"I see it very much as an end-of-life food" - Barriers to oral nutritional supplement adherence, views from healthy older adults.

Malnutrition affects approximately one quarter of UK adults aged 65 years and over. As the global demographic shift continues, malnutrition is expected to increase. Oral nutritional supplements (ONS) are used both to prevent and to treat malnutrition. However, their effectiveness is compromised by poor adherence, and it is not well understood what contributes to this. Therefore, the current research was designed to explore ONS adherence from the parallel perspectives of ONS as a prescribed "medication" and as a food supplement/substitute. Eighteen older adults (13F, 5M; mean age = 73.4 yr; range: 70-80 yr) participated in focus groups (three in-person and one online), to investigate experiences of taking prescribed medications, including dietary supplements, and what should be factors to consider in supporting regular intake of ONS for trial development, as well as any potential improvements to products. Focus group sessions were recorded and then transcribed. Thematic Analysis was applied to the transcripts by the first author, and themes were discussed in depth, using exemplar quotes from participants. Five dominant themes were identified from the data: Disgust, Palatability and Acceptance; End-of-Life Care; Resistance to Medicines; Rituals and Reminders; and Real Food Displacement. Nutritional supplements were characterised as "disgusting", "manufactured", and associated with serious, chronic illness, as well as end-of-life care, in contrast to probiotics which were linked with health and wellness. The sweet taste of ONS was identified as a barrier to intake, given that it is generally associated with a signal to stop eating, and low hunger. As a group, participants tried to "avoid taking medicines", and viewed the need to have them negatively, yet most regularly took prescribed medication and/or vitamin supplements. Participants identified several, rituals and reminders to take medicines, including meal-based, or time-of-day-based prompts (e.g., before, with or after meals). To improve adherence, savoury products were suggested, as well as a more person-centred approach to individual nutritional needs and preferences. Overall, the group discussion mainly identified barriers to intake, but that improving taste, adding to "real food" (not replacing meals), and offering variety of flavour and form (e.g., savoury soups as well as sweet drinks) could be included in future trials to improve appeal and therefore intake. Future work should continue to explore how best to formulate, market and/or prescribe ONS, and how this might vary for malnutrition prevention vs treatment strategies.

Appetitive traits from childhood to adolescence: Analysis of their stability, derivation of trajectory profiles, and associated characteristics.

This study aimed to assess the potential stability of appetitive traits from childhood to early adolescence, identify groups of individuals with distinct trajectories for these traits, and explore their association with other child and family characteristics. Participants were 5040 children from the Generation XXI cohort. Appetitive traits were assessed with the Children's Eating Behaviour Questionnaire (CEBQ) at ages seven, 10, and 13 (eight subscales). Mixed-effect models estimated individual trajectories of appetitive traits and Gaussian mixture models identified groups following different trajectories (appetitive trait trajectory profiles). Appetitive traits showed moderate-to-high stability across the three ages (intra-class correlation coefficients:0.66-0.83); most of the variance observed across time were due to persistent individual differences rather than age-related changes. Six appetitive trait trajectory profiles were identified: 'Moderate appetite' (scores close to the average) (29% of children), 'Small to moderate appetite' (lowest food approach and emotional eating) (26%), 'Increasing appetite' (increasing food approach) (15%), 'Avid appetite' (highest food approach and lowest food avoidance) (12%), 'Smallest appetite' (highest food avoidance and low food approach) (10%), and 'Small appetite but increasing' (decreasing high food avoidance and Desire to Drink) (8%). In multinomial logistic regression, these profiles were associated with different child and family characteristics. Compared to children with a 'Moderate appetite' profile, those with higher BMI, who desired a thinner body, whose mothers were younger, had lower education, higher pre-pregnancy BMI (OR = 1.07; 95%CI:1.04,1.09), smoked during pregnancy (OR = 1.51; 95%CI:1.21,1.90), and used more restrictive feeding practices (OR = 1.79; 95%CI:1.57,2.03) had increased odds of belonging to the 'Avid Appetite'. In conclusion, distinct appetitive trait trajectory profiles emerged, differentiating individuals with avid and small appetites. These findings have implications for identifying children at higher risk for obesogenic profiles.

