Reducing Visual Differences in Whole Grain Bread Prepared with Hard Red and Hard White Wheat: Application for Sensory Studies.

Consumer taste preference can be influenced by visual preference. To eliminate the influence of visual preference in the sensory evaluation of whole grain wheat, a reproducible method to eliminate color differences between Whole Grain breads prepared from hard white wheat (HWW) and hard red wheat (HRW) was evaluated. Response surface methodology (RSM) was used to match the color of HWW to HRW with the addition of commercially available dye solutions: McCormick black (red #40, yellow #5, blue #1), red (red #40, red #3, yellow #6), and yellow (yellow #5). Bread color was assessed by L* , a* , and b* color parameters according to the CIELAB international system of color measurement. Four replicates of the control and dye treated breads were analyzed. Initial color values for HRW were L* = 56.8 ± 0.40; a* = 8.04 ± 0.44; b* = 21.34 ± 0.46. RSM was used to predict dye addition levels to match color between HWW and HRW. With the addition of black (0.457 µL/mL), red (0.574 µL/mL), and yellow (1.165 µL/mL) dye to HWW, breads could be produced with L* , a* , and b* values of no statistical difference to the HRW (P < 0.05). A timed storage trail demonstrated the need to standardize the time between bread production and feeding studies. Visual bias can hinder assessment of wheat varieties in sensory studies. A reproducible method of dying wheat was developed that can be used to reduce this bias in sensory studies. PRACTICAL APPLICATIONS: The ability to control color variability is a critical tool in determining perceived quality in sensory analysis of breads. In this study, a method to reduce or eliminate visual bias between breads made from different varieties of wheat was developed. This method is applicable to any foods where dye could be added to reduce or eliminate color bias in sensory studies.

Skipping breakfast is associated with lower diet quality in young US children.

BACKGROUND/OBJECTIVES: Breakfast consumption has been shown to impact children's growth and development, but the influence of breakfast skipping on total daily intakes is not known. The purpose of this study was to examine the differences in nutritional intakes and food consumption between children who consume breakfast versus those who do not. SUBJECTS/METHODS: Dietary recall data were assessed for 2-year-old to 5-year-old children (n = 3443) and 6-year-old to 12-year-old children (n = 5147) from NHANES 2005-2012. Dietary intakes and diet quality scores were compared across breakfast consumption and skipping with means and 95% confidence interval. RESULTS: Children who skipped breakfast on the day of intake had significantly lower energy intakes for the total day (5911 vs 6723 kJ) but had greater energy intakes from non-breakfast meals and snacks. Children who skipped breakfast consumed nearly 40% of the day's intake (2332 kJ of 5911 kJ) from snacks, with 586 kJ from snacks as added sugars. Breakfast skipping was also related to significantly lower intakes of fiber, folate, iron, and calcium intakes. Overall diet quality scores, as well as fruit, whole fruit, whole grains, dairy and empty calorie subscale scores were significantly better in children who ate breakfast. CONCLUSIONS: Children who skipped breakfast presented poorer overall diet quality and lower total intakes commonly obtained at breakfast. To address missed opportunities, nutrition professionals should encourage children's consumption of a nutritious breakfast to support overall diet quality.

Contribution of snacks to dietary intakes of young children in the United States.

Nutritional quality of children's diets is a public health priority in the fight against childhood obesity and chronic diseases. The main purpose of this study was to determine contribution of snacks to energy and nutrient intakes and to identify leading snack food sources of energy, total fat, and added sugars amongst young children in the United States. Using the 2005-2012 NHANES data, dietary intakes of 2- to 5-year-old children were analysed from a parent-reported 24-hour dietary recall (n = 3,429). Snacking occasions were aggregated to determine the proportion of total food/beverage intake obtained from snacks, estimate energy, and nutrient intakes, and identify the leading snack food sources of energy, added sugars, and total fat. Nearly all children consumed a snack on the reported day (62% morning, 84% afternoon, and 72% evening). Snacks accounted for 28% of total energy intake, 32% of carbohydrates, 39% of added sugars, and 26% of total fat and dietary fiber intakes for the day. Snacking occasions accounted for 46.6% of all beverages consumed on the reported day. Snacks and sweets food category (i.e., cookies and pastries) were the leading sources of energy (44%), total fat (52%), and added sugars (53%) consumed during snacking occasions. Sweetened beverages (e.g., fruit and sport drinks) contributed 1-quarter of all added sugars obtained from snacks. Snacks contribute considerable amount of energy and nutrients to young children's diets, with a heavy reliance on energy-dense foods and beverages. Targeted interventions are needed to improve the nutritional quality of snacks consumed by young children.

