A review on children's oral texture perception and preferences in foods.

Texture properties of foods are particular drivers for food acceptance and rejection in children. The texture preferences follow the developmental progression of the child and these changes modulate the present and future food habits. This paper reviews the development and factors influencing texture preferences in children and the methods in food texture research with children. The child's acceptance of more complex food textures is age-dependent. The progression is indorsed by the development of oral processing skills at an early age and bolstered by repeated exposures to foods with varying textures. Children generally reject foods containing pieces or bits (i.e., geometrical textural properties); however, the impact of mechanical textural properties on food acceptance is less clear. Child characteristics such as food neophobia, picky eating, and tactile over-responsivity, negatively affect the acceptance of more diverse food textures. Depending on the child's age, the prevailing methods of characterizing food texture preferences in children include observational techniques and self-reported questionnaires. Despite knowledge of children's development of masticatory skills, learning, and cognitive abilities, the relationships of these changes to food texture acceptance and the recommended test methodology for evaluating product texture acceptance in this period of life are still limited.

Repeated exposure to vegetable-enriched snack bars may increase children's liking for the bars - but not for the vegetables.

Most children do not consume enough vegetables and a key reason is their relatively low hedonic acceptance. The aims of this study were to test if integration of vegetables into a popular snack product might serve as a means to increase the liking for vegetables and to test how exposure frequency influences the intake and liking. Totally 256 children from 12 school classes, aged 7-10 years, participated in the study. School classes were assigned to one of six intervention groups based on the bar they were exposed to: beetroot/carrot (B/C), n = 45; spinach/Jerusalem artichoke (S/J), n = 34; pumpkin/sweet potato (P/S), n = 44; Neutral, n = 46, who received a neutral bar without vegetables; and a Boredom Group, who received the beetroot/carrot (b/c) bar at high frequency, n = 47. These groups received 8 exposures. The Boredom Group was exposed daily while the other groups were exposed every second day. A Control Group (n = 40) was not exposed. Liking for the bars was assessed at baseline and post-intervention and the intake of the bars was recorded during all exposures. Results showed increases in liking for the exposed bars in all groups except the Boredom Group, but changes were only significant in the B/C Group (p = 0.03) and the P/S Group (p = 0.02). Some increases towards unexposed bars were observed. Liking for vegetables remained stable or decreased. Intake of the bars during exposures did not differ significantly between groups, but was somewhat lower in the Boredom Group. In conclusion, repeated exposure may be a successful approach to increase liking for a vegetable bar, but does not generalize to changes in vegetable liking, and a lower exposure frequency may be advantageous.

Breast-feeding duration and child eating characteristics in relation to later vegetable intake in 2-6-year-old children in ten studies throughout Europe.

OBJECTIVE: Breast-feeding is thought to facilitate young children's acceptance of new foods, including vegetables, but the evidence for this relationship appears inconsistent across studies. Increasing children's vegetable intake remains challenging; therefore the present study aimed to investigate whether breast-feeding duration predicts vegetable intake in 2-6-year-old children. DESIGN: Actual vegetable intake was measured in studies across three European countries. General linear model analyses with breast-feeding duration, sex and age of the child and maternal education as variables were used to predict children's vegetable intake per country. Additionally, the relationships between child eating behaviour characteristics (asked through the Child Eating Behaviour Questionnaire) and vegetable intake were investigated via Pearson correlations. SETTING: Daycare centres, schools and home settings in Denmark, Greece and the Netherlands. SUBJECTS: Children aged 2-6 years (n 750). RESULTS: Breast-feeding duration was positively associated with children's vegetable intake at 2-6 years old in Denmark (P<0·01) and the Netherlands (P<0·05), but not in Greece (P=0·17). Age of the child, maternal education and sex of the child did not predict vegetable intake in our sample. All countries showed an inverse relationship between food neophobia and children's vegetable intake and a positive relationship between vegetable liking and intake. CONCLUSIONS: The present study found that breast-feeding duration is a predictor of later vegetable intake, but that current child eating behaviour characteristics, such as vegetable liking, food neophobia and enjoyment of food, also influence vegetable intake. Besides encouragement of breast-feeding duration, strategies that support vegetable liking and food enjoyment and decrease food neophobia are needed to support young children's vegetable intake.

