Impact of weight management nutrition interventions on dietary outcomes in children and adolescents with overweight or obesity: a systematic review with meta-analysis.

BACKGROUND: The impact of obesity interventions on dietary intake in children and adolescents with overweight or obesity is unclear. This systematic review aimed to investigate the impact of the dietary component of weight management interventions on the change in diet in children and adolescents with overweight or obesity. METHODS: Eligible randomised controlled trials (RCTs) published between 1975 and 2020 were identified by a systematic search following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Meta-analyses of eligible study outcomes were performed using statistical software. A multilevel random effects model was used with three significant random effects fitted using restricted maximum likelihood estimation. RESULTS: This review identified 109 RCTs, including 95 that reported at least one statistically significant dietary outcome change and 14 reporting no significant dietary change. Results from the meta-analyses (n = 29 studies) indicated that, compared to control groups, intervention groups achieved significantly greater reductions in mean total energy intake at ≤6 months (-194 kcal day-1 , 95% confidence interval = -275.80 to -112.90 kcal day-1 , P < 0.001) and up to 12 months (-112 kcal day-1 95% confidence interval = -218.92 to -5.83 kcal day-1 ) P = 0.038), increases in fruit and/or vegetable intakes over 2-12 months (n = 34, range +0.6 to +1.5 servings day-1 ) and reductions in consumption of sugar-sweetened beverages (n = 28, range -0.25 to -1.5 servings day-1 ) at 4-24 months follow-up. CONCLUSIONS: Obesity interventions with a dietary component have a modest but sustained impact on reducing total energy intake and improving intakes of specific food groups in children and adolescents with overweight or obesity. High quality RCTs that are powered to detect change in diet as a primary outcome are warranted.

A systematic review of recall errors associated with portion size estimation aids in children.

To reduce errors in portion size estimation, a number of aids have been developed and tested. This systematic review synthesizes what is known about error associated with use of different portion size estimation aids (PSEAs) within self-reported dietary recall studies in children (aged ≤18 years). Eight electronic databases were searched using relevant keywords. From 8184 records identified and screened, 327 full texts were retrieved, with 10 records representing 9 studies meeting inclusion criteria. Studies using proxy reporting were excluded. Thirteen PSEAs were identified. To facilitate comparisons between different types of aids they were categorized into 'physical 2-dimensional (2D)', 'digital 2D' and '3-dimensional' PSEAs. Seven were physical 2D (e.g. food atlas), two were digital 2D (i.e. computer-based), and four were 3D (e.g. modelling clay, household items). Comparisons of PSEAs within studies found the smallest estimation errors for digital 2D and largest for 3D aids. Errors in relation to food type were varied, with portions of amorphous foods overestimated in multiple studies. No effects for recall interval time or sex were identified. One study reported a significant improvement in estimation error with increasing age. Across studies, large variations in study design and reporting of estimation error hindered the synthesis of evidence regarding the influence of different types of PSEAs on accuracy. While a definitive conclusion about the most accurate PSEA could not be drawn, a check-list to guide future PSEA development and testing has been proposed in the current review. This will assist comparability with future studies of PSEAs for children facilitate development of more accurate PSEAs in the future.

Evaluation of the effectiveness and usability of an educational portion size tool, ServARpreg, for pregnant women.

BACKGROUND: Elevated blood glucose levels in pregnancy increases the risk of adverse pregnancy outcomes. Modifying consumption of carbohydrate-rich foods is important for blood glucose regulation; however, the tools commonly used to assist in guiding portion control are impractical. The present study aimed to evaluate usability of ServARpreg, a mobile phone-based nutrition tool, and its effectiveness with respect to improving carbohydrate and standard serve size knowledge in pregnant women. METHODS: A baseline survey assessed knowledge of carbohydrates and standard serve sizes of pregnant women. A subset of women living in Newcastle were invited to use ServARpreg, containing pregnancy nutrition information and augmented reality guidance on portion control. A follow-up survey was sent to all women 4 weeks after baseline and women who received ServARpreg also received a process evaluation survey after 10 weeks. RESULTS: Responses were received from 186 pregnant women for the baseline survey, with 97 completing the follow-up (52.2%). Of the 56 women eligible to receive ServARpreg in the sub-study, 47 accepted (83.9%) and, of these, 40 completed the process evaluation survey (85.1%). At follow-up, there was a significant group × time interaction in favour of the ServARpreg group for carbohydrate quantification knowledge (F1,279  = 9.705, P = 0.002). Standard serve size knowledge did not change between groups. In the process evaluation survey, 80% strongly agreed/agreed that ServARpreg made them more aware of how much they ate and 72.5% found ServARpreg easy to use. CONCLUSIONS: ServARpreg has shown potential to educate pregnant women about carbohydrate quantification and increase portion size awareness. Further refinement of the tool and evaluation is needed to improve standard serve size knowledge.