Providers perspectives on self-regulation impact their use of responsive feeding practices in child care.

Supporting children's self-regulation in eating through caregivers' practice of responsive feeding is paramount to obesity prevention, and while much attention has been given to supporting children's self-regulation in eating through parents' responsive feeding practices in the home setting, little attention has been given to this issue in childcare settings. This qualitative study examines childcare providers' perspectives on using responsive feeding practices with young children (2-5years). Individual semi-structured interviews were conducted with providers until saturation was reached. Data was analyzed using thematic analysis. The final sample included 18 providers who were employed full-time in Head Start or state-licensed center-based childcare programs, cared for children (2-5y), and were directly responsible for serving meals and snacks. Providers were primarily (67%) employed in childcare programs that served children from low-income families and received reimbursement for meals and snacks from the US Department of Agriculture's Child and Adult Care Food Program. Three factors emerged that shaped childcare providers' experiences using responsive feeding practices: the providers' perspectives about whether or not young children can self-regulate food intake, their understanding of Child and Adult Care Food Program (CACFP) portion size regulations, and the availability of food at the center where they worked. Future research should examine how childcare providers' understanding of children's ability to self-regulate their food intake, the appropriate use of the CACFP regulations in relationship to serving sizes, and having food available to offer seconds promotes providers' use of responsive feeding practices in center-based childcare programs and children's dietary behaviors.

Implementing the Academy of Nutrition and Dietetics Benchmarks for Nutrition Education for Children: Child-Care Providers' Perspectives.

BACKGROUND: National childhood obesity prevention policies recommend that child-care providers educate young children about nutrition to improve their nutrition knowledge and eating habits. Yet, the provision of nutrition education (NE) to children in child-care settings is limited. OBJECTIVE: Using the 2011 Academy of Nutrition and Dietetics benchmarks for NE in child care as a guiding framework, researchers assessed child-care providers' perspectives regarding delivery of NE through books, posters, mealtime conversations, hands-on learning, and sensory exploration of foods to young children (aged 2 to 5 years). DESIGN: Using a qualitative design (realist method), individual, semistructured interviews were conducted until saturation was reached. PARTICIPANTS/SETTING: The study was conducted during 2012-2013 and used purposive sampling to select providers. Final sample included 18 providers employed full-time in Head Start or state-licensed center-based child-care programs in Central Illinois. MAIN OUTCOME MEASURE: Child-care providers' perspectives regarding implementation of NE. STATISTICAL ANALYSES PERFORMED: Thematic analysis to derive themes using NVivo software. RESULTS: Three overarching themes emerged, including providers' motivators, barriers, and facilitators for delivering NE to children. Motivators for delivering NE included that NE encourages children to try new foods, NE improves children's knowledge of healthy and unhealthy foods, and NE is consistent with children's tendency for exploration. Barriers for delivering NE included that limited funding and resources for hands-on experiences and restrictive policies. Facilitators for delivering NE included providers obtain access to feasible, low-cost resources and community partners, providers work around restrictive policies to accommodate NE, and mealtime conversations are a feasible avenue to deliver NE. Providers integrated mealtime conversations with NE concepts such as food-based sensory exploration and health benefits of foods. CONCLUSIONS: Present study findings offer insights regarding providers' perspectives on implementing NE in child care. Drawing from these perspectives, registered dietitian nutritionists can train providers about the importance of NE for encouraging healthy eating in children, integrating NE with mealtime conversations, and practicing low-cost, hands-on NE activities that meet the food safety standards for state licensing. Such strategies may improve providers' ability to deliver NE in child-care settings.

Engaging Overweight Adolescents in a Health and Fitness Program Using Wearable Activity Trackers.