A review of instruments developed to measure food neophobia.

BACKGROUND: Food choices are influenced by an individual's attitude towards foods. Food neophobia may be associated with less variety of diets, inadequate nutrient intake and high product failure rate for new food products entering the market. To quantify the extent of these challenges, instruments to measure the food neophobia in different target groups are needed. Several such instruments with significantly different measurement outcomes and procedures have been developed. This review provides an overview and discusses strengths and weaknesses of these instruments. OBJECTIVE: We evaluate strengths and weaknesses of previously developed instruments to measure neophobia and willingness to try unfamiliar foods. DESIGN: Literature was searched through the databases Web of Science and Google Scholar. We identified 255 studies concerning neophobia and willingness to try unfamiliar foods. Of these, 13 studies encompassing 13 instruments to measure neophobia and willingness to try unfamiliar foods were included in the review. Results are summarized and evaluated with a narrative approach. RESULTS: In the 13 instruments to assess neophobia and willingness to try unfamiliar foods, 113 to 16.644 subjects aged 2-65 years were involved, scales with 3-7 response categories were used and behavioral validation tests were included in 6 studies. CONCLUSIONS: Several instruments to measure neophobia and willingness to try unfamiliar foods exist. We recommend selecting one or more among the 13 instruments reviewed in this paper to assess relevant aspects of neophobia.

Development of novel tools to measure food neophobia in children.

BACKGROUND: The main tool currently used to measure food neophobia (the Food Neophobia Scale, FNS, developed by Pliner & Hobden, 1992) may not remain optimal forever. It was developed around 25 years ago, and the perception and availability of "novel" and "ethnic" foods may have changed in the meantime. Consequently, there is a need for developing updated tools for measuring food neophobia. OBJECTIVE: To develop novel tools to measure food neophobia in children. DESIGN: Based on a review of 13 designs to assess food neophobia and willingness to try unfamiliar foods, a Food Neophobia Test Tool (FNTT) was developed. A questionnaire including the FNS, a 19-item FNTT, items about willingness to taste novel foods in different surroundings and a behavioral test was administered to 235 children aged 9-13 years. Reliability and validity of the FNS and FNTT were assessed through calculations of Cronbach's alpha, item-item and item-rest correlations. Comprehension issues related to tools were evaluated based on qualitative observations and finally, behavioral validity was assessed. RESULTS: A considerable number of children indicated difficulties understanding certain items in the original FNS. FNTT could be reduced to a 6- and 9-item tool with high validity (item-rest coefficients, r = 0.60-0.80). Internal consistency of the FNTT (Cronbach α ≥ 0.90) was higher relative to the FNS (Cronbach α ≥ 0.72). Scores from the FNTT correlated significantly (p < 0.05) with results from the behavioral test confirming construct validity of the FNTT as a measure of neophobic behavior. CONCLUSIONS: Results from this study provide evidence for the FNTT as reliable and valid tool for measuring food neophobia in children aged 9-13 years. Moreover, when modified, the FNS continue to produce reliable and valid results.

Changing children's eating behaviour - A review of experimental research.

The interest in children's eating behaviours and how to change them has been growing in recent years. This review examines the following questions: What strategies have been used to change children's eating behaviours? Have their effects been experimentally demonstrated? And, are the effects transient or enduring? Medline and Cab abstract (Ovid) and Web of Science (Thomson Reuters) were used to identify the experimental studies. A total of 120 experimental studies were identified and they are presented grouped within these 11 topics; parental control, reward, social facilitation, cooking programs, school gardens, sensory education, availability and accessibility, choice architecture and nudging, branding and food packaging, preparation and serving style, and offering a choice. In conclusion, controlling strategies for changing children's eating behaviour in a positive direction appear to be counterproductive. Hands-on approaches such as gardening and cooking programs may encourage greater vegetable consumption and may have a larger effect compared to nutrition education. Providing children with free, accessible fruits and vegetables have been experimentally shown to positively affect long-term eating behaviour. The authors recommend future research to examine how taste and palatability can positively affect children's attitudes and eating behaviour.

