best strategy to support parents and children.

Eating in the lockdown during the Covid 19 pandemic; self-reported changes in eating behaviour, and associations with BMI, eating style, coping and health anxiety.

The global coronavirus pandemic (Covid 19) resulted in national lockdowns where individuals were asked to isolate in their homes to stop the spread of the disease. Using a cross-sectional survey, the current paper aimed to examine self-reported changes in eating patterns and behaviour during the lockdown in the UK, and associations with BMI, demographic variables, eating styles, health anxiety, food insecurity and coping strategies. Participants (N = 620) were recruited online through social media advertising. The results showed that there were self-reported changes to food consumption during the lockdown across the sample. Increases in consumption of HED (high energy density) snack foods during the lockdown was associated with sex, pre-lockdown eating behaviour (emotional eating and uncontrolled eating), and Covid-specific health anxiety. Increases in positive eating practices such as eating more home prepared foods, and fruits and vegetables, were associated with adaptive coping strategies. Higher emotional eating (EE) during the lockdown was associated with a higher BMI, higher pre-lockdown EE and maladaptive coping strategies. Maladaptive coping strategies moderated the relationship between BMI and EE during the lockdown. In particular a higher BMI was associated with higher EE during the lockdown if an individual also had higher maladaptive coping strategies. These findings suggest that changes to eating behaviour may be part of a wider style of maladaptive or adaptive coping, particularly in those with a history of EE or uncontrolled eating. Preparing individuals to adopt more adaptive coping strategies during lockdown situations may be crucial to improving health during subsequent the lockdown events.

Using repeated visual exposure, rewards and modelling in a mobile application to increase vegetable acceptance in children.

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.

"It's always on the safe list": Investigating experiential accounts of picky eating adults.

Previous research into severely restricted eating for reasons which are not cultural, medical, due to a lack of food or due to concerns about body image has focused predominantly on "picky/fussy eating" in children. Despite evidence that picky eating does continue into adulthood and recognition in the new diagnostic category Avoidant Restrictive Food Intake Disorder (ARFID) that problematically avoidant and restrictive patterns of eating affect people across the lifespan, relatively little is known about the challenges and consequences faced by older adolescents and adults. This research employs qualitative methods to explore the experience of living as an adult with picky eating behaviours. Semi-structured interviews were undertaken with thirteen adults who identify as picky eaters and eat a highly limited diet, as determined by a checklist food questionnaire. Data were analysed using interpretative phenomenological analysis (IPA). Two themes are presented in this paper: "Constructions of food" and "Motivators for and barriers to change". These themes show the importance of how individuals perceive food, their diet and themselves, and implications for clinical practice and future research in light of these findings are considered.

Play with your food! Sensory play is associated with tasting of fruits and vegetables in preschool children.

The objective of the current study was to ascertain whether taking part in a sensory play activity with real fruits and vegetables (FV) can encourage tasting in preschool children, compared to a non-food activity or visual exposure to the activity. Three to four year old pre-school children (N = 62) were recruited from three preschool nursery classes from a school in Northamptonshire, UK. A between participants experimental study was conducted with each class assigned to one of three conditions; sensory FV play, sensory non-food play and visual FV exposure. Parental report of several baseline variables were taken; child baseline liking of the foods used in the study, parental and child FV consumption (portions/day), child neophobia and child tactile sensitivity. Outcome measures were the number of fruits and vegetables tasted in a post experiment taste test which featured (n = 5) or did not feature (n = 3) in the task. Analyses of covariance controlling for food neophobia and baseline liking of foods, showed that after the activity children in the sensory FV play condition tried more FV than both children in the non-food sensory play task (p < 0.001) and children in the visual FV exposure task (p < 0.001). This was true not only for five foods used in the activity (p < 0.001), but also three foods that were not used in the activity (p < 0.05). Sensory play activities using fruits and vegetables may encourage FV tasting in preschool children more than non food play or visual exposure alone. Long term intervention studies need to be carried out to see if these effects can be sustained over time.

Self-Disgust within Eating Disordered Groups: Associations with Anxiety, Disgust Sensitivity and Sensory Processing.

This study aimed to assess the relationship between self-disgust and sensory processing within eating psychopathology. Five hundred and ninety-one women with a self-reported diagnosis of anorexia nervosa, bulimia nervosa or who had no previous history of an eating disorder completed a battery of online questionnaires measuring disgust, emotion and sensory variables. Those with an eating disorder reported significantly higher rates of self-disgust than those with no history of disordered eating. In groups of women with self-reported bulimia, self-disgust was associated with sensation avoidance and sensation seeking. Within the group with anorexia nervosa, self-disgust was associated with low registration and sensation seeking. This report is the first to examine the expression of the emotion self-disgust within eating psychopathology and examine associations of this factor with sensory processing. The emotion self-disgust needs to be further examined to understand its possible role in the onset and maintenance of disordered eating. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Food neophobia and enjoyment of tactile play: Associations between preschool children and their parents.