INTRODUCTION: Our objectives were to (a) examine feasibility and receptivity of overweight adolescents joining a community-based group fitness program and (b) test preliminary efficacy of a 12-week pilot intervention designed to promote health, fitness, and self-efficacy for the identified teens. METHODS: The 12-week fitness program for overweight adolescents was developed and included planned physical activities, nutrition classes, and goal-setting sessions. A one-group pre-/posttest study design evaluated 20 participants from grades 10 through 12 who enrolled in the program pilot study. Participants were given a wearable activity tracker that captured data using an Internet-based platform. Outcome measures included body mass index, screen time, fitness, and cardiovascular measures. RESULTS: A community fitness program for overweight adolescents was successfully implemented. High school students were receptive to the intervention and reported high program satisfaction. Positive effects included measurements of strength, systolic blood pressure, weight, and screen time behaviors. DISCUSSION: This study provides evidence to support the feasibility, acceptance, and preliminary effects of the pilot program with overweight adolescents.

Gaps in international nutrition and child feeding guidelines: a look at the nutrition and young child feeding education of Ghanaian nurses.

OBJECTIVE: To examine the nutrition and young child feeding (YCF) education and training of nurses in public health clinics of Ghana's Komenda-Edina-Eguafo-Abrem region (KEEA) in relation to global health guidelines, and how nurses served as educators for caregivers with children aged 0-5 years. DESIGN: A qualitative study of semi-structured one-on-one and group interviews (n 21) following a questionnaire of closed- and open-ended questions addressing child feeding, nutrition and global health recommendations. Interviews were conducted in English, audio-recorded, transcribed and coded. Descriptive data were tabulated. Content analysis identified themes from open-ended questions. SETTING: KEEA public health clinics (n 12). SUBJECTS: Nurses (n 41) purposefully recruited from KEEA clinics. RESULTS: A model capturing nurses' nutrition and YCF education emerged with five major themes: (i) adequacy of nurses' basic knowledge in breast-feeding, complementary feeding, iron-deficiency anaemia, YCF and hygiene; (ii) nurses' delivery of nutrition and YCF information; (iii) nurses' evaluation of children's health status to measure education effectiveness; (iv) nurses' perceived barriers of caregivers' ability to implement nutrition and YCF education; and (v) a gap in global health recommendations on YCF practices for children aged 2-5 years. CONCLUSIONS: Nurses demonstrated adequate nutrition and YCF knowledge, but reported a lack of in-depth nutrition knowledge and YCF education for children 2-5 years of age, specifically education and knowledge of YCF beyond complementary feeding. To optimize child health outcomes, a greater depth of nutrition and YCF education is needed in international health guidelines.

Engaging Parents to Promote Children's Nutrition and Health.

PURPOSE: Using the Academy of Nutrition and Dietetics benchmarks as a framework, this study examined childcare providers' (Head Start [HS], Child and Adult Care Food Program [CACFP] funded, and non-CACFP) perspectives regarding communicating with parents about nutrition to promote children's health. DESIGN: Qualitative. SETTING: State-licensed center-based childcare programs. PARTICIPANTS: Full-time childcare providers (n = 18) caring for children 2 to 5 years old from varying childcare contexts (HS, CACFP funded, and non-CACFP), race, education, and years of experience. METHODS: In-person interviews using semi-structured interview protocol until saturation were achieved. Thematic analysis was conducted. RESULTS: Two overarching themes were barriers and strategies to communicate with parents about children's nutrition. Barriers to communication included-(a) parents are too busy to talk with providers, (b) parents offer unhealthy foods, (c) parents prioritize talking about child food issues over nutrition, (d) providers are unsure of how to communicate about nutrition without offending parents, and (e) providers are concerned if parents are receptive to nutrition education materials. Strategies for communication included-(a) recognize the benefits of communicating with parents about nutrition to support child health, (b) build a partnership with parents through education, (c) leverage policy (federal and state) to communicate positively and avoid conflict, (d) implement center-level practices to reinforce policy, and (e) foster a respectful relationship between providers and parents. CONCLUSION: Policy and environmental changes were recommended for fostering a respectful relationship and building a bridge between providers and parents to improve communication about children's nutrition and health.

Variety of fruit and vegetables is related to preschoolers' overall diet quality.