Variety in snack servings as determinant for acceptance in school children.

Variety within a meal is known to increase intake. However, intake of certain food items (e.g. vegetables) in children is consistently below recommendations, and increasing the consumption of such food would lead to health benefits. This study investigated how different levels of food variety influence children's acceptance. A total of 132 children, aged from 9 to 11 years, were exposed to vegetables, fruits and nut snacks during mid-morning break at school. Two different sets of stimuli were used in a within subject design: Classical Variety (CV), i.e. serving of different foods and Perceived Variety (PV), i.e. serving of the same food in different shapes. For each set, three levels of variety in the servings were tested: low, medium, and high. Intake and liking were determined for each serving set. ANOVA results showed that intake of CV set decreased according to the level of variety, whereas results of PV set only showed an increase of liking with increasing levels of variety. Adding more variations of products appeared to be less successful on consumption despite changing the liking of the products, may be because consumption is more affected by acceptability and familiarity for the stimuli than by variety.

Relation of nonsteroidal anti-inflammatory drugs to serious bleeding and thromboembolism risk in patients with atrial fibrillation receiving antithrombotic therapy: a nationwide cohort study.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are assumed to increase bleeding risk, but their actual relation to serious bleeding in patients with atrial fibrillation (AF) who are receiving antithrombotic medication is unknown. OBJECTIVE: To investigate the risk for serious bleeding and thromboembolism associated with ongoing NSAID and antithrombotic therapy. DESIGN: Observational cohort study. SETTING: Nationwide registries. PATIENTS: Danish patients with AF hospitalized between 1997 and 2011. MEASUREMENTS: Absolute risk for serious bleeding and thromboembolism with ongoing NSAID and antithrombotic therapy, assessed by using Cox models. RESULTS: Of 150 900 patients with AF (median age, 75 years [interquartile range, 65 to 83 years]; 47% female), 53 732 (35.6%) were prescribed an NSAID during a median follow-up of 6.2 years (interquartile range, 2.1 to 14.0 years). There were 17 187 (11.4%) and 19 561 (13.0%) occurrences of serious bleeding and thromboembolism, respectively. At 3 months, the absolute risk for serious bleeding within 14 days of NSAID exposure was 3.5 events per 1000 patients compared with 1.5 events per 1000 patients without NSAID exposure. The risk difference was 1.9 events per 1000 patients. In patients selected for oral anticoagulant therapy, the absolute risk difference was 2.5 events per 1000 patients. Use of NSAIDs was associated with increased absolute risks for serious bleeding and thromboembolism across all antithrombotic regimens and NSAID types. An NSAID dosage above the recommended minimum was associated with a substantially increased hazard ratio for bleeding. LIMITATION: Observational design and unmeasured confounders. CONCLUSION: Use of NSAIDs was associated with an independent risk for serious bleeding and thromboembolism in patients with AF. Short-term NSAID exposure was associated with increased bleeding risk. Physicians should exercise caution with NSAIDs in patients with AF. PRIMARY FUNDING SOURCE: None.

Association of NSAID use with risk of bleeding and cardiovascular events in patients receiving antithrombotic therapy after myocardial infarction.

