Evaluation of a long day care intervention targeting the mealtime environment and curriculum to increase children's vegetable intake: a cluster randomised controlled trial using the multiphase optimisation strategy framework.

OBJECTIVE: To determine the reach, adoption, implementation and effectiveness of an intervention to increase children's vegetable intake in long day care (LDC). DESIGN: A 12-week pragmatic cluster randomised controlled trial, informed by the multiphase optimisation strategy (MOST), targeting the mealtime environment and curriculum. Children's vegetable intake and variety was measured at follow-up using a modified Short Food Survey for early childhood education and care and analysed using a two-part mixed model for non-vegetable and vegetable consumers. Outcome measures were based on the RE-AIM framework. SETTING: Australian LDC centres. PARTICIPANTS: Thirty-nine centres, 120 educators and 719 children at follow-up. RESULTS: There was no difference between intervention and waitlist control groups in the likelihood of consuming any vegetables when compared with non-vegetable consumers for intake (OR = 0·70, (95 % CI 0·34-1·43), P = 0·32) or variety (OR = 0·73 (95 % CI 0·40-1·32), P = 0·29). Among vegetable consumers (n 652), there was no difference between groups in vegetable variety (exp(b): 1·07 (95 % CI:0·88-1·32, P = 0·49) or vegetable intake (exp(b): 1·06 (95 % CI: 0·78, 1·43)), P = 0·71) with an average of 1·51 (95 % CI 1·20-1·82) and 1·40 (95 % CI 1·08-1·72) serves of vegetables per day in the intervention and control group, respectively. Intervention educators reported higher skills for promoting vegetables at mealtimes, and knowledge and skills for teaching the curriculum, than control (all P < 0·001). Intervention fidelity was moderate (n 16/20 and n 15/16 centres used the Mealtime environment and Curriculum, respectively) with good acceptability among educators. The intervention reached 307/8556 centres nationally and was adopted by 22 % eligible centres. CONCLUSIONS: The pragmatic self-delivered online intervention positively impacted educator's knowledge and skills and was considered acceptable and feasible. Intervention adaptations, using the MOST cyclic approach, could improve intervention impact on children' vegetable intake.

A great way to bring up health behaviour topics at playgroup: a qualitative evaluation of the Healthy Conversations @ Playgroup program.

BACKGROUND: The early years is a critical stage to establish optimal nutrition and movement behaviours. Community playgroups are a relaxed environment for parents with a focus on social connection and supporting parents in their role as 'First Teachers'. Playgroups are therefore an opportunistic setting to promote health behaviours in the early years. To support parents with young children around healthy lifestyle behaviours, the Healthy Conversations @ Playgroup program was delivered in urban and regional areas, across three Australian jurisdictions between 2021-2023. OBJECTIVE: This qualitative evaluation aimed to understand how the Healthy Conversations @ Playgroup program was experienced by parents, playgroup coordinators and peer facilitators. DESIGN: Semi-structured virtual interviews and focus groups were conducted with parents, playgroup coordinators (i.e., person responsible for coordinating the playgroup) and peer facilitators (i.e., trained facilitator for the program) that participated in the Healthy Conversations @ Playgroup study. Transcripts were analysed following a thematic analysis approach. RESULTS: Twenty-eight playgroup parents, coordinators or peer facilitators participated in one of 8 focus groups or 5 interviews. Four themes were developed: Program strengths and challenges; Setting strengths and challenges; Factors that impact program delivery; Participant's suggestions for future program delivery. CONCLUSIONS: The Healthy Conversations @ Playgroup program was valued by parents, providing validation and normalisation of parenting practices, and fostering a shared experience of parenting. Playgroups are a convenient setting for families to attend. The dynamic and distracting nature of the playgroup setting were carefully considered when designing the program. Strategies to further enhance program engagement could include use of coordinator or parent champions, tailored delivery, and extending the reach to other family members. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12621000055808, registered 22 January 2021, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380890.

Unpacking the cost of the lunchbox for Australian families: a secondary analysis.