A cross-sectional study was conducted to examine whether the relationship between enjoyment of tactile play and food neophobia observed in children (Coulthard & Thakker, 2015) would be related to levels seen in their parents. One hundred and twenty six participants were recruited from playgroup centres in the Walsall area of the West Midlands, UK; 63 children (2-5 years; 30 girls and 33 boys) and 63 attendant parents (53 mothers and 10 fathers). Children and their parents' enjoyment of a tactile play task was rated by both the parent and a researcher, and questionnaire measures of food neophobia and tactile sensitivity were completed by the parent for both themselves and their children. Strong associations were found between parent and child scores across all the measures; food neophobia, tactile sensitivity and tactile play enjoyment. The variables most strongly related to child food neophobia were parental neophobia and enjoyment of tactile play (parent and child). These findings indicate that family resemblance exists not only for food neophobia, but for tactile sensory processing as well, and may represent a possible inherited route to neophobia. The findings strengthen the suggestion that tactile processing is associated with food neophobia although the causal nature of this relationship is still not known.

Sensory evaluation of a novel vegetable in school age children.

A behavioural sensory task was undertaken to further understanding into whether children's sensory evaluation of a new vegetable is associated with tasting and food neophobia scores. A sample of ninety-five children, aged 7-11 years, was recruited from a primary school in inner city Birmingham, UK. They were asked to rate the sight, smell and feel of a familiar vegetable (carrot) and an unfamiliar vegetable (celeriac) in a randomised order to control for order effects. They were then asked to try the each vegetable, and rate its taste. It was found that children rated the sensory characteristics of the familiar vegetable more positively than the novel vegetable across all sensory domains (p < 0.05). Refusing to try the novel vegetable was associated with food neophobia scores and olfactory ratings. The ratings of the taste of the novel vegetable were associated with olfactory and tactile ratings. In addition there was a clear developmental shift in the sample with younger children being more likely to rate the novel vegetable as 'looking strange' and older children rating the novel vegetable as 'smelling strange'. This research strengthens the idea that sensory information is important in children deciding to try, and their hedonic evaluation of the taste of a new vegetable.

Association between tactile over-responsivity and vegetable consumption early in the introduction of solid foods and its variation with age.

The main aim of the current study was to test the hypothesis that early reactions to a vegetable in infants may be associated with sensory processing, in particular, tactile over-responsivity. A secondary aim was to see whether the relationship between sensory over-responsivity and vegetable consumption would be moderated by the age of the infant. A sample of 61 infants was recruited from children's centres and playgroups in South Birmingham, UK. Infant's acceptance of carrot was measured in grams during the first week of complementary feeding in one testing situation. Mothers filled in self-report measures of infant sensory processing, as well as their own fruit and vegetable consumption. Infant carrot consumption in the first week of solid food consumption was negatively associated with total sensory over-responsivity across different sensory domains (P < 0.01). Across the sensory domains only tactile over-responsivity predicted carrot consumption, accounting for 10.7% of the variance in consumption scores. Across the sample as a whole, the relationship between carrot consumption and tactile over-responsivity varied according to the age of introduction to solid foods. In particular, those who were weaned later and had high tactile over-responsivity ate less carrot (P < 0.001). Infants who were weaned early ate a similar amount of carrot, regardless of their tactile responsivity (P > 0.05). This study constitutes some of the first evidence to suggest that sensory processing styles be associated with early vegetable acceptance; however, more research is needed to evaluate the best strategies to use when feeding infants who are sensitive to tactile information.

Exposure to vegetable variety in infants weaned at different ages.

The aim of the current study was to examine the effectiveness of different vegetable exposure methods (variety versus single taste) over a 9 day period in two groups of infants; those introduced to solids prior to the age of 5.5 months, and those introduced after 5.5 months. Sixty parent-infant dyads were recruited in South Birmingham, UK. Infants' acceptance of a novel vegetable (pea puree) was measured after a 9 day exposure period in the infants a week after they were first introduced to solid foods. During the exposure period half of each age group was given carrot every day, and the other half was given a variety pack of courgette, parsnip and sweet potato. A baseline measurement of the infants' acceptance of a vegetable (carrot) was taken prior to the exposure period. There was no difference between the groups in consumption of the baseline vegetable (carrot). There were no main effects of exposure group or age group on consumption of pea after the exposure period. There was, however, an interaction between the age of introduction and exposure group on consumption of the new vegetable (pea). In particular, infants weaned at 6 months in the single taste group ate significantly less pea puree than those in the variety group. These findings suggest that infants, who are weaned at 6 months or later, may benefit from being weaned onto a variety of tastes rapidly to ensure adequate exposure to taste. This study constitutes some of the first evidence to suggest that there may be a sensitive period for the acceptance of tastes between the ages of 4 and 6 months.