IMPORTANCE: Antithrombotic treatment is indicated for use in patients after myocardial infarction (MI); however, concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) could pose safety concerns. OBJECTIVE: To examine the risk of bleeding and cardiovascular events among patients with prior MI taking antithrombotic drugs and for whom NSAID therapy was then prescribed. DESIGN, SETTING, AND PARTICIPANTS: Using nationwide administrative registries in Denmark (2002-2011), we studied patients 30 years or older admitted with first-time MI and alive 30 days after discharge. Subsequent treatment with aspirin, clopidogrel, or oral anticoagulants and their combinations, as well as ongoing concomitant NSAID use, was determined. EXPOSURES: Use of NSAIDs with ongoing antithrombotic treatment after first-time MI. MAIN OUTCOMES AND MEASURES: Risk of bleeding (requiring hospitalization) or a composite cardiovascular outcome (cardiovascular death, nonfatal recurrent MI, and stroke) according to ongoing NSAID and antithrombotic therapy, calculated using adjusted time-dependent Cox regression models. RESULTS: We included 61,971 patients (mean age, 67.7 [SD, 13.6] years; 63% men); of these, 34% filled at least 1 NSAID prescription. The number of deaths during a median follow-up of 3.5 years was 18,105 (29.2%). A total of 5288 bleeding events (8.5%) and 18,568 cardiovascular events (30.0%) occurred. The crude incidence rates of bleeding (events per 100 person-years) were 4.2 (95% CI, 3.8-4.6) with concomitant NSAID treatment and 2.2 (95% CI, 2.1-2.3) without NSAID treatment, whereas the rates of cardiovascular events were 11.2 (95% CI, 10.5-11.9) and 8.3 (95% CI, 8.2-8.4). The multivariate-adjusted Cox regression analysis found increased risk of bleeding with NSAID treatment compared with no NSAID treatment (hazard ratio, 2.02 [95% CI, 1.81-2.26]), and the cardiovascular risk was also increased (hazard ratio, 1.40 [95% CI, 1.30-1.49]). An increased risk of bleeding and cardiovascular events was evident with concomitant use of NSAIDs, regardless of antithrombotic treatment, types of NSAIDs, or duration of use. CONCLUSIONS AND RELEVANCE: Among patients receiving antithrombotic therapy after MI, the use of NSAIDs was associated with increased risk of bleeding and excess thrombotic events, even after short-term treatment. More research is needed to confirm these findings; however, physicians should exercise appropriate caution when prescribing NSAIDs for patients who have recently experienced MI.

Non-steroidal anti-inflammatory drugs and risk of cardiovascular disease in patients with rheumatoid arthritis: a nationwide cohort study.

OBJECTIVE: To examine the risk of major cardiovascular disease associated with non-steroidal anti-inflammatory drugs (NSAIDs) in a large 'real-world' contemporary rheumatoid arthritis (RA) cohort. METHODS: A longitudinal cohort study was conducted with use of Danish nationwide individual-level registry data on inpatient and outpatient health care provision, pharmacotherapy and income during 1997-2009. 17 320 RA patients were identified and matched with 69 280 controls (4 : 1) by age and sex. NSAID-associated risk of major cardiovascular disease defined as the combined endpoint of myocardial infarction, stroke or cardiovascular mortality was assessed in multivariable survival models. RESULTS: During follow-up (median 4.9 years) 6283 events occurred. The cardiovascular risk associated with overall NSAID use was significantly lower in RA patients than in controls (HR 1.22 (95% CI 1.09 to 1.37) vs 1.51 (1.36 to 1.66), p<0.01). The pattern of lower NSAID-associated risk in RA patients was generally found with the individual NSAIDs investigated. While use of rofecoxib (HR 1.57 (1.16 to 2.12)) and diclofenac (HR 1.35 (1.11 to 1.64)) was associated with increased cardiovascular risk in RA patients, there was no significant risk increase associated with use of other NSAIDs in these patients. CONCLUSIONS: The cardiovascular risk associated with NSAID use in RA patients was modest and significantly lower than in non-RA individuals. Moreover, only a few of the individual NSAIDs were associated with increased cardiovascular risk. NSAID use should be assessed in the individual patient based on the indication for pain relief and risk factors for adverse effects, and not automatically be avoided due to concerns of severe cardiovascular outcomes alone.

