Lessons learned from talking with adults about nutrition: A qualitative study in the PREPARED project.

Improving diet and dietary behaviour of men and women before pregnancy has the potential to benefit both their current and long-term health and the health of their children. Little is known, however, about adults' perception of diet's role in prepregnancy health. This study aimed to explore the state of knowledge and awareness of preconception nutritional health in adults within the fertile age range and what they perceived could motivate healthy eating using the self-determination theory as a theoretical framework. We analysed 33 short exploratory interviews with men (n = 18) and women (n = 15) aged 18-45 years. Participants were grab sampled from three different public locations in the southern part of Norway. Interviews were audio-recorded, transcribed verbatim in 2020 and analysed using a thematic analysis with a semantic approach in 2022. The findings suggest that adults within the fertile age range are not intrinsically motivated to eat healthily, but when they do, it is because eating healthily often aligns with other goals consistent with their values, that is, getting fit or looking good. They possess some basic knowledge of healthy behaviours during pregnancy but are generally unaware of the importance of preconception health and nutrition. There is a need to increase awareness of the impact of preconception health on the health of this and future generations. Improved nutritional education on the significance of diet before conception might facilitate optimal conditions for conceiving and for pregnancy in the adult population within fertile age range.

Nutrition in a lifecourse perspective: From molecular aspects to public health approaches.

This Special Issue covers a variety of topics related to nutrition from a lifecourse perspective, addressing diet in sensitive periods (preconception, pregnancy and infancy/toddlerhood), in different contexts, spanning from molecular nutrition to settings and gatekeepers of diet in these sensitive periods. It highlights challenges and research gaps within the field.

Maternal mental health is associated with children's frequency of family meals at 12 and 24 months of age.

Diet during the child's first years is important for growth and development. In toddlerhood, higher diet quality is reported among children eating meals together with family. Although previous literature has documented several associations between maternal mental health and early child feeding practices, less is known about the relationship between maternal mental health and child frequency of shared family meals. This study explores associations between maternal symptoms of anxiety and depression, measured by The Hopkins Symptoms Checklist (SCL-8), and toddler participation in family meals. We used cross-sectional data from the Norwegian study Early Food for Future Health, in which participants responded to questionnaires at child age 12 (n = 455) and 24 months (n = 295). Logistic regression was used to explore associations between maternal mental health and child having regular (≥5 per week) or irregular (<5 per week) family meals (breakfast and dinner), adjusting for relevant child and maternal confounding variables. Children of mothers with higher scores of anxiety and depression had higher odds of Irregular family meals at both timepoints; (OR: 2.067, p = 0.015) and (OR: 2.444, p = 0.023). This is one of few studies exploring associations between maternal mental health and child frequency of shared family meals in early childhood, a period where the foundation for life-long health is shaped. Given the high prevalence of mental ailments and disorders, these findings are important and may inform future public health interventions. Further exploration of this relation is needed, including longitudinal research to test predictive associations and qualitative studies to increase insight and understanding.

A qualitative study of public health nurses' perspectives and experiences on nutritional guidance for parents of infants and toddlers.

In Norway, public health nurses (PHNs) are responsible for giving parents nutritional knowledge, but limited research describes how they perceive this task. This study explores PHNs' perceptions and experiences on nutritional guidance for parents of infants and toddlers. Semistructured interviews with six PHNs were conducted and transcribed verbatim. Data were subjected to thematic analysis. Five main themes were identified: (1) Dietary guidance for parents is central to the work; (2) PHNs perceive they have parents' trust, and parents are in general open to nutrition counselling; (3) food and meals must be seen in light of the family context; (4) The dialogue must be adapted to the individual family; and (5) PHNs have expertise on nutrition; however, updating knowledge is difficult. Nutritional guidance was perceived by PHNs as a core activity. They felt that they had parents' trust, and that parents were particularly open to nutritional guidance during the first 2 years. Counselling was generally well received, but conversations on overweight were perceived as difficult. PHNs strove to tailor their guidance to individual needs. However, providing guidance on a wide range of issues in different families and cultures could be challenging. They acknowledged a need for updating knowledge but the offer of courses was sparse. Our findings suggest a discrepancy between how nutrition is prioritized in the education of PHNs and what they encounter in clinical practice. In the future, this should be given more attention given the PHNs' unique position to promote healthy eating and long-term health.

