Examination of eating competence in a geo-diverse sample with metabolic syndrome.

Eating competence (EatC) is an intra-individual approach to eating attitudes and behaviors associated with greater well-being. EatC research has not included persons with confirmed metabolic syndrome (MetS). Therefore, EatC of persons with MetS was explored to identify unique associations and inform implementation of MetS lifestyle interventions using baseline data from a multisite, randomized trial of a 2-year lifestyle intervention with MetS. EatC, measured with the Satter Eating Competence Inventory 2.0 (ecSI 2.0™), was examined for relationships with bioclinical measures (e.g., blood pressure, lipids), medication use, BMI, waist circumference, fruit/vegetable intake, and psychosocial factors, (e.g., stress, mindfulness). Data were collected in person and video call by trained research personnel. EatC was examined as a continuous score and as a categorical variable with ecSI 2.0™ scores ≥ 32 considered eating competent. Participants (n = 618) were predominantly female (76%), White (74%), college educated (60%). Mean age was 55.5 ± 11 y. Mean ecSI 2.0™ was 29.9 ± 7.4 and 42% were eating competent. EatC was greater for males, persons who were older and food secure. Competent eaters (vs. non-eating competent) had lower waist circumference (112.7 ± 12.5 cm vs.116.8 ± 16.0 cm; P < 0.001) and BMI (35.0 ± 6.1 vs. 37.5 ± 7.3; P < 0.001). Serum triglycerides, HDL-cholesterol, fasting blood glucose, HbA1c, and blood pressure did not differ by EatC status. Compared to non-eating competent persons, competent eaters perceived less stress, were more mindful, indicated better physical function, and more habitual vegetable intake (all P < 0.001) and sensory awareness (P < 0.05). EatC in MetS paralleled the non-MetS profile. EatC was associated with a healthier psychosocial profile, waist circumference and BMI. Findings support further research to examine the mediational or moderating influence of EatC in the treatment of MetS.

The sDOR.2-6y™ Is a Valid Measure of Nutrition Risk Independent of BMI-for-Age z-Score and Household Food Security Status in Preschool Aged-Children.

Parents' feeding practices are a function of child eating behaviors, health, and other factors. Adherence to the Satter Division of Responsibility in Feeding (sDOR) model has not been examined relating to child BMI, household food security, or child eating behavior. This study evaluates the adherence to sDOR in relation to child eating behavior, nutrition risk, BMI-for-age, dietary intake, and food security. Ninety-one parent-child (3 to <6 years) dyads completed a cross-sectional asymmetric survey in August-November 2019; n = 69 parents from the original sample completed additional and retrospective questions in June 2021. Main outcomes included sDOR adherence (sDOR.2-6y™), a Child Eating Behavior Questionnaire (CEBQ), nutrition risk (NutriSTEP®), the USDA 6-item screener, the Block Kids Food Screener, and eating competence (ecSI 2.0™). The children's weight and height were investigator-measured. Associations were tested with Pearson's r and Chi Square for continuous and categorical variables, independent sample t-test, one-way ANOVA, or Mann-Whitney U compared means. The dietary comparisons used Spearman's rho correlation coefficient. sDOR adherence was associated with a lower nutrition risk (r = 0.26, p = 0.03) and showed convergent validation with child eating behavior for three child eating behavior (CEBQ) constructs. sDOR.2-6y™ was not related to the child BMI-for-age z-score (r = 0.11, p = 0.39, n = 69). NutriSTEP® was associated with dietary quality and higher ecSI 2.0TM (r = 0.32, p = 0.008, n = 69). No associations between sDOR.2-6y™ and food security or dietary intake were noted.

Fuel for Fun Process Evaluation Reveals Strong Implementation and Approval with Varied Parent Engagement.