Month-to-month variation in sleep among healthy, Scandinavian daytime workers.

BACKGROUND: The overall purpose of the present study was to attain more insight in month-to-month variation of sleep duration and quality in order to improve design and interpretation of, e.g. epidemiological studies using sleep as outcome. METHODS: The study design entailed monthly self-reports from 38 (26 women/12 men) daytime workers, who completed the Karolinska Sleep Diary (KSD) once a month during one year. A subgroup (n = 16) also wore actigraphs on one day every month during a year. Self-reports of bedtime, time of awakening, sleep duration, individual sleep characteristics, disturbed sleep index (DSI, 4 items) and awakening index (AWI, 3 items) were analyzed together with actigraphy-derived measures. Hours of daylight were used to test for circa-annual variation in statistical models adjusted for intake of hypnotics and alcohol, gender, age and within-person variability. RESULTS: Hours of daylight were found to be associated to self-reported bedtime (p = 0.032) and DSI (p = 0.030), thereby indicating a circa-annual variation. Bedtime was delayed by 1.8 min (95% CI: 0.6-2.9 min) per 1 hour increase in length of daylight. Sleep was slightly more disturbed during the winter. CONCLUSION: Only circa-annual variation in self-reports of bedtime and DSI were observed in a healthy daytime working population, and the effects were small. Therefore potential bias due to circa-annuality in the studied parameters appears to be of limited concern in adult daytime working populations.

Bitter taste phenotype and body weight predict children's selection of sweet and savory foods at a palatable test-meal.

Previous studies show that children who are sensitive to the bitter taste of 6-n-propylthiouracil (PROP) report more frequent intake of sweets and less frequent intake of meats (savory fats) relative to children who are PROP insensitive. Laboratory studies are needed to confirm these findings. In this study, seventy-nine 4- to 6-year-olds from diverse ethnicities attended four laboratory sessions, the last of which included a palatable buffet consisting of savory-fats (e.g. pizza), sweet-fats (e.g. cookies, cakes), and sweets (e.g. juices, candies). PROP phenotype was classified by two methods: 1) a common screening procedure to divide children into tasters and nontasters, and 2) a three-concentration method used to approximate PROP thresholds. Height and weight were measured and saliva was collected for genotyping TAS2R38, a bitter taste receptor related to the PROP phenotype. Data were analyzed by General Linear Model ANOVA with intake from savory fats, sweet-fats, and sweets as dependent variables and PROP status as the independent variable. BMI z-score, sex, age, and ethnicity were included as covariates. Adjusted energy intake from the food group "sweets" at the test-meal was greater for tasters than for nontasters. PROP status did not influence children's adjusted intake of savory-fats, but BMI z-score did. The TAS2R38 genotype did not impact intake at the test-meal. At a palatable buffet, PROP taster children preferentially consumed more sweets than nontaster children, while heavier children consumed more savory fats. These findings may have implications for understanding differences in susceptibility to hyperphagia.

Oral size perception and texture preferences for particle-containing foods in children aged 5-12.

Foods containing bits and pieces are often less liked by children; however, there is a limited understanding of how perceptions and preferences for foods with particles change during childhood. This study aimed to investigate preferences and perceptions of particle-containing foods in children aged 5-12 years. Children (n = 485) completed a forced-choice questionnaire on drawings of six pairs of foods, each available with or without particles. Additionally, children tasted yogurts added with muesli differing in particle size (median diameter: 3.9 or 7.5 mm) and evaluated their perception of particle size in mouth and their liking. The questionnaire results showed that children had a clear preference for foods without particles. The average probability of choosing the 'with-particle' foods was 28%, significantly below the midpoint of 50% (p < .0001). Preferences for particle-containing foods were lowest at age six and increased significantly with age (p = .0007). In the taste test, muesli particle size affected oral size perception (p < .0001) but not liking (p = .60). Older children were better able to differentiate particle size than younger children. However, there was no relationship between individual preferences for particle-containing foods and oral size perception of muesli particles. The observation that children's texture preferences changed with age highlights the role of increased experience in shaping preferences for foods with particles.