Children are encouraged to eat a specific amount of fruits and vegetables to optimize health. The purpose of this study was to assess whether consumption of a variety of fruits and vegetables, respectively, was associated with a greater diet quality among preschool-aged children. Analyses were performed using a cross-sectional, nationally representative sample of US children. Dietary intakes from 24-h dietary recalls of two-five year old children (n = 2595) in 2005-2010 NHANES were examined. Diet quality was evaluated using MyPlate equivalents and the Healthy Eating Index 2010 (HEI-2010). Variety categories were determined based on children's fruit, fruit juice, and vegetable consumption on the recalled day. Differences in diet quality were examined using t-tests. Variety of fruits and vegetables was linked to higher overall diet quality. Children who consumed whole fruit had better diet quality scores for total fruit, whole fruit, whole grains, dairy, seafood, refined grains, sodium, and empty calories (P ≤ 0.018). Significantly higher HEI-2010 scores for total fruit, whole fruit, fatty acids, sodium, and empty calories, but a lower dairy HEI-2010 score, were identified in children who drank fruit juice (P ≤ 0.038). Vegetable consumption was significantly associated with higher total vegetables, greens/beans, and empty calories, but a lower sodium score (P ≤ 0.027). Children who consumed whole fruit, fruit juice and non-starchy vegetables (P ≤ 0.017), but not white potatoes, had significantly higher total HEI-2010 scores. Reinforcing fruit and 100% fruit juice consumption may indirectly support healthier diets among children. However, underlying associations between fruit and vegetable intakes and overall diet quality should be examined further.

A Comparison of College Students' Reported Fruit and Vegetable Liking and Intake from Childhood to Adulthood.

OBJECTIVES: Fruit and vegetable intake (FVI) is below recommendations and fruit and vegetable liking (FVL) is associated with intake. Greater understanding of college student FVL and FVI is needed; therefore, the study objectives were to compare reported FVL and frequency of FVI in adulthood to recollection of FVL and frequency of fruit and vegetable offering (FVO) in childhood and identify factors related to FVL and FVI in college students. METHODS: A retrospective survey was administered via e-mail to randomly selected college students (18-25 years) from 2 Northwestern universities (n = 676). McNemar's chi-square tests were used to evaluate differences in FVL and FVI scores. Spearman's rank identified an association between current FVL and FVI scores and their recollection of FVO as a child. Pearson's chi-square tests were used to examine differences in FVL and FVI scores within the demographic factors age, gender, year in school, urban/rural, body mass index (BMI), childhood overweight, breastfed, and forced to eat fruits or vegetables. RESULTS: FVL was more frequent in adulthood, but college students reported FVO as a child more frequently than their current FVI. Females reported greater FVL and FVI. Upperclassmen and the 21-25 age group reported greater frequency of vegetable liking and intake compared to underclassmen and the 18-20 age group. Lower vegetable liking and fruit intake were reported for those identifying as overweight, and recollection of FVO in childhood was associated with increased FVL and FVI scores in adulthood. Individuals forced by caregivers to eat vegetables as a child reported a lower vegetable liking than those not forced. CONCLUSIONS: FVL increased from childhood to adulthood, demonstrating a progression; however, recollection of childhood offering was higher than FVI in young adulthood. Results indicate a need for behavioral strategies to increase FVI in college students and encourage offering fruit and vegetables but refrain from forcing children to eat vegetables.

Maternal Perceptions Related to Eating and Obesity Risk Among Low-Income African American Preschoolers.

Objectives Health disparities are prevalent in the U.S., with low-income African American children suffering from high rates of obesity and related conditions. Better understanding of parental attitudes and barriers related to healthy eating and obesity risk is needed to suggest more effective intervention foci for this at-risk population. Methods African American caregivers of 3-5 year old children were recruited for focus groups and a questionnaire completion from two Head Start programs in a southeastern state of the U.S. The Social Cognitive Theory was utilized to develop a focus group guide. Focus group recordings were transcribed verbatim and analyzed using the comparative content analysis. Results Eight focus groups (all participants were mothers) yielded the following main themes: (1) general nutrition knowledge but common misconceptions about foods/beverages; (2) beliefs that meals have to include meat and starch and be home-cooked to be healthy; (3) desire to feed children better than their own parents; (4) lack of family support and child pickiness perceived as the greatest barriers to healthy eating; (5) awareness of family history of diseases; and (6) low concern about children's current diet and weight status. Over 25 % of mothers underestimated their child weight status. Conclusions Our findings highlight the importance of understanding maternal perspectives related to food, eating, and weight among low-income African American mothers of preschoolers. Nutrition educators should be aware of misconceptions and recognize that mothers might not perceive diet quality in early childhood as having strong impact on the child's future health and/or obesity risks.

