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.

Bringing down barriers to children's healthy eating: a critical review of opportunities, within a complex food system.

This narrative review revises the scientific evidence of recent years on healthy eating in children and adolescents, making sense of promising avenues of action, from a food system perspective. A conceptual framework is provided to better understand how eating habits of children and adolescents are shaped to identify key multisectoral approaches that should be implemented to promote healthier diets. The following influencing factors are discussed: individual factors (physiological and psychological factors, food preferences and food literacy competencies), factors within the personal and socio-cultural food environments, external food environments, and the supply chain. In each section, the main barriers to healthy eating are briefly discussed focussing on how to overcome them. Finally, a discussion with recommendations of actions is provided, anchored in scientific knowledge, and transferable to the general public, industry, and policymakers. We highlight that multidisciplinary approaches are not enough, a systems approach, with a truly holistic view, is needed. Apart from introducing systemic changes, a variety of interventions can be implemented at different levels to foster healthier diets in children through fostering healthier and more sustainable food environments, facilitating pleasurable sensory experiences, increasing their food literacy, and enhancing their agency by empowering them to make better food related decisions. Acknowledging children as unique individuals is required, through interpersonal interactions, as well as their role in their environments. Actions should aim to enable children and adolescents as active participants within sustainable food systems, to support healthier dietary behaviours that can be sustained throughout life, impacting health at a societal level.

Where is the father? Challenges and solutions to the inclusion of fathers in child feeding and nutrition research.

Despite an increasing acknowledgement of fathers' involvement in and impact on children's lives, fathers remain underrepresented in child feeding and childhood obesity prevention research, interventions, and actions. Built on our own experiences with conducting research with fathers and recent evidence on this topic, this Research in Practice article has three aims. It will first substantiate the importance of including and studying fathers in the field of child feeding and childhood obesity prevention based on recent study results. Secondly, the article will present and discuss barriers to fathers' inclusion and participation (why isn't it happening?), among other issues, by drawing on sociological and gender ideological insights. Finally, it will provide recommendations and suggestions related to recruitment, focus and methods that can facilitate fathers' involvement in future research, interventions, and practice. Taken together, this article aims to provide tools for giving fathers a voice in the field of child nutrition and by doing so, to decrease maternal-only "burden" of care. We hope our experiences and theoretical reflections will inspire and support researchers and practitioners to be as successful as possible in the realm of family care.

Why do preconception and pregnancy lifestyle interventions show little evidence of success in preventing overweight and obesity in children? A scoping review.

BACKGROUND: Adverse lifestyle factors in the periconception and early life period, including high maternal prepregnancy BMI and excessive gestational weight gain, are important risk factors for childhood obesity. Early prevention is key, but results from systematic reviews of preconception and pregnancy lifestyle interventions have shown mixed success in improving children's weight outcomes and adiposity. We aimed to investigate the complexity of these early interventions and process evaluation components and authors' statements to improve our understanding regarding their limited success. METHODS: We did a scoping review, guided by frameworks of the Joanna Briggs Institute and Arksey and O'Malley. Eligible articles (with no language restriction) were identified between July 11 and Sept 12, 2022, by searching PubMed, Embase, and CENTRAL; consulting previous reviews; and conducting CLUSTER searches. A thematic analysis was conducted with NVivo in which process evaluation components and authors' interpretations were coded as reasons. Intervention complexity was evaluated with the Complexity Assessment Tool for Systematic Reviews. FINDINGS: 40 publications corresponding to 27 eligible preconception or pregnancy lifestyle trials with child data beyond age 1 month were included. Most interventions started during pregnancy (n=25) and focused on multiple lifestyle factors (eg, diet and exercise). The preliminary results show that almost no interventions involved the participants' partner or social network. Potential reasons for limited success in the interventions preventing overweight or obesity in children included the start time of the intervention, duration and intensity, and sample size or dropout rates. The results will be discussed with an expert group as part of a consultation stage. INTERPRETATION: The results and discussions with an expert group are expected to uncover gaps and inform the design or adaptation of future interventions and approaches to potentially increase success rates in preventing childhood obesity. FUNDING: Funded by the Irish Health Research Board through the transnational JPI HDHL ERA-NET HDHL-INTIMIC-2020 call (PREPHOBES): EU Cofund action (number 727565; EndObesity project).

Poor conceptual knowledge in the food domain and food rejection dispositions in 3- to 7-year-old children.