The impact of school-based cooking classes on vegetable intake, cooking skills and food literacy of children aged 4-12 years: A systematic review of the evidence 2001-2021.

BACKGROUND: Many children consume a poor quality diet with only a third of children aged 6-9 years eating vegetables daily. A high quality diet is important for good health in childhood; however, the prevalence of children living with obesity has doubled from 10% to 23% during primary school in the UK. Cooking lessons have the potential to improve diet quality and reduce obesity prevalence in childhood, both of which are associated with improved cardiometabolic outcomes in adulthood. The aim of this systematic review is to investigate the impact of school-based cooking classes on cooking skills, food literacy and vegetable intake of children aged 4-12 years. METHODS: We conducted a systematic review of OVID Medline, OVID Embase, EBSCO CINHAL and EBSCO ERIC for comparative studies that evaluated outcomes of children receiving cooking classes compared to a control group. Interventions included contained food preparation or a cooking activities and took place on school premises. Risk of bias was assessed using ROB2 and Robins-I. Outcomes were pooled in a meta-analysis using a random-effects model using standardised mean differences or reviewed using narrative synthesis. Certainty of evidence was assessed using GRADE. RESULTS: We included 21 studies, (6 randomised). Meta-analysis showed a small positive effect on cooking self-efficacy of 0.39 units (95% CI 0.05 to 0.54), and a small positive effect on vegetable intake of 0.25 units (95% CI 0.05 to 0.45). Programmes with more than 6 h of cooking showed the greatest effects. CONCLUSIONS: Children's cooking programmes result in small improvements in cooking efficacy and vegetable intake, particularly those with more than 6 h of classes. It is recommended that future interventions use consistent measurement for children's food literacy and cooking confidence.

Maternal perception, concern and dissatisfaction with child weight and their association with feeding practices in the Generation XXI birth cohort.

What a mother thinks about her child's weight status might influence what and how she feeds her child. We examined the association between maternal perception, concern and dissatisfaction with child weight alongside feeding practices. Participants were from the Generation XXI birth cohort (n = 3233). A validated version of the Child Feeding Questionnaire and the Overt/Covert Control scale were used. Associations were evaluated by linear regression models (ß coefficients and 95 % confidence intervals (95 % CI) with Bonferroni correction). Perceived underweight was associated with practices promoting food intake, such as higher pressure to eat at ages 4 and 7 years (ß = 0·229; 95 % CI: 0·059, 0·398 and ß = 0·190; 95 % CI:0·005, 0·376, respectively) and lower restriction at age 4 (ß = -0·175; 95 % CI: -0·0310, -0·039). At age 7, perceived overweight was associated with higher covert control (ß = 0·203; 95 % CI: 0·029, 0·376). Mothers who were concerned about child weight reported higher restriction (ß = 0·226; 95 % CI: 0·142, 0·310 at 4 years and ß = 0·261; 95 % CI: 0·169, 0·353 at 7 years) and covert control (ß = 0·183; 95 % CI: 0·083, 0·282 at 4 years and ß = 0·171; 95 % CI: 0·073, 0·269 at 7 years). Maternal desire for a heavier child was associated with higher pressure to eat at both ages (ß = 0·285; 95 % CI: 0·163, 0·406 and ß = 0·393; 95 % CI: 0·266, 0·520), while the desire for a thinner child was related to higher covert control at 7 years of age (ß = 0·158; 95 % CI: 0·001, 0·316). Maternal perceptions and concern for child weight status are associated with feeding practices independently of actual weight status.

From food preference development to responsive feeding - Selective studies to commemorate the life and work of Dr Leann Birch.

