Effects of increasing the availability of vegetarian options on main meal choices, meal offer satisfaction and liking: a pre-post analysis in a French university cafeteria.

BACKGROUND: Changing the food environment is an important public health lever for encouraging sustainable food choices. Targeting the availability of vegetarian main meals served in cafeterias substantially affects food choice, but acceptability has never been assessed. We examined the effects of an availability intervention at a French university cafeteria on students' main meal choices, meal offer satisfaction and liking. METHODS: A four-week controlled trial was conducted in a university cafeteria in Dijon, France. During the two-week control period, vegetarian main meals constituted 24% of the offer. In the subsequent two-week intervention period, this proportion increased to 48%, while all the other menu items remained unchanged. Students were not informed of the change. Student choices were tracked using production data, and daily paper ballots were used to assess student satisfaction with the meal offer and liking of the main meal they chose (score range [1;5]). Nutritional quality, environmental impact, and cost of production of meal choices were calculated for each lunchtime. Food waste was measured over 4 lunchtimes during control and intervention periods. An online questionnaire collected student feedback at the end of the study. RESULTS: Doubling availability of vegetarian main meals significantly increased the likelihood of choosing vegetarian options (OR = 2.57, 95% CI = [2.41; 2.74]). Responses of the paper ballots (n = 18,342) indicated slight improvements in meal offer satisfaction from 4.05 ± 0.92 to 4.07 ± 0.93 (p = 0.028) and in liking from 4.09 ± 0.90 to 4.13 ± 0.92 (p < 0.001) during control and intervention periods, respectively. The end-of-study questionnaire (n = 510) revealed that only 6% of students noticed a change the availability of vegetarian main meals. The intervention led to a decrease in the environmental impact of the main meals chosen, a slight decrease in nutritional quality, a slight increase in meal costs and no change in food waste. CONCLUSIONS: Doubling availability of vegetarian main meals in a university cafeteria resulted in a twofold increase in their selection, with students reporting being more satisfied and liking the main meals more during the intervention period. These results suggest that serving an equal proportion of vegetarian and nonvegetarian main meals could be considered in French university cafeterias to tackle environmental issues. TRIAL REGISTRATION: Study protocol and analysis plan were pre-registered on the Open Science Framework ( https://osf.io/pf3x7/ ).

Impact of a minimally processing route for the production of infant formulas on their sensory properties.

Infant formulas (IFs), the sole adequate substitute to human milk, undergo several thermal treatments during production that can damage milk proteins and promote the formation of Maillard reaction products, modifying nutritional and sensory properties. The aim of this study was to determine the impact of a minimally processing route based on membrane filtration associated with different levels of heat treatment, on the odor, taste, texture and color attributes of IFs, then to compare with those of commercial milks. Three experimental IFs (produced with membrane filtration associated with low - T-, medium - T+, or high thermal treatments - T+++) were evaluated. Triangular tests conducted with a panel of 50 adults highlighted clear disparities between all the IFs. The same panel applied the Check-All-That-Apply method to evaluate the IFs: the range of variability between T- and T+++ was similar to that between the 2 commercial IFs, and the sensory characteristics of the experimental IFs were not far from the commercial brands for flavor and texture attributes. Analysis performed on the citation frequencies for each descriptor differentiated T-/T+ from T+++, but all the experimental IFs were described with positive sensory characteristics, unlike one commercial IF. Volatile organic compounds (VOCs) content of IFs with low and high thermal treatments were analyzed. Forty VOCs were identified by gas chromatography-mass spectrometry. T- contained a higher quantity of VOCs than T+++, except for benzaldehyde (Maillard reaction product), and aldehydes (oxidation-related products) were the most represented compounds. In conclusion, the processing was associated with sensory differences among IFs, but no marked difference in flavors was found according to CATA and physicochemical analysis. Additionally, no unpleasant sensory descriptors were noted. This shows that the minimally processed route leads to IFs that could fit well within the market from a sensory point of view.

Children's liking for vegetarian and non-vegetarian school meals at the scale of a French city.

