The big squeeze: a product content and labelling analysis of ready-to-use complementary infant food pouches in Australia.

BACKGROUND: Encouraging the early development of healthy eating habits prevents diet-related chronic disease. It is well understood that highly processed foods with high amounts of sugars, salt and fats are a risk factor for non-communicable diseases. Commercial baby foods in ready-to-use squeeze pouches emerged in the global food market around 2012. The long-term effects of this now ubiquitous packaging on the quality of infant diets, baby food consumption and marketing are unknown. This study aimed to conduct a rigorous mixed-methods audit of squeeze pouches in Australia to inform product regulation and policy. METHODS: Nutritional and marketing data were sourced from products available in Australian retailers. Analysis of nutritional content, texture and packaging labelling and serving size was conducted. Pouches were given a Nutrition Profile Index (NPI) score and compared with the Australian Infant Feeding Guidelines. Marketing text was thematically analysed and compared to existing infant nutrition policy around regulation of marketing claims. RESULTS: 276 products from 15 manufacturers were analysed, targeting infants from 4 + to 12 + months. Total sugar content ranged 0.8-17.5 g/100 g, 20% (n = 56) of products had added sugars, 17% (n = 46) had added fruit juice, 71% (n = 196) had added fruit puree. Saturated fat content ranged from 0.0 to 5.0 g/100 g, sodium 0.0-69 mg/100 g and dietary fibre 0.0-4.3 g/100 g. Only two products were nutritionally adequate according to a nutrient profiling tool. Marketing messages included ingredient premiumisation, nutrient absence claims, claims about infant development and health, good parenting, and convenience. Claims of 'no added sugar' were made for 59% of pouches, despite the addition of free sugars. CONCLUSIONS: Squeeze pouch products available in Australia are nutritionally poor, high in sugars, not fortified with iron, and there is a clear risk of harm tothe health of infant and young children if these products are fed regularly. The marketing messages and labelling on squeeze pouches are misleading and do not support WHO or Australian NHMRC recommendations for breastfeeding or appropriate introduction of complementary foods and labelling of products. There is an urgent need for improved regulation of product composition, serving sizes and labelling to protect infants and young children aged 0-36 months and better inform parents.

Fix my food: An urgent call to action from adolescents on how they experience and want to see change in their food systems.

BACKGROUND: Global food systems are failing adolescents. Poor diet quality driving malnutrition among adolescents around the world and the quality of foods eaten by adolescents not only determines their health and development, but also is the foundation of thriving communities. The present study aimed to engage adolescents across low-income, middle-income and high-income countries to determine their lived experience of food, food systems and the challenges they face within their food systems. METHODS: The study used the Distributed Data Generation method pioneered by the Young and Resilient Research Centre, at Western Sydney University, to conduct workshops with adolescents aged 10-19 years across the globe in collaboration with UNICEF. Participatory workshops were designed to capture qualitative data on adolescents lived experiences and perspectives of their food systems, food sustainability and food security, and how improvements can be made. Thematic analysis was undertaken to analyse qualitative data. Descriptive statistics were generated for demographic data captured. RESULTS: Six hundred and forty adolescents across 18 countries participated. Three key themes emerged, which included experiences of food, challenges to food systems and strengthening food systems. Adolescents saw potential in empowering communities to create change and contribute to food system transformation. Adolescents called for inclusion in decision-making from local food practice to large global policy development. CONCLUSIONS: The study results demonstrated how adolescents experience their food systems and want to see sustainable change, although they also want to be a part of the change. Adolescents described that there needs to be an active choice to work with them, listen to their lived experience and across all levels of society strengthen food systems. To achieve this, adolescents need to be involved in decision-making around their food systems for a sustainable future.

Poor diet quality and adverse eating behaviors in young survivors of childhood cancer.

BACKGROUND: The long-term impact of childhood cancer treatment on dietary intake is likely to be complex, and the length of time dietary behaviors are affected after childhood cancer treatment is unknown. AIM: The aim of this study was to determine the diet quality in childhood cancer survivors recently off treatment and explore possible contributing factors that may affect diet quality in this population. METHODS: Participants were 65 parents and/or carers of childhood cancer survivors (CCS) (aged 2-18 years), recently off treatment, and 81 age-matched controls. Participants completed two self-administered dietary intake and eating behavior questionnaires. Study data were explored to determine between group differences, bivariate analysis using Spearman correlations was used to determine the relationship between diet quality and identified variables, and hierarchical cluster analysis was completed to characterize specific variables into clusters. RESULTS: One hundred and forty-six parents of children aged 2-18 years completed the study (65 parents of CCS and 81 control). CCS had a significantly poorer diet quality score than the age-matched controls (32.25 vs 34.83, P = 0.028). CCS had significantly higher parent-reported rates of "picky eating" behavior than the control group (2.31 vs 1.91; P = 0.044). Factors such as picky eating, emotional overeating, and body mass index z-score might drive diet quality in survivors. CONCLUSIONS: CCS were found to have poorer diet quality and more likely to have parents report picky eating behaviors. The outcomes highlighted the need for a tailored intervention aimed at improving healthy eating behaviors in CCS after treatment for cancer.