Relationships between sensory sensitivity, anxiety and selective eating in children.

The present study examines whether parental reports of child selective eating are associated with child anxiety and sensitivity to sensory stimuli in their environment. Parents of 95 children aged 5-10 completed questionnaires about child eating behavior, child anxiety and sensory sensitivity. Results indicated that both anxiety and sensory sensitivity were associated with selective eating. In addition, child sensory sensitivity fully mediated the relationship between anxiety and selective eating in children suggesting that it is greater sensitivity to sensory information which explains why more anxious children are more likely to be selective eaters. Further research is necessary to better understand these relationships and indicate whether gradual exposure interventions with children who are sensory sensitive may help to prevent or reduce selective eating.

Long-term consequences of early fruit and vegetable feeding practices in the United Kingdom.

OBJECTIVE: To describe fruit and vegetable (FV) feeding practices at 6 months, and to examine whether these practices predict children's FV intake at 7 years of age. DESIGN: A prospective, longitudinal design was adopted. The mothers completed self-reported questionnaires at 6 months and 7 years postpartum, containing questions about their child's FV intake. SETTING: The study was carried out on a geographically representative population of infants born in Avon, UK, from 1991 to 1992, as part of the Avon Longitudinal Study of Parents and Children. SUBJECTS: Information was collected from 7866 mothers of infants. RESULTS: Hierarchical linear regressions were used to predict FV consumption at 7 years from the early feeding variables. Children who were given home-cooked fruit or vegetables more often at 6 months were more likely to be eating a higher proportion of FV at 7 years, than those who were given home-cooked FV less often. There was no positive difference found in consumption of FV at 7 years according to how often ready-prepared fruits or vegetables were given at 6 months. The age of introduction to home-cooked vegetables moderated the relationship between frequency of consumption at 6 months and 7 years. CONCLUSIONS: The findings support the concept that exposure to FV is important in the early weaning period. The finding that consumption of ready-prepared FV was not positively associated with later FV consumption needs to be further investigated, with reference to theories of exposure, modelling and parental food choices. If vegetables are introduced later in weaning, they need to be fed frequently, to ensure adequate exposure.

Fruit and vegetable consumption in children and their mothers. Moderating effects of child sensory sensitivity.

A cross-sectional study was carried out to ascertain the relative contribution of food neophobia and taste sensitivity to the amount of fruit and vegetables consumed in a typical day by 73, 2-5-year-old children attending nurseries in the South Birmingham area, UK. Sensory processing, parental control, child food neophobia and fruit and vegetable (FV) consumption of both mothers and children were measured. Parental and child FV consumption in the sample were positively associated (p<0.001). Moderated regression analyses showed that taste/smell sensitivity, but not food neophobia or tactile sensitivity, moderated the relationship between maternal and child FV consumption. In particular, children who were sensitive to taste/smell stimuli ate fewer fruit and vegetables, regardless of their mothers FV consumption. This finding implies that those children, who are sensitive to taste/smell stimuli, may be less likely to model maternal FV consumption. For these children, a more gradual route to encouraging acceptance, with attention to small sensory changes in foods, may be necessary to increase FV consumption.

Delayed introduction of lumpy foods to children during the complementary feeding period affects child's food acceptance and feeding at 7 years of age.

The study aimed to follow up children who had been introduced to lumpy solids (chewy foods) at different ages, and to assess their dietary intake and feeding difficulties at seven years of age. Information was collected from a geographically defined population of 7821 mothers of children born in 1991/92, part of the Avon Longitudinal Study of Parents and Children (ALSPAC). Self-report questionnaires were completed by the mother about her child at 6 months, 15 months, and 7 years postpartum about food foods eaten and feeding difficulties. Children were divided into three groups based on the age at which they were first introduced to 'lumpy' solids: 12.1% were introduced before 6 months of age, 69.8% were introduced between 6 and 9 months of age and 18.1% were introduced after 9 months. Children introduced to lumpy solids after the age of 9 months ate less of many of the food groups at seven years, including all 10 categories of fruit and vegetables, than those introduced to lumpy foods between 6-9 months (P < 0.05-0.001). In addition they were reported as having significantly more feeding problems at seven years (P < 0.05-0.001). The long-term feeding problems and reduced consumption of important food groups such as fruit and vegetables in children who are introduced to lumpy foods after the age of 9 months is a cause for concern. Health professionals must encourage the progression from purees and exposure to important food groups.