Dr Leann Birch was a pioneer in conducting research on infant and child eating behaviour. At the beginning of her research career, Leann recognised a significant gap in the developmental psychology literature, namely that few studies had been conducted to understand infant eating and feeding behaviours. This seems an unusual omission given that food intake is essential and that developmental milestones from milk to solids, and from being fed to becoming an autonomous eater, are obvious to most caregivers. Leann paved the way for interdisciplinary research from psychology, paediatrics and public health to explore and apply this knowledge to infant and child appetite, eating behaviour, dietary patterns, food preferences, and obesity risk. Early studies in her laboratory demonstrated that children form food preferences through experience and socialisation. Experiments published in 1979 tested the role of familiarisation through repeat exposure, and the impact of instrumental and social learning on the acquisition of food preferences. In 1984, a presentation given to the British Feeding and Drinking Group (BFDG) in Brighton set out three organising principles for understanding how children acquire food preferences: genetically pre-programmed behavioural propensities; social constraints on experience with food; and social transmission resulting from direct social interaction. Building on these three organising principles, research on child eating behaviour has flourished, including the intersection between individual differences, food experience and environmental influences on children's food preferences, energy regulation, and weight outcomes. In this review, the initial groundwork set out by Leann Birch on food preference development in children is considered followed by a discussion of how this has since inspired an interdisciplinary, international and expanding field of research on children's food intake, appetite and body weight regulation.

Association of early feeding practices with dietary patterns of 7-year-olds from the birth cohort Generation XXI.

Early feeding practices have been related to child's body mass index (BMI), however, their role in establishing dietary patterns is less well understood. The aim of this study was to examine the association of parent-reported early feeding practices (breastfeeding duration, type of foods and timing of complementary feeding) and dietary patterns identified at age 7 to explain BMI z-scores at 10 years of age. Participants were children from the Generation XXI cohort, evaluated at 4, 7 and 10 years of age (n = 3673). At 7 years-old, dietary intake was assessed with a validated food-frequency questionnaire. Two dietary patterns were previously derived: "Energy-dense foods" (higher in energy-dense foods, and lower in vegetable soup, significantly associated with BMI z-score at 10 years-old, and the "Fish-based" dietary pattern (higher in fish consumption and low in energy-dense foods). Adjusted sex-stratified associations were estimated by generalized linear models. Boys and girls who were never breastfed or were breastfed for a very short duration had lower scores in the "Fish-based" dietary pattern, compared to those with longer breastfeeding durations (Boys: ß = -0.219; 95%CI: 0.361; -0.077; Girls: ß = -0.223; 95%CI: 0.358; -0.088). No significant associations between breastfeeding and the "Energy-dense foods" dietary pattern were found. Boys and girls who were offered cereals as a first food during complementary feeding, in comparison with soup, presented lower scores in the "Energy-dense foods" dietary pattern (Boys: ß = -0.183; 95%CI: 0.292; -0.074; Girls: ß = -0.155; 95%CI: 0.259; -0.050), but only girls presented higher scores in the 'Fish-based' dietary pattern (ß = 0.137; 95%CI: 0.006; 0.267). The age of introduction of complementary feeding was not significantly associated with the dietary patterns. Parents should be supported in their infant feeding decisions, given the potential effects of breastfeeding duration and first foods at complementary feeding on shaping longer term dietary patterns of young children.

Construct validation of the Reasons Individuals Stop Eating Questionnaire (RISE-Q) and the development of the RISE-Q-15.

Consumers vary in the explanations they give for meal termination. The Reasons Individuals Stop Eating Questionnaire (RISE-Q) was developed to measure these satiation processes. Individual differences in satiation may be associated with a general capacity to recognise and respond to contextual and interoceptive cues. The aims of the present study were to validate the factor structure of the RISE-Q and to explore its construct validity. In particular, we tested the prediction that a latent variable "Sensitivity to Internal Satiation Cues" is associated with high satiety responsiveness, high scores on the RISE-Q Physical Satisfaction (PS) and Decreased Food Appeal (DFA) scales and a healthy BMI. Participants (n = 216 adults) completed an online survey which included the RISE-Q, Mindful Eating Questionnaire, Multidimensional Assessment of Interoceptive Awareness, Adult Eating Behaviour Questionnaire (AEBQ) and self-reported height and weight. Confirmatory Factor Analysis supported the 5-factor structure of the RISE-Q, but model fit was improved by a new short form (RISE-Q-15) of the questionnaire. Construct validity replicated for most RISE-Q subscales, but not RISE-Q and BMI. Structural Equation Modelling demonstrated that Sensitivity to Internal Satiation Cues was associated with RISE-Q PS but not with the DFA, whereas AEBQ Satiety Responsiveness was associated with DFA, but not with PS. The RISE-Q-15 may be more sensitive to specific meal termination behaviours than pre-existing questionnaires, and due to its low participant burden, it provides a useful tool to explore further multiple processes of satiation in various contexts.