Individual nutrients and serum klotho levels in adults aged 40-79 years.

Several dietary factors (including adherence to the Mediterranean diet or higher nut intake) seem to positively affect circulating antiaging Klotho protein levels; yet, a description of possible relationships between individual nutrients and Klotho activity has not been evaluated. We analyzed the association of dietary intake of individual macro- and micronutrients and nonnutritive food components with circulating Klotho levels in a sample of 40- to 79-year-old US adults. Data from the 2015-2016 National Health and Nutrition Examination Survey were analyzed. Nutrient/food component intakes were calculated in relation to total energy intake using the nutrient density method, and available pristine serum samples were analyzed for serum Klotho concentrations. The final study sample consisted of 2637 participants (mean age 59.0 ± 10.7 years; 52% women). Higher Klotho concentrations were found with higher intake of carbohydrates (p < .001), total sugars (p < .001), dietary fibers (p < .001), vitamin D (p = .05), total folates (p = .015), and copper (p = .018). The results of the regression analysis with a crude model showed significant associations among five nutrients/food components (carbohydrates, alcohol, total sugars, dietary fibers, and niacin) and soluble Klotho levels across the sample. After adjusting the models for age and gender, the nutrient/food component-Klotho association remained significant for carbohydrates, total sugars, and alcohol (p < .05). Dietary exposure to individual nutrients and nonnutritive food components appears to be associated with Klotho activity; however, additional research is needed to investigate the relationship between cause and effect in diet composition-Klotho interplay.

Diet in Early Life Is Related to Child Mental Health and Personality at 8 Years: Findings from the Norwegian Mother, Father and Child Cohort Study (MoBa).

There is rising concern about population mental health. Personality and mental health traits manifest early. Sufficient nutrition is fundamental to early development. However, little is known about early life dietary impact on later mental health. The aim of this study was to investigate associations of exposure to a healthy and sustainable antenatal and early childhood diet with personality traits and symptoms of depression and anxiety measured at 8 years of age. This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa) and uses data from the Medical Birth Registry of Norway (MBRN) including 40,566 participants. Mental health measures and personality traits were assessed at 8 years. Dietary data from pregnancy, child age 6 and 18 months and 3 and 7 years were used. With few exceptions, inverse associations were observed between healthier diet at all time points and depression and anxiety symptom scores at age 8. We found positive associations between diet scores at almost all time points and extraversion, benevolence, conscientiousness and imagination. Inverse associations were observed between diet scores and neuroticism. Combined, these findings underpin a probable impact of both maternal pregnancy diet and early childhood diet on several aspects of child mental health.

"It is really just brilliant to get credits for something that is so important to you!" Skills for Life: University students' perceptions of a planned dietary life skills course.

OBJECTIVE: Universities have a role in educating and empowering students to become healthy and literate citizens of the 21st century society. The aim of this study was to explore university students' perceptions regarding the relevance and utility of a planned dietary life skills course. DESIGN: Qualitative design including focus group discussions. SETTING: A Norwegian university with participating undergraduate students from seven different disciplines. METHOD: Data collection included 13 semi-structured focus group discussions involving 57 university students (35 women and 22 men aged 18-38 years). The focus group discussions were recorded and transcribed verbatim. To ensure in-depth knowledge of the research participants' thoughts and reflections, thematic analysis strategy was undertaken by a team of researchers. RESULTS: When presented to the idea of a dietary life skills course as a university course, the students were mostly positive regarding its relevance and utility, however both motivators and barriers for attending were put forward. Some mentioned potential academic course benefits, such as enhanced CV, and a few mentioned potential societal benefits such as a healthy population and sustainable food consumption. Several motivators for attending the course were launched, such as increased knowledge and cooking skills, having dinner and expanded network. The students wanted to learn about food, nutrients and health, and how to cook simple, affordable, healthy and sustainable meals. Potential barriers for attending were mostly related to practicalities, such as potential lack of alignment with ordinary study programme or too demanding lectures. CONCLUSION: Most students acknowledged the value of a dietary life skills course and thought that such a course could benefit their personal life. This encourages the offering of such courses at university level, tailored to consider both motivators and barriers for attending.