In Western countries, a behavioural shift towards more plant-based diets is helpful in protecting population and planet health. School canteens are an important public policy target to achieve this transition. Increasing the frequency of vegetarian meals in school canteens has been proposed as a solution to decrease greenhouse gas emissions while maintaining a good nutritional quality. However, vegetarian meals acceptance by children is key to limit unintended consequences such as increased food waste or increased nutritional inequalities. We aimed to examine children's liking for vegetarian and non-vegetarian main dishes at school canteens; and whether it varied across socioeconomic level. Connected scoring devices displaying a five-point smiley scale were installed in all the 38 primary school canteens of a French city, located in socially diverse neighbourhoods. Every day after their school lunch, children were asked to rate the main dish they had just eaten. During one school year, from September 2021 to June 2022, we collected 208,985 votes for 125 main dishes, including 32 vegetarian (i.e., no meat or fish) and 93 non-vegetarian dishes, for an average of 1672 (SD 440) votes per day across the 38 school canteens. We showed no difference in children's liking for vegetarian and non-vegetarian dishes. Additionally, the socioeconomic level of the schools was found to interact negatively with children's liking for vegetarian main dishes whereby vegetarian main dishes tended to be more liked in schools of lower socioeconomic level. In this French city, children's acceptance would not be a barrier to increase the frequency of vegetarian school meals and would not increase social dietary inequalities.

Behavioural determinants of healthy and environmentally friendly diets in French university students.

Although encouraging the shift toward sustainable diets in young adults is a major challenge to preserve population and planet health, the precursors of sustainable diets in this population remain unknown. This study aimed to identify the behavioural determinants of healthier and more environmentally friendly diets among university students. A sample of 582 French university students reported their food consumption using an online 125-item food frequency questionnaire. The nutritional quality (adherence to French recommendations, sPNNS-GS2) and the greenhouse gas emissions (GHGE) of students' diets were calculated for an isocaloric diet. Behavioural determinants were measured based on a literature review and classified into the Capability, Opportunity, Motivation Behaviour (COM-B) framework. Linear models, adjusted for socioeconomic characteristics, were run to identify the most prominent behavioural predictors of nutritional quality and GHGE of students' diets. Higher cooking skills (ß = 0.38, p = 0.01) and health motives (ß = 0.91, p < 0.001) were associated with higher nutritional quality. Greater environmental knowledge was linked to lower GHGE (ß = -0.07, p = 0.002), while health and weight control motives were associated with higher GHGE (ß = 0.26, p = 0.02 and ß = 0.39, p < 0.001). Enhancing cooking skills and environmental knowledge could enable healthy and environmentally friendly diets, but health-based motives can act as a lever and as a barrier.

Infant feeding practices and body mass index up to 7.5 years in the French nationwide ELFE study.

BACKGROUND/OBJECTIVES: The infant diet represents one of the main modifiable determinants of early growth. This study aimed to investigate the associations of infant feeding practices with body mass index (BMI) until 7.5 years. SUBJECTS/METHODS: Analyses were based on data from the French nationwide ELFE birth cohort. Data on breastfeeding (BF) and complementary feeding (CF) were collected monthly from 2 to 10 months. Infant feeding practices were characterized using principal component analyses (PCA) and hierarchical ascendant classification. BMI z-score was computed at 1, 2, 3, 5 and 7.5 years, from data collected in the child's health booklet; 7.5-year overweight was defined according to IOTF references. Associations between infant feeding practices and BMI were investigated by linear regression models adjusted for main confounders. RESULTS: Ever breastfeeding was not associated with BMI up to 7.5 years. Compared to intermediate breastfeeding duration (1 to <3 months), longer breastfeeding duration (≥6 months) was related to lower 1-year BMI, but not at older ages. Compared to the recommended age at CF introduction (4-6 months), early CF (<4 months) was related to higher BMI up to 5 years with a similar trend at 7.5 years, but not to the risk of overweight. The PCA patterns characterized by early baby cereal introduction and late food pieces introduction or by frequent intake of main food groups were related to a lower BMI up to 7.5 years. CONCLUSION: Breastfeeding was related with a lower BMI in infancy but not thereafter, whereas an early CF initiation (<4 months) was associated with a higher BMI in childhood.