OBJECTIVE: To describe the implementation and process characteristics of Fuel for Fun: Cooking with Kids Plus Parents and Play (FFF). DESIGN: Mixed methods. SETTING: Elementary schools in 2 Northern Colorado school districts. PARTICIPANTS: Fourth graders (aged 9-11 years), parents, school staff, and implementation researchers; measured over 2 consecutive years in 8 schools (851 students, 45 classrooms). INTERVENTION(S): Social Cognitive and active learning theory-based classroom cooking with tasting lessons, active recess games, cooking with tasting food promotion during school lunch, family nights, and take-home intervention reinforcements. A 7-month program delivered by a trained intervention team. MAIN OUTCOME MEASURE(S): Implementation measures (observations and debriefings) assessed context, reach, dose delivered, fidelity, and dose received; process measures (surveys) assessed student and parent perceptions and intervention participation. ANALYSIS: Descriptive statistics for quantitative and themes for qualitative data. RESULTS: Minor adjustments in program delivery plans were required to accommodate changes in school schedules and policies. Process measures demonstrated > 90% achievement of goals for nearly all child-centered activities. One-quarter of eligible families participated in evening events, with strong parent and student approval. Fifty out of 116 parents (43%) completing an online survey reported preparing ≥ 1 of 5 recipes with their child. Fifty-nine percent of eligible students completed >1 of 10 take-home activity sheets with their parents. CONCLUSIONS AND IMPLICATIONS: Engagement and commitment of the intervention team and school staff supported strong implementation. Participant responses were positive, but improvement in parent engagement requires investigation.

Fourth-Grade Cooking and Physical Activity Intervention Reveals Associations With Cooking Experience and Sex.

OBJECTIVE: Examine the impact of Fuel for Fun: Cooking with Kids Plus Parents and Play (FFF) on children's culinary self-efficacy, attitude, fruit and vegetable (FV) preferences, physical activity (PA), and body mass index. DESIGN: Randomized controlled trial. SETTING: Eight elementary schools in 2 Northern Colorado districts. PARTICIPANTS: Fourth-grade students; 7-month interventions: school (S.FFF)-theory-based cooking + tasting lessons, active recess, lesson-driven cafeteria promotions; or school + family (S+F.FFF) with added family nights and home activities. MAIN OUTCOME MEASURE(S): Cooking self-efficacy and attitudes, FV preferences, PA, and measured height/weight. ANALYSIS: Individual outcomes nested by classroom, school, and district and assessed > 12 months with repeated measures controlled by sex and baseline cooking experience, with a significance level of P < 0.05. RESULTS: The sample included 1,428 youth, 38 teachers, 4 cohorts, 50% boys, 75% White, and 15% Hispanic. No intervention effect was observed. Those who cooked retained higher self-efficacy, attitude, and FV preferences (P < 0.001). Girls reported higher self-efficacy and attitude than boys. Moderate-to-vigorous PA and metabolic equivalent minutes increased for all students; boys retained higher levels (P < 0.001). Body mass index percentile remained stable. CONCLUSIONS AND IMPLICATIONS: Cooking and sex were associated with all outcome measures and should be considered for intervention tailoring. Treatment impacts were not evident nesting by classroom, school, and district. Accurate assessment of school-based interventions requires rejecting student independence from group assignment assumptions.

Changes in Depressive Symptoms, Perceived Stress, and Food Security Among Study Participants With Metabolic Syndrome During a COVID-19-Mandated Research Pause.

INTRODUCTION: We explored how depressive symptoms, perceived stress, and food security of people with metabolic syndrome (MetS) changed during the COVID-19 pandemic. METHODS: An online survey was administered from October 2019 through March 2020, to participants in a 2-year lifestyle intervention trial to reverse MetS; the survey was repeated during the COVID-19 pandemic. Outcomes were a change in depressive symptoms, perceived stress, and food security as measured by the Patient Health Questionnaire-8 (PHQ-8), Perceived Stress Scale, and US Department of Agriculture's 10-item Adult Food Security Module. We analyzed changes in outcomes with measures of association, paired t tests, repeated measures, and independent t tests. RESULTS: Survey respondents (N = 132) were mostly female (67%), White (70%), and middle-aged, with a median income of $86,000. Frequency of depressive symptoms increased from baseline to follow-up and the increase was related to lower mean (SD) baseline vitality (44.4 [20.7] vs 60.3 [18.9]; P = .01) and mental health decline (71.0 [14.3] vs 82.0 [10.4]; P = .002). Mean (SD) perceived stress was significantly higher at baseline than follow-up (18.5 [6.4] vs 14.9 [7.2]; P < .001). Food security increased from 83% at baseline to 90% at follow-up (P < .001). Movement to or continued food insecurity (n = 13) tended to be associated with a racial or ethnic minority group (P = .05). CONCLUSION: A sample at high risk for COVID-19 did not experience increased stress or food insecurity, but demonstrated increased depressive symptoms after the onset of the COVID-19 pandemic, with some baseline susceptibility.