Ninety per cent of Australian school children bring a home-packed lunch to school, with 44% of the food consumed during school hours being unhealthy. Among other factors, cost is a key consideration for food provision; however, the costs to Australian families are not well understood. Therefore, we aimed to determine what families are currently paying for school lunchboxes in Australian primary schools and to examine associations between food costs and socio-demographic factors with dietary quality. An audit of local retail outlets was used to determine the food costs of lunchbox contents. Costs (AUD) were adjusted for inflation as of early 2023. The lunchboxes of 1026 children aged 4-12 years at 12 Catholic primary schools in New South Wales, Australia, were assessed at the start of the day, using photography assessment methods and a validated School Food Checklist. The mean cost of lunchbox contents was $4.48 AUD (SD 1.53), containing a mean energy of 2699 kJ (SD 859), with 37.3% (SD 23.9) of energy sourced from unhealthy foods. Multiple linear regression analyses found that the strongest predictors of higher lunchbox cost (P < 0.05) were a higher proportion of energy from unhealthy foods (B = 0.016) and lower Socio-Economic Indexes for Areas (B = -0.178), when controlling for child socio-demographics. The results indicated that lunchbox food costs to Australian families are comparable to alternative school food service models in Australia and internationally. Results demonstrate the cost of food is not the only barrier to providing a healthy school lunchbox. Demonstrating a need for cost-considerate systematic interventions addressing food provision challenges and socio-economic disparities faced by families.

Evaluation of a menu box delivery service for Australian long-day care services to improve food provision and child intake: a cluster randomised controlled trial.

OBJECTIVE: To evaluate the impact of a menu box delivery service tailored to the long-day care (LDC) setting on improving menu compliance with recommendations, children's diet quality and dietary intake while in care. DESIGN: A cluster randomised controlled trial in LDC centres randomly assigned to an intervention (menu box delivery) or comparison (menu planning training) group. The primary outcome was child food provision and dietary intake. Secondary outcomes include menu compliance and process evaluation, including acceptability, fidelity and menu cost (per child, per day). SETTING: South Australian LDC centres. PARTICIPANTS: Eight LDC centres (n 224 children) provided data. RESULTS: No differences were observed in serves/d between intervention and comparison centres, for provision (intervention, 0·9 inter-quartile range (IQR) 0·7-1·2; comparison, 0·8 IQR 0·5-1·3) or consumption (intervention, 0·5 IQR 0·2-0·8; comparison, 0·5 IQR 0·3-0·9) of vegetables. Child food provision and dietary intake were similar across both groups for all food groups (P < 0·05). At follow-up, all intervention centres met menu planning guidelines for vegetables, whereas only one comparison centre met guidelines. Intervention centre directors found the menu box delivery more acceptable than cooks. Cost of the intervention was AUD$2·34 greater than comparison centres (intervention, AUD$4·62 (95 % CI ($4·58, $4·67)); comparison, AUD$2·28 (95 % CI ($2·27, $2·30)) per child, per day). CONCLUSIONS: Menu compliance can be improved via a menu delivery service, delivering equivalent impacts on child food provision and dietary intake compared with an online training programme. Further exploration of cooks acceptability and cost is essential before scaling up to implementation.

Development and internal validation of the SMILE-FSS: a Free Sugars Screener for Australian children aged 2 and 5 years.

OBJECTIVE: To develop and internally validate a Free Sugars Screener (FSS) for Australian children aged 2 and 5 years. DESIGN: Using data collected from a ninety-nine-item (2-year-olds) and ninety-eight-item (5-year-olds) FFQ in the Study of Mothers' and Infants' Life Events affecting oral health (SMILE-FFQ), a regression-based prediction modelling approach was employed to identify a subset of items that accurately estimate total free sugars intake (FSI). The predictors were grams of free sugars (FSg) for individual items in the SMILE-FFQ and child's age and sex. The outcome variable was total FSI per person. To internally validate the SMILE-FSS items, the estimated FSg was converted to percent energy from free sugars (%EFS) for comparison to the WHO free sugars guideline categories (< 5 %, 5-< 10 % and ≥ 10 %EFS) using cross-classification analysis. SETTING: Australia. PARTICIPANTS: 858 and 652 2- and 5-year-old children, respectively, with complete dietary (< 5 % missing) and sociodemographic data. RESULTS: Twenty-two and twenty-six items were important in predicting FSI at 2 and 5 years, respectively. Items were similar between ages with more discretionary beverage items (e.g. sugar-sweetened beverages) at 5 years. %EFS was overestimated by 4·4 % and 2·6 %. Most children (75 % and 82 %) were categorised into the same WHO free sugars category with most (87 % and 95 %) correctly identified as having < 10 %EFS in line with the WHO recommendation. CONCLUSIONS: The SMILE-FSS has good internal validity and can be used in research and practice to estimate young Australian children's FSI and compare to the WHO free sugars guidelines to identify those 'at risk'.