Associations between infant and maternal characteristics measured at child age 5 months and maternal feeding styles and practices up to child age two years.

Facilitating positive feeding practices from infancy may be an important strategy to prevent childhood overweight and obesity. Since the feeding situation early in life constitutes a bidirectional relationship, it is important to understand the impact of both maternal and infant characteristics on maternal feeding practices to intervene in a customized and tailored way. Few studies have concurrently examined associations between maternal and infant characteristics in relation to early maternal feeding practices. The aim of the present study was to explore potential associations between infant and maternal characteristics measured at child age five months, and maternal feeding styles and practices during the child's first two years. Cross-sectional data from a Norwegian randomized controlled trial in which participants responded to questionnaires at child age 5 months (n = 474), 12 months (n = 293) and 24 months (n = 185) were used to explore potential associations. All maternal and child predictor variables were collected at child age five months. Maternal feeding styles and practices were mapped using subscales from the Infant Feeding Questionnaire at child age 5 and 12 months and the Child Feeding Questionnaire and the Parental Feeding Style Questionnaire at child age 24 months. The subscale-scores were split into roughly equal tertiles, and the upper or lower tertile for the outcome of interest were used to create binary outcome variables. Multivariable binary logistic regression models were conducted for each outcome. We found that maternal education and mental health symptoms as well as infant weight, temperament and feeding mode were associated with maternal feeding styles and practices over time. Our findings indicate that risk factors which may have long-term implications for child weight and health outcomes can be identified early. Larger, population-based studies with a longitudinal design are needed to further explore these pathways.

Effectiveness of a digital dietary intervention program targeting young adults before parenthood: protocol for the PREPARED randomised controlled trial.

INTRODUCTION: The importance of preconception health for lifelong physical and mental health in the next generation has gained increasing recognition in recent years. Preconception paternal and maternal risk factors such as obesity and inadequate diet affect the metabolic and cardiovascular health of their offspring later in life. This highlights the importance of diet and dietary behaviour in the years before parenthood. In our project, PREPARED, we will evaluate the effectiveness of a digital intervention targeting young adults. Our primary aim is to improve participants' preconception diet, and our secondary aim is to improve preconception quality of life and maternal and child perinatal outcomes. METHODS AND ANALYSIS: We plan to recruit 7000 men and women individually, aged 20-35 years without children, to be randomised to an intervention or a control group. The intervention group will receive access to a digital resource for 6 months promoting a healthy diet for their health now, later in life and for the next generation. Follow-up is up to 20 years or until they have their first child. To evaluate intervention effects, we will collect dietary data (2×24-hour dietary recalls and a screener). For those participants for which birth ensues, we will link study data with data from the Medical Birth Registry of Norway on maternal and child perinatal outcomes. ETHICS AND DISSEMINATION: The study is approved by the Regional Ethics Committee, the Norwegian Data Protection Service and our Faculty Ethical Committee (REC: 78104, NSD: 907212, FEC 20/10119). Participation is voluntary and all participants will provide informed consent. Participants can withdraw their consent without giving any reason. Findings will be communicated to the public through a project website and social media, and to professionals through conferences and peer-reviewed papers. TRIAL REGISTRATION NUMBER: ISRCTN44294662.

Wow! They really like celeriac! Kindergarten teachers' experiences of an intervention to increase 1-year-olds' acceptance of vegetables.

