Australians' willingness to change their discretionary food intake: findings from the CSIRO junk food analyser.

Introduction: Overconsumption of energy dense, nutrient poor foods and beverages is a major problem globally. This study describes what and how Australian adults consume and are willing to change their intake in terms of discretionary food and beverage categories. Methods: Cross-sectional data were collected via the CSIRO Junk Food Analyser. This online tool contains short questions on discretionary food and beverage consumption, and items relating to stage of and willingness and strategies to reduce discretionary food and beverage intake. Analyses focussed on describing discretionary intake, adherence to guidelines and the prediction of willingness to change discretionary food intake amongst those exceeding guidelines. Results: In 2021, 41,109 Australian adults completed the CSIRO Junk Food Analyser. Participants were mostly female (73.1%) and aged 31-70 years (78.9%). Most participants exceeded dietary guidelines for discretionary food and beverage intake (67.4%, 27,694/41,109) with 40% reporting actively trying to reduce intake. Most people exceeding guidelines did so in categories of alcohol (39.3%) and cakes and biscuits (21.0%). Yet, willingness to change intake was lowest for alcohol (median, IQR of 3, 2:4 out of 5). Almost half of the participants were willing to try 'having a few days off per week' (46.0%), while only 13.4% were willing to try to 'eliminate' their highest ranked category. Discussion: Australian adults are willing to reduce their discretionary food and beverage intake, but simply targeting the foods and beverages consumed most may not be the best place to start. Messages encouraging days off frequently consumed discretionary foods and beverages may be well received.

Variety Predicts Discretionary Food and Beverage Intake of Australian Adults: A Cross-Sectional Analysis of an Online Food Intake Survey.

BACKGROUND: Variety has been used as a strategy for increasing intakes of healthy foods, but has not been well explored with respect to discretionary food/beverages. The diverse sensory properties of these foods suggests that variety could play an important role in total intake. OBJECTIVE: This study explored variety as a predictor of intake of discretionary food/beverages, and described the variety of these items consumed by Australian adults. DESIGN: Secondary analyses of cross-sectional data from a validated, online survey that assesses participants' dietary intake using frequency and portion-based questions. Discretionary food/beverages are grouped into 11 categories. PARTICIPANTS/SETTING: Participants included 235,203 Australian adults, aged 18 years or older, who provided data from May 2015 to November 2020. OUTCOME MEASURES: Variety was the number of categories of discretionary food/beverages consumed. Servings were estimated from usual intake questions, and percent contribution summarized by category. Consumption prevalence was the proportion of the sample/subgroup consuming each category. Consumption was calculated as the mean of the sample and per capita in servings. STATISTICAL ANALYSES PERFORMED: Descriptive statistics were used to present variety and percent contribution to total intake across the sample and subgroups, and multiple regression was used to examine whether or not variety predicted intake of discretionary food/beverages. RESULTS: Participants consumed a median of 8 categories of discretionary food/beverages, with every additional category associated wit h an increase in intake of half a serving of discretionary food/beverages per day (B = 0.48; P < 0.001). Alcohol, cakes and cookies, takeaway, and confectionary collectively contributed around two-thirds of total daily intake of discretionary food/beverages, with alcohol contributing the largest proportion (28.3% of total daily intake). CONCLUSIONS: Variety is related to total intake of discretionary food/beverages. Intervention approaches targeting a reduction in variety, as an alternative to a focus on portion size or frequency of intake, would be a novel way of addressing overconsumption of discretionary food/beverages in future research.

Correction: Moumin et al. Usual Nutrient Intake Distribution and Prevalence of Inadequacy among Australian Children 0-24 Months: Findings from the Australian Feeding Infants and Toddlers Study (OzFITS) 2021. Nutrients 2022, 14, 1381.

The authors would like to correct an error in their recently published paper [...].

Precision health in behaviour change interventions: A scoping review.