Quantifying parent engagement in the randomized Fuel for Fun impact study identified design considerations and BMI relationships.

BACKGROUND: Parent participation in children's health interventions is insufficiently defined and measured. This project quantified parent participation to enable future examination with outcomes in an intervention focused on 4th graders, aged 9-11 years, and their families living in northern Colorado. METHODS: Indices were developed to measure type (Parent Participation Profile; PPP) and intensity (Parent Engagement Intensity; PEI) of engagement in Fuel for Fun (FFF), an asymmetric school-and family-based intervention for 4th graders. Study arm-specific participation opportunities were catalogued and summed to calculate the PPP. An algorithm considered frequency, effort, convenience, and invasiveness of each activity to calculate PEI. Indices were standardized (0-100%) using study arm-specific divisors to address asymmetric engagement opportunities. Parents who completed ≥75% of the PPP were defined as Positive Deviants. Youth height and weight were measured. Youth BMI percentile change was compared with parent Positive Deviant status using general linear modeling with repeated measures that included the participation indices. RESULTS: Of 1435 youth, 777 (54%) had parent participation in at least one activity. Standardized means were 41.5 ± 25.4% for PPP and 27.6 ± 20.9% for PEI. Demographics, behaviors or baseline FFF outcomes did not differ between the Positive Deviant parent (n = 105) and non-Positive Deviant parents (n = 672); but more Positive Deviant parents followed an indulgent feeding style (p = 0.015). Standardized intensity was greater for Positive Deviant parents; 66.9 ± 20.6% vs 21.5 ± 12.7% (p < 0.001) and differences with non-Positive Deviant parents were related to activity type (p ≤0.01 for six of eight activities). Standardized participation intensity was associated with engagement in a greater number of standardized activity types. Among participating parents, standardized intensity and breadth of activity were inversely related to the youth BMI percentile (n = 739; PEI r = -0.39, p < 0.001; PPP r = -0.34, p < 0.001). Parent engagement was not associated with parent BMI change. CONCLUSIONS: An activity-specific intensity schema operationalized measurement of parent engagement in a complex, unbalanced research design and can serve as a template for more sensitive assessment of parent engagement. Positive deviance in parent engagement was not a function of personal, but rather activity characteristics. PPP and PEI increased with fewer requirements and convenient, novel, and personalized activities. Parent engagement indices affirmed lower engagement by parents of overweight/obese youth and concerns about target reach.

Associations between Dietary Patterns and Inflammatory Markers during Pregnancy: A Systematic Review.

Elevated inflammation in pregnancy has been associated with multiple adverse pregnancy outcomes and potentially an increased susceptibility to future chronic disease. How maternal dietary patterns influence systemic inflammation during pregnancy requires further investigation. The purpose of this review was to comprehensively evaluate studies that assessed dietary patterns and inflammatory markers during pregnancy. This review was guided by the Preferred Reporting Items for Systematic Review and Meta-Analyses. Included studies were sourced from EMBASE, PubMed, Web of Science, and Scopus and evaluated using The Quality Assessment Tool for Quantitative Studies. Inclusion criteria consisted of human studies published in English between January 2007 and May 2020 that addressed associations between dietary patterns and inflammatory markers during pregnancy. Studies focused on a single nutrient, supplementation, or combined interventions were excluded. A total of 17 studies were included. Despite some inconsistent findings, maternal diets characterized by a higher intake of animal protein and cholesterol and/or a lower intake of fiber were shown to be associated with certain pro-inflammatory markers (C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF- α), IL-8, serum amyloid A (SAA), and glycoprotein acetylation (GlycA)). Future studies that explore a broader range of inflammatory markers in the pregnant population, reduce measurement errors, and ensure adequate statistical adjustment are warranted.