Exposure to varied foods in early life is important for short- and long-term health and development. Strategically introducing toddlers to new vegetables is not a common practice in Norwegian kindergartens. Therefore, we developed, conducted, and evaluated a web-based cluster randomised kindergarten intervention, Pre-schoolers' Food Courage 2.0. The purpose of the current qualitative study was to explore kindergarten teachers' experience of implementing this intervention and what they thought facilitated the positive impact of the intervention reported in the quantitative evaluation. Ten individual telephonic interviews with kindergarten teachers who took part in the intervention study were conducted using a semi-structured interview guide. Data were transcribed verbatim and subjected to thematic analysis. Five main themes were identified: 1) One-year-olds love food and renewal of the menus was inspiring; 2) One-year-olds are surprisingly willing to try and accept novel foods; 3) Novel food at meals stimulate social interaction; and 4) The Sapere method is a fun and explorative activity for 1-year-olds. These four themes were the features perceived as the effective elements of the intervention by the kindergarten teachers. The fifth main theme was: 5) Sustained impact on kindergarten teachers' practices and beliefs. The kindergarten teachers found the intervention easy to implement, and they were surprised by the foods 1-year-olds like and how the intervention increased their food acceptance. This age window of opportunity seems to be underused in kindergartens. By using the strategies described in the intervention, kindergarten staff effectively took advantage of this opportunity and consequently, child and kindergarten staff behaviour in relation to food was enhanced. Interventions targeting healthy feeding practices may potentially have a long-term public health impact by increasing food variety and vegetable intake in toddlers. TRIAL REGISTRATION: ISRCTN98064772.

Parental phone use during mealtimes with toddlers and the associations with feeding practices and shared family meals: a cross-sectional study.

BACKGROUND: Positive parental feeding practices and a higher frequency of family meals are related to healthier child dietary habits. Parents play an essential role when it comes to the development of their child's eating habits. However, parents are increasingly distracted by their mobile phone during mealtimes. The aim of this study was to describe the feeding practices and daily shared family meals among parents who use and do not use a mobile phone during mealtimes, and further to explore the associations between the use of a mobile phone during mealtimes and feeding practices and daily shared family meals, respectively. METHODS: Cross-sectional data from the Food4toddler study were used to explore the association between mobile use during meals and parental feeding practices including family meals. In 2017/2018 parents of toddlers were recruited through social media to participate in the study. In total 298 out of 404 who volunteered to participate, filled in a baseline questionnaire, including questions from the comprehensive feeding practices questionnaire (CFPQ), questions of frequency of family meals and use of mobile phone during meals. RESULTS: Herein, 4 out of 10 parents reported various levels of phone use (meal distraction) during mealtimes. Parental phone use was associated with lower use of positive parental feeding practices like modelling (B = - 1.05 (95% CI -1.69; - 0.41)) and family food environment (B = - 0.77 (95% CI -1.51; - 0.03)), and more use of negative parental feeding practices like emotional regulation (B = 0.73 (95% CI 0.32; 1.14)) and the use of pressure to eat (B = 1.22 (95% CI 0.41; 2.03)). Furthermore, parental phone use was associated with a lower frequency of daily family breakfast (OR = 0.50 (95% CI 0.31; 0.82)) and dinner (OR = 0.57 (95% CI 0.35; 0.93)). CONCLUSIONS: Mobile phone use is common among parents during mealtimes, and findings indicate that parental phone use is associated with less healthy feeding practices and shared family meals. These findings highlight the importance of making parents aware of potential impacts of meal distractions. TRIAL REGISTRATION: ISRCTN92980420 . Registered 13 September 2017. Retrospectively registered.

Family meal participation is associated with dietary intake among 12-month-olds in Southern Norway.

BACKGROUND: Family meal participation is associated with healthier eating among children and adolescents. Less is known about family meal participation among infants and toddlers. The objective of the present study was to explore whether family meal participation at 12 months of age is associated with dietary intake and whether a potential relationship differs according to maternal education or child sex. METHODS: Follow-up data from children born to mothers participating in the Norwegian Fit for Delivery (NFFD) trial during pregnancy were used to assess the frequency of intake of 11 dietary items according to frequency of participating in the respective family meals. Dietary differences according to seldom (0-3 times/week) or often (4-7 times/week) participating in each respective meal category were assessed in linear regression models. Potential dose-response associations with frequency of participation in all family meal categories combined were also estimated. Models were adjusted for maternal randomization status, education, and child sex. RESULTS: The sample comprised 408 children. A total of 74, 53 and 74% had breakfast, lunch, and dinner with family ≥4 times/week, respectively, while 39% had supper and 27% between-meal snacks with family ≥4 times/week. Having family dinner ≥4 times/week was associated with more frequent intake of vegetables, homemade infant cereal, milk, and water, and less frequent intake of commercial infant foods while the other family meal categories were associated with fewer dietary outcomes. For each additional meal category eaten with family ≥4 times/week, frequency of vegetable intake (ß = 0.45), water (ß = 0.17), and milk (ß = 0.09) per day increased, while commercial infant cereal was eaten less frequently (ß = - 0.18). The inverse association between family meals and commercial infant cereal was only evident in children born to mothers in the intervention group. Several associations with diet were stronger and only significant among boys. CONCLUSIONS: Being fed in the context of family meals at 12 months of age was associated with a more favorable diet. Including the infant in family meals has potential in the promotion of early nutritional health.

