How to reduce parental provision of unhealthy foods to 3- to 8-year-old children in the home environment? A systematic review utilizing the Behaviour Change Wheel framework.

BACKGROUND AND OBJECTIVE: The effectiveness of obesity prevention interventions to improve children's diet can be enhanced. Deconstructing past interventions can identify components with potential to change behaviour. This systematic review using the Behaviour Change Wheel aimed to examine the behaviour change content of interventions supporting parents of 3- to 8-year olds to reduce provision of unhealthy foods to children. METHODS: Ebscohost, Ovid, Scopus and Web of Science were searched. Eligible studies included controlled interventions with active parent involvement, at least one intervention strategy and outcome measure for unhealthy foods ≥3 months from baseline. Seventeen interventions were included describing 18 intervention arms. RESULTS: Interventions frequently targeted parents' reflective motivation (n = 17) and psychological capability (n = 15), through education (n = 15) or enablement (n = 15) intervention functions and service provision (n = 18) policy category. Only 24 of the 93 behaviour change techniques were used with an average of five techniques used per intervention. CONCLUSIONS: Existing interventions achieving small reductions in unhealthy food intake are homogenous in approach. There is potential to utilize untapped behaviour change techniques, through comprehensive intervention design and behavioural analysis guided by the Behaviour Change Wheel. Interventions targeting opportunity through persuasion, modelling or environmental restructuring, and using different policy categories are urgently needed to provide an evidence base to inform policy and practice.

Validity of short food questionnaire items to measure intake in children and adolescents: a systematic review.

BACKGROUND: Short food questions are appealing to measure dietary intakes. METHODS: A review of studies published between 2004 and 2016 was undertaken and these were included in the present study if they reported on a question or short item questionnaire (≤50 items, data presented as ≤30 food groups) measuring food intake or food-related habits, in children (aged 6 months to 18 years), and reported question validity or reliability. Thirty studies met the inclusion criteria. RESULTS: Most questions assessed foods or food groups (n = 29), with the most commonly assessed being fruit (n = 22) or vegetable intake (n = 23), dairy foods and discretionary foods (n = 20 studies each). Four studies assessed food habits, with the most common being breakfast and meal frequency (n = 4 studies). Twenty studies assessed reliability, and 25 studies determined accuracy and were most commonly compared against food records. Evaluation of question performance relied on statistical tests such as correlation. CONCLUSIONS: The present study has identified valid and reliable questions for the range of key food groups of interest to public health nutrition. Questions were more likely to be reliable than accurate, and relatively few questions were both reliable and accurate. Gaps in repeatable and valid short food questions have been identified that will provide direction for future tool development.

Short communication: a food-systems approach to assessing dairy product waste.

Concern about world population increase, food security, and the environmental burdens of food production have made food-waste reduction a social and environmental priority. In this context, the quantification of dairy product waste is especially difficult due to the varied means of disposal, by solid and liquid waste streams, and due to inclusion as an ingredient in many processed foods. In this study, food intake data from the Australian National Nutrition Survey (>13,000 participants; >4,500 food items) were disaggregated into basic foods and total national dairy product intake was expressed in whole-milk equivalents. This result was compared with total domestic milk supply, indicating a level of waste of 29% for dairy products in the Australian food system. With national food-waste reduction targets becoming increasingly common, reliable estimates of food waste at the national scale are important for goal setting, baseline reporting, and performance monitoring. For this purpose, the systems approach to assessing food waste demonstrated in this project is deemed to have advantages over other common methods of food-waste assessment, such as bin audits, waste diaries, and surveys.

The impact of replacing regular- with reduced-fat dairy foods on children's wider food intake: secondary analysis of a cluster RCT.

BACKGROUND/OBJECTIVES: The effect of changing one aspect of diet needs to be considered within the context of total diet. The study aim was to evaluate the changes in children's overall food intake following replacement of regular-fat with reduced-fat dairy foods. SUBJECTS/METHODS: Secondary analysis of a cluster Randomized Controlled Trial where families were received parental behavioral nutrition education to change to reduced-fat dairy foods (intervention) or reduce screen time (comparison control). Food intake was assessed via multiple 24-h recalls at baseline, week 12 (end of the intervention) and week 24. Participants were parents and their children (4-13 years, N=145) who were regular-fat dairy food consumers. The intervention effect was based on mixed model analysis adjusted for covariates, and baseline food intake. RESULTS: At week 24, total dairy servings per day were similar between groups and servings of reduced-fat dairy foods were higher in the intervention group (0.8 servings per day 95% confidence interval (CI) 0.5-1.1, P<0.0001). Fruit intake was higher in the intervention group (0.5 servings per day 95% CI 0.02-0.9, P=0.040), with no other statistically significant differences in food intake. In the intervention group, the contribution of core food groups to saturated fat intake was 45% at baseline and 31% at week 24, with 'extra foods' being the largest contributor to total energy (28%) and saturated fat (40%) intake at follow-up. CONCLUSIONS: Changing children's dairy food choices to reduced-fat varieties did not adversely affect overall food intake. Replacing energy-dense foods with nutrient-rich foods should be the focus of interventions to lower in saturated fat.

Interventions that involve parents to improve children's weight-related nutrition intake and activity patterns - what nutrition and activity targets and behaviour change techniques are associated with intervention effectiveness?

Parent involvement is an important component of obesity prevention interventions. However, the best way to support parents remains unclear. This review identifies interventions targeting parents to improve children's weight status, dietary and/or activity patterns, examines whether intervention content and behaviour change techniques employed are associated with effectiveness. Seventeen studies, in English, 1998-2008, were included. Studies were evaluated by two reviewers for study quality, nutrition/activity content and behaviour change techniques using a validated quality assessment tool and behaviour change technique taxonomy. Study findings favoured intervention effectiveness in 11 of 17 studies. Interventions that were considered effective had similar features: better study quality, parents responsible for participation and implementation, greater parental involvement and inclusion of prompt barrier identification, restructure the home environment, prompt self-monitoring, prompt specific goal setting behaviour change techniques. Energy intake/density and food choices were more likely to be targeted in effective interventions. The number of lifestyle behaviours targeted did not appear to be associated with effectiveness. Intervention effectiveness was favoured when behaviour change techniques spanned the spectrum of behaviour change process. The review provides guidance for researchers to make informed decisions on how best to utilize resources in interventions to support and engage parents, and highlights a need for improvement in intervention content reporting practices.