Predictors of vegetable consumption in children and adolescents: analyses of the UK National Diet and Nutrition Survey (2008-2017).

Children's vegetable consumption is generally below national recommendations in the UK. This study examined predictors of vegetable intake by children aged 1·5-18 years using counts and portion sizes derived from 4-d UK National Diet and Nutrition Survey food diaries. Data from 6548 children were examined using linear and logit multilevel models. Specifically, we examined whether demographic variables predicted vegetable consumption, whether environmental context influenced portion sizes of vegetables consumed and which food groups predicted the presence (or absence) of vegetables at an eating occasion (EO). Larger average daily intake of vegetables (g) was predicted by age, ethnicity, equivalised income, variety of vegetables eaten and average energy intake per d (R2 0·549). At a single EO, vegetables were consumed in larger portion sizes at home, with family members and at evening mealtimes (Conditional R2 0·308). Within EO, certain configurations of food groups such as carbohydrates and protein predicted higher odds of vegetables being present (OR 12·85, 95 % CI 9·42, 17·54), whereas foods high in fats, sugars and salt predicted a lower likelihood of vegetable presence (OR 0·03, 95 % CI 0·02, 0·04). Vegetables were rarely eaten alone without other food groups. These findings demonstrate that only one portion of vegetables was eaten per d (median) and this was consumed at a single EO, therefore falling below recommendations. Future research should investigate ways to encourage vegetable intake at times when vegetables are not regularly eaten, such as for breakfast and as snacks, whilst considering which other, potentially competing, foods are presented alongside vegetables.

The impact of food packaging on measured food intake: A systematic review of experimental, field and naturalistic studies.

Chronic, excess energy intake contributes to overweight and obesity. Solutions are needed to guide consumers towards portion control, especially for high energy density (HED), palatable foods. Food packaging, a key element of the eating environment, offers a potential solution. To investigate whether packaging design influences measured food intake, a systematic search was undertaken in four electronic databases (Ovid Medline; Ovid PsycInfo; Ovid Embase and Web of Science) across the previous decade. This process yielded 1671 discrete papers, of which 23 articles containing 40 relevant studies were retrieved. Most (n = 36) of the manipulated packaging features influenced consumption quantity with the largest effect sizes observed for packaging which guided consumers either by on-pack cues or structural features. For example, images on the front of the pack, packaging size, as well as partitioning and resealability all helped to reduce food intake. However, individual differences and attentional focus mediate packaging effects. Overall, packaging features can help to limit intake of HED foods and increase intake of nutrient-dense foods (e.g., carrots). Future studies on packaging for portion control (downsizing) might benefit from long term, randomised control trials to test effects outside of the laboratory context and applied to everyday consumer usage.

Development and validation of the Reasons Individuals Stop Eating Questionnaire (RISE-Q): A novel tool to characterize satiation.

A variety of factors can influence satiation, and individual differences in reasons for meal termination may help to explain variability in food intake and susceptibility to overconsumption. We developed and validated a questionnaire to characterize the Reasons Individuals Stop Eating (RISE-Q). The initial RISE-Q was created by reviewing the published literature and identifying 47 reasons why individuals might stop eating. The RISE-Q asks respondents to rate how often each reason influences why they stop eating at a typical dinner meal by using a seven-point scale. Adults (N = 477, 77% women) from a participant database completed a survey online that included the initial RISE-Q and the satiation-related Satiety Responsiveness and Food Responsiveness scales of the Adult Eating Behavior Questionnaire (AEBQ). Self-reported height and weight were collected to calculate body mass index (BMI). The survey also assessed self-reported typical meal size. After factor analysis, the RISE-Q retained 31 items and identified five distinct scales of reasons for stopping eating: Decreased Food Appeal (mean ± SD: 2.6 ± 0.05, Cronbach's α = 0.89), Physical Satisfaction (5.0 ± 0.04, α = 0.85), Planned Amount (4.4 ± 0.05, α = 0.82), Self-Consciousness (2.4 ± 0.05, α = 0.88), and Decreased Priority of Eating (2.3 ± 0.04, α = 0.69). Thus, the most frequently reported reasons for meal termination were related to Physical Satisfaction and Planned Amount. Each RISE-Q scale was significantly correlated with at least one of the satiation-related AEBQ scales, suggesting that the RISE-Q has construct validity. RISE-Q scales were also correlated with BMI and measures of typical meal size. The RISE-Q provides a novel tool to assess differences across individuals in reported reasons for eating cessation. The RISE-Q can aid in further understanding risk factors for overconsumption and has potential clinical utility in the design of targeted weight-management interventions.

