Reproducibility and relative validity of a semi-quantitative food and beverage frequency questionnaire for Spanish children aged 3 to 11 years: the COME-Kids F&B-FQ.

A reliable food and beverage frequency questionnaire (F&B-FQ) to measure dietary intakes for children across Spain is currently unavailable. Thus, we designed and assessed the reproducibility and relative validity of a new F&B-FQ in 210 Spanish children aged 3-11 years. COME-Kids F&B-FQ contained 125 items to assess the usual diet intake in the past year among children. To explore the reproducibility, caregivers answered COME-Kids F&B-FQ twice over a 15-day period (± 1 week). To evaluate the relative validity, estimates from a third COME-Kids F&B-FQ administered at 1 year of follow-up were compared with the mean estimates from 3-day dietary records (3d-DR) collected at baseline, 6 months, and after 1 year of follow-up. Reproducibility and relative validity of the COME-Kids F&B-FQ in estimating food groups and nutrients were assessed using Pearson (r) and intra-class (ICC) correlation coefficients. We used the kappa index to evaluate the agreement in repeat administrations or with the 3d-DR. We used Bland-Altman plots to identify bias across levels of intake. A total of 195 children (105 boys, 90 girls) completed the study. The reproducibility of data estimated from COME-Kids F&B-FQ was substantial with mean r and ICC being 0.65 and 0.64 for food groups and 0.63 and 0.62 for nutrients, respectively. Validation assessments comparing the FFQ and 3d-DRs showed r = 0.36 and ICC = 0.30 for food groups and r = 0.29 and ICC = 0.24 for nutrients. The mean agreement for food group reproducibility and relative validity was 86% and 65%, respectively. These estimates were 85% for reproducibility and 64% for relative validity in the case of nutrients. For reproducibility and relative validity, the overall mean kappa index was 63% and 37% for all food groups and 52% and 27% for nutrients, respectively. Bland-Altman plots showed no specific bias relating to the level of intake of nutrients and several food groups. CONCLUSION: COME-Kids F&B-FQ showed substantial reproducibility and acceptable relative validity to assess food and beverage intake in Spanish children aged 3 to 11 years. Most children were correctly classified in relation to the intake of food groups and nutrients, and misclassification was unlikely with reference to 3d-DR. WHAT IS KNOWN: • The estimation of dietary intake in children is complex, especially in large cohorts. • The food frequency questionnaire is a well-recognized and the most frequently used method for assessing food consumption. WHAT IS NEW: • A new food and beverage frequency questionnaire including a beverage section and novel plant-based food items has been validated in Spanish children aged 3-11 years.

Weight Status Determines the Impact of a School-Based Nutrition Education Intervention on Lifestyle Behaviors in Children.

BACKGROUND/OBJECTIVES: This study investigated the impact of the FLUYE school-based intervention on children's lifestyle behaviors, Mediterranean diet adherence, and emotional well-being in Spain. The objective was to promote healthy habits through nutrition education, physical activity, and emotional support within the school environment, with a focus on addressing the needs of both normal-weight and overweight/obese children. METHODS: A total of 552 children aged 3 to 12 years participated in the study, with data collected at baseline (T0) and follow-up (T1). The intervention was designed to integrate health education into the school curriculum, emphasizing the development of personal competencies in diet, physical activity, and emotional well-being. The analysis included changes in dietary habits, screen time, physical activity, and psychosocial outcomes, with comparisons made between the normal-weight and overweight/obese groups. RESULTS: Significant improvements were observed in water consumption and reductions in sugar-sweetened beverage intake across both weight groups. However, an increase in screen time, particularly among normal-weight children, highlighted ongoing challenges in reducing sedentary behavior. Adherence to the Mediterranean diet improved more significantly in the overweight/obese group, suggesting the program's effectiveness in promoting healthier eating patterns among at-risk children. Emotional well-being and self-esteem also saw significant enhancements, with children reporting increased feelings of pride and positivity post-intervention. CONCLUSIONS: The FLUYE program effectively improved various aspects of children's lifestyle behaviors, particularly in dietary habits and emotional well-being. These findings underscore the importance of comprehensive, school-based interventions that address both physical and psychosocial aspects of health, especially for children at higher risk for obesity.

Diet Quality Scores, Obesity and Metabolic Syndrome in Children and Adolescents: A Systematic Review and Meta-Analysis.