Exploring the views of parents regarding dietary habits of their young cancer-surviving children.

PURPOSE: Adult survivors of childhood cancer have a poor dietary intake. These habits may be manifesting themselves soon after treatment completion. This qualitative study aimed to assess parental views regarding the dietary habits of young child cancer survivors. METHODS: The parents/carers of 18 young child cancer patients (YCCP) treated at Sydney Children's Hospital, Australia (<5 years since treatment completion and <13 years of age), participated in this study. Eighteen age- and sex-matched healthy controls were recruited from Sydney-based community organizations. The interview schedule was semi-structured, and the interview was conducted over the telephone. Interviews were conducted until thematic saturation was reached. Coding and analysis was facilitated by qualitative analysis software. RESULTS: Three main themes emerged regarding parental perceptions of YCCP current intake as compared with their pre-diagnosis eating habits: (1) decreased fruit and vegetable intake, (2) increased consumption of "junk food," and (3) increased portion sizes. Parents also described a continuation of poor eating habits that were established during their cancer treatment. The eating habits of YCCP were substantively different to that described by parents of the control group. CONCLUSION: This exploratory project revealed parental concern regarding their child's dietary intake once the cancer treatment had been completed. The varying habits of YCCP are likely multifactorial and may be related to treatment-related side effects and food habits established during the cancer treatment.

Parent feeding interactions and practices during childhood cancer treatment. A qualitative investigation.

In the general population it is evident that parent feeding practices can directly shape a child's life long dietary intake. Young children undergoing childhood cancer treatment may experience feeding difficulties and limited food intake, due to the inherent side effects of their anti-cancer treatment. What is not clear is how these treatment side effects are influencing the parent-child feeding relationship during anti-cancer treatment. This retrospective qualitative study collected telephone based interview data from 38 parents of childhood cancer patients who had recently completed cancer treatment (child's mean age: 6.98 years). Parents described a range of treatment side effects that impacted on their child's ability to eat, often resulting in weight loss. Sixty-one percent of parents (n = 23) reported high levels of stress in regard to their child's eating and weight loss during treatment. Parents reported stress, feelings of helplessness, and conflict and/or tension between parent and the child during feeding/eating interactions. Parents described using both positive and negative feeding practices, such as: pressuring their child to eat, threatening the insertion of a nasogastric feeding tube, encouraging the child to eat and providing home cooked meals in hospital. Results indicated that parent stress may lead to the use of coping strategies such as positive or negative feeding practices to entice their child to eat during cancer treatment. Future research is recommended to determine the implication of parent feeding practice on the long term diet quality and food preferences of childhood cancer survivors.

Factors Associated with Childhood Stunting in Four North African Countries: Evidence from Multiple Indicator Cluster Surveys, 2014-2019.

Stunting remains a significant public health issue among North African children, even though significant progress has been made in reducing hunger and poverty. This study aimed to identify factors associated with stunting among children in four North African countries (Algeria, Egypt, Sudan, and Tunisia). A logistic regression model adjusted for clustering and sampling weights was used to identify factors associated with childhood stunting. It was found that the prevalence of stunting in Algeria, Egypt, Sudan, and Tunisia was 9.7%(95% CI: 9.1, 10.3), 21.1% (95% CI: 19.8, 22.5), 33.8% (95% CI: 32.7, 34.9), and 8.2% (95% CI: 7.3, 9.2), respectively. Stunting was more common among children from Sudan and Egypt. Our analysis showed that a low wealth index, being a boy, low BMI, dietary diversity <5 foods, and low birth weight were associated with stunting from 0 to 23 months; however, rural residency, a low-educated mother, low BMI, family size, and diarrhea were associated with stunting from 24 to 59 months. A collaborative approach that prioritizes maternal health and nutrition, invests in struggling families, and customizes interventions to meet the specific needs of each North African country is essential for eradicating undernutrition by 2030.

Feeding Practices, Parent Perceptions, and Diet Diversity in a Sample of Children Aged 0-5 Years from Western Sydney, Australia: A Mixed Methods Study.