Development of an initiatives package to increase children's vegetable intake in long day care centres using the Multiphase Optimisation Strategy (MOST) randomised factorial experiment.

OBJECTIVE: To inform a package of initiatives to increase children's vegetable intake while in long day care (LDC) by evaluating the independent and combined effects of three initiatives targeting food provision, the mealtime environment and the curriculum. DESIGN: Using the Multiphase Optimisation Strategy (MOST) framework, a 12-week, eight-condition (n 7 intervention, n 1 control) randomised factorial experiment was conducted. Children's dietary intake data were measured pre- and post-initiative implementation using the weighed plate waste method (1× meal and 2× between-meal snacks). Vegetable intake (g/d) was calculated from vegetable provision and waste. The optimal combination of initiatives was determined using a linear mixed-effects model comparing between-group vegetable intake at follow-up, while considering initiative fidelity and acceptability. SETTING: LDC centres in metropolitan Adelaide, South Australia. PARTICIPANTS: 32 centres, 276 staff and 1039 children aged 2-5 years. RESULTS: There were no statistically significant differences between any of the intervention groups and the control group for vegetable intake (all P > 0·05). The curriculum with mealtime environment group consumed 26·7 g more vegetables/child/day than control (ratio of geometric mean 3·29 (95 % CI 0·96, 11·27), P = 0·06). Completion rates for the curriculum (> 93 %) and mealtime environment (61 %) initiatives were high, and acceptability was good (4/5 would recommend), compared with the food provision initiative (0-50 % completed the menu assessment, 3/5 would recommend). CONCLUSION: A programme targeting the curriculum and mealtime environment in LDC may be useful to increase children's vegetable intake. Determining the effectiveness of this optimised package in a randomised controlled trial is required, as per the evaluation phase of the MOST framework.

Barriers and enablers to the family meal across time; a grounded theory study comparing South Australian parents' perspectives.

Family meals are positively associated with numerous beneficial health and social outcomes. Current discourse however claims that parents are faced with numerous barriers when trying to bring the family together to share a meal. Solutions for overcoming barriers to a positive shared family meal are often individualistic and do not address the systemic pressures and burdens families have faced for decades. The aim of this study was to explore the systemic and novel barriers and enablers to shared family meals as experienced by families across time. To achieve this, a qualitative study informed by grounded theory was conducted. Parents of South Australian families were recruited and interviewed in the 1990s, and a new sample of parents were recruited and interviewed in 2020. Transcripts were analysed using grounded theory and comparative analysis methods. Thirty-two parents from 16 families were interviewed in the 1990s, and 22 parents from 10 families in 2020. Ten factors were identified presenting as either enablers or barriers to the family meal, depending on the context they were experienced. Barriers and enablers were largely consistent across time. Scheduling and flexibility, children's disruptions and children's independence, privileges required to have family meals and motivation and commitment to the family meal were identified as persistent enablers and barriers across time. These findings indicate that parents are faced with similar challenges they have been facing for decades and are still not being adequately supported to execute family meals regularly. Recognising that factors present as either barriers or enablers to the family meal provides us with opportunities to transform barriers to enablers and support families to have regular, meaningful family meals.

The family meal, a ritual frozen in time; an Australian grounded theory study.

Family meals are recognized as an opportunity to promote the health of families. Popular discourse posits that changes to contemporary family life have made family meals harder to achieve and promotion of the 'traditional' family meal may be adding pressures to contemporary families. While research has been conducted on family meals over the last three decades, there is no explicit investigation of the experiences and practices of family meals over this time. Understanding the evolution of family meal practices across time is important for developing achievable expectations in relation to this ritual. Qualitative interviews were conducted with a diverse population of South Australian parents in the 1990s (n = 32) and with a separate population of parents in 2020 (n = 22) to gather their experiences of family meal practices. A comparative analysis, informed by grounded theory, was undertaken to identify similarities and differences in experiences across these two time periods. The results indicated stability in many family meal experiences across time, particularly in their value and significance in family life. Negotiations balancing time, cost, food preferences and responsibility persisted. The stability of family meal values and practices is important to consider when making recommendations, designing interventions and creating services targeting the family meal.

Parental work hours and household income as determinants of unhealthy food and beverage intake in young Australian children.