Precision health seeks to optimise behavioural interventions by delivering personalised support to those in need, when and where they need it. Conceptualised a decade ago, progress toward this vision of personally relevant and effective population-wide interventions continues to evolve. This scoping review aimed to map the state of precision health behaviour change intervention research. This review included studies from a broader precision health review. Six databases were searched for studies published between January 2010 and June 2020, using the terms 'precision health' or its synonyms, and including an intervention targeting modifiable health behaviour(s) that was evaluated experimentally. Thirty-one studies were included, 12 being RCTs (39%), and 17 with weak study design (55%). Most interventions targeted physical activity (27/31, 87%) and/or diet (24/31, 77%), with 74% (23/31) targeting two to four health behaviours. Interventions were personalised via human interaction in 55% (17/31) and digitally in 35% (11/31). Data used for personalising interventions was largely self-reported, by survey or diary (14/31, 45%), or digitally (14/31, 45%). Data was mostly behavioural or lifestyle (20/31, 65%), and physiologic, biochemical or clinical (15/31, 48%), with no studies utilising genetic/genomic data. This review demonstrated that precision health behaviour change interventions remain dependent on human-led, low-tech personalisation, and have not fully considered the interaction between behaviour and the social and environmental contexts of individuals. Further research is needed to understand the relationship between personalisation and intervention effectiveness, working toward the development of sophisticated and scalable behaviour change interventions that have tangible public health impact.

Does Food Intake of Australian Toddlers 12-24 Months Align with Recommendations: Findings from the Australian Feeding Infants and Toddlers Study (OzFITS) 2021.

(1) Background: Food-based dietary guidelines promote population health and well-being through dietary patterns that reduce chronic disease risk while providing adequate energy and nutrients. In Australia, recommended dietary patterns based on servings per day from the five food groups-fruits, vegetables, cereals and grains, meats and alternatives, and dairy-have been developed for toddlers 1-2 years of age. However, no study has assessed the intake of the five food groups in this age group nationally. (2) Aim: To compare daily servings and the percentage of energy from the five food groups and discretionary foods in toddlers 1-2 years old to the Australian Dietary Guidelines. (3) Methods: Dietary intake was assessed using a one-day food record for 475 toddlers. (4) Results: Apart from fruit and dairy, servings of the five food groups were below the recommendations. Two-thirds of toddlers did not consume enough vegetables, and only 10% consumed the recommended number of servings for cereals and grains. On average, toddlers consumed only half the recommended servings of meat and alternatives. Nearly all toddlers (89%) consumed discretionary foods, which accounted for ~12% of total energy. Forty-five percent of toddlers received breastmilk. On average, breastfed toddlers consumed fewer servings from the five food groups than non-breastfed toddlers. Dairy contributed 20% of daily energy in all toddlers; however, this food group accounted for 13% in breastfed and 32% in non-breastfed toddlers on the day of the food record. (4) Conclusions: Compared to the recommendations, alignment with the servings of the five food group foods was not achieved by most toddlers, except for fruit and dairy. Discretionary foods may have displaced nutritious family foods. Consistent with Australian Infant Feeding Guidelines, many toddlers in this study continued to receive breastmilk but the recommended dietary patterns do not include breastmilk. Dietary modeling, including breastmilk as the primary milk source, is urgently needed, along with practical advice on incorporating breastmilk in a toddler's diet while optimizing food consumption.

Usual Nutrient Intake Distribution and Prevalence of Inadequacy among Australian Children 0-24 Months: Findings from the Australian Feeding Infants and Toddlers Study (OzFITS) 2021.