Complementary Feeding Practices of Mothers and Their Perceived Impacts on Young Children: Findings from KEEA District of Ghana.

Objective Appropriate and timely complementary feeding practices are fundamental to a child's growth, health, and development during the first 2 years of life. This study aimed to understand (1) Ghanaian mother's complementary feeding practices, and (2) their perceived and observed impacts of complementary feeding on their children. Methods Ghanaian mothers with children 4-24 months of age were recruited from four communities in the Komenda Edina Eguafo Abrem district in the Central Region of Ghana (n = 99). A qualitative methodological approach with focus group interview discussions was used. Eleven focus group interviews were conducted, and were audio recorded and transcribed. The audio transcriptions were coded and analyzed into pertinent themes, meta-themes, and theoretical concepts. Results Over 80 % (85) of mothers reported poor knowledge about the effects of complementary feeding on their children and 45 % (45) of the children were undernourished, indicating inappropriate complementary feeding practices. Some mothers held misconceptions about the effect of food on children's health. Four overarching themes were identified: (1) mothers' background knowledge about food, child health and growth outcomes, (2) mothers' motivation in feeding their children, (3) barriers to feeding, (4) foods mothers offered their children. Conclusion for Practice Nutrition education on complementary feeding is needed for Ghanaian mothers. Health facilities and community outreach programs could be a venue to provide education to mothers regarding infant and young child feeding practices in Ghana.

Creating potential for common ground and communication between early childhood program staff and parents about young children's eating.

OBJECTIVES: To explore child care staff and parent perspectives and communications about children's eating in child care. DESIGN: Focus groups (FGs) conducted with child care staff and parents. SETTING: Four Western states in the United States. PARTICIPANTS: Thirty-nine child care staff in 7 FGs and 25 parents in 6 FGs. PHENOMENON OF INTEREST: Thoughts and concerns about children's eating and opportunities to improve communication between staff and parents. ANALYSIS: Content analysis (FG coding inter-rater reliability: staff = 0.74; parents = 0.81) and identification of meta-themes. RESULTS: Three meta-themes were identified: (1) recognition of positive influences of the child care setting in children's development of healthy eating; (2) concerns about children's eating in child care and at home; and (3) strategies to improve communications and transactions related to children's eating. CONCLUSIONS AND IMPLICATIONS: Staff reported that their roles included informing parents about food at mealtimes in child care (eg, menus, recipes) but also educating parents about child nutrition and feeding. Parents valued daily information about their child's eating to adjust home mealtimes and to feel connected to their child. Barriers to effective communication included limited time and concerns regarding parent reactions and defensiveness. Staff requested training about child nutrition and feeding and about sensitive communications with parents.

Child Care Mealtime and Active Play Partnerships (Child Care MAPP): evaluation of a training resource Web site for enhancing nutrition education communication.

The communication component of the Child Care MAPP Web site was designed according to an established theoretical base, and was critically reviewed. The communication materials were targeted for use by trainers who educate child care providers, and may be incorporated into higher education curricula to guide nutrition educators who will be working in child nutrition and child feeding programs. Evaluation of the impact of the communication materials on a group of trainers demonstrated a significant increase in participant confidence to communicate about nutrition. In particular, the child- and adult-centered phrases developed as a novel and developmentally appropriate approach to nutrition education were evaluated by respondents as useful, and were found to increase confidence to communicate with children. Future research should further examine the use of child-centered and adult-centered nutrition phrases in nutrition education and higher education, to determine whether the way in which adults talk with children improves children's knowledge about nutrition, and whether use of the phrases can positively affect children's nutrition behaviors.

Kindergarteners' entrée intake increases when served a larger entrée portion in school lunch: a quasi-experiment.