Influence of changing dentition on food texture preferences and perception of eating difficulty in Australian children.

The transition from primary to permanent dentition is an important phase in children's oral development, yet its impact on texture perception and food acceptance are less explored. This study aimed to investigate how changing dentition and tooth loss influence texture preferences and perception of eating difficulty among children aged 5 to 12 years. Children (n = 475) completed a forced-choice questionnaire featuring drawings of six food pairs, each available in hard or soft texture, and reported whether they had started losing primary teeth and the number of tooth gaps present. They also tasted four samples: chocolate snacks (cake and biscuits) and cheddar cheese (grated and cubes), evaluating their perceived eating difficulty and liking for each sample. Analysis of questionnaire responses showed a general preference for softer food textures among children, with a 36% probability of choosing hard foods. Preferences were not related to child's dental state, including primary teeth loss (p = .13) or number of tooth gaps (p = .45). In the taste test, chocolate biscuits and cheese cubes were perceived as significantly more difficult to eat than chocolate cake and grated cheese, respectively (both p < .0001). Children with more than two tooth gaps reported greater eating difficulty for chocolate biscuits and cheese cubes compared to children with fewer or no tooth gaps. This study demonstrated that children's texture preferences for hardness of foods remained consistent during dentition change, while their perception of eating difficulty could vary based on their dental state at specific points in time.

Long-term cardiovascular risk of nonsteroidal anti-inflammatory drug use according to time passed after first-time myocardial infarction: a nationwide cohort study.

BACKGROUND: The cardiovascular risk after the first myocardial infarction (MI) declines rapidly during the first year. We analyzed whether the cardiovascular risk associated with using nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with the time elapsed following first-time MI. METHODS AND RESULTS: We identified patients aged 30 years or older admitted with first-time MI in 1997 to 2009 and subsequent NSAID use by individual-level linkage of nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark. We calculated the incidence rates of death and a composite end point of coronary death or nonfatal recurrent MIs associated with NSAID use in 1-year time intervals up to 5 years after inclusion and analyzed risk by using multivariable adjusted time-dependent Cox proportional hazards models. Of the 99 187 patients included, 43 608 (44%) were prescribed NSAIDs after the index MI. There were 36 747 deaths and 28 693 coronary deaths or nonfatal recurrent MIs during the 5 years of follow-up. Relative to noncurrent treatment with NSAIDs, the use of any NSAID in the years following MI was persistently associated with an increased risk of death (hazard ratio 1.59 [95% confidence interval, 1.49-1.69]) after 1 year and hazard ratio 1.63 [95% confidence interval, 1.52-1.74] after 5 years) and coronary death or nonfatal recurrent MI (hazard ratio, 1.30 [95% confidence interval,l 1.22-1.39] and hazard ratio, 1.41 [95% confidence interval, 1.28-1.55]). CONCLUSIONS: The use of NSAIDs is associated with persistently increased coronary risk regardless of time elapsed after first-time MI. We advise long-term caution in the use of NSAIDs for patients after MI.

Time-perspective in cardiovascular risk of NSAID use after first-time myocardial infarction.

PURPOSE OF REVIEW: Despite the fact that NSAIDs are not recommended among patients with established cardiovascular disease, many patients receive NSAID treatment for a short period of time. However, up until recently, data on the relationship between treatment duration and associated cardiovascular risk were sparse and have not been summarized. RECENT FINDINGS: A series of recent studies of patients with prior myocardial infarction (MI) demonstrated that short-term treatment with most NSAIDs is associated with an increased cardiovascular risk relative to no NSAID treatment. These studies furthermore demonstrated that NSAID use among patients with first-time MI was associated with persistently increased risk of all-cause mortality and of a composite of coronary death or nonfatal recurrent MI for at least 5 years thereafter. SUMMARY: The present review indicates that there is no apparent well-tolerated therapeutic window for associated cardiovascular risk and NSAID use in patients with prior MI. Further randomized studies are warranted to evaluate the cardiovascular safety of NSAIDs, but, at this point, the overall evidence suggests advising caution in using NSAIDs at all times after MI. Legislation bodies need to address this issue of public health proportions, as studies have shown that utilization rates of NSAID keep increasing.