(1) Background: Breastmilk provides all the nutrition an infant requires between 0−6 months. After that, complementary foods are needed to meet the child's increasing energy and nutrient requirements. Inadequate energy and nutrient intake may lead to growth faltering, impaired neurodevelopment, and increased disease risk. While the importance of early life nutrition is well recognized, there are few investigations assessing the nutritional adequacy of Australian children <24 months. Here, we describe usual energy and nutrient intake distributions, including the prevalence of inadequate intakes and exceeding the upper limit (UL), in a national sample of Australian children 6− 24 months and infants < six months who had commenced solids and/or formula. (2) Methods: Dietary intakes were assessed using a one-day food record for 976 children with a repeat one-day record in a random subset. (3) Results: Based on the Nutrient Reference Values for Australia and New Zealand, children's intakes were above the Adequate Intake or Estimated Average Requirement for most nutrients. Exceptions were iron and zinc where the prevalence of inadequacy was estimated to be 90% and 20%, respectively, for infants aged 6−11.9 months. Low iron intake was also observed in one quarter of toddlers 12−24 months. On average, children consumed 10% more energy than predicted based on Estimated Energy Requirements, and ~10% were classified as overweight based on their weight for length. One third of toddlers exceeded the tolerable upper limit for sodium and consumed > 1000 mg/day. Of the children under six months, 18% and 43% exceeded the UL for vitamin A (retinol) and zinc. (4) Conclusions: Compared to nutrient reference values, diets were sufficient for most nutrients; however, iron was a limiting nutrient for infants aged 6−11.9 months and toddlers 12−24 months potentially putting them at risk for iron deficiency. Excessive sodium intake among toddlers is a concern as this may increase the risk for hypertension.

Parental work hours and household income as determinants of unhealthy food and beverage intake in young Australian children.

OBJECTIVE: This study examined parental work hours and household income as determinants of discretionary (energy dense, nutrient poor) food and beverage intake in young children, including differences by eating occasion. DESIGN: Secondary analysis of cross-sectional data. Three hierarchical regression models were conducted with percent energy from discretionary food and beverages across the day, at main meals, and at snack times being the outcomes. Dietary intake was assessed by 1x24-hour recall and 1-2x24-hour food record(s). Both maternal/paternal work hours were included, and total household income. Covariates included household, parent and child factors. SETTING: Data from the NOURISH/SAIDI studies were collected between 2008-13. PARTICIPANTS: Participants included 526 mother-child dyads (median(IQR) child age 1.99(1.96,2.03) years). Forty-one percent of mothers did not work while 57% of fathers worked 35-40 hours/week. Most (85%) households had an income of ≥$50k AUD/year. RESULTS: Household income was consistently inversely associated with discretionary energy intake (ß= -0.12 to -0.15). Maternal part-time employment (21-35 hours/week) predicted child consumption of discretionary energy at main meals (ß=0.10, p=0.04). Paternal unemployment predicted a lower proportion of discretionary energy at snacks (ß= -0.09, p=0.047). CONCLUSIONS: This work suggests that household income should be addressed as a key opportunity-related barrier to healthy food provision in families of young children. Strategies to reduce the time burden of healthy main meal provision may be required in families where mothers juggle longer part-time working hours with caregiving and domestic duties. The need to consider the role of fathers and other parents/caregivers in shaping children's intake was also highlighted.

The Australian Feeding Infants and Toddlers Study (OzFITS) 2021: Study Design, Methods and Sample Description.

(1) Background: Caregiver feeding practices during the first two years of a child's life influence nutrition, growth, and development, as well as long term taste preferences and dietary patterns. Suboptimal feeding practices lead to poorer health outcomes, such as obesity, that persist into adulthood. Although the importance of early life nutrition is well-established, there are no Australia-wide surveys of dietary intakes of children under two years of age. The 2021 Australian Feeding Infants and Toddlers Study (OzFITS) aims to fill this gap. This paper describes the methods and study sample of OzFITS 2021. (2) Methods: OzFITS 2021 is a cross-sectional study of children aged 0 to 23.9 months of age and their caregiver across Australia. Data were collected between April 2020 and April 2021. A telephone-based survey was completed with a caregiver to obtain information on child and caregiver characteristics and feeding practices. For exclusively breastfed infants, the number of breastfeeds in a 24 h period was reported. Dietary intakes for mixed fed children were estimated using a one-day food record, with 30% of caregivers completing a second food record on a non-consecutive day. (3) Results: We enrolled 1140 caregiver and child dyads. Of those eligible to complete a food record, 853 (87%) completed the food record. Compared to the Australian population, caregivers were more likely to be university-educated (>75%), married or in a de facto relationship (94%), and have a household income >$100,000/y (60%). (4) Conclusions: OzFITS 2021 is the first national study to examine food and nutrient intake in Australian children aged under 2 years. The study will provide information on breastfeeding rates and duration, use of breast milk substitutes, and timing of solid food introduction. Dietary intake data will allow the comparison of core food groups and discretionary food intake to Australian guidelines and estimate the prevalence of inadequate intake of key nutrients, like iron. Healthcare practitioners and policymakers can use the study findings as a source of evidence to inform the next iteration of infant feeding guidelines.