Development of food literacy in children and adolescents: implications for the design of strategies to promote healthier and more sustainable diets.

Food literacy has emerged as a key individual trait to promote the transformation of food systems toward healthy and sustainable diets. Childhood and adolescence are key periods for establishing the foundations of eating habits. Different food literacy competencies are acquired as children develop different cognitive abilities, skills, and experiences, contributing to the development of critical tools that allow them to navigate a complex food system. Thus, the design and implementation of programs to support the development of food literacy from early childhood can contribute to healthier and more sustainable eating habits. In this context, the aim of the present narrative review is to provide an in-depth description of how different food literacy competencies are developed in childhood and adolescence, integrating the extensive body of evidence on cognitive, social, and food-related development. Implications for the development of multisectoral strategies to target the multidimensional nature of food literacy and promote the development of the 3 types of competencies (relational, functional, and critical) are discussed.

Willingness for more vegetarian meals in school canteens: Associations with family characteristics and parents' food choice motives in a French community.

The school meal system could contribute to the transition towards more sustainable food system by promoting plant-based meals. Knowing whether parents want more vegetarian school meals for their children is a prerequisite for a successful implementation. The present study aimed to estimate the proportion of parents who would opt for more vegetarian school meals for their children and to study associations of willingness with family characteristics and food choice motives. An online survey was sent to parents whose children are registered for school canteen in Dijon (France). We collected child-level information, data on family sociodemographic characteristics, and data on dietary habits and food choice motives of the family. We examined family characteristics associated with the willingness to increase the frequency of vegetarian school meals from one meal per week to two or daily. Generalized linear models were performed. In total, 49% of parents were willing to opt for a second weekly vegetarian meal and 26% for a daily vegetarian meal for their children (n = 1261). Parents willing to opt for more vegetarian meal were more likely to have higher education, be flexitarian or vegetarian and to currently opt for pork-free meals for their children, and their children attended the school canteen less frequently. Environmental motives were positively associated with the willing to opt for a second weekly vegetarian meal; familiarity and sensory appeal motives were negatively associated. Health and animal welfare motives were positively associated with the willing to opt for a daily vegetarian meal and sensory appeal was negatively associated. Increasing the frequency of vegetarian school meals would satisfy a demand expressed by parents but must be accompanied by interventions enhancing pleasure of eating vegetarian meals.

Hydrolysed proteins in infant formula and child neurodevelopment up to the age of 3·5 years: the nationwide Étude Longitudinale Française depuis l'Enfance (ELFE) birth cohort.

While breast-feeding is the recommended feeding mode in infancy, rates are low in some Western societies, and infants are widely fed formula. France, in particular, shows high rates of infant formula use, including formulas with protein hydrolysates. The degree of protein hydrolysis has previously been associated with neurodevelopmental outcomes. The present study examines the associations between the protein's hydrolysis degree in infant formula and child neurodevelopment up to 3·5 years of age in the French nationwide Étude Longitudinale Française depuis l'Enfance (ELFE study). Parents reported on brand and name of the formula used at 2 months, and protein hydrolysis degree was derived from the ingredient list. Analyses were based on 6979 infants (92·2, 6·8 and 1 % consuming non-hydrolysed, partially and extensively hydrolysed formulas, respectively). Neurodevelopment was assessed at age 1 and 3·5 years with the Child Development Inventory (CDI), at age 2 years with the MacArthur-Bates Communicative Development Inventories and at age 3·5 years with the Picture Similarities sub-scale (British Ability Scales). Associations between protein hydrolysis degree and child neurodevelopment were assessed using linear and logistic regression for overall scores and poor CDI sub-domain scores (<25th centile), respectively. Among formula-fed infants, protein hydrolysis degree in infant formula was not associated with overall neurodevelopmental scores up to 3·5 years. Some associations were found with the motor skills CDI sub-domain, but they were not consistent at 1 and 3·5 years as well as across sensitivity analyses. The use of hydrolysed formula appears safe in terms of overall neurodevelopment, and research should further investigate specific neurodevelopmental domains.