A systematic review and meta-analysis of nutrition interventions for chronic noncancer pain.

BACKGROUND: This systematic review aimed to evaluate the impact of nutrition interventions on participant reported pain severity and intensity in populations with chronic pain. METHODS: Eight databases were systematically searched for studies that included adult populations with a chronic pain condition, a nutrition intervention and a measure of pain. Where possible, data were pooled using meta-analysis. Seventy-one studies were included, with 23 being eligible for meta-analysis. RESULTS: Studies were categorised into four groups: (i) altered overall diet with 12 of 16 studies finding a significant reduction in participant reported pain; (ii) altered specific nutrients with two of five studies reporting a significant reduction in participant reported pain; (iii) supplement-based interventions with 11 of 46 studies showing a significant reduction in pain; and (iv) fasting therapy with one of four studies reporting a significant reduction in pain. The meta-analysis found that, overall, nutrition interventions had a significant effect on pain reduction with studies testing an altered overall diet or just one nutrient having the greatest effect. CONCLUSIONS: This review highlights the importance and effectiveness of nutrition interventions for people who experience chronic pain.

Do the contemporary dietary patterns of children align with national food and nutrient recommendations?

BACKGROUND: Childhood nutrition is important in optimising growth, development and future health. The present study compared dietary intakes of Australian children aged 4-8 years with (i) Australian Guide to Healthy Eating (AGHE) food group recommendations and (ii) age-specific Nutrient Reference Values (NRVs), in addition to (iii) describing food group intakes of children meeting key NRVs. METHODS: Data were obtained from a representative sample of children (n = 789) from the National Nutrition and Physical Activity Survey between May 2011 and June 2012. Parent-reported 24-h recall dietary data were disaggregated into five core food groups, along with energy-dense, nutrient-poor (EDNP) foods, with intakes being compared with AGHE recommendations. Food group intakes were compared for children meeting the NRVs for 10 nutrients used for the development of AGHE food groups. Chi-squared and t-tests were performed to determine differences in food group intakes with P < 0.05 considered statistically significant. RESULTS: Only one child met the recommended daily servings for all AGHE core food groups and none met both core and energy-dense, nutrient-poor (EDNP) food group recommendations. The lowest level of alignment (percentage meeting recommendations) was for vegetables (4.6%) and the highest was for fruit (47.7%). Mean (SD) daily intake of EDNP foods [4.7 (3.2) serves day-1 ] accounted for 38.4% of total energy intakes. Children meeting key NRVs (n = 395) consumed greater daily servings of fruit [2.2 (1.7)], dairy [2.2 (1.2)] and EDNP foods [5.0 (3.4)] compared to the total sample (n = 789). CONCLUSIONS: Significant discrepancies exist between contemporary dietary patterns of Australian children and national recommendations. Future AGHE revisions should incorporate greater diversity of consumption patterns, including sub-categories of EDNP foods.

VITAL change for mums: a feasibility study investigating tailored nutrition and exercise care delivered by video-consultations for women 3-12 months postpartum.