OBJECTIVE: This study examined parental work hours and household income as determinants of discretionary (energy dense, nutrient poor) food and beverage intake in young children, including differences by eating occasion. DESIGN: Secondary analysis of cross-sectional data. Three hierarchical regression models were conducted with percent energy from discretionary food and beverages across the day, at main meals, and at snack times being the outcomes. Dietary intake was assessed by 1x24-hour recall and 1-2x24-hour food record(s). Both maternal/paternal work hours were included, and total household income. Covariates included household, parent and child factors. SETTING: Data from the NOURISH/SAIDI studies were collected between 2008-13. PARTICIPANTS: Participants included 526 mother-child dyads (median(IQR) child age 1.99(1.96,2.03) years). Forty-one percent of mothers did not work while 57% of fathers worked 35-40 hours/week. Most (85%) households had an income of ≥$50k AUD/year. RESULTS: Household income was consistently inversely associated with discretionary energy intake (ß= -0.12 to -0.15). Maternal part-time employment (21-35 hours/week) predicted child consumption of discretionary energy at main meals (ß=0.10, p=0.04). Paternal unemployment predicted a lower proportion of discretionary energy at snacks (ß= -0.09, p=0.047). CONCLUSIONS: This work suggests that household income should be addressed as a key opportunity-related barrier to healthy food provision in families of young children. Strategies to reduce the time burden of healthy main meal provision may be required in families where mothers juggle longer part-time working hours with caregiving and domestic duties. The need to consider the role of fathers and other parents/caregivers in shaping children's intake was also highlighted.

The Family Meal Framework: A grounded theory study conceptualising the work that underpins the family meal.

The family meal has been recognised as an integral part of family life. With the positive health outcomes associated with the family meal, it has been proposed as a strategy for encouraging health-promoting behaviours. However, a detailed understanding of the physical and mental work required to execute the family meal is lacking. The aim of this research was to conduct a grounded theory study to understand the components required to successfully execute the family meal. Two temporal data sets (1993-4/2020) in which diverse participants were sampled were used for this study. Methods used to conduct qualitative interviews with parents in the 1990s were mirrored in the conduct of qualitative interviews with parents in 2020. The interview data was analysed drawing on grounded theory methodology and methods. The entire sample included 54 parents from 28 families. A conceptual framework, 'The Family Meal Framework', was developed from the analyses. The five main components of The Framework are the cognitions (invisible work considering the needs of the family), actions (physical tasks required for the family meal), outcomes (the event of the family meal), the beliefs and feelings (expectations and attitudes toward the family meal), and the person(s) responsible (who undertakes the work). This framework provides a novel theory describing the reactive, cyclical nature of the work required to execute the family meal. This new understanding provides discrete opportunities for intervention in family meal research, practice, policy and promotion.

The food and nutrient intake of 5- to 12-year-old Australian children during school hours: a secondary analysis of the 2011-2012 National Nutrition and Physical Activity Survey.

OBJECTIVE: School food intake of Australian children is not comprehensively described in literature, with limited temporal, nationally representative data. Greater understanding of intake at school can inform school-based nutrition promotion. This study aimed to describe the dietary intake of primary-aged children during school hours and its contribution to daily intake. DESIGN: This secondary analysis used nationally representative, cross-sectional data from the 2011 to 2012 National Nutrition and Physical Activity Survey. Dietary intake was assessed using validated 24-h dietary recalls on school days. Descriptive statistics were undertaken to determine energy, nutrients, food groups and food products consumed during school hours, as well as their contributions to total daily intake. Associations between school food intake and socio-demographic characteristics were explored. SETTING: Australia. PARTICIPANTS: Seven hundred and ninety-five children aged 5-12 years. RESULTS: Children consumed 37 % of their daily energy and 31-43 % of select nutrient intake during school hours, with discretionary choices contributing 44 % of school energy intake. Most children consumed less than one serve of vegetables, meat and alternatives or milk and alternatives during school hours. Commonly consumed products were discretionary choices (34 %, including biscuits, processed meat), bread (17 %) and fruit (12 %). There were limited associations with socio-economic position variables, apart from child age. CONCLUSIONS: Children's diets were not aligned with national recommendations, with school food characterised by high intake of discretionary choices. These findings are consistent with previous Australian evidence and support transformation of the Australian school food system to better align school food consumption with recommendations.

Identifying opportunities for strengthening advice to enhance vegetable liking in the early years of life: qualitative consensus and triangulation methods.