Valid and Reliable Measure of Adherence to Satter Division of Responsibility in Feeding.

OBJECTIVE: To examine the validity and psychometrics of sDOR.2-6y, a 12-item measure of adherence to the Satter Division of Responsibility in Feeding (sDOR). DESIGN: Cross-sectional survey. SETTING: Online respondents in central Pennsylvania. PARTICIPANTS: 117 parents (94% female, 77% White, 62% in ≥1 income-based assistance program) of preschoolers aged 2-6 years (28% moderate/high nutrition risk). MAIN OUTCOME MEASURES: The sDOR.2-6y and Nutrition Screening Tool for Every Preschooler (NutriSTEP), a measure of child nutrition risk and other validated measures of eating behavior and parent feeding practices. ANALYSIS: Relationships were evaluated with Pearson r, t tests, ANOVA, or chi-square. Factor structure was investigated using principal components analysis with varimax rotation. Binary logistic regression and general linear model controlling for low-income status compared with sDOR.2-6y and NutriSTEP scores. Linear regression predicted NutriSTEP and Satter Eating Competence Inventory 2.0 scores from sDOR.2-6y. RESULTS: The sDOR.2-6y ranged from 16-32 (mean, 25.9 ± 3.3; n = 114). Parents of youth at nutrition risk had lower sDOR.2-6y scores (P = 0.004). Each 1 point sDOR.2-6y increase decreased nutrition risk odds by 21% (95% confidence interval, 0.675-0.918; P = 0.002). The sDOR.2-6y scores were higher with less restriction and pressure to eat (both P < 0.001) and were associated with feeding style. Specificity was 87% with sDOR.2-6y cutoff ≥24; sensitivity was 66% with cutoff ≥26. CONCLUSIONS AND IMPLICATIONS: The sDOR.2-6y accurately and reliably indicated adherence of low-income mothers to sDOR. Larger, diverse samples for future studies are recommended.

Use of an Observational Comparative Strategy Demonstrated Construct Validity of a Measure to Assess Adherence to the Satter Division of Responsibility in Feeding.

BACKGROUND: Currently developed parent feeding measures do not exclusively measure behaviors compatible with theoretical underpinnings of the Satter Division of Responsibility in Feeding for Children Aged 2 to 6 Years (sDOR.2-6y). A measure of adherence to sDOR.2-6y has been constructed and shown to have translational validity. OBJECTIVE: To examine the construct validity of the 15 sDOR.2-6y items. DESIGN: Observations from in-home mealtime video-capture in a household with a child aged 2 to 6 years were compared with parent sDOR.2-6y responses. One sDOR.2-6y item about mealtime regularity was compared with mealtime data provided in the Automated Self-Administered 24-Hour Dietary Assessment Tool that had been completed by a larger sample of parents that included the smaller sample of video-capture participants. PARTICIPANTS/SETTING: Parents of preschool children aged 2 to 6 years in central Pennsylvania participated in Automated Self-Administered 24-Hour Dietary Assessment Tool online dietary assessment (n = 61) from May to November 2013 or in-home mealtime video-capture (n = 20) during October 2013 or both (n = 16). MAIN OUTCOME MEASURES: Consensus of three trained sDOR coders of plausible parent sDOR.2-6y item responses after video viewing, parent responses to sDOR.2-6y items, and mealtime regularity from three Automated Self-Administered 24-Hour Dietary Assessment Tool recalls. STATISTICAL ANALYSIS: Data analysis included identification of codeable 5-minute segments, coding by three sDOR experts, intraclass correlation coefficient, and determination of coder congruence to establish plausible sDOR.2-6y responses and comparison between coder-observed and parent sDOR.2-6y responses. RESULTS: Video-capture participants were mostly women, White, and overweight with a mean ± standard deviation age of 35.3 ± 6.4 years. Postvideo debriefing supported the observed meal as typical in location, timing, and composition. Of 273 coding decisions, coder congruence was inadequate or dissonant for 3.7% and intraclass correlation coefficient was 0.81 (0.77 to 0.84; P < 0.001). Parent and congruent coder responses were in agreement for nearly 70% of the possible comparisons. Of the original 15 items, three were deemed not valid, nine of the remaining 12 were considered valid, and three could not be invalidated. CONCLUSIONS: Congruence between observed and self-reported behaviors supported additional validation and scoring studies with the 12-item sDOR.2-6y to assess adherence of parents to sDOR.