Traffic-light front-of-pack environmental labelling across food categories triggers more environmentally friendly food choices: a randomised controlled trial in virtual reality supermarket.

BACKGROUND: Food systems highly contribute to anthropogenic greenhouse gas emissions and shifting towards more environmentally friendly diets is urgently needed. Enabling consumers to compare the environmental impact of food products at point-of-purchase with front-of-pack labelling could be a promising strategy to trigger more environmentally friendly food choices. This strategy remained to be tested. METHODS: The effect of a new traffic-light front-of-pack environmental label on food choices was tested in a 2-arm randomised controlled trial in a virtual reality supermarket. Participants (n = 132) chose food products to compose two main meals for an everyday meal scenario and for an environmentally friendly meal scenario with or without the label. The environmental label (ranging from A: green/lowest impact, to E: red/highest impact) was based on the Environmental Footprint (EF) single score calculation across food categories. The effect of the label on the environmental impact of food choices in each scenario was tested using linear mixed models. RESULTS: In the everyday meal scenario, the environmental impact of meals was lower in the label condition than in the no label condition (-0.17 ± 0.07 mPt/kg, p = 0.012). This reduction was observed at no nutritional, financial nor hedonic cost. The effectiveness of the label can be attributed to a change in the food categories chosen: less meat-based and more vegetarian meals were chosen with the label. In the environmentally friendly meal scenario, we demonstrated that the label provided new information to the participants as they were able to further reduce the environmental impact of their food choices with the label (-0.19 ± 0.07 mPt/kg, p = 0.005). CONCLUSIONS: Implementing a front-of-pack environmental label on food products in real supermarkets could increase awareness of the environmental impact of food and contribute to drive more environmentally friendly food choices. TRIAL REGISTRATION: The study protocol was pre-registered prior to data collection at Clinicaltrials.gov (NCT04909372).

Identification of three dietary groups in French university students and their associations with nutritional quality and environmental impact.

Introduction: The student period is associated with changes in eating habits, usually leading to diets of lower nutritional quality. However, some variability may exist in students' dietary patterns. We aimed to describe French students' diets and identify dietary groups that may vary in nutritional quality and environmental impact. Methods: A representative sample of French students (N = 582) for age, sex and scholarship status completed an online 125-item food frequency questionnaire. The nutritional quality of diets was assessed by a score of adherence to the French nutritional guidelines (sPNNS-GS2 score, ranging from-17 to 11.5) and its environmental impact by greenhouse gas emissions for an isocaloric diet (GHGE). An ascending hierarchical classification analysis on food and beverage intakes led to three dietary groups. Between-group differences in food consumption, dietary indicators and sociodemographic characteristics were investigated using ANOVA models. Results: The average sPNNS-GS2 score of students' diets was -0.8 ± 2.8, representing a 57% coverage of French nutritional recommendations, and GHGE were 5.4 ± 1.7 kg eCO2/2000 kcal. The three dietary groups were: a healthy diet group (20% of the sample) with the highest nutritional quality and high GHGE, which included older students with a higher level of physical activity; a Western diet group (40%) with the worst nutritional quality and high GHGE, which included more students who lived with their parents; and a frugal diet group (40%) with the lowest energy intake, intermediate nutritional quality, and low GHGE, which included more students who lived alone. Conclusion: None of the dietary groups optimized both nutritional quality and environmental impact simultaneously, which suggests an apparent incompatibility in the student population between these two sustainability dimensions. These findings emphasize the need for tailored public health policies that acknowledge the diversity of student eating patterns and address specific individual barriers to healthy and sustainable diets.

Counseling parents about child feeding: a qualitative evaluation of French doctors and health/childcare professionals' experiences and perception of a brochure containing new recommendations.