E-&mHealth interventions targeting nutrition, physical activity, sedentary behavior, and/or obesity among children: A scoping review of systematic reviews and meta-analyses.

Childhood obesity is a public health concern. Electronic and mobile health (e-&mHealth) approaches can facilitate the delivery of interventions for obesity prevention and treatment. Synthesizing reviews of e-&mHealth interventions to improve weight and weight-related behaviors (physical activity, sedentary behavior, and diet) is useful to characterize the current scope of the literature and identify opportunities for future reviews and studies. Using a scoping review methodology, we aimed to evaluate the breadth and methodological quality of systematic reviews and meta-analyses of e-&mHealth interventions targeting weight and weight-related behaviors in children and adolescents aged <19 years. A systematic search of seven databases was conducted, including reviews published between 2000 and 2019. Review characteristics were extracted, and methodological quality was assessed using the AMSTAR 2 tool. Forty-five systematic reviews and meta-analyses were included. All reviews evaluated intervention efficacy (100%), but few assessed other aspects (20% in total) such as cost-effectiveness. Smartphone applications (47%), text messages (44%), and websites (35%) were the main modalities. Weight (60%), physical activity (51%), and diet (44%) were frequently assessed, unlike sedentary behavior (8%). Most reviews were rated as having critically low or low methodological quality (97%). Reviews that identify the effective active ingredients of interventions and explore metrics beyond efficacy are recommended.

eHealth interventions targeting nutrition, physical activity, sedentary behavior, or obesity in adults: A scoping review of systematic reviews.

A vast body of evidence regarding eHealth interventions for nutrition, physical activity, sedentary behavior, and obesity exists. This scoping review of systematic reviews aimed to evaluate the current level of evidence in this growing field. Seven electronic databases were searched for systematic reviews published until October 27, 2019. The systematic reviews must have included adult participants only and have evaluated eHealth behavioral interventions with the primary aim of changing nutrition, physical activity, and sedentary behavior or treating or preventing overweight and obesity. One hundred and six systematic reviews, published from 2006 to 2019, were included. Almost all (n = 98) reviews evaluated the efficacy of interventions. Over half (n = 61) included interventions focused on physical activity, followed by treatment of obesity (n = 28), nutrition (n = 22), prevention of obesity (n = 18), and sedentary behavior (n = 6). Many reviews (n = 46) evaluated one type of eHealth intervention only, while 60 included two or more types. Most reviews (n = 67) were rated as being of critically low methodological quality. This scoping review identified an increasing volume of systematic reviews evaluating eHealth interventions. It highlights several evidence gaps (e.g., evaluation of other outcomes, such as reach, engagement, or cost effectiveness), guiding future research efforts in this area.

Commercially Available Apps to Support Healthy Family Meals: User Testing of App Utility, Acceptability, and Engagement.