"Wrap healthy snacks with cool packaging" - A qualitative study of mothers' portion size strategies for their children.

Offering large portions of high energy dense (HED) foods increases overall energy intake in children, a potentially important contributing factor to childhood overweight and obesity. Packaging offers a simple heuristic to encourage healthy eating for nutrient dense foods and to downsize portions of HED foods. However, it is not clear how parents use packaging for portion control, nor how packaging might be used as a solution to offset large portions. Therefore, the aim of the present study was to investigate mothers' portion strategies and how they use packaging to facilitate portion control for children. 21 mothers of 25 children aged 1-5 years participated in semi-structured interviews to identify strategies used by mothers for portioning snack and meal items. Mothers reported feeling confident in amounts offered to their children, and were unaware of, or did not apply, recommendations for age-appropriate portions of meal items and snacks. Mothers portioned according to child appetite, needs and characteristics, not necessarily age. They reported that their child was able to determine for themselves how much to consume. However, mothers also applied restrictions to some foods. No differences in considerations and strategies were found between different ethnic groups of British and Chinese mothers. Mothers reported that packaging was an important determinant of preferences and a useful, convenient means of portion control. To promote appropriate consumption norms in children, a packaging design concept is described to aid downsizing for a highly liked HED food. Future studies should examine how creative packaging solutions influence parents' feeding practices and how this might influence dietary quality through user testing.

"An invisible map" - maternal perceptions of hunger, satiation and 'enough' in the context of baby led and traditional complementary feeding practices.

Mothers' responsiveness to hunger and fullness cues has been implicated in the development of infant overweight, and baby led weaning (BLW) is argued to be one way to protect against overfeeding. Whilst studies have examined maternal perceptions of hunger, fullness and adequate intake to some degree in traditional weaning (TW) contexts, less is known about this in BLW. This study therefore aimed to understand and compare maternal perceptions of cues and intake in BLW and TW. Eleven mothers of infants (7-24m) participated in semi-structured interviews based on discussions of short videos featuring participants feeding their infants. Interviews were read and transcribed in full. Data were selected for coding which addressed mothers' perceptions of infant hunger, fullness and sufficient consumption and subsequently subjected to template analysis. A sample of data was coded to produce an initial template which was applied to all interviews and revised in an iterative process to produce a final template for interpreting findings. Mothers in the study were adept at recognising fullness cues and gauging feeding state. Both groups perceived similar hunger cues although TW mothers reported a wider range of fullness cues. Both groups used numerous strategies for judging the adequacy of their babies' intake. These included the use of infant cues, however perceived adequacy of intake was also influenced by factors such as infant tiredness and maternal worries about over and under-eating. Findings have implications for the development of responsive feeding interventions while also highlighting the utility of video elicited interviews for understanding feeding interactions.

Association between eating frequency and eating behaviours related to appetite from 4 to 7 years of age: Findings from the population-based birth cohort generation XXI.