BACKGROUND: Parents are crucial in establishing their children's eating habits, and doctors and health/childcare professionals (HCCPs) can provide meaningful and trusted guidance on feeding, especially in the 0-3-year-old period. With the upcoming release of the official brochure containing the new child feeding recommendations in France, this study aims to: (1) assess professionals' practices and perceptions regarding their communication with parents on child feeding and (2) evaluate their perception of the draft of the new brochure. METHODS: A 15-page draft brochure (without pictures) containing updated child feeding recommendations for children 0-3 years old was developed by Santé publique France (the French public health agency). Online semi-structured interviews were conducted with professionals (n = 21), including 13 pediatricians and general practitioners (doctors) and eight healthcare or childcare professionals (HCCPs) two weeks after they were provided with this draft brochure to read. The interview guide was developed and piloted with other professionals (n = 3) prior to these interviews. Interview data were transcribed verbatim and analyzed thematically using an inductive approach. RESULTS: While doctors and HCCPs mostly communicate orally with parents, both acknowledged that the brochure might be a helpful supplement, especially for HCCPs to legitimize their advice to parents. For doctors, giving the brochure to parents may help provide systematic advice and save time during consultations. Professionals serving parents of lower socioeconomic status would prefer a supplement with less text and more illustrations. In general, the messages were perceived to be easily understandable but providing detachable cards to distribute according to the child's age would facilitate information dissemination and might be more useful to parents. Professionals reported that lack of training, the circulation of contradictory information, and language barriers were common challenges. CONCLUSION: French professionals welcomed the new official brochure as a means to spread updated child feeding recommendations. However, this brochure could be modified and specific tools developed to better adapt to professionals' needs of communication with parents and to facilitate the relay of information. Providing updated and consistent information to parents should be considered a priority for public health stakeholders toward increased adherence to new recommendations.

Nutritional quality and greenhouse gas emissions of vegetarian and non-vegetarian primary school meals: A case study in Dijon, France.

Since 2018 in France, national regulation mandates that school canteens serve a weekly vegetarian meal to reduce school canteens' environmental impact in addition to previous regulations imposing nutritional composition guidelines. However, a lunch without meat is often perceived as inadequate to cover the nutritional needs of children. The present study aims to assess the nutritional quality and greenhouse gas emissions (GHGE) of vegetarian and non-vegetarian school meals served in primary schools in Dijon, France. The catering department provided the composition of 249 meals served in 2019. Nutritional content and GHGE were retrieved from national food databases. The portion size of each meal component was the standard portion size recommended by the relevant French authority (GEMRCN). Meals were classified into vegetarian meals, i.e., without meat or fish (n = 66), or non-vegetarian meals (n = 183). The nutritional adequacy of the meals for children aged from 6 to 11 years was estimated using the mean adequacy ratio (MAR/2,000 kcal) as the mean percentage of daily recommended intake for 23 nutrients and the mean excess ratio (MER/2,000 kcal) as the mean percentage of excess compared to the maximum daily recommended value for three nutrients. This analysis of actual school meals shows that both vegetarian and non-vegetarian meals had a similar good nutritional quality with MAR/2,000 kcal of 87.5% (SD 5.8) for vegetarian and of 88.5% (SD 4.5) for non-vegetarian meals, and a MER/2,000 kcal of 19.3% (SD 15.0) for vegetarian and of 19.1% (SD 18.6) for non-vegetarian meals. GHGE were more than twofold reduced in vegetarian compared to non-vegetarian meals (0.9 (SD 0.3) vs. 2.1 (SD 1.0) kgC02 eq/meal). Thus, increasing the frequency of vegetarian meals, by serving egg-based, dairy-based or vegan recipes more frequently, would reduce GHGE while maintaining adequate nutritional quality of primary school meals.

The sweet tooth of infancy: Is sweetness exposure related to sweetness liking in infants up to 12 months of age?