BACKGROUND: A tailored approach to nutrition and physical activity advice can support women following childbirth in managing barriers (i.e. time and childcare) to making healthy lifestyle changes. The aim of the present study was to evaluate the implementation, acceptability and preliminary efficacy of a personally tailored nutrition and exercise programme for postpartum women delivered via video-consultations by an accredited practising dietitian (APD) and accredited exercise physiologist (AEP). METHODS: In this feasibility study (VITAL change for mums), postpartum (3-12 months) women (body mass index ≥25 or >2 kg above pre-pregnancy weight) who were seeking to achieve a healthy weight participated in a single-arm intervention. Participants received up to five real-time personalised video-consultations (2 × APD, 2 × AEP, 1 × either) over the 8-week intervention period. Implementation (recruitment, retention, utilisation), acceptability (participant satisfaction) and preliminary efficacy (anthropometry, dietary intake, cardiovascular fitness, physical activity level, psychological wellbeing) were assessed. RESULTS: Thirty women [mean (SD) age 31.6 (3.1) years, body mass index 29.0 (4.0) kg m-2 , 100% married/de facto, 80% university level education] were recruited within 10 days and 27 completed the study. Women's mean (SD) ratings (out of a score of 5) indicated satisfaction with the video-consultations [4.4 (0.9)] and the online setting [4.5 (0.8)]. Women agreed that accessing an APD [4.4 (0.8)] and AEP [4.3 (0.9)] was easier using video-consultations than attending an in-person consultation. Statistically significant improvements in waist circumference, body composition, cardiorespiratory fitness, dietary intake and physical activity were observed from baseline to 8 weeks. CONCLUSIONS: The findings of the present study suggest that a nutrition and exercise intervention delivered by qualified health professionals via video-consultations is feasible, acceptable and achieves positive outcomes for women following childbirth.

Dietary outcomes of overweight fathers and their children in the Healthy Dads, Healthy Kids community randomised controlled trial.

BACKGROUND: Few studies have examined dietary intake changes following a weight loss intervention in fathers and the association between father-child dietary intakes. The present study aimed to: (i) evaluate the change in dietary intake in overweight fathers randomised to a family-based lifestyle intervention [Healthy Dads Healthy Kids (HDHK)] versus controls and (ii) investigate whether an association exists between father-child dietary intakes. METHODS: A secondary analysis was conducted of father-child baseline and 3-month post-intervention data (n = 93) collected in the HDHK community randomised controlled trial. Intention-to-treat linear mixed models were used to assess dietary changes by group, time (baseline and 3-month) and the group-by-time interaction. Cohens d was used to determine effect sizes. RESULTS: Significant group-by-time effects (all P < 0.05) favouring fathers in the intervention group were identified for total daily energy intake (-1956 kJ, d = 0.74), total sugars (-45 g, d = 0.63), sodium (-414 mg, d = 0.58) and % energy from nutrient-dense, core foods (+10.1%, d = 0.86), fruit (+2.4%, d = 0.71), vegetarian protein sources (+1.2%, d = 0.57), pre-packed snacks (+1.7%, d = 0.58) and sugar-sweetened beverages (-4.1%, d = 0.58). At baseline, positive correlations were observed between father-child intakes for a number of dietary variables, and significant correlations were observed between father-child change scores for % energy carbohydrate (r = 0.35, P = 0.023), % energy from fruit (r = 0.47, P = 0.002), vegetarian protein sources (r = 0.46, P = 0.002) and frequency of consuming meals with vegetables (r = 0.38, P = 0.012). CONCLUSIONS: The HDHK intervention successfully improved some aspects of father's dietary intakes compared to controls. The fathers' eating patterns also correlated with those of their children for several dietary variables. These novel data suggest that fathers can be targeted as agents of dietary change within obesity prevention and treatment programmes.

A pilot intervention to reduce postpartum weight retention and central adiposity in first-time mothers: results from the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) study.

BACKGROUND: Postpartum weight retention (PPWR) increases the risk for obesity and complications during subsequent pregnancies. Few interventions have been successful in limiting PPWR in mothers. The present study assessed the effectiveness of the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) intervention with respect to reducing PPWR and improving diet, physical activity and sedentary behaviour. METHODS: A subsample of first-time mothers enrolled in the Extended Melbourne Infant Feeding Activity and Nutrition Trial (InFANT Extend) completed the nonrandomised mums OnLiNE intervention. Women in the intervention (I) group (n = 28) received access to an online calorie tracking program, smartphone app, three telephone counselling calls with a dietitian and written material. Women in two comparison groups (CI and C2) (n = 48; n = 43) were from the control (C1) and intervention (C2) arms of InFANT Extend and received no additional support. Weight and waist circumference were measured objectively. Written surveys assessed diet and physical activity. Sedentary behaviour was self-reported. Linear and logistic regression assessed changes in outcomes between groups from 9 to 18 months postpartum. RESULTS: Mean PPWR decreased in the (I) group (-1.2 kg) and the C2 group (-1.2 kg), although the changes were not significant. Mean waist circumference for all groups exceeded recommendations at baseline but decreased to below recommendations for women in the (I) group (78.3 cm) and significantly for the (I) group (-6.4 cm) compared to C1 (-1.1 cm; P = 0.002) and C2 (-3.3 cm; P = 0.001). Changes in diet, physical activity or sedentary behaviour were not significant. CONCLUSIONS: The online intervention reported in the present study shows promise with respect to reducing waist circumference in postpartum women. Further evidence of strategies that may improve weight and related behaviours in this target group is needed.