The examination of specific characteristics of eating habits in childhood and its influence on eating behaviours is needed to better understand the establishment of appetite-related eating behaviours. This study aimed to assess the association between eating frequency (EF) (main meals vs. snacks) at 4 and 7y and problematic eating behaviours and appetite-related eating behaviours at 7y. The analysis included 1359 children from the birth cohort Generation XXI who provided 3-day food diaries, at both ages, and complete information on the Child Eating Behaviour Questionnaire, at 7y. Problematic eating behaviours were assessed using parental perception of child's poor eating (including not eating enough, eating too slow or overeating) at both ages. A time-of-day approach was used to distinguish main meals from snacks. A cross-lagged analysis was performed to check the direction of the association between EF and parental concerns regarding problematic eating behaviours. Associations between EF and appetite-related eating behaviours were evaluated through linear regression models. Between 4 and 7y a moderate tracking of EF was described as well as a strong tracking of parental concerns. We found a bidirectional relationship between EF and parental concerns. Prospectively, a higher frequency of snacks at 4y was independently associated with higher scores in 'Desire to Drink' at 7y (ß = 0.051, 95%CI:0.009; 0.093). At 7y, a higher EF had a positive association with 'Satiety Responsiveness' but an inverse association with 'Enjoyment of Food'. A higher number of main meals had a positive association with 'Enjoyment of Food' and 'Food Responsiveness'. In conclusion, children who had more eating occasions seem to have more food-avoidance behaviours, traits that might protect these children from gaining excessive weight.

The effects of repeated exposure and variety on vegetable intake in pre-school children.

Children's vegetable consumption in the UK remains lower than national recommendations, presenting potential long-term health risks. It is known that repeated exposure promotes intake of novel vegetables and that offering children variety and choice can also encourage intake. The current study aimed to compare the impact of offering variety over simple repeated exposure as a strategy for increasing pre-school children's vegetable consumption. Children (N = 95) aged 24-55 months were recruited through participating nurseries and assigned to receive repeated exposure (RE) to a single vegetable snack or a mixed snack consisting of five different vegetables (variety: V). A minimum of 5 (maximum 6) exposures were given for both RE and V conditions. Pre and post-intervention intake measures of both the RE and V snacks were taken for each child. Follow up measures took place 1 month post-intervention (n = 40). Vegetable intake increased significantly from pre to post intervention for snacks congruent to the condition to which children were assigned. Magnitude of change was smaller for the variety condition. Follow up data revealed that snack intake remained significantly higher than baseline 1 month post-intervention (p < 0.001). In agreement with previous work this study confirmed that repeated exposure was effective in promoting children's vegetable intake but there was no additional benefit of variety in this context. It may be that for moderately familiar vegetables, serving them alone encourages intake and for this age group, avoids contamination fears or effects of neophobia.

The eyes have it: Infant gaze as an indicator of hunger and satiation.

Infant gaze serves as a measure of attention to food cues in adults and children and may play a role in signalling infant hunger and satiation. Maternal responsiveness to infant satiation cues, including gaze, supports healthy appetite development and may reduce obesity risk. However, mothers often experience difficulty in interpreting feeding cues, and there have been few attempts to study cues systematically. This study aimed to develop a reliable coding scheme for categorising and tracking infant gaze behaviours during complementary feeding (CF). Twenty infants aged between six and eighteen months were filmed during typical meals on two occasions at home. The Infant Gaze at Mealtime (IGM) coding scheme was devised from the analysis of a sample of videos, a piloting and testing process, and the feeding cues and developmental psychology literature. Inter and intra-rater reliability tests of the scheme with 20% of the study videos revealed high levels of reliability. When applied to the full sample of 225 video clips, the IGM coding scheme revealed a significant decrease over time in the frequency of infants gazing at food and a significant increase in exploratory gaze behaviour within a meal. These changes were consistent across main and dessert courses, suggesting they may be indicative of changes in infant feeding state. The results suggest that infant gaze may offer a means of identifying infant hunger and satiation and, as an easily observed behaviour, an effective tool for mothers and professionals for promoting responsive feeding.

A systematic review of practices to promote vegetable acceptance in the first three years of life.