Effect of a Parent-Focused eHealth Intervention on Children's Fruit, Vegetable, and Discretionary Food Intake (Food4toddlers): Randomized Controlled Trial.

BACKGROUND: In Western countries, children's diets are often low in fruits and vegetables and high in discretionary foods. Diet in early life tends to track through childhood and youth and even into adulthood. Interventions should, therefore, be delivered in periods when habitual traits are established, as in toddlerhood when children adapt to their family's diet. OBJECTIVE: In this study, we assessed the effect of the Food4toddlers eHealth intervention, which aimed to enhance toddlers' diets by shaping their food and eating environment. METHODS: The Food4toddlers randomized controlled trial was conducted in Norway in 2017-2018. Parent-child dyads were recruited through social media. In total, 298 parents completed an online questionnaire at baseline (mean child age 10.9 months, SD 1.2). Postintervention questionnaires were completed immediately after the intervention (ie, follow-up 1; mean child age 17.8 months, SD 1.3) and 6 months after the intervention (ie, follow-up 2; mean child age 24.2 months, SD 1.9). The intervention was guided by social cognitive theory, which targets the linked relationship between the person, the behavior, and the environment. The intervention group (148/298, 49.7%) got access to the Food4toddlers website for 6 months from baseline. The website included information on diet and on how to create a healthy food and eating environment as well as activities, recipes, and collaboration opportunities. To assess intervention effects on child diet from baseline to follow-up 1 and from baseline to follow-up 2, we used generalized estimating equations and a time × group interaction term. Between-group differences in changes over time for frequency and variety of fruits and vegetables and frequency of discretionary foods were assessed. RESULTS: At follow-up 1, a significant time × group interaction was observed for the frequency of vegetable intake (P=.02). The difference between groups in the change from baseline to follow-up 1 was 0.46 vegetable items per day (95% CI 0.06-0.86) in favor of the intervention group. No other significant between-group differences in dietary changes from baseline to follow-up 1 or follow-up 2 were observed. However, there is a clear time trend showing that the intake of discretionary foods increases by time from less than 1 item per week at baseline to more than 4 items per week at 2 years of age (P<.001), regardless of group. CONCLUSIONS: A positive intervention effect was observed for the frequency of vegetable intake at follow-up 1 but not at follow-up 2. No other between-group effects on diet were observed. eHealth interventions of longer duration, including reminders after the main content of the intervention has been delivered, may be needed to obtain long-terms effects, along with tailoring in a digital or a personal form. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN) 92980420; https://doi.org/10.1186/ISRCTN92980420.

Alcohol consumption among students and its relationship with nutritional intake: a cross-sectional study.