Disparities exist between the dietary intake of Indigenous Australian women during pregnancy and the Australian dietary guidelines: the Gomeroi gaaynggal study.

BACKGROUND: Little is known about the adequacy of nutrient intakes and the overall diet quality of Indigenous Australian pregnant women. The aim of this cross-sectional study was to assess nutrient sufficiency and diet quality, as measured using the Australian Recommended Food Score (ARFS), in pregnant women from the Gomeroi gaaynggal cohort (n = 58). METHODS: Maternal dietary intake during pregnancy was assessed using the Australian Eating Survey Food Frequency Questionnaire, which was self-administered in the third trimester. Diet quality was determined using the ARFS. Food group servings and nutrient intakes were compared to the Australian Guide to Health Eating (AGHE) and Australian Nutrient Reference Values (NRVs). The current analysis examined the adequacy of usual intakes from food sources only, excluding supplements. RESULTS: None of the women met all AGHE daily food group serving recommendations. The highest alignment rates were for dairy (33%), meat/alternatives (31%) and vegetables (29.3%). Almost 93% of participants exceeded the recommended intake of energy-dense, nutrient-poor foods and percentage energy from saturated fat was high (15%). Of the five key nutrients for optimal reproductive health (folate, iron, calcium, zinc and fibre), the nutrients with the highest percentage of pregnant women achieving the NRVs were zinc (77.6%) and folate (68.9%), whereas iron was the lowest. Only one person achieved all NRVs (folate, iron, calcium, zinc and fibre) important in pregnancy. The median ARFS was 28 points (maximum of 73). CONCLUSIONS: Although the small cohort limits the generalisability of the findings of the present study, the data obtained indicate that the diets of these Indigenous pregnant women are inadequate. Therefore, strategies aiming to optimise nutrient intakes of Indigenous pregnant women are needed urgently.

Modifiable risk factors of maternal postpartum weight retention: an analysis of their combined impact and potential opportunities for prevention.

BACKGROUND/OBJECTIVES: Pregnancy triggers a physiological change in weight status. Postpartum weight retention in the childbearing years can substantially alter a woman's weight gain trajectory, with several potential contributing factors identified. Most research has relied on women's recall of pre-pregnancy weight during pregnancy or later, and not considered risk factors in combination. Using measured pre-pregnancy weight, this study aimed to examine the associations of maternal postpartum weight retention with parity, pre-pregnancy BMI, excessive gestational weight gain (GWG), maternal serum vitamin D concentration and dietary Glycaemic Index in early and late pregnancy, and breastfeeding duration, including analysis of the combined impact of potentially modifiable risk factors. SUBJECTS/METHODS: Prospective cohort study of 12 583 non-pregnant women aged 20-34 years in Southampton (UK) who were assessed prior to pregnancy, with those who subsequently became pregnant followed up in early and late gestation, and after delivery (n=2559 in the final sample). Linear regression models examined potential predictors of weight retention in adjusted individual and multivariate analyses, and as a risk factor score. RESULTS: Compared with pre-pregnancy weight, 73% of women retained some weight at 6 months postpartum (mean (s.d.): 3.5 (6.2) kg). In the adjusted multivariate model, women who were primiparous, had a lower pre-pregnancy BMI, excessive GWG, a lower early pregnancy vitamin D concentration and breastfed for <6 months had greater weight retention 6 months postpartum (P<0.05 for all variables). For each additional modifiable risk factor (excessive GWG, low vitamin D concentration in early pregnancy and short breastfeeding duration; scale 0-3), women retained an additional 2.49 kg (95% CI: 2.16, 2.82; P<0.001). CONCLUSIONS: Having a greater number of modifiable risk factors was associated with greater weight retention 6 months postpartum. Initiatives supporting women to target these risk factors in the years prior to, during and after pregnancy could impact on their weight gain trajectory and later risk of adverse weight-related outcomes.