A Definition of "Regular Meals" Driven by Dietary Quality Supports a Pragmatic Schedule.

Public health guidelines advise eating regular meals without defining "regular." This study constructed a meaning for "regular" meals congruent with dietary quality. Parents of 4th grade youth in a school-based intervention (Clinicaltrials.gov NCT02491294) completed three, ASA24 online 24-h dietary recalls. Differences in time of intake across days for breakfasts, lunches, dinners were categorized with consistency denoted as always, often/sometimes or rarely/never and assigned values of 3, 2 or 1, respectively. Meal-specific values were summed to form mealtime regularity scores (mReg) ranging from 3 (low) to 9. Healthy eating index (HEI) scores were compared to mReg controlling for weekday/weekend recall pattern. Linear regression predicted HEI scores from mReg. Parents (n = 142) were non-Hispanic white (92%), female (88%) and educated (73%). One mReg version, mReg1 was significantly associated with total HEI, total fruit, whole fruit, tended to correlate with total protein, seafood/plant protein subcomponents. mReg1 predicted total HEI (p = 0.001) and was inversely related to BMI (p = 0.04). A score of three (always) was awarded to breakfasts, lunches or dinners with day-to-day differences of 0-60 min; also, lunches/dinners with one interval of 60-120 min when two meals were ≤60 min apart. More rigid mReg versions were not associated with dietary quality.

Sex modifies the association between the CLOCK variant rs1801260 and BMI in school-age children.

Disruption of circadian rhythms and variations in the FTO gene may interfere with energy homeostasis and play a role in the development of obesity. The current study assessed the association of common polymorphisms in the CLOCK and FTO genes with standardized body mass index scores (BMI z-scores) and their potential modification of the impact of a culinary nutrition and physical activity intervention in school-age children. Anthropometric measurements were collected in 121 children at the baseline and one-year follow-up of a controlled trial of a school-based culinary nutrition and physical activity intervention. Genotypes of the CLOCK polymorphism (rs1801260) and the FTO polymorphism (rs9939609) were obtained from buccal swabs. Linear mixed-effects regression was applied to evaluate the genetic association and adjust for clusters within families and schools. In our participants, obesity affected 6.6% (8/121) of the children at the baseline and 6.4% (7/109) of the children at the follow-up. The associations between the age- and sex-adjusted BMI z-scores and the two polymorphisms did not reach statistically significance. Yet, sex potentially modified the association between rs1801260 and BMI z-scores. In girls, the G allele carriers had a higher BMI z-scores at the baseline and the follow-up. These polymorphisms did not modify the effect of our culinary nutrition and physical activity intervention on BMI z-scores. Sex is a potential modifier for the association between the CLOCK polymorphism, rs1801260, and BMI z-scores in school-age children. Further investigation is warranted to delineate the sex-dependent role of the CLOCK polymorphisms in the development of childhood obesity.

The Weight Optimization Revamping Lifestyle using the Dietary Guidelines (WORLD) Study: Sustained Weight Loss Over 12 Months.

OBJECTIVE: This study aimed to compare two energy-restricted, nutrient-dense diets at the upper or lower ends of the dietary fat recommendation range (lower fat [20% energy from fat] versus moderate fat [35%]) on weight loss using behavioral theory-based nutrition education. METHODS: A total of 101 premenopausal women with overweight or obesity were randomized to an energy-restricted lower-fat or moderate-fat diet for 1 year. Interventions included 28 behavioral theory-based nutrition education sessions plus weekly exercise sessions. RESULTS: Both treatment groups experienced weight loss (-5.0 kg for lower fat and -4.3 kg for moderate fat; P < 0.0001), but there was no difference in weight loss or fat intake between groups. Total and low-density lipoprotein cholesterol decreased (-3. 4 mg/dL and -3.8 mg/dL; P < 0.05), and high-density lipoprotein cholesterol increased (1.9 mg/dL; P < 0.05) in both groups at 12 months. Diet quality, assessed by the Healthy Eating Index, increased significantly at 4 months versus baseline (70.8 [0.9] vs. 77.8 [1.0]) and was maintained through 12 months. Higher Healthy Eating Index scores were associated with greater weight loss at 4 months (r = -0.2; P < 0.05). CONCLUSIONS: In the context of a well-resourced, free-living weight-loss intervention, total fat intake did not change; however, theory-based nutrition education underpinned by food-based recommendations resulted in caloric deficits, improvements in diet quality, and weight loss that was sustained for 1 year.