(1) Background: Sub-optimal feeding practices and dietary intakes in childhood are associated with poor health outcomes in adulthood. This mixed methods study aims to profile feeding practices, parent perceptions, and dietary diversity in a sample of children aged 0-5 years (n = 29) from Western Sydney, Australia. (2) Methods: In 2019, semi-structured interviews were conducted with parents, exploring their child's feeding practices. An online quantitative survey was used to assess children's feeding history. Nutrient intakes and dietary diversity scores were assessed using an online 24-h dietary recall. Quantitative data were analysed using descriptive statistics and one-way ANOVA, while qualitative data were analysed using inductive thematic analysis. (3) Results: The analysis showed that 27.6% of children were exclusively breastfed until 6 months of age and that 62.1% of children were introduced to solids before 6 months. Over 60% of children achieved minimum dietary diversity. The thematic analysis identified four themes, including mothers' feeding choices, mothers' perceptions of their children's diet, influences on feeding choices, and mothers' personal experiences. (4) Conclusions: The feeding history of over half the children in this sample indicated non-compliance with Australian and WHO infant feeding guidelines. The thematic analysis revealed various possible influences on parent feeding choices that can be used to inform targeted support.

Wasting and Underweight in Northern African Children: Findings from Multiple-Indicator Cluster Surveys, 2014-2018.

Northern Africa faces multiple severe detrimental factors that impact child nutrition. This study aimed to identify the predictors for wasting and underweight in children aged 0-59 months in Northern Africa. We analysed pooled cross-sectional data from multiple-indicator cluster surveys conducted in four countries (Algeria, Egypt, Sudan, and Tunisia) involving 37,816 children aged 0-59 months. A logistic regression analysis was used, considering clustering and sampling weights, to identify factors associated with wasting and underweight among children aged 0-23, 24-59, and 0-59 months. Among children aged 0-59 months, the overall prevalence was 7.2% (95% CI: 6.8-7.5) for wasting and 12.1% (95% CI:11.7-12.5) for underweight. Sudan and Algeria had the highest rates of wasting, while Sudan and Egypt had the highest rates of underweight. Multiple regression analyses indicate that factors associated with wasting and being underweight include child age, country, rural residency, poor wealth index, being male, birth order, maternal education, body mass index, media use, lack of diverse foods, longer duration of breastfeeding, perceived small baby size, and diarrhoea. These findings highlight the importance of implementing targeted health and nutrition initiatives, such as maternal education, family planning, and community engagement. Priority should be given to children from underprivileged areas who lack proper dietary variety.

Childhood undernutrition in North Africa: systematic review and meta-analysis of observational studies.

BACKGROUND: Undernutrition remains a major public health issue in low- and middle-income countries. Objective Our aim for this study was to identify the factors contributing to undernutrition in children under five years old in North Africa. METHODS: We searched five electronic bibliographic databases (Ovid MEDLINE, Web of Science, Embase (Ovid), ProQuest, and CINAHL) for eligible observational studies published after 2006. STATA version 17 software was used to calculate the odds ratios between associated factors and indicators of undernutrition, with 95% confidence intervals. For each factor, the overall odds were pooled using a forest plot. Due to the significant heterogeneity among the studies (I2 > 50%), a random-effects model was used, and sensitivity analysis was conducted to examine the effect of outliers. RESULTS: Out of 1093 initially identified studies, 14 met the selection criteria. Our meta-analysis revealed that uneducated mothers were the most common factor associated with undernutrition in North African children. Children aged 0-23 months were significantly associated with stunting (odds ratios (OR) = 1.27; 95% CI: 1.18; 1.37) and wasting (OR = 1.68; 95% CI: 1.42; 1.99). Children living in rural areas were also at higher odds of being stunted (OR = 1.74; 95% CI: 1.64; 1.84) and underweight (OR = 1.59; 95% CI: 1.35; 1.88). These analyses also indicated that a lower wealth index, mothers' nutritional health, uneducated fathers, and low birth weight were other factors significantly associated with stunting. CONCLUSION: Addressing undernutrition in Northern Africa requires a multidisciplinary approach prioritising mothers and young children, especially families in underprivileged areas.

A systematic review and meta-analysis of the prevalence of childhood undernutrition in North Africa.

Undernutrition (stunting, wasting and underweight) among children remains a public health concern in North Africa, especially following recent conflicts in the region. Therefore, this paper systematically reviews and meta-analyses the prevalence of undernutrition among children under five in North Africa to determine whether efforts to reduce undernutrition are on track to achieving the Sustainable Development Goals (SDGs) by 2030. Eligible studies published between 1st January 2006 and 10th April 2022 were searched for, using five electronic bibliographic databases (Ovid MEDLINE, Web of Science, Embase (Ovid), ProQuest and CINAHL). The JBI critical appraisal tool was used, and a meta-analysis was conducted using the 'metaprop' command in STATA, to estimate the prevalence of each undernutrition indicator in the seven North African countries (Egypt, Sudan, Libya, Algeria, Tunisia, Morocco, and Western Sahara). Due to the significant heterogeneity among studies (I2 >50%), a random effect model and sensitivity analysis were conducted to examine the effect of outliers. Out of 1592 initially identified, 27 met the selection criteria. The prevalence of stunting, wasting and being underweight were 23.5%, 7.9% and 12.9%, respectively. Significant variations between the countries with the highest rates of stunting and wasting were reported in Sudan (36%, 14.1%), Egypt (23.7%, 7.5%), Libya (23.1%, 5.9%), and Morocco (19.9%, 5.1%). Sudan also had the highest prevalence of underweight (24.6%), followed by Egypt (7%), Morocco (6.1%), and Libya (4.3%) with more than one in ten children in Algeria and Tunisia having stunted growth. In conclusion, undernutrition is widespread in the North African region, particularly in Sudan, Egypt, Libya, and Morocco, making it challenging to meet the SDGs by 2030. Nutrition monitoring and evaluation in these countries is highly recommended.