PURPOSE OF REVIEW: We aimed to examine the relationship between various diet quality scores and obesity and Metabolic Syndrome (MetS) in children and adolescents. RECENT FINDINGS: Obesity and MetS, which increase the risk of type 2 diabetes and cardiovascular disease from childhood through adolescence, have been associated with adherence to various diet quality scores. A systematic search was performed in PubMed/Medline, Scopus, SciELO, Embase, and Cochrane, covering the period until March 2024. Two researchers evaluated 3,519 studies according to the inclusion criteria. Finally, 73 articles that analysed the relationship between diet quality scores and obesity and MetS were included, and 6 of them were included in a meta-analysis. Children younger than 12 years old showed statistically significant differences indicating a higher Mediterranean diet (MD) score adherence compared to those with a low score adherence for BMI (MD = 0.33 kg/m2, 95% CI: 0.01, 0.64) and WC values (MD = 1.21 cm, 95% CI: 0.50, 1.93). Additionally, in the meta-regression analysis, boys showed stronger associations for BMI, z-score BMI and WC (ß = 19.82, 95% CI: 17.62, 22.03, ß = 0.64, 95% CI: 0.33, 0.96 and ß = 67.03, 95% CI: 57.29, 76.77, respectively). Studies in this review suggest an association between high adherence to different diet quality scores and low BMI. Meta-analysis assessing the association between adherence to the MD and BMI, and WC, showed a protective effect of the MD pattern against obesity outcomes. This systematic review and meta-analyses provided evidence on the effect of the diet quality on obesity and MetS in children and adolescents.

Mediterranean Diet and Genetic Determinants of Obesity and Metabolic Syndrome in European Children and Adolescents.

Childhood obesity and metabolic syndrome (MetS) are multifactorial diseases influenced by genetic and environmental factors. The Mediterranean Diet (MD) seems to modulate the genetic predisposition to obesity or MetS in European adults. The FTO gene has also been shown to have an impact on the MD benefits to avoid obesity or MetS. Since these interaction effects have been scarcely analyzed in European youth, the aim was to describe the gene-MD interplay, analyzing the impact of the genetic factors to reduce the obesity and MetS risk through MD adherence, and the MD impact in the obesity and MetS genetic profile. From the limited evidence on gene-MD interaction studies in European youth, a study showed that the influence of high MD adherence on adiposity and MetS was only observed with a limited number of risk alleles; the gene-MD interplay showed sex-specific differences, being higher in females. Most results analyzed in European adults elucidate that, the relationship between MD adherence and both obesity and MetS risk, could be modulated by obesity genetic variants and vice versa. Further research is needed, to better understand the inter-individual differences in the association between MD and body composition, and the integration of omics and personalized nutrition considering MD.

Lifestyle Risk Factors for Overweight/Obesity in Spanish Children.

Childhood obesity is one of the main public health concerns in Europe. The aim was to identify possible risk factors associated with overweight/obesity in Spanish preschool and school-age children. The sample (1075 (50.7% girls) children aged 3 to 12) is part of the project 'Alimentando el Cambio' whose objective is to promote healthy lifestyles in schools. Child height and weight were measured, and parents filled out questionnaires related to the children's lifestyle. There was a positive and significant association between sweetened beverage consumption and body mass index (BMI) z-score in both sexes and age groups. There was a negative and significant association between BMI z-score and dairy products in girls of both age groups. There was also a protective effect of regular nut consumption on overweight/obesity in girls 6-12 y. Night-time sleep during weekdays showed a negative association with BMI z-score for older boys and girls. A positive and significant association was found between total screen time and BMI z-score during weekdays. Regarding emotional well-being and self-esteem, having girls 6-12 y laughing and feeling happy and good about themselves in the last week was a protective factor against overweight/obesity. Childhood obesity prevention efforts may benefit from targeting these key risk factors.

The Effect of Food Vouchers and an Educational Intervention on Promoting Healthy Eating in Vulnerable Families: A Pilot Study.

Cost has been reported as the main barrier to healthy eating in vulnerable groups. We aimed to evaluate the effect of a nutrition education intervention on adherence to Mediterranean Diet and health when providing food vouchers. This pilot study has a randomized control trial design. We included 66 vulnerable users from the Red Cross of Zaragoza (Spain). Intervention and control group individuals received 120 euros/month of food vouchers over 3 months to be spent in supermarkets (60 euros/month if under 12 y) plus a 10-week nutrition education program for the intervention group. Family food purchases were assessed using electronically recorded supermarket-obtained transactions. During and at the end of the intervention the percentage of healthy food was higher in the intervention than in the control group. Once the nutrition education was over, differences between groups dissipated. In the intervention group, health parameters improved, particularly weight-status, lipids, and liver enzymes. Control participants gained weight, although lipid and liver enzymes improved. Blood pressure and HbA1c did not improve in either the intervention or the control group. In conclusion, providing unrestricted food vouchers to vulnerable groups to increase healthy food consumption appears to be insufficient and should be accompanied by medium-long term nutrition education.