OBJECTIVE: Excessive alcohol consumption during reproductive years may impact the integrity of developing eggs and sperm, potentially affecting the life-long health of future children. Inadequate diets could aggravate these preconception effects of alcohol. The aim of the present study was to assess the prevalence of excessive alcohol consumption and explore whether weekly alcohol intake is associated with energy and nutrient intake and adequacy of micronutrient intake among students. DESIGN: Cross-sectional survey using a validated and reproducibility-tested FFQ. SETTING: University of Agder, Norway, in 2018. PARTICIPANTS: 622 students (71 % female). RESULTS: More than 80 % reported having consumed alcoholic beverages the past 4 weeks. One-third of men and 13 % of women exceeded the upper recommended limit of 14 UK alcohol units/week. An inverse association between increasing alcohol intake and energy-adjusted micronutrient intake was evident for thiamine, phosphate, Fe, Zn and Se in men, and for vitamin A, ß-carotene, vitamin E and C, thiamine, vitamin B6, folate, P, Mg, K, Fe, Zn and Cu in women. A substantial proportion had vitamin D, folate, Fe and I intakes below average requirement regardless of alcohol consumption level. The combination of prevalent alcohol use, decreasing micronutrient density of diet across alcohol consumption level and a high probability of micronutrient inadequacy indicate reason for concern in a preconception public health perspective. CONCLUSIONS: Our findings call for investigations into young adults' knowledge, reflections and beliefs regarding diet and alcohol use to understand how these behaviours could be improved ahead of parenthood.

Association between parental feeding practices and shared family meals. The Food4toddlers study.

BACKGROUND: Parental feeding practices and family meals are important determinants for infants' diet and health. Still, there is no previous research of the association between feeding practices and family meals in infants. OBJECTIVE: Explore potential associations between feeding practices and family meals among infants. DESIGN: We present cross-sectional results (baseline) from the Food4toddlers study. In total 298 parents of 1-year-olds, recruited from all over Norway, filled in a questionnaire regarding frequency of shared family meals (breakfast, lunch, dinner) and feeding practices using the validated instrument Comprehensive Feeding Practices Questionnaire. Logistic regression was used to explore the associations between having family meals every day and feeding practices (10 dimensions). RESULTS: The children included were about 11 months old, and 55% were boys. Parents were highly educated. Most children had family breakfast and dinner (60-65%), while fewer had family lunch every day (35%). We found that eating family breakfast and lunch every day was associated with use of the positive feeding practices: encourage balance and variety, environment and modelling (ORs ranging from 1.15 to 1.37), while eating family breakfast and family lunch less often was associated with the negative feeding practice pressure to eat (OR, 95% CI: 0.90 (0.83, 0.96) and 0.91 (0.84, 0.97), respectively). Eating family dinner every day was associated with more use of the positive feeding practice balance and variety (OR, 95% CI: 1.21 (1.06, 1.38), while having family dinner less often was associated with use of the negative feeding practices pressure to eat and restriction to health (OR, 95% CI: 0.89 (0.83, 0.96) and 0.94 (0.87, 1.01), respectively). DISCUSSION AND CONCLUSION: In this group of infants, having family meals every day was associated with positive feeding practices, while having family meals less often was associated with negative feeding practices. Shared family meals provide an important setting for healthy eating, development of feeding skills and dietary habits formation.

StudentKost: a cross-sectional study assessing college students' diets: reason for concern?

College students constitute a significant proportion of the young adult population in Norway. They are in their reproductive years, which is of interest regarding diet and preconception health. Our objective was to assess young college students' diet and nutrient intake in relation to national dietary recommendations and assess the probability of inadequate micronutrient intake for both genders using the Nordic Nutrition Recommendations, and also to evaluate its consequences on preconception health and create a groundwork for future interventions on this group. At the University of Agder (UiA), we enrolled 622 students aged 18-40 years for a cross-sectional study of student's diet, StudentKost. The students completed a food frequency questionnaire, including questions of supplement use, over the past 4 weeks. Intake of fruits, vegetables, oily fish, and whole grain was lower than recommended, as were mean intake of folate, iron, and iodine. Our main findings are that students have a somewhat suboptimal diet compared to the Norwegian dietary guidelines. Male students had generally lower diet quality than females. Compared to the Nordic Nutrition Recommendations (NNR), we also saw a relatively high probability of inadequate intake of several micronutrients and a very high probability for some micronutrients in a significant portion of the sample. Public health effort should be directed towards improving students and young adults' diet in general, and interventions towards improving preconception health should be explored. The low participation rate limits the generalizability of our findings. Our findings encourage further investigation into young adults' diet.

Examining the effects of an eHealth intervention from infant age 6 to 12 months on child eating behaviors and maternal feeding practices one year after cessation: The Norwegian randomized controlled trial Early Food for Future Health.