Infants become increasingly exposed to sweet-tasting foods in their first year of life. However, it is still unclear whether repeated exposure to sweet taste is linked to infants' sweetness liking during this period. Making use of data from the OPALINE cohort, this study aimed to examine the link between sweetness exposure and sweetness liking during two important periods in early infant feeding: at the start of complementary feeding (3-6 months) and the transition to the family table (10-12 months). Infants' sweetness exposure was assessed using 7-d food records which were completed by mothers every month (n 312), reporting daily consumption rates of formula/breast milk or complementary food and the type of formula milk and/or complementary foods for each feeding occasion. Infants' sweetness liking was studied in the laboratory at 3, 6 and 12 months of age by assessing their response to a lactose-water solution and the amount drunk of this solution compared with plain water. Linear regressions and structural equation model assessed associations between exposure to and liking for sweetness at 6 and 12 months. Neither at 6 (n 182) nor at 12 months (n 197) was sweetness exposure associated with sweetness liking. While sweetness liking at 3 months was unrelated to liking at 6 months, the latter predicted sweetness liking at 12 months. These findings demonstrate no association between sweetness exposure at 3 to 12 months and liking at 6 and 12 months despite a sharp increase in sweetness exposure in that period. However, sweetness liking at 6 and 12 months was positively associated.

Short- and Mid-Term Impacts of COVID-19 Outbreak on the Nutritional Quality and Environmental Impact of Diet.

Background: Changes in dietary behaviors that occurred at the beginning of the COVID-19 outbreak and in particular during the first national lockdowns have been extensively studied across countries. Beyond the understanding of contextual changes in diets due to a temporary lockdown, it is of interest to study longer-term consequences of the COVID-19 outbreak as sustained changes in diets may have both an impact on population health and the environment. Objectives: This study aimed to examine both short- (after 1 month) and mid-term (after 1 year) impacts of the COVID-19 outbreak on the nutritional quality and environmental impact of diets, and as a secondary objective on food choice motives. Methods: We collected dietary data [food frequency questionnaire (FFQ)] and the importance of nine food choice motives through online questionnaires before, during, and after 1 year of the first lockdown for 524 French participants. Adherence to the French dietary recommendations was estimated using the simplified PNNS-GS2, which scores from -17 to 11.5. Environmental impact of diets was assessed by calculating greenhouse gas emissions in CO2eq/2,000 kcal. Results: We showed a short-term decrease in nutritional quality (-0.26 points on sPNNS-GS2, p = 0.017) and environmental impact (-0.17 kg CO2eq/2,000 kcal, p = 0.004) but this decrease was only temporary, and nutritional quality (-0.01 points on sPNNS-GS2, p = 0.974) and environmental impact (-0.04 kg CO2eq/2,000 kcal, p = 0.472) were not different from their initial values 1 year later. Some of the food choice motives followed the trend of a short-term increase and a mid-term stability (health, natural content, ethical concern, and weight control). On the contrary, we showed both short- and mid-term decreases in convenience, familiarity, and price motives. Conclusion: Changes in diets and motives observed during the first lockdown were mostly temporary. However, we highlighted a sustained decrease in the importance of perceived constraints due to food shopping and food preparation which may suggest a trend toward a more positive perception of food-related activities.

Increasing Parental Knowledge About Child Feeding: Evaluation of the Effect of Public Health Policy Communication Media in France.

Background: Unhealthy eating behaviors are risk factors for non-communicable diseases. Parents largely influence the development of eating behaviors during childhood through their feeding practices. Parental feeding practices in line with recommendations are more likely to turn into healthier outcomes in children. From a public health perspective, it should be first ascertained whether providing parents with recommendations about child feeding is a useful approach for increase parental knowledge. Recently, the French health authorities developed a brochure covering updated child feeding recommendations. The present study aims to evaluate the short-term effects of reading this brochure on parental knowledge about child feeding, distinguishing knowledge accuracy and certainty. Methods: A brochure containing updated child feeding recommendations for 0-3 years old was developed by the French public health agency. A representative sample of French parents (n = 400) was targeted to complete an online questionnaire (T0) comprising 30 statements regarding child feeding. For each statement, parents indicated whether it was true/false and how certain they were of their answer (4-point scale). After receiving and reading the brochure, the same parents completed the same questionnaire 3 weeks later (T1). Accuracy (number of correct answers) and certainty (number of mastered answers: correct answers given with the maximal degree of certainty) were compared at T1 vs. T0 using paired t-tests. Knowledge evolution based on parental age, parity and education level was tested with linear models. Results: A total of 452 parents responded at T0 and T1 and were considered for analysis. Between T0 and T1, the number of correct answers [median 22-25, t(451) = 17.2, p ≤ 0.001] and mastered answers [median 11-17, t(451) = 18.8, p ≤ 0.001] significantly increased. The median of the difference between T1 and T0 was larger for mastered than for correct answers. The observed evolution in knowledge was independent of parental age, parity or education level. Conclusions: A brochure containing child feeding recommendations has the potential to increase the accuracy and, to an even greater degree, the certainty of parental knowledge. This increase was observed even for younger or less educated parents.