BACKGROUND: Although most children do not meet vegetable intake recommendations no clear universal guidelines exist on the best method of introducing and promoting vegetables in infants. OBJECTIVE: To identify strategies to promote vegetable acceptance in children from the start of complementary feeding until 3 years of age. DESIGN: A comprehensive search strategy was performed using the databases Scopus and Pubmed. Articles published before March 2018 measuring vegetable intake and/or liking were included. RESULTS: 46 papers, 25 experimental (intervention) studies, and 21 observational studies were included. Intervention studies revealed that repeated exposure increased acceptance of the target vegetable, whereas exposure to variety was found to be particularly effective in increasing acceptance of a new vegetable. Starting complementary feeding with vegetables increased vegetable acceptance, whereas starting with fruits did not. Visual exposure to an unfamiliar vegetable increased the acceptance of that vegetable even without consuming it, while visual exposure to a familiar vegetable did not. A stepwise introduction of vegetables resulted in better initial acceptance of vegetables than introducing vegetables directly. Observational studies showed that vegetable consumption was associated with frequency of exposure, exposure to variety, and modelling. A majority of studies found a positive association between breastfeeding and vegetable acceptance, but only two out of seven studies found an association between age of vegetable introduction and their acceptance. CONCLUSIONS: Based on the papers reviewed, we conclude that introducing vegetables at the beginning of complementary feeding, giving a different type of vegetable every day and ensuring repeated exposure to the same vegetable following an interval of a few days are the most promising strategies to promote vegetable intake in children starting complementary feeding until they are 3 years of age.

A Low Energy-Dense Diet in the Context of a Weight-Management Program Affects Appetite Control in Overweight and Obese Women.

Background: Low energy-dense (LED) foods reduce energy intake (EI); whether this effect is sustained over time and during weight loss is unknown. Objective: This trial examined the effects of LED compared with high energy-dense (HED) meals on appetite, EI, and control over eating in the laboratory and during a weight-management program that encourages unrestricted intake of LED foods [Slimming World, UK (SW)] compared with a self-led Standard Care program [NHS weight-loss plan (SC)]. Methods: Overweight and obese women [n = 96; mean ± SD age: 41.03 ± 12.61 y; mean ± SD body mass index (in kg/m2): 34.00 ± 3.61] were recruited from the SW or SC programs. Primary outcomes included appetite, food preferences (liking and wanting for LED and HED foods), cravings, and evening meal EI (LED, HED) in response to calorie-matched LED (≤0.8 kcal/g) and HED (≥2.5 kcal/g) breakfast and lunch meals. Probe-day tests were conducted at weeks 3 and 4 and repeated at weeks 12 and 13 in a within-day crossover design. Secondary outcomes, including body weight and program experience, were measured from weeks 1 to 14 in a parallel-group design. Dietary compliance was monitored with the use of weighed food diaries at weeks 3 and 12. Results: Intention-to-treat (ITT) and completers analyses showed that the SW group lost more weight than the SC group [ITT: -5.9% (95% CI: -4.7%, -7.2%) compared with -3.5% (-2.3%, -4.8%), P < 0.05; completers: -6.2% (-4.8%, -7.6%) compared with 3.9% (-2.5%, -5.2%), P < 0.05]. The SW group reported greater control over eating and more motivation to continue the program compared with the SC group. LED meals increased sensations of fullness and reduced hunger on probe days (P < 0.001). Total-day EI was 1057 ± 73 kcal less (95% CI: 912, 1203 kcal; 36%) under LED compared with HED conditions (P < .001). Liking for LED and HED foods and wanting for HED foods were lower before lunch under LED compared with HED conditions, and liking decreased to a greater extent after the LED lunch. The SW group reported fewer cravings under LED compared with HED conditions (P < 0.05). On probe days, appetite and EI outcomes did not differ between weeks 3 and 12 or between the SW and SC groups. Conclusion: LED meals improve appetite control in women attempting weight loss and the effect is sustainable. Consumption of LED meals likely contributed to weight loss in the SW program. This study was registered at clinicaltrials.gov as NCT02012426.

Favouring more rigour when investigating human eating behaviour is like supporting motherhood and apple pie: A response to Robinson, Bevelander, Field, and Jones (2018).

