Responsive Feeding Practices to Promote Healthy Diets: A Mixed Method Study among Low-Income Caregivers with Toddlers.

Responsive feeding (RF), the reciprocal feeding approach between caregiver and child that promotes child health, is understudied among low-income caregivers. This mixed methods study with low-income caregivers of 12-to-36-month-olds aimed to (1) assess variability in RF and associations with children's dietary intake, and (2) explore caregivers' perceptions of RF. Caregivers (n = 134) completed an online survey with RF questions (n = 25), grouped into environmental (meal environment, caregiver modeling, caregiver beliefs) and child (self-regulation, hunger/satiety cues, food for reward, food acceptance) influences scores. Children's recent food group consumption was loaded onto healthy and less healthy intake scores. In an adjusted multiple linear regression analysis, greater RF scores for environmental and child influences were associated with greater healthy intake scores (p's < 0.01). Greater scores for environmental influences were also associated with lower scores for unhealthy intake (p < 0.01). From focus groups with a separate sample of caregivers (n = 24), thematic analysis uncovered that two themes aligned (trust in child cues, positive strategies to encourage children to eat non-preferred foods) and two misaligned (lack of trust in child cues, use of force/bribery) with RF. Complementary integration of quantitative and qualitative findings can inform future interventions with low-income caregivers, encouraging trust in young children's hunger/satiety cues and positive strategies for food acceptance to improve diet quality.

Child-targeted fast-food television advertising exposure is linked with fast-food intake among pre-school children.

OBJECTIVE: To determine whether exposure to child-targeted fast-food (FF) television (TV) advertising is associated with children's FF intake in a non-experimental setting. DESIGN: Cross-sectional survey conducted April-December 2013. Parents reported their pre-school child's TV viewing time, channels watched and past-week FF consumption. Responses were combined with a list of FF commercials (ads) aired on children's TV channels during the same period to calculate children's exposure to child-targeted TV ads for the following chain FF restaurants: McDonald's, Subway and Wendy's (MSW). SETTING: Paediatric and Women, Infants, and Children (WIC) clinics in New Hampshire, USA. SUBJECTS: Parents (n 548) with a child of pre-school age. RESULTS: Children's mean age was 4·4 years; 43·2 % ate MSW in the past week. Among the 40·8 % exposed to MSW ads, 23·3 % had low, 34·2 % moderate and 42·5 % high exposure. McDonald's accounted for over 70 % of children's MSW ad exposure and consumption. Children's MSW consumption was significantly associated with their ad exposure, but not overall TV viewing time. After adjusting for demographics, socio-economic status and other screen time, moderate MSW ad exposure was associated with a 31 % (95 % CI 1·12, 1·53) increase and high MSW ad exposure with a 26 % (95 % CI 1·13, 1·41) increase in the likelihood of consuming MSW in the past week. Further adjustment for parent FF consumption did not change the findings substantially. CONCLUSIONS: Exposure to child-targeted FF TV advertising is positively associated with FF consumption among children of pre-school age, highlighting the vulnerability of young children to persuasive advertising and supporting recommendations to limit child-directed FF marketing.

The Smart Choices front-of-package nutrition label. Influence on perceptions and intake of cereal.

Numerous front-of-package (FOP) nutrition labeling systems exist, but it is unclear if such labels influence behavior. A single-summary label called Smart Choices (SC) appeared briefly on products in the United States in 2009. The current study aimed to evaluate (1) the influence the SC symbol has on the serving and consumption of cereal; and (2) the impact of providing calorie and serving size information on a FOP label. Two hundred and sixteen adults were randomized to a high-sugar breakfast cereal that had either (1) no label; (2) the SC symbol; or (3) a modified SC symbol with serving size information. Participants rated perceptions of healthfulness, taste, and purchase intent, estimated calories per serving and poured and ate the cereal for breakfast. Participants in the SC label conditions were better able to estimate calories per serving, but there were no differences across groups on perceptions of healthfulness, taste, purchase intent, and levels of vitamins, and sugar or amount of cereal poured or consumed. These results suggest that calories per serving information on FOP labels can increase knowledge, but the SC symbol had little impact on behavior. Studies examining FOP label influence on purchasing, consumption, and product reformulation are greatly needed to determine label utility.

Nutrition-related claims on children's cereals: what do they mean to parents and do they influence willingness to buy?

OBJECTIVE: To examine parents' beliefs about the meaning of common front-of-package nutrition-related claims on children's cereals and determine whether the claims would make them more willing to buy the cereals. DESIGN: Parents viewed images of box fronts for children's cereals of below-average nutritional quality, as assessed by a validated nutrient profiling model. These boxes featured various nutrition-related claims including 'supports your child's immunity', 'whole grain', 'fibre', 'calcium and vitamin D' and 'organic'. Participants were provided possible meanings for these claims and asked to select any that applied with the option to write in additional meanings. They also indicated how the claim would affect their willingness to buy the product. SETTING: Online survey. SUBJECTS: Parents with children between the ages of 2 and 11 years (n 306) recruited through an online panel. RESULTS: The majority of parents misinterpreted the meaning of claims commonly used on children's cereals. They inferred that cereals with claims were more nutritious overall and might provide specific health-related benefits for their children; and these beliefs predicted greater willingness to buy the cereals. CONCLUSIONS: These findings indicate that common front-of-package nutrition-related claims are potentially misleading, especially when placed on products with high levels of nutrients to limit (e.g. sugar, sodium) and low levels of other nutrients to encourage (e.g. fibre, protein). Additional regulation is needed to protect consumers in the USA.

Biochemical characterization of prostasin, a channel activating protease.

Human prostasin was recently identified as a potential regulator of epithelial sodium channel (ENaC) function. Through the use of positional scanning combinatorial substrate libraries, prostasin was shown to have a preference for poly-basic substrates: in position P4 preference was for arginine or lysine; in P3 preference was for histidine, lysine or arginine; in P2 preference was for basic or large hydrophobic amino acids; and in P1 preference was for arginine and lysine. P1', P2', and P3' displayed broad selectivity with the exception of a lack of activity for isoleucine, and P4' had a preference for small, unbranched, amino acids such as alanine and serine. A prostasin-preferred poly-basic cleavage site was found in the extracellular domains of the ENaC alpha- and beta-subunits, and may present a mechanism for prostasin activation. The absence of activity seen with substrates containing isoleucine in position P1' explains the inability of prostasin to autoactivate and suggests that prostasin proteolytic activity is regulated by an upstream protease. Prostasin activity was highly influenced by mono- and divalent metal ions which were potent inhibitors and substrate specific modulators of enzymatic activity. In the presence of sub-inhibitory concentrations of zinc, the activity of prostasin increased several-fold and its substrate specificity was significantly altered in favor of a strong preference for histidine in positions P3 or P4 of the substrate.