Accuracy of the ICD-10 discharge diagnosis for syncope.

AIMS: Administrative discharge codes are widely used in epidemiology, but the specificity and sensitivity of this coding is unknown and must be validated. We assessed the validity of the discharge diagnosis of syncope in administrative registers and reviewed the etiology of syncope after workup. METHODS AND RESULTS: Two samples were investigated. One sample consisted of 5262 randomly selected medical patients. The other sample consisted of 750 patients admitted or seen in the emergency department (ED) for syncope (ICD-10: R55.9) in three hospitals in Denmark. All charts were reviewed for baseline characteristics and to confirm the presence/absence of syncope and to compare with the administrative coding. In a sample of 600 admitted patients 570 (95%) and of 150 patients from ED 140 (93%) had syncope representing the positive predictive values. Median age of the population was 69 years (IQR: ± 14). In the second sample of 5262 randomly selected medical patients, 75 (1.4%) had syncope, of which 47 were coded as R55.9 yielding a sensitivity of 62.7%, a negative predictive value of 99.5%, and a specificity of 99.9%. CONCLUSION: ED and hospital discharge diagnostic coding for syncope has a positive predictive value of 95% and a sensitivity of 63%.

Predictors of parental perceptions and concerns about child weight.

Appropriate levels of parental perception and concern about child weight are important components of successful obesity treatment, but the factors that contribute to these attitudes need clarification. The aim of this study was to identify child and parent characteristics that best predict parental perceptions and concerns about child weight. A cross-sectional design was used to assess characteristics of parents (e.g. age, income, and feeding attitudes) and children (e.g. body composition, ad libitum intake, and reported physical activity). Results are reported for 75, 4-6year-olds from diverse ethnicities. Perceived child weight and concern were measured with the Child Feeding Questionnaire (CFQ). Multiple linear regression was used to identify the best models for perceived child weight and concern. For perceived child weight, the best model included parent age, children's laboratory intake of sugar-sweetened beverages (SSBs) and palatable buffet items, and two measures of child body composition (ratio of trunk fat-to-total fat and ratio of leg fat-to-total fat). For concern, child android/gynoid fat ratio explained the largest amount of variance, followed by restrictive feeding and SSB intake. Parental perceptions and concerns about child weight are best explained by models that account for children's eating behavior and body fat distribution.

Eating a rainbow. Introducing vegetables in the first years of life in 3 European countries.

Low vegetable consumption in children is a concern in many EU countries, fewer than one fifth of children in Europe consume the WHO recommended amounts. Systematic studies demonstrate that experience with a variety of vegetables early in childhood can promote later consumption as early dietary habits often track into adulthood. This study examined pre-school children's experience with vegetables across three European countries in order to assess cultural differences, effects of age and culinary practices. Mothers of pre-school children (N=234) in the UK (N=71), Denmark (N=93) and France (N=70) completed a survey assessing parental and infant familiarity, frequency of offering and liking for 56 vegetables as well as preparation techniques for these vegetables. Analyses revealed that although children aged 25-36 months had been introduced to the greatest number of vegetables, children aged 6-12 months were offered vegetables more frequently and had a higher reported liking for these vegetables. UK children's liking was related to frequency of maternal intake and frequency of offering. Denmark had introduced the greatest number of vegetables and offered vegetables more frequently than both the UK and France. Choice of preparation methods differed between countries while choice of seasonings was similar. Results suggest increasing variety and frequency of vegetable offering between 6 and 12 months, when children are most receptive, may promote vegetable consumption in children.