The international food unit: a new measurement aid that can improve portion size estimation.

BACKGROUND: Portion size education tools, aids and interventions can be effective in helping prevent weight gain. However consumers have difficulties in estimating food portion sizes and are confused by inconsistencies in measurement units and terminologies currently used. Visual cues are an important mediator of portion size estimation, but standardized measurement units are required. In the current study, we present a new food volume estimation tool and test the ability of young adults to accurately quantify food volumes. The International Food Unit™ (IFU™) is a 4x4x4 cm cube (64cm3), subdivided into eight 2 cm sub-cubes for estimating smaller food volumes. Compared with currently used measures such as cups and spoons, the IFU™ standardizes estimation of food volumes with metric measures. The IFU™ design is based on binary dimensional increments and the cubic shape facilitates portion size education and training, memory and recall, and computer processing which is binary in nature. METHODS: The performance of the IFU™ was tested in a randomized between-subject experiment (n = 128 adults, 66 men) that estimated volumes of 17 foods using four methods; the IFU™ cube, a deformable modelling clay cube, a household measuring cup or no aid (weight estimation). Estimation errors were compared between groups using Kruskall-Wallis tests and post-hoc comparisons. RESULTS: Estimation errors differed significantly between groups (H(3) = 28.48, p < .001). The volume estimations were most accurate in the group using the IFU™ cube (Mdn = 18.9%, IQR = 50.2) and least accurate using the measuring cup (Mdn = 87.7%, IQR = 56.1). The modelling clay cube led to a median error of 44.8% (IQR = 41.9). Compared with the measuring cup, the estimation errors using the IFU™ were significantly smaller for 12 food portions and similar for 5 food portions. Weight estimation was associated with a median error of 23.5% (IQR = 79.8). CONCLUSIONS: The IFU™ improves volume estimation accuracy compared to other methods. The cubic shape was perceived as favourable, with subdivision and multiplication facilitating volume estimation. Further studies should investigate whether the IFU™ can facilitate portion size training and whether portion size education using the IFU™ is effective and sustainable without the aid. A 3-dimensional IFU™ could serve as a reference object for estimating food volume.

Validity of short food questionnaire items to measure intake in children and adolescents: a systematic review.

BACKGROUND: Short food questions are appealing to measure dietary intakes. METHODS: A review of studies published between 2004 and 2016 was undertaken and these were included in the present study if they reported on a question or short item questionnaire (≤50 items, data presented as ≤30 food groups) measuring food intake or food-related habits, in children (aged 6 months to 18 years), and reported question validity or reliability. Thirty studies met the inclusion criteria. RESULTS: Most questions assessed foods or food groups (n = 29), with the most commonly assessed being fruit (n = 22) or vegetable intake (n = 23), dairy foods and discretionary foods (n = 20 studies each). Four studies assessed food habits, with the most common being breakfast and meal frequency (n = 4 studies). Twenty studies assessed reliability, and 25 studies determined accuracy and were most commonly compared against food records. Evaluation of question performance relied on statistical tests such as correlation. CONCLUSIONS: The present study has identified valid and reliable questions for the range of key food groups of interest to public health nutrition. Questions were more likely to be reliable than accurate, and relatively few questions were both reliable and accurate. Gaps in repeatable and valid short food questions have been identified that will provide direction for future tool development.

The association between portion size, nutrient intake and gestational weight gain: a secondary analysis in the WATCH study 2006/7.

BACKGROUND: Excessive gestational weight gain (GWG) is associated with adverse maternal-child health outcomes. Managing energy intake and GWG versus optimising nutrient intake can be challenging. The present study aimed to examine the relationships between dietary portion size, GWG and nutrient intakes during pregnancy. It is hypothesised that, after adjustment for potential confounders, portion size would be positively associated with both GWG and nutrient intakes during pregnancy. METHODS: Prospective data were obtained for 179 Australian women from the Women and Their Children's Health Study. A validated food frequency questionnaire was used at 18-24 and 36-40 weeks of gestation to quantify diet and portion size during the previous 3 months of pregnancy. Nutrient intakes were compared with Australian Nutrient Reference Values (NRVs). GWG was measured up to 36 weeks and compared with the Institute of Medicine weight gain recommendations (WtAdh). RESULTS: In multivariate regression models, portion size factor (PSF) was positively associated with GWG in women with high socio-economic status (SES; ß = 0.20, P = 0.04) and those with an overweight/obese pre-pregnancy body mass index (BMI) (ß = 0.28, P = 0.04). PSF uniquely accounted for 8.2% and 3.7% of the variability in GWG for women with high SES and overweight/obese pre-pregnancy BMIs, respectively. Nutrient intakes and PSF were similar regardless of WtAdh. Women achieved NRVs for calcium and zinc in all PSF categories. Most of the women with large PSF still failed to achieve the NRVs for folate (95.7%), iron (89.6%) and fibre (85.5%). CONCLUSIONS: All women require advice on quality food choices during pregnancy to optimise health outcomes. Targeting portion size alone is insufficient to manage GWG but may prove to be a valuable tool in pregnant women of high SES and/or those who are overweight/obese pre-pregnancy.