Information seeking of French parents regarding infant and young child feeding: practices, needs and determinants.

OBJECTIVE: As part of an update of feeding benchmarks targeting children aged 0-3 years, this study aimed to explore parental perceptions, information-seeking practices and needs concerning infant and young child feeding (IYCF) to design an efficient communication strategy. DESIGN: Participants were recruited using the quota sampling to complete an online survey. Effects of parity, child age, prematurity, parental education and financial situation on parents' responses were evaluated separately. SETTING: France. PARTICIPANTS: A nationally representative sample of 1001 parents of children <4 years. RESULTS: Parents whose child had any medical condition affecting feeding (children with medical condition (CMC), 17 %) were considered separately from healthy children's parents. All the healthy children's parents recognised the importance of IYCF for children's health and growth; however, one-third considered the available advice contradictory and not guilt-free. The most used information sources were healthcare professionals (HCP, 81 %), internet (72 %) and parental networks (63 %). The most influential sources (mean influence ± sd) included HCP (7·7 ± 1·7/10), childcare professionals (7·3 ± 1·8/10) and parental networks (6·9 ± 1·8/10). Parents searched for practical tips for implementing IYCF starting when their child was 5 months old. Differences regarding the type of source used by parents with higher v. lower educations were small. Search strategies differed according to parity or child age but not to prematurity. The CMC parents reported slightly different practices and needs. CONCLUSIONS: Parents receive information from multiple sources, which can lead to confusion when deciding which advice to follow. A public health communication strategy adapted to the current parental needs should target these various sources.

Associations between Infant Dietary Intakes and Liking for Sweetness and Fattiness Sensations in 8-to-12-Year-Old Children.

An exposure to sweetened and fatty foods early in life may be involved in high liking later in life. The objective is to investigate the association between dietary exposure to carbohydrate, sugars and fat in infancy, with liking for sweetness, fattiness and fattiness-and-sweetness sensations at 8-to-12-year-old. Analyses were conducted on 759 French children from the EDEN mother-child cohort. Carbohydrate, sugar or fat intake, being a consumer of added sugars or added fats were assessed at 8 and 12 months using 3-day food records. The liking score (0-10) for the different sensations was assessed through an online child-completed questionnaire. Associations were tested by linear regressions adjusted for main confounders and the interaction with sex was tested. None of the early dietary exposure variables was related to fattiness liking. Carbohydrate intake at 8 months was positively but weakly associated with liking for sweetness-and-fattiness. In girls only, carbohydrate intake at 12 months was positively associated with liking for sweetness. Globally, no marked associations were observed between infant dietary exposure to sweet and fat and liking for sweetness and fattiness in young children. The positive link in girls between early carbohydrate exposure and later liking for sweetness needs to be confirmed in further studies.

The Perceptions and Needs of French Parents and Pediatricians Concerning Information on Complementary Feeding.