BACKGROUND: Parents juggling caregiving and paid employment encounter a range of barriers in providing healthy food to their families. Mobile apps have the potential to help parents in planning, purchasing, and preparing healthy family food. The utility and acceptability of apps for supporting parents are unknown. User perspectives of existing technology, such as commercially available apps, can guide the development of evidence-based apps in the future. OBJECTIVE: This study aims to determine the feasibility of existing commercially available apps for supporting the healthy food provision practices of working parents. METHODS: Working parents (N=133) were recruited via the web and completed a 10-item Capability, Opportunity, Motivation, and Behavior (COM-B) self-evaluation survey assessing their needs in relation to the provision of healthy family meals. A total of 5 apps were selected for testing, including a meal planning app, recipe app, recipe manager app, family organizer app, and barcode scanning app. Survey items were mapped to app features, with a subsample of parents (67/133, 50.4%) allocated 2 apps each to trial simultaneously over 4 weeks. A semistructured interview exploring app utility and acceptability and a web-based survey, including the System Usability Scale and the user version of the Mobile App Rating Scale, followed app testing. The interview data were analyzed using a theoretical thematic approach. RESULTS: Survey participants (N=133; mean age 34 years, SD 4 years) were mainly mothers (130/133, 97.7%) and partnered (122/133, 91.7%). Participants identified a need for healthy recipes (109/133, 82% agreed or strongly agreed) and time for food provision processes (107/133, 80.5%). Engagement quality was the lowest rated domain of the user version of the Mobile App Rating Scale across all 5 apps (mean score per app ranging from 3.0 to 3.7 out of a maximum of 5). The family organizer, requiring a high level of user input, was rated the lowest for usability (median 48, IQR 34-73). In the interviews, participants weighed the benefits of the apps (ie, time saving) against the effort involved in using them in determining their acceptability. Organization was a subtheme emerging from interviews, associated with the use of meal planners and shopping lists. Meal planners and shopping lists were used in time, while behavior was occurring. CONCLUSIONS: Meal planning apps and features promoting organization present feasible, time-saving solutions to support healthy food provision practices. Attention must be paid to enhancing app automation and integration, as well as recipe and nutrition content, to ensure that apps do not add to the time burden of food provision and are supportive of healthy food provision behavior in time.

Understanding the Variation within a Dietary Guideline Index Score to Identify the Priority Food Group Targets for Improving Diet Quality across Population Subgroups.

Globally, population dietary intakes fall below the guideline recommendations and large-scale interventions have had modest success in improving diet quality. To inform the development of more targeted approaches, this study analysed the variations in self-reported data from an online survey of Australian adults collected between 2015 and 2020, to identify common combinations of low scoring components within a dietary guideline index. A low score was defined as meeting less than half the guideline recommendations (a score <50 out of 100). Among 230,575 adults, a single component analysis showed that 79.5% had a low score for discretionary choices, 72.2% for healthy fats and 70.8% for dairy. The combinations approach showed 83.0% of individuals had two to five low scoring components, with men, younger adults aged 18-30 years and individuals with obesity (BMI ≥ 30) more likely to have five or more. The most common dietary pattern combination included low scores for discretionary choices, dairy and healthy fats. There was a considerable but systematic variation in the low scoring components within the dietary patterns, suggesting that interventions with the flexibility to address particular combinations of key food groups across subgroups could be an effective and resource efficient way to improve diet quality in the population.

Understanding, comparing and learning from the four EPOCH early childhood obesity prevention interventions: A multi-methods study.

BACKGROUND: Childhood obesity is a global problem. Early obesity prevention interventions are complex and differ in effectiveness. Novel frameworks, taxonomies and experience from the Early Prevention of Obesity in CHildren (EPOCH) trials were applied to unpack interventions. OBJECTIVES: Deconstruct interventions into their components (target behaviours, delivery features and behaviour change techniques [BCTs]). Identify lessons learned and future recommendations for intervention planning, delivery, evaluation and implementation. METHODS: This multi-methods study deconstructed the four EPOCH interventions into target behaviours, delivery features and BCTs from unpublished and published materials using systematic frameworks. Additionally, semi-structured interviews were conducted with intervention facilitators and principal investigators. RESULTS: Each trial targeted between 10 and 14 obesity-related behaviours. Key variations in delivery features related to intensity, delivery mode and tailoring. BCTs consistently used across trials included goal-setting, social support, shaping knowledge, role-modelling and credible source. Recommendations from interview analyses include the importance of stakeholder collaboration and consideration of implementation throughout the study process. CONCLUSIONS: The combination of frameworks, methodologies and interviews used in this study is a major step towards understanding complex early obesity prevention interventions. Future work will link systematic intervention deconstruction with quantitative models to identify which intervention components are most effective and for whom.