The Family Diet Study: a cross-sectional study into the associations between diet, food habits and body weight status in Malay families.

BACKGROUND: Childhood obesity is becoming more common as Malaysia experiences rapid nutrition transition. Current evidence related to parental influences on child dietary intake and body weight status is limited. The present study aimed to report, among Malay families, the prevalence of energy mis-reporting and dietary relationships within family dyads. METHODS: The cross-sectional Family Diet Study (n = 236) was conducted at five primary schools in central of Peninsular Malaysia. Each family consisted of a Malay child, aged 8-12 years, and their main caregiver(s). Information on socio-demographics, dietary intake and anthropometry were collected. Correlations and regression analyses were used to assess dietary relationships within family dyads. RESULTS: Approximately 29.6% of the children and 75.0% parents were categorised as being overweight or obese. Intakes of nutrients and food groups were below the national recommended targets for majority of children and adults. A large proportion of energy intake mis-reporters were identified: mothers (55.5%), fathers (40.2%) and children (40.2%). Children's body mass index (BMI) was positively associated with parental BMI (fathers, r = 0.37; mothers, r = 0.34; P < 0.01). For dietary intakes, moderate-to-strong (0.35-0.72) and weak-to-moderate (0.16-0.35) correlations were found between mother-father and child-parent dyads, respectively. Multiple regression revealed that maternal percentage energy from fat (ß = 0.09, P < 0.01) explained 81% of the variation in children's fat intake. CONCLUSIONS: Clear parental dietary relationships, especially child-mother dyads, were found. Despite a significant proportion of families with members who were overweight or obese, the majority reported dietary intakes below recommended levels, distorted by energy mis-reporting. The findings of the present study can inform interventions targeting parent-child relationships to improve family dietary patterns in Malaysia.

Core food intakes of Australian children aged 9-10 years: nutrients, daily servings and diet quality in a community cross-sectional sample.

BACKGROUND: The present study aimed to evaluate core food intakes in 9-10-year-old Australian children by considering adequacy of nutrient intakes, comparing servings of core food groups with Australian recommendations and scoring overall diet quality. METHODS: Children from an established community-based cohort study completed a semi-quantitative food frequency questionnaire. Daily intakes of energy, macronutrients, micronutrients, servings of core (i.e. nutrient-rich) foods and a diet quality index were calculated and compared with appropriate standards. Sex and socio-economic differences were examined. RESULTS: The 436 children participating were from low to high socio-economic status families. As a group, over half of the children met estimated average requirements for key macro- and micronutrients, with the exception of fibre (inadequate in 41% of boys and 24% of girls). Children obtained 55% of their daily energy from core foods. Most children had fewer than the recommended servings of vegetables (91%) and meat/alternatives (99.8%), whereas boys generally ate fewer servings of grains and cereals than recommended (87%), and girls ate fewer servings of dairy (83%). Diet quality scores indicated room for improvement (median score of 26 for boys and 25 for girls, out of a maximum of 73 points). CONCLUSIONS: As a group, a large proportion of children were able to meet their daily nutrient requirements. However, achieving this through noncore foods meant that diets were high in salt, saturated fat and sugar; more servings of core foods and greater dietary diversity would be preferable. These results suggest that families need more support to optimise dietary patterns of children in this age group.

Relationships between dietary intakes of children and their parents: a cross-sectional, secondary analysis of families participating in the Family Diet Quality Study.