OBJECTIVES: The Norwegian randomized controlled trial Early Food for Future Health provided parental anticipatory guidance on early protective feeding practices from child age 6 to 12 months through an eHealth intervention. Previously published outcomes at child age 12 months indicated that the eHealth intervention increased daily vegetable/fruit intake and promoted more beneficial mealtime routines. The objective of the current paper is to evaluate the effects of the intervention at child age 24 months, one year after cessation. METHODS: Parents of infants aged 3-5 months were recruited via social media and child health clinics during spring 2016. At child age 5.5 months, 715 mothers were randomized to either control (n = 358) or intervention (n = 360) arm. Primary study-outcomes were child eating behaviors, dietary intake, mealtime routines and maternal feeding practices and feeding styles. Secondary outcome was child anthropometry. RESULTS: In total 295 mothers (41%) completed the follow-up questionnaire at child age 24 months. Regarding fruit intake, 54.3% in the intervention group had a high score compared with 48.3% of the control group (p = 0.29). For intake of vegetables, 54.5% in the intervention group had a high score compared with 50.7% in the control group (p = 0.49). A total of 65.7% of the children in the intervention group were eating breakfast together with family ≥ 4 times per week, compared with 57.3% of the children in the control group (p = 0.12). There was no difference between the groups for child anthropometric outcomes at child age 24 months. CONCLUSIONS: At child age 24 months, we found no evidence of sustained intervention-effects. Although dietary patterns and mealtime routines at child age 24 months were reasonably consistent and in the same directions as at child age 12 months, the between-group differences were not significant. The large loss to follow-up may have limited power and validity and makes it difficult to draw overall conclusions. Future research is needed to improve knowledge of how short-time effects could be retained over longer term, taking into account that larger samples are necessary when planning longer-term follow-up studies. TRIAL REGISTRATION: ISRCTN, ISRCTN13601567.

The Food4toddlers study - study protocol for a web-based intervention to promote healthy diets for toddlers: a randomized controlled trial.

BACKGROUND: Eating habits are established during childhood and track into adolescence and later in life. Given that these habits have a large public health impact and influence the increasing rates of childhood obesity worldwide, there is a need for effective, evidence-based prevention trials promoting healthy eating habits in the first 2 years of life. The aim of this study was to develop and evaluate the effect of an eHealth intervention called Food4toddlers, aiming to promote healthy dietary habits in toddlers by targeting parents' awareness of their child's food environment (i.e., how food is provided or presented) and eating environment (e.g., feeding practices and social interaction). This paper describes the rationale, development, and evaluation design of this project. METHODS/DESIGN: We developed a 6-month eHealth intervention, with the extensive user involvement of health care nurses and parents of toddlers. This intervention is in line with the social cognitive theory, targeting the interwoven relationship between the person, behavior, and environment, with an emphasis on environmental factors. The intervention website includes recipes, information, activities, and collaboration opportunities. The Food4toddlers website can be used as a mobile application. To evaluate the intervention, a two-armed pre-post-follow-up randomized controlled trial is presently being conducted in Norway. Parents of toddlers (n = 404) were recruited via social media (Facebook) and 298 provided baseline data of their toddlers at age 12 months. After baseline measurements, participants were randomly allocated to an intervention group or control group. Primary outcomes are the child's diet quality and food variety. All participants will be followed up at age 18 months, 2 years, and 4 years. DISCUSSION: The results of this trial will provide evidence to increase knowledge about the effectiveness of an eHealth intervention targeting parents and their toddler's dietary habits. TRIAL REGISTRATION: ISRCTN92980420 . Registered 13 September 2017. Retrospectively registered.

Evaluation of an eHealth intervention aiming to promote healthy food habits from infancy -the Norwegian randomized controlled trial Early Food for Future Health.