A systematic evaluation of digital nutrition promotion websites and apps for supporting parents to influence children's nutrition.

BACKGROUND: Globally children's diet quality is poor. Parents are primary gatekeepers to children's food intake; however, reaching and engaging parents in nutrition promotion can be challenging. With growth in internet and smartphone use, digital platforms provide potential to disseminate information rapidly to many people. The objectives of this review were to conduct a comprehensive and systematic evaluation of nutrition promotion via websites and apps supporting parents to influence children's nutrition, from three different perspectives: 1) current evidence base, 2) end user (parent) experience and 3) current commercial offerings. METHODS: Three systematic reviews were undertaken of (1) studies evaluating the effectiveness for digital platforms for improving nutrition in children and parents, (2) studies conducting user-testing of digital tools with parents, (3) websites and apps providing lunch-provision information to parents. Searches were conducted in five databases for reviews one and two, and systematic search of Google and App Store for review three. Randomised controlled trials, cohort and cross-sectional and qualitative studies (study two only) were included if published in English, from 2013, with the intervention targeted at parents and at least 50% of intervention content focused on nutrition. Search results were double screened, with data extracted into standardised spreadsheets and quality appraisal of included search results. RESULTS: Studies evaluating digital nutrition interventions targeting parents (n = 11) demonstrated effectiveness for improving nutrition outcomes, self-efficacy and knowledge. Six of the included randomised controlled trials reported digital interventions to be equal to, or better than comparison groups. User-testing studies (n = 9) identified that digital platforms should include both informative content and interactive features. Parents wanted evidence-based information from credible sources, practical tools, engaging content and connection with other users and health professionals. Websites targeting lunch provision (n = 15) were developed primarily by credible sources and included information-based content consistent with dietary guidelines and limited interactive features. Lunchbox apps (n = 6), developed mostly by commercial organisations, were more interactive but provided less credible information. CONCLUSIONS: Digital nutrition promotion interventions targeting parents can be effective for improving nutrition-related outcomes in children and parents. As demonstrated from the lunchbox context and user-testing with parents, they need to go beyond just providing information about positive dietary changes, to include the user-desired features supporting interactivity and personalisation.

Mobile Apps to Support Healthy Family Food Provision: Systematic Assessment of Popular, Commercially Available Apps.

BACKGROUND: Modern families are facing conflicting demands on their time and resources, which may be at the detriment of child and family diet quality. Innovative nutrition interventions providing parents with behavioral support for the provision of healthy food could alleviate this issue. Mobile apps have the potential to deliver such interventions by providing practical behavioral support remotely, interactively, and in context. OBJECTIVE: This review aimed to identify and assess popular, commercially available food- and nutrition-related mobile apps that offer support for the provision of healthy family food by (1) describing app scope and characteristics, (2) assessing app quality, and (3) conducting a behavioral analysis of app content and features. METHODS: Searches in the Google Play Store and Apple App Store between August 2017 and November 2017 identified apps addressing the food provision process. Apps were included if they were applicable to parents or families, written in English, and with a user rating of ≥4 stars. Weight loss and diet monitoring apps and subscription apps with no free versions were excluded. App quality was assessed using the Mobile App Rating Scale (4 domains: engagement, functionality, aesthetics, and information). App content and features were extracted and behavior change techniques (BCTs) identified. RESULTS: Of the 2881 apps screened, 1.77% (51/2881) were included for assessment, comprising 23 recipe and recipe manager apps, 12 meal planning apps, 10 shopping list apps, 4 family organizers, and 2 food choice apps. Half (n=26) of the apps functioned primarily through user data input. Food choice and family organizer apps scored highest for app quality (mean 3.5 [SD 0.6] out of 5), whereas most apps scored well for functionality and poorly for engagement. Common app features with the potential to support healthy food provision included meal planners (n=26), shopping lists (n=44), and the ability to share app content (n=48). Behavioral support features mapped to relatively few BCTs (mean 3.9 [SD 1.9] per app), with Adding objects to the environment present in all apps, and 65% (33/51) including Instruction on how to perform the behavior. CONCLUSIONS: Recipe and recipe manager apps, meal planning apps, and family organizers with integrated meal planning and shopping lists scored well for functionality and incorporated behavioral support features that could be used to address barriers to healthy food provision, although features were focused on planning behaviors. Future apps should combine a range of features such as meal planners, shopping lists, simple recipes, reminders and prompts, and food ordering to reduce the burden of the food provision pathway and incorporate a range of BCTs to maximize behavior change potential. Researchers and developers should consider features and content that improve the engagement quality of such apps.