In a 1987 paper, addressing questions about factors that influence the initiation, maintenance, and termination of food intake, we wrote, "development of systematic procedures to measure eating behaviour is essential if descriptive and inferential statistics are to be applied to answering such questions, giving them power and replicability" (Hetherington & Rolls, 1987 page 77). Therefore, as longstanding advocates of rigorous procedures in laboratory-based investigations of food intake, we welcome Robinson et al.'s (2018) clear recommendations for laboratory studies. However, this is akin to voting for "motherhood and apple pie", and few would argue against deployment of improved procedures for these studies. What then can we contribute to the debate in order to refine the recommendations made or add to them? Our most important message for researchers is that the central hypothesis or main research question will determine the most appropriate methods for any study. If a laboratory-based study is planned, then there are basic methodological questions that must be answered before proceeding to a final protocol. While such guidelines are needed to ensure basic methodological rigour, these should not be so prescriptive as to inhibit creativity. Here we provide several thoughts on how to advance studies of ingestive behaviour, including the need to apply appropriate controls, encouragement to move beyond convenience samples, and to remember the value of exploratory, observational, and naturalistic studies to complement laboratory-based studies.

Tracking diet variety in childhood and its association with eating behaviours related to appetite: The generation XXI birth cohort.

Research on the influence of early eating habits on eating behaviours related to appetite using a prospective approach is scarce, especially in children. The aim of this study was to explore the relationship between changes in diet variety from 4 to 7 years of age and appetitive traits measured at 7 years of age. Participants are from the population-based birth cohort Generation XXI (2005-2006). The present analysis included 4537 children with complete data on a food frequency questionnaire (FFQ) at both ages, and on the Children's Eating Behaviour Questionnaire at 7y. A healthy diet variety index (HDVI) was calculated at both ages using data from the FFQ. To assess tracking of diet variety, tertiles of HDVI scores were calculated and then re-categorized as 'maintain: low', 'maintain: high', 'increase' and 'decrease'. Although the HDVI score decreased from 4 to 7y (p < .001), it showed a high stability, a positive predictive value, and a fair agreement. Increasing diet variety, compared to maintaining a low variety, was inversely associated with the 'Desire to Drink' (ß = -0.090, 95%CI: 0.174; -0.006) and 'Satiety Responsiveness' (ß = -0.119, 95%CI: 0.184; -0.054) subdimensions and positively with 'Enjoyment of Food' (ß = 0.098, 95%CI: 0.023; 0.172) and 'Emotional Overeating' (ß = 0.073, 95%CI: 0.006; 0.139). Those classified as either increase or maintain a high diet variety, in comparison with maintaining a low variety, had lower scores of 'Food Fussiness'. In conclusion, diet variety decreased from 4 to 7y with a fair tracking. Children with a higher diet variety were less fussy, had a lower desire to drink and a higher general interest in food.

Systematic review and meta-analysis of strategies to increase vegetable consumption in preschool children aged 2-5 years.

BACKGROUND: Most children do not meet daily recommendations for fruit and vegetable intake, and consumption of vegetables remains especially low. Eating habits track from childhood to adulthood hence establishing liking and intake of vegetables is important. OBJECTIVE: To identify the most successful strategies to enhance vegetable intake in preschool children aged 2-5 years. DESIGN: The research was a systematic review and a meta-analysis of published studies. A comprehensive search strategy was performed using key databases such as Medline, Embase, PsychINFO, EBSCO and CENTRAL. Articles published between 2005-January 2016, specifically with measured vegetable consumption were included. RESULTS: 30 articles and 44 intervention arms were identified for inclusion (n = 4017). Nine dominant intervention strategies emerged to promote vegetable intake in preschool children. These included; choice, pairing (stealth), education, food service, modelling, reward, taste exposure, variety and visual presentation. The meta-analysis revealed that interventions implementing repeated taste exposure had better pooled effects than those which did not. Intake increased with number of taste exposures and intake was greater when vegetables offered were in their plain form rather than paired with a flavor, dip or added energy (e.g. oil). Moreover, intake of vegetables which were unfamiliar/disliked increased more than those which were familiar/liked. CONCLUSIONS: Repeated taste exposure is a simple technique that could be implemented in childcare settings and at home by parents. Health policy could specifically target the use of novel and disliked vegetables in childcare settings with emphasis on a minimum 8-10 exposures. The systematic review protocol was registered on the PROSPERO (number: CRD42016033984).