BACKGROUND: Strategies to optimize early-life nutrition provide an important opportunity for primary prevention of childhood obesity. Interventions that can be efficiently scaled-up to the magnitude needed for sustainable childhood obesity prevention are needed. The objective of this study was to evaluate the effects of an eHealth intervention on parental feeding practices and infant eating behaviors. METHODS: The Norwegian study Early Food for Future Health is a randomized controlled trial. Parents were recruited via social media and child health clinics during spring 2016 when their child was aged 3 to 5 months. In total 718 parents completed a web-based baseline questionnaire at child age 5.5 months. The intervention group had access to a webpage with monthly short video clips addressing specific infant feeding topics and age-appropriate baby food recipes from child age 6 to 12 months. The control group received routine care. The primary outcomes were child eating behaviors, dietary intake, mealtime routines and maternal feeding practices and feeding styles. The secondary outcomes were child anthropometry. This paper reports outcomes at child age 12 months. RESULTS: More than 80% of the intervention group reported viewing all/most of the video clips addressing infant feeding topics and indicated that the films were well adapted to the child's age and easy to understand. Children in the intervention group were served vegetables/fruits more frequently (p = 0.035) and had tasted a wider variety of vegetables (p = 0.015) compared to controls. They were also more likely to eat family breakfast (p = 0.035) and dinner (p = 0.011) and less likely to be playing or watching TV/tablet during meals (p = 0.009) compared to control-group children. We found no group differences for child anthropometry or maternal feeding practices. CONCLUSIONS: Our findings suggest that the eHealth intervention is an appropriate and feasible tool to propagate information on healthy infant feeding to Norwegian mothers. Our study also suggests that anticipatory guidance on early protective feeding practices by such a tool may increase young children's daily vegetable/fruit intake and promote beneficial mealtime routines. TRIAL REGISTRATION: ISRCTN, ISRCTN13601567. Registered 29 February 2016, http://www.isrctn.com/ISRCTN13601567.

Pre-pregnancy and early pregnancy dietary behavior in relation to maternal and newborn health in the Norwegian Fit for Delivery study - a post hoc observational analysis.

BACKGROUND: Randomized controlled trials targeting maternal dietary and physical activity behaviors during pregnancy have generally failed to accomplish reductions in the prevalence of adverse maternal and neonatal outcomes. Interventions carried out during pregnancy could thus be missing the mark in maximizing intervention health benefit. OBJECTIVE: To investigate whether pre-pregnancy and early pregnancy dietary behavior as reported at inclusion into the Norwegian Fit for Delivery (NFFD) trial was associated with maternal and neonatal outcomes irrespective of subsequent randomization assignment. DESIGN: The study is a post-hoc observational analysis of data from a randomized controlled lifestyle intervention. We constructed two diet scores from participant responses to a 43-item questionnaire that addressed dietary behavior in retrospect (pre-pregnancy diet score) and dietary behavior at inclusion (early pregnancy diet score), respectively. The diet scores ranged from 0 to 10, with higher score reflecting healthier dietary behavior. Associations between diet scores and maternal and neonatal health outcomes were estimated in multivariate logistic regression models. RESULTS: A total of 591 women were eligible for analysis. A one-point increase in pre-pregnancy diet score was associated with lower odds of excessive gestational weight gain (GWG) (odds ratio [OR]adj: 0.92; 95% confidence interval [CI]: 0.84-1.00, p = 0.050), preterm delivery (ORadj: 0.81; 95% CI: 0.68-0.97, p = 0.019), and birthweight ≥ 4,000 g (ORadj: 0.88; 95% CI: 0.78-0.99, p = 0.038). A one-point increase in early pregnancy diet score was associated with lower odds of excessive GWG (ORadj: 0.88; 95% CI: 0.79-0.97, p = 0.009), preterm delivery (ORadj: 0.82; 95% CI: 0.67-0.99, p = 0.038), and preeclampsia (ORadj: 0.78; 95% CI: 0.62-0.99, p = 0.038). DISCUSSION: Higher diet score either pre-pregnancy or in early pregnancy was protectively associated with excessive GWG and preterm delivery, whereas the protective association with high birthweight was confined to pre-pregnancy diet and with preeclampsia to early pregnancy diet. CONCLUSIONS: Both pre-pregnancy and early pregnancy dietary behavior was associated with important maternal and neonatal health outcomes in the NFFD dataset.