Identification of a Framework for Best Practices in Nutrition Education for Low-Income Audiences.

To promote effective low-income nutrition education programs, an expert panel of nutrition education and public health researchers built consensus around 28 best practices grouped into 5 domains (Program Design, Program Delivery, Educator Characteristics, Educator Training, and Evaluation) targeting direct delivery of nutrition education. These best practices can be used to assess program strengths, promote fidelity in delivery and evaluation, and design research to strengthen programs' evidence base. A survey of Supplemental Nutrition Assistance Program-Education nutrition education leaders helped identify staff development needs and interest relative to specific best practices. Best practices can be used to identify staff development needs among frontline educators, supervisors, and program leaders in Supplemental Nutrition Assistance Program-Education, Expanded Food and Nutrition Education Program, and other programs targeting low-income audiences.

Eating Competence and Oral Health in Supplemental Nutrition Assistance Program Eligible Populations.

Purpose. To determine the association of eating competence and Mediterranean diet adherence with oral health and to examine if they lessen any impact of food insecurity on oral health of SNAP-eligible persons.Methods. Free clinic patrons (n=93) in Pennsylvania evaluated oral health nutrition education via an online survey. The Satter Eating Competence Inventory, Mediterranean diet and USDA Food Security scores were compared to tested measures of oral health as assessed by self-report.Results. Respondents noted food insecurity (33%), food selection (32%), and oral health problems that interfered with life satisfaction (30%), and unafforded dental care (60%). Mediterranean diet adherence was associated with annual dental visits (82% vs. 46%, p=.026). Competent eaters had greater food security and less frequently reported oral health issues interfering with life satisfaction (13% vs. 43%; p=.002) or avoiding particular foods (18% vs 45%; p=.006). These relationships remained significant controlling for low-income (p=.008, p=.006 respectively) but not when controlling for food security.Conclusions. Competent eaters had fewer oral health issues except when controlling for food security, a considerable challenge to oral health.

Eating Competent Parents of 4th Grade Youth from a Predominantly Non-Hispanic White Sample Demonstrate More Healthful Eating Behaviors than Non-Eating Competent Parents.

The purpose of this study was to determine if the associations between eating competence (EC) and eating behaviors that were found in a USA sample of predominantly Hispanic parents of 4th grade youth could be replicated in a USA sample of predominantly non-Hispanic white parents of 4th graders. Baseline responses from parents (n = 424; 94% white) of youth participating in a year-long educational intervention were collected using an online survey. Validated measures included the Satter Eating Competence Inventory (ecSI 2.0TM), in-home fruit/vegetable (FV) availability, healthful eating behavior modeling, and FV self-efficacy/outcome expectancies (SE/OE). Data were analyzed with general linear modeling and cluster analyses. The findings replicated those from the primarily Hispanic sample. Of the 408 completing all ecSI 2.0TM items, 86% were female, 65% had a 4-year degree or higher, and 53% were EC (ecSI 2.0TM score ≥ 32). Compared with non-EC parents, EC modeled more healthful eating, higher FV SE/OE, and more in-home FV availability. Behaviors clustered into those striving toward more healthful practices (strivers; n = 151) and those achieving them (thrivers; n = 255). Striver ecSI 2.0TM scores were lower than those of thrivers (29.6 ± 7.8 vs. 33.7 ± 7.6; p < 0.001). More EC parents demonstrated eating behaviors associated with childhood obesity prevention than non-EC parents, encouraging education that fosters parent EC, especially in tandem with youth nutrition education.