BACKGROUND: Being overweight and obese in Australian children is common. Current evidence related to parental influence on child dietary intake is conflicting, and is particularly limited in terms of which parent exerts the stronger relationship. The present study aimed to assess mother-father and parent-child dietary relationships and to identify which parent-child relationship is stronger. METHODS: A cross-sectional analysis was performed of dietary intake data from 66 families with one parent and one child aged 8-12 years who were participating in the Family Diet Quality Study, in the Hunter and Forster regions of New South Wales, Australia. Dietary intakes were assessed using adult and child specific, validated semi-quantitative 120-item food frequency questionnaires. Diet quality and variety subscores were assessed using the Australian Recommended Food Scores for adults and children/adolescents. Pearson's correlations were used to assess dietary relationships between mother-father, father-child and mother-child dyads. RESULTS: Weak-to-moderate correlations were found between mother-child dyads for components of dietary intake (r = 0.27-0.47). Similarly, for father-child dyads, predominantly weak-to-moderate correlations were found (r = 0.01-0.52). Variety of fruit intake was the most strongly correlated in both parent-child dyads, with the weakest relationships found for fibre (g 1000 kJ(-1) ) in father-child and percentage energy from total fats for mother-child dyads. Mother-father dyads demonstrated mostly moderate-to-strong correlations (r = 0.13-0.73), with scores for condiments showing the weakest relationship and vegetables the strongest. For all dyads, strong correlations were observed for overall diet quality (r = 0.50-0.59). CONCLUSIONS: Parent-child dietary intake is significantly related but differs for mother versus fathers. Further research is required to examine whether differing dietary components should be targeted for mothers versus fathers in interventions aiming to improve family dietary patterns.

Systematic review of diet quality indices and their associations with health-related outcomes in children and adolescents.

BACKGROUND: Diet quality indices add an important dimension to dietary assessment. The aim of this systematic review was to: (i) identify and describe the attributes and applications of diet quality indices developed for use or used in paediatric populations; (ii) describe associations between these diet quality indices and health-related variables in paediatric populations; and (iii) identify factors that are associated with diet quality in paediatric populations worldwide. METHODS: Studies were identified by searching electronic databases for relevant papers from 1980 to October 2013 using keywords. Inclusion criteria were original studies that utilised a quantitative measure of diet quality in children and adolescents aged 0-18 years. RESULTS: One hundred and nineteen studies met the inclusion criteria, from which 80 different diet quality indices were identified. The majority of studies had >1000 participants and were of acceptable quality. Of the 56 studies that investigated health-related outcomes, weight status was the most researched. Europe produced the most number of diet quality indices (n = 27 indices). Of the 119 studies, seven intervention studies were identified. Paediatric diet quality indices were found to be associated with environmental, behavioural and maternal factors. CONCLUSIONS: The use of diet quality indices in paediatric populations is a rapidly expanding area of research in diverse populations internationally. In economically disadvantaged countries, diet quality indices may be predictive of child growth. However, prospective cohort, intervention and validation studies are required to draw stronger conclusions concerning risk of future disease in paediatric populations in general.

Diet quality of Australian breast cancer survivors: a cross-sectional analysis from the Australian Longitudinal Study on Women's Health.

BACKGROUND: Evidence supports strong associations between healthful eating patterns and maintaining a healthy weight with favourable health outcomes for breast cancer survivors (BCS). The present study aimed to evaluate the diet quality of Australian BCS and to determine whether diet quality differed between BCS and age-matched healthy controls (HC) or by geographical location. METHODS: This cross-sectional study included 281 BCS and 4069 HC from the Australian Longitudinal Study on Women's Health mid-aged cohort completing Survey 3 in 2001. Data from the Dietary Questionnaire for Epidemiological Studies food frequency questionnaire were used to calculate the Australian Recommended Food Score (ARFS), a validated summary estimate of diet quality based on adherence to the Australian dietary guidelines. RESULTS: The mean (SD) ARFS of the BCS group was 33.2 (9.4) out of a maximum of 74. Mean (SD) total ARFS and component scores of BCS did not differ from the HC group [32.9 (8.7)] and no differences were found in ARFS between urban and rural BCS. CONCLUSIONS: This is the first study dedicated exclusively to describing the diet quality of Australian BCS. Although no difference was found when comparisons were made with a HC group, there is considerable room for improvement in the diet quality of Australian BCS. Given research suggesting higher risk of chronic conditions such as obesity amongst BCS, and the recognition of optimising diet quality as a key factor in health promotion for all population groups, data from the present study suggest the need for research targeting the feasibility and impact of improving diet quality of Australian BCS.