Previous research established that children with poorer taxonomic knowledge in the food domain display increased levels of food rejection. However, the food domain heavily lends itself to script and thematic conceptual knowledge (e.g., pancakes at breakfast), to which young children already attend. This series of studies investigated the development of conceptual knowledge, specifically in the food domain, and the link with food rejection. Study 1 used a nonconflicting triad task testing children's knowledge of four subtypes of script and thematic associations (food-food pairs, food-utensil pairs, event scripts, and meal scripts) with children aged 3-6 years living in the United States (18 males and 14 females). Study 2 employed the same design along with a measure of food rejection in 3- to 6-year-olds living in France (67 males and 62 females). There was significant conceptual development in both groups, but thematic food concepts are acquired earlier than meal script concepts. Study 3 investigated the link between thematic and script cross-classification and food rejection in 39 females and 33 males living in France (4- to 7-year-olds). Results demonstrate that children as young as 3 years old are already attending to thematic and script structures to inform food-based decision making. Even more critically, Study 3 showed that increased food rejection tendencies are negatively related to script and thematic understanding in the food domain. Such seminal studies illustrate the importance of conceptual knowledge in children's interpretation and acceptance of food, highlighting promising avenues for knowledge-based interventions to foster dietary variety.

Why do preconception and pregnancy lifestyle interventions demonstrate limited success in preventing overweight and obesity in children? A scoping review protocol.

Adverse family-based lifestyle factors in the preconception period, pregnancy and early-childhood are major risk factors for childhood obesity and there is a growing consensus that early life interventions to prevent overweight and obesity in children are required. However, results from recent systematic reviews of preconception and pregnancy interventions have demonstrated mixed success. Therefore, this protocol presents a study aiming to summarise and evaluate complex preconception and pregnancy intervention components, process evaluation components, and authors' statements, with a view to improving our understanding regarding their success and informing design or adaptation of more effective interventions to prevent childhood obesity. A scoping review will be conducted, using the frameworks of the JBI and Arksey and O'Malley. A two-step approach will be used to identify relevant literature: (1) systematic searches will be conducted in the databases PubMed, Embase and CENTRAL to identify all eligible preconception and pregnancy trials with offspring data; and (2) CLUSTER searches will be conducted to find linked publications to eligible trials (follow-ups, process evaluation publications). Two researchers will independently select studies, chart, and synthesise data. A qualitative thematic analysis will be performed in which statements related to process evaluation components and authors' interpretations will be coded as "reasons". A descriptive analysis will be performed to evaluate intervention complexity using a complex intervention framework (AHRQ series; Medical Research Council guidance). The results of this study, which will be discussed with an expert group as part of a consultation stage, aim to identify gaps and inform the design or adaptation of future preconception and pregnancy interventions and approaches to potentially increase success rates. We expect that our results, which will be submitted for publication in a peer-reviewed journal, will be of interest to researchers, families, and practitioners concerned with good preconception and prenatal care, and healthy child outcomes.

Parental feeding practices and parental involvement in child feeding in Denmark: Gender differences and predictors.

Studies about fathers and feeding are scarce and little is known about predictors of parental involvement in child feeding and of paternal feeding practices. Therefore, this study aimed to examine possible differences between Danish mothers and fathers with regard to their feeding practices and involvement in feeding related tasks, and to assess possible parent-related predictors of parental practices and involvement. A total of 261 mothers and 321 fathers of pre-schoolers completed an online survey with items from validated questionnaires. Gender differences were observed; fathers reported using higher levels of coercive control practices, while mothers reported using higher levels of structure practices and autonomy support practices. Both mothers and fathers reported to be highly involved in feeding their child. Regressions showed that a higher concern for child weight and a higher motivation for child preference when buying food were linked to a higher use of coercive control practices while a higher motivation for health control when buying food, cooking confidence, feeding/general self-efficacy and perceived responsibility for feeding were linked to a higher use of structure and autonomy support practices. The results of this study provide valuable insight into maternal and paternal practices in Denmark and their determinants.

Young Children's Eating in the Absence of Hunger: Links With Child Inhibitory Control, Child BMI, and Maternal Controlling Feeding Practices.