BACKGROUND: The influence of portion size on children's intake and self-regulation of food has gained attention; however, few studies have examined portion sizes in school lunch. This study investigated kindergarteners' intake when they were given different entrée portion sizes from the lunch menu. METHODS: Plate waste was used as a proxy to measure intake. A standardized lunch of chicken nuggets, rice, green beans, applesauce, and milk was served every Tuesday for 5 consecutive weeks at a Kinder Center. All menu items and the self-selection of 2, 3, or 4 nuggets were served the first week as a pilot. In the second and fourth weeks, trained servers preportioned kindergarteners' plates with 4 nuggets. In the third and fifth weeks, kindergarteners verbally self-selected 2, 3, or 4 chicken nuggets. A Mann-Whitney test was used to determine a significant difference in intake between the 2 days kindergarteners were allowed to select the portion size and the 2 days they were preportioned. RESULTS: A significant difference (p < .009) in intake was found between the self-selection of entrée portion size and the preportioned entrée regardless of sex or whether kindergarteners attended the am or pm session. No significant difference was found in milk, fruit, vegetable, or rice intake between choice and nonchoice lunches. In this study, kindergarteners ate more chicken nuggets when they were offered a larger portion size. CONCLUSIONS: Further investigation is needed on the impact of letting kindergarteners self-select portion sizes, and the potential negative outcomes of larger portion sizes on children's caloric consumption in elementary schools.

Six characteristics of nutrition education videos that support learning and motivation to learn.

OBJECTIVE: To identify characteristics in nutrition education video vignettes that support learning and motivation to learn about feeding children. METHODS: Nine focus group interviews were conducted with child care providers in child care settings from 4 states in the western United States: California, Idaho, Oregon, and Washington. At each focus group interview, 3-8 participants (n = 37) viewed video vignettes and participated in a facilitated focus group discussion that was audiorecorded, transcribed, and analyzed. RESULTS: Primary characteristics of video vignettes child care providers perceived as supporting learning and motivation to learn about feeding young children were identified: (1) use real scenarios; (2) provide short segments; (3) present simple, single messages; (4) convey a skill-in-action; (5) develop the videos so participants can relate to the settings; and (6) support participants' ability to conceptualize the information. CONCLUSIONS AND IMPLICATIONS: These 6 characteristics can be used by nutrition educators in selecting and developing videos in nutrition education.

How much is enough? Tablespoon per year of age approach meets nutrient needs for children.

BACKGROUND: Adults often ask health professionals for guidance on offering the appropriate serving sizes for young children and little research is available on whether serving size approaches meet children's nutrient needs. OBJECTIVE: Determine whether three serving size approaches for young children meet dietary standards for nutrient adequacy. DESIGN: We examined nutrient contents of three serving size approaches for children ages 2-5 years of age: 1 tablespoon per year of age (T/y), MyPyramid, and Child and Adult Care Food Program. Nutrient content of the three approaches were compared to the Estimated Energy Requirements (EER), Estimated Average Requirement (EAR), or Adequate Intake (AI) for each year of age for males and females; Analysis of Variance identified differences in nutrient content among the three approaches. RESULTS: Young children's nutrient requirements were met for most nutrients by all approaches. However, the recommendation for vitamin E, potassium, and fat were not met by any approach, for any year, for either girls or boys. Energy content of the T/y serving size approach was below the EER for each year of age and for both sexes but still met minimal vitamin and mineral needs. CONCLUSION: Health professionals can feel comfortable using any of the three approaches. However, the T/y approach is a more graduated serving size approach, may be more consistently age appropriate for young children, and may be implemented more easily by adults.

"Are you done?" Child care providers' verbal communication at mealtimes that reinforce or hinder children's internal cues of hunger and satiation.

OBJECTIVE: To explore the verbal communication of child care providers regarding preschool children's internal and non-internal hunger and satiation cues. METHODS: Video observation transcripts of Head Start staff (n=29) at licensed child care centers in Colorado, Idaho, and Nevada were analyzed for common themes. RESULTS: Adults' verbal communication with children at mealtimes emphasized non-internal cues: (1) cueing children to amounts without referencing children's internal cues; (2) meal termination time; (3) asking children if they wanted more without referencing their internal cues; (4) asking children if they were done without referencing their internal cues; (5) telling children to take, try, eat, or finish food; (6) praising children for eating; and (7) telling children about food being good for you. Adults demonstrated an overriding effort to get children to eat. CONCLUSIONS AND IMPLICATIONS: Training needs to be developed that gives specifics on verbally cueing young children to their internal hunger and satiation cues.