Food neophobia and its association with diet quality and weight in children aged 24 months: a cross sectional study.

BACKGROUND: Food neophobia, the rejection of unknown or novel foods, may result in poor dietary patterns. This study investigates the cross-sectional relationship between neophobia in children aged 24 months and variety of fruit and vegetable consumption, intake of discretionary foods and weight. METHODS: Secondary analysis of data from 330 parents of children enrolled in the NOURISH RCT (control group only) and SAIDI studies was performed using data collected at child age 24 months. Neophobia was measured at 24 months using the Child Food Neophobia Scale (CFNS). The cross-sectional associations between total CFNS score and fruit and vegetable variety, discretionary food intake and BMI (Body Mass Index) Z-score were examined via multiple regression models; adjusting for significant covariates. RESULTS: At 24 months, more neophobic children were found to have lower variety of fruits (ß = -0.16, p = 0.003) and vegetables (ß = -0.29, p < 0.001) but have a greater proportion of daily energy from discretionary foods (ß = 0.11, p = 0.04). There was no significant association between BMI Z-score and CFNS score. CONCLUSIONS: Neophobia is associated with poorer dietary quality. Results highlight the need for interventions to (1) begin early to expose children to a wide variety of nutritious foods before neophobia peaks and (2) enable health professionals to educate parents on strategies to overcome neophobia.

Predictors of and reasons for pacifier use in first-time mothers: an observational study.

BACKGROUND: The use of pacifiers is commonplace in Australia and has been shown to be negatively associated with breastfeeding duration. In order to influence behaviour related to the use of pacifiers it is important to understand the reasons for their use. The primary aim of this observational study was to investigate who (if anyone) advises first-time mothers to give a pacifier and the reasons for which they first give (or try to give) a pacifier to their infant. Additionally, this study investigated the predictors of pacifier use and the relationship between pacifier use and breastfeeding duration. METHODS: In total, 670 Australian first-time mothers recruited as part of the NOURISH trial completed a questionnaire regarding infant feeding and pacifier use. RESULTS: Pacifiers were introduced by 79% of mothers, of whom 28.7% were advised to use a pacifier by their mother/mother-in-law with a further 22.7% being advised by a midwife. The majority of mothers used a pacifier in order to soothe their infant (78.3%), to help put them to sleep (57.4%) and to keep them comforted and quiet (40.4%). Pacifiers given to infants before four weeks (adjHR 3.67; 95%CI 2.14-6.28) and used most days (adjHR 3.28; 95%CI 1.92-5.61) were significantly associated with shorter duration of breastfeeding. CONCLUSIONS: This study identifies an opportunity for educating new mothers and their support network, particularly their infant's grandmothers, with regards to potential risks associated with the early and frequent use of a pacifier, and alternative methods for soothing their infant, in order to reduce the use of pacifiers and their potentially negative effect on breastfeeding duration.