Family information needs at childhood cancer treatment completion.

BACKGROUND: Despite the recognized importance of information provision across the cancer trajectory, little research has investigated family information needs recently after childhood cancer. This mixed-methods, multiperspective, study explored the information needs of families of childhood cancer survivors in the first year post-treatment. PROCEDURE: In total, 112 semi-structured telephone interviews were conducted with 19 survivors (mean age 16.2 years, off treatment for ≤36 months), 44 mothers, 34 fathers, and 15 siblings. Interviews were analyzed inductively, line-by-line, using the framework of Miles and Huberman. Emergent themes were cross-tabulated by sample characteristics using QSR NVivo8. RESULTS: Participant views were mixed regarding the need for a "finishing treatment review" with their oncologist (the primary information source for most families); however, many mothers (29/44) and fathers (17/34) and most siblings (14/15) reported receiving insufficient information post-treatment. Information regarding fertility and how to prepare for likely post-treatment challenges were the most cited unmet needs. Online support was ranked highest by survivors (mean score: 7/2/10) and siblings (7.4/10), whilst parents preferred an information booklet (often due to concerns about accessing accurate and relevant information from the Internet). While many participants reported feelings of isolation/loneliness, many were reluctant to attend face-to-face support groups/seminars. CONCLUSIONS: Family members of survivors may experience the most acute unmet needs for information about fertility and in preparation for post-treatment challenges. However, provision of the correct amount of information at the right time for each family member during a highly stressful period remains clinically challenging.

Dietary intake after treatment in child cancer survivors.

BACKGROUND: Childhood cancer survivors (CCS) are at increased risk of complications such as obesity, diabetes, and osteoporosis which have the potential to, in part, be controlled with dietary interventions. To allow the development of appropriate dietary interventions for younger cancer survivors data on their dietary intake as well as information on parental nutrition views and practices need to be assessed. PROCEDURE: Dietary intake of 50 CCS was assessed with a 3-day food diary (parent report). Parent child feeding practices were assessed with the Child Feeding Questionnaire (CFQ). Historical and anthropometric data was extracted from medical records. Survivors were less than 13 years old and less than 5 years after treatment completion. RESULTS: Twenty percent of participating CCS was overweight or obese and 54% were consuming above their estimated energy requirements. Fifty, 32% and 44% of children did not meet requirements for folate, calcium, and iron respectively. There was a significant trend for increasing BMI percentiles from diagnosis to time of assessment (56.29 vs. 67.17, P = 0.01). Results from the CFQ showed that parents were more likely to monitor (3.99) and use a restrictive form of parenting (3.43) to control their child's food intake rather than pressure their child to eat (2.77) (P = 0.001). CONCLUSION: This group displayed excessive energy intake (kilojoules) and poor dietary habits. Parents' restrictive feeding style may be contributing to these habits. Early interventions targeting the dietary intake of young survivors and associated parent feeding practices may prevent some of the deleterious long-term effects associated with childhood cancer therapy.

Double Discourse: Qualitative Perspectives on Breast Screening Participation among Obese Women and Their Health Care Providers.

Obesity in Australia is rising rapidly, and is a major public health concern. Obesity increases the risk of breast cancer and worsens associated outcomes, yet breast screening participation rates in Australia are suboptimal and can be lower in higher risk, obese women. This study qualitatively explored barriers to breast screening participation in obese women in Australia. In-depth interviews (n = 29), were conducted with obese women (body mass index ≥ 30) and key health providers. A disconnect between providers' and women's perceptions was found. For women, low knowledge around a heightened need to screen existed, they also reported limited desire to prioritize personal health needs, reluctance to screen due to poor body image and prior negative mammographic experiences due to issues with weight. Providers perceived few issues in screening obese women beyond equipment limitations, and health and safety issues. Overall, weight was a taboo topic among our interviewees, indicating that a lack of discourse around this issue may be putting obese women at increased risk of breast cancer morbidity and mortality. Consideration of breast screening policy in obese women is warranted. Targeted health promotion on increased breast cancer risk in obese women is required as is a need to address body image issues and encourage screening participation.