This study aimed to gain a better understanding of the associations between young children's eating in the absence of hunger (EAH), inhibitory control, body mass index (BMI) and several maternal controlling feeding practices (food as reward, restriction for health, restriction for weight control). In addition, to more properly assess the relationship between children's and maternal variables, the link between EAH and restriction was explored separately in two directionalities: "child to parent" or "parent to child." To do this, mothers of 621 children aged 2.00-6.97years (51% boys, M=4.11years, SD=1.34) filled in a questionnaire with items from validated questionnaires. Structural equation modeling (SEM) was used to analyze the data. The results showed, whatever the directionality considered, a positive association between children's eating in the absence of hunger and their BMI z-scores. Restriction for health and restriction for weight control were differently linked to EAH and to children's BMI z-scores. Namely, low child inhibitory control, food as reward and restriction for health were identified as risk factors for EAH. Restriction for weight control was not linked to EAH, but was predicted by child BMI z-scores. Interventions aiming to improve children's abilities to self-regulate food intake could consider training children's general self-regulation, their self-regulation of intake, and/or promoting adaptive parental feeding practices.

How Do French Parents Determine Portion Sizes for Their Pre-Schooler? A Qualitative Exploration of the Parent-Child Division of Responsibility and Influencing Factors.

Large portion sizes can make children overeat, alter their self-regulation abilities and induce weight gain. However, little is known about how parents determine portion sizes for their children. Using semi-structured interviews with 5 fathers and 32 mothers of pre-schoolers, this study examined French parents' food portioning practices. The division of responsibility between parent and child in deciding portion sizes was explored, as well as the influencing factors and possible sources of information. Parents described a wide range of practices. For most, determining portion sizes is an intuitive action that depends on habits and mainly arises from experiences with feeding their child and his/her appetitive traits. Few parents grant autonomy to their child for portioning and serving food, especially for the first serving. Many influencing factors were identified, including child-related (e.g., appetite, food preferences), parent-related (e.g., avoiding food waste), and external factors (e.g., influence of siblings, French food culture). Most parents do not search for information/recommendations to guide their practices. Stimulating optimal self-regulation of eating in children is important and parents can play a crucial role in this. This study identified barriers and facilitators to guide parents in providing appropriate portion sizes and help include children in this decision process.

Are food parenting practices gendered? Impact of mothers' and fathers' practices on their child's eating behaviors.

Past research has mainly focused on the links between child eating behaviors and maternal food practices. The impact of fathers and of concordant/discordant food parenting practices within families has received much less attention. To fill this gap, both parents of 105 French children aged 2.01-6.51 years (54 boys, Mage = 3.88 years, SD = 1.40) filled in a survey with items from validated questionnaires. Results showed that fathers and mothers perceived their child's eating behaviors in similar ways (Pearson correlations between 0.34 and 0.78; M = 0.60), despite mothers taking significantly more meals with their child than fathers. Fathers reported using significantly more pressure to eat and food as reward, but reported lower levels of "family meal setting" than mothers. Moderate to high correlations were observed between mothers' and fathers' feeding practices and styles. Regression analyses showed that both maternal and paternal practices and styles were predictors for child eating behaviors. One interaction effect was observed: in households where both parents used higher levels of pressure to eat, the child showed a significantly lower food enjoyment than expected if the effects were additive. Our findings underline the importance of studying the individual role of each parent in child feeding research and that both parents within families should avoid using coercive practices. This could finally stimulate new interventions and recommendations addressed to both parents.

Child eating behaviors, parental feeding practices and food shopping motivations during the COVID-19 lockdown in France: (How) did they change?

The COVID-19 pandemic caused France to impose a strict lockdown, affecting families' habits in many domains. This study evaluated possible changes in child eating behaviors, parental feeding practices, and parental motivations when buying food during the lockdown, compared to the period before the lockdown. Parents of 498 children aged 3-12 years (238 boys; M = 7.32; SD = 2.27) completed an online survey with items from validated questionnaires (e.g., CEDQ, CEBQ, HomeSTEAD). They reported on their (child's) current situation during the lockdown, and retrospectively on the period before the lockdown. Many parents reported changes in child eating behaviors, feeding practices, and food shopping motivations. When changes occurred, child appetite, food enjoyment, food responsiveness and emotional overeating significantly increased during the lockdown. Increased child boredom significantly predicted increased food responsiveness, emotional overeating and snack frequency in between meals. When parents changed their practices, they generally became more permissive: less rules, more soothing with food, more child autonomy. They bought pleasurable and sustainable foods more frequently, prepared more home-cooked meals and cooked more with the child. Level of education and increased stress level predicted changes in parental practices and motivations. This study provides insights in factors that can induce positive and negative changes in families' eating, feeding and cooking behaviors. This can stimulate future studies and interventions.