Diet-induced weight loss in obese children with asthma: a randomized controlled trial.

BACKGROUND: Obesity is highly prevalent in asthmatic children and associated with worse clinical outcomes. Energy restriction to induce weight loss in asthmatic children has not been investigated in a randomized controlled trial (RCT). OBJECTIVE: To assess if (1) weight loss can be achieved in obese asthmatic children using a dietary intervention; and (2) changes in asthma outcomes occur following diet-induced weight loss. METHODS: In a 10-week pilot RCT, obese asthmatic children, aged 8-17 years, were randomized to a wait-list control (WLC) (n = 15) or dietary-intervention group (DIG) (n = 13). Lung function, Asthma Control Questionnaire (ACQ) score, and sputum and systemic inflammation were assessed at baseline and post-intervention. (Australian New Zealand Clinical Trials Registry: ACTRN12610000955011). RESULTS: Body mass index (BMI) z-score reduced significantly in the DIG vs. the WLC (-0.2 [-0.4, -0.1] vs. 0.0 [-0.1, 0.0], P = 0.014). Expiratory reserve volume (ERV) increased significantly within the DIG, but not compared to the WLC (0.7 [0.0, 1.0] L vs. 0.3 [0.0, 0.8] L, P = 0.355). ACQ improved significantly in the DIG, compared to the WLC (-0.4 [-0.7, 0.0] vs. 0.1 [0.0, 0.6], P = 0.004). Airway and systemic inflammation did not change within the DIG. In comparison, C-Reactive Protein (CRP) increased significantly in the WLC (-0.4 [-0.5, 0.4] vs. 0.7 [-0.1, 1.9], P = 0.037). Change (∆) in BMI z-score correlated with ∆CRP (r = 0.47, P = 0.012) and ∆exhaled nitric oxide (eNO) (r = 0.46, P = 0.034), and ∆ACQ was associated with ∆CRP (r = 0.43, P = 0.029). CONCLUSION AND CLINICAL RELEVANCE: Dietary intervention can induce acute weight loss in obese asthmatic children with subsequent improvements in static lung function and asthma control. Systemic and airway inflammation did not change following weight loss. However, changes in BMI z-score were associated with changes in airway and systemic inflammation and this requires further investigation in a larger RCT. This is the first weight loss RCT conducted in obese asthmatic children. Diet-induced weight loss can achieve significant improvements in clinical outcomes for obese children with asthma.

Can a Web-based food record accurately assess energy intake in overweight and obese women? A pilot study.

BACKGROUND: Innovative dietary intake measurement tools, such as web-based food records, are becoming increasingly available for self-monitoring. However, the accuracy of this method has not been well studied. This pilot study aimed to evaluate the accuracy of energy intake (EI) estimated by a web-based food record, by comparison with total energy expenditure (TEE) measured by doubly-labelled water (DLW) in overweight and obese women. METHODS: Total energy expenditure (TEE) was assessed in weight stable (±1 kg) women (n = 9), with a mean (SD) age of 34.5 (11.3) years and body mass index of 29.2 (1.4) kg m(-2) over 10 days using the DLW technique. All food and beverages were self-reported for 9-days using a web-based food record and mean daily EI calculated. Food record accuracy was assessed by calculating the absolute (EI - TEE) and percentage (EI/TEE × 100) differences between EI and TEE. Women were identified as under-reporters of EI based on the 95% confidence limits of the expected EI : TEE of 1. RESULTS: The mean (SD) self-reported EI was 8351 (1225) kJ day(-1) [1996 (293) kcal day(-1) ] and TEE was 10 648 (1774) kJ day(-1) [2545 (424) kcal day(-1) ]. The mean (SD) absolute difference in self-reported EI and TEE was -2301 (1535) kJ day(-1) [-550 (367) kcal day(-1) ], representing a mean reporting accuracy of 79.6% (14.1%), with four participants under-reporting EI. CONCLUSIONS: This pilot study highlights the opportunity for the use of the Internet as a novel medium for recording and assessing dietary intake. Although further research is needed in more diverse population groups, the accuracy of web-based food records for assessing EI appears to be consistent with other published dietary intake methods.