Appropriate complementary feeding (CoF) is the key to preventing childhood obesity and promoting long-term health. Parents must be properly informed through the CoF process. Pediatricians have opportunities to interact with parents during the CoF transition and influence parental feeding decisions. They can convey public health nutrition messages to parents. With the release of new CoF recommendations in France in 2019, and from the perspective of their conversion into official public health communication material, the aim of this study was to explore parents' and pediatricians' perceptions and needs regarding information on CoF. Two online surveys were disseminated to gather information on CoF communication and guidance: one for parents (n = 1001, January 2020); one for pediatricians (n = 301, October 2019). The results showed that the importance of CoF for children's healthy growth was well recognized by both parents and pediatricians. Parents acknowledged pediatricians as the most influential source of advice; and pediatricians were aware of their responsibility in counselling parents on CoF. However, pediatricians neglected the fact that parents gave high trust to their personal network when looking for advice. The Internet was a well-recognized source of information according to all. Diverging from what pediatricians considered useful, parents were interested in practical advice for implementing CoF. This study highlights common expectations and points of divergence between parents' needs and pediatricians' perceptions of those needs with regard to CoF information.

Effects of Apple Form on Energy Intake During a Mid-Afternoon Snack: A Preload Paradigm Study in School-Aged Children.

Consuming foods with a form or a texture that requires longer oral processing is a way to decrease food intake. Although this approach is promising for leveraging healthier eating patterns in adults, it has never been explored in children. This study evaluated whether starting a mid-afternoon snack by eating either apple segments or applesauce would modify hunger and subsequent food intake during this meal. Forty-four children (8-10 years old) participated in two videotaped mid-afternoon snacks, during which they received one of the two forms of apple as a food preload followed 10 min later by ad libitum consumption of sweetened cottage cheese. They self-reported their level of hunger throughout consumption, and the weight of cottage cheese consumed was determined at the end of the snack. Children's chewing capabilities and eating traits were parent-reported. Eating a raw apple increased oral exposure time and decreased bite size compared to eating applesauce. However, neither the reported hunger nor consecutive food intake were modified. Regardless of the meal, children eating fast had a higher ad libitum energy intake. The individual eating rate for the cottage cheese was correlated with the eating rate observed for applesauce but not for apple segments, the latter being associated with children's chewing difficulties. This study suggests that the form of a fruit offered at the start of a mid-afternoon snack does not impact food intake; the findings clearly call for more exploration of satiation mechanisms related to food texture properties among children and indicate the need to consider children's oral processing skills.

Supporting strategies for enhancing vegetable liking in the early years of life: an umbrella review of systematic reviews.

BACKGROUND: Many children worldwide do not eat recommended amounts of vegetables. Disliking vegetables is a key factor associated with low intake. OBJECTIVE: This umbrella review synthesized systematic reviews to determine the effectiveness of sensory and behavioral strategies to facilitate liking of vegetables (primary outcome) in young children up to 5 y of age, as key predictors of vegetable intake (secondary outcome). METHODS: Nine databases were searched up to May 2019 (updated in September 2020). Two reviewers independently conducted study screening and selection, data extraction, and assessment of methodological quality using AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews). Eleven reviews (n = 1 rated strong quality, n = 4 moderate quality, n = 6 low/critically low quality) examining 85 primary studies met the review criteria: systematic reviews and meta-analyses of primary studies (any quantitative design) that examined sensory or behavioral strategies on vegetable liking or intake (outcomes reported separately for children ≤5 y). Strategy effectiveness was synthesized into 3 categories based on evidence strength: 1) promising (large and consistent body of moderate quality evidence), 2) emerging (small to moderate body of mixed consistency and quality evidence), and 3) limited (small body of limited consistency and quality evidence). RESULTS: Promising evidence was identified for repeated exposure to a single or a variety of vegetables. Emerging evidence was identified for several strategies that increase familiarity with vegetable flavors (e.g., via exposure in utero and through breast milk, and a "vegetable first" approach to complementary feeding) and/or willingness to try vegetables (e.g., via parental role modeling, nonfood rewards, and vegetable-based story books). CONCLUSIONS: Current evidence supports incorporation of tailored advice into guideline documents for parents and carers to repeatedly expose their children to a variety of vegetables to increase vegetable intake. Ongoing robust research on strategies to facilitate children's liking of vegetables is warranted to strengthen the evidence base underpinning advice for parents and health professionals.