OBJECTIVE: To prioritise and refine a set of evidence-informed statements into advice messages to promote vegetable liking in early childhood, and to determine applicability for dissemination of advice to relevant audiences. DESIGN: A nominal group technique (NGT) workshop and a Delphi survey were conducted to prioritise and achieve consensus (≥70 % agreement) on thirty evidence-informed maternal (perinatal and lactation stage), infant (complementary feeding stage) and early years (family diet stage) vegetable-related advice messages. Messages were validated via triangulation analysis against the strength of evidence from an Umbrella review of strategies to increase children's vegetable liking, and gaps in advice from a Desktop review of vegetable feeding advice. SETTING: Australia. PARTICIPANTS: A purposeful sample of key stakeholders (NGT workshop, n 8 experts; Delphi survey, n 23 end users). RESULTS: Participant consensus identified the most highly ranked priority messages associated with the strategies of: 'in-utero exposure' (perinatal and lactation, n 56 points) and 'vegetable variety' (complementary feeding, n 97 points; family diet, n 139 points). Triangulation revealed two strategies ('repeated exposure' and 'variety') and their associated advice messages suitable for policy and practice, twelve for research and four for food industry. CONCLUSIONS: Supported by national and state feeding guideline documents and resources, the advice messages relating to 'repeated exposure' and 'variety' to increase vegetable liking can be communicated to families and caregivers by healthcare practitioners. The food industry provides a vehicle for advice promotion and product development. Further research, where stronger evidence is needed, could further inform strategies for policy and practice, and food industry application.

Study protocol for Healthy Conversations @ Playgroup: a multi-site cluster randomized controlled trial of an intervention to promote healthy lifestyle behaviours in young children attending community playgroups.

BACKGROUND: Early childhood is a critical window for preventing obesity and chronic disease. Yet, 1 in 4 Australian children aged 5 years and under are affected by overweight or obesity; and significant proportions of children under 5 years fail to meet guidelines for diet quality, physical activity (PA), screen time, and sleep. Consequently, effective interventions to promote healthy lifestyle behaviors and prevent obesity during early childhood are needed. Community playgroups provide an opportunity for parents, carers, and children to meet in a safe and relaxed environment to play and share information. The structure, low cost and reach of playgroups provide a unique platform to engage parents in a scalable program to promote healthful lifestyle behaviors and prevent childhood obesity. However, the evidence base for the effectiveness of health promotion programs delivered in community playgroup settings is limited and lacking credible evidence from rigorously conducted randomized controlled trials. METHODS: The Healthy Conversations @ Playgroup randomized controlled trial (RCT) aims to address the underlying behavioral risk factors for obesity by helping parents take effective steps to improve their child's dietary, PA, screen time, and sleep behaviors. The intervention program comprises 10 "healthy conversations" led by a trained peer facilitator, designed to increase parents' behavioral capability and self-efficacy to implement autonomy-supportive parenting practices. The program will be delivered biweekly during regularly scheduled playgroup sessions over 10-weeks. Effectiveness will be tested in a 2-arm cluster RCT involving 60 community playgroups in three states across Australia. After baseline assessments, participating playgroups will be randomly allocated to either intervention or wait-list control conditions. Primary outcomes (vegetable intake, discretionary foods, daily PA, screen time, sleep duration, and body mass index [BMI] z-score) will be assessed at baseline, immediately post-intervention (10-weeks; T2) and 6-months post-intervention (T3). Outcomes will be assessed for differential change at T2 and T3. DISCUSSION: The Healthy Conversations @ Playgroup trial will rigorously evaluate a novel peer-led intervention program to promote healthful lifestyle behaviors and prevent obesity in children and families attending community playgroups. If effective, the program could be immediately scaled-up and delivered in community playgroups across Australia. TRIAL REGISTRATION: Trial registered 22nd January 2021 with the Australian and New Zealand Clinical Trials Registry ( ACTRN12621000055808 ).

Understanding the influence of physical resources and social supports on primary food providers' snack food provision: a discrete choice experiment.

BACKGROUND: Snack eating occasions contribute approximately a third of children's energy intake, with approximately half of all unhealthy foods consumed during snack times. Therefore, it is critical to understand the drivers of primary food providers' snack provision. The study aims were to determine the relative importance of physical resources and social supports when primary food providers are choosing snacks to provide to their child, and to investigate how these attributes differ in social versus non-social occasions, and between subgroups of primary food providers based on socio-economic position. METHODS: Primary food providers of three to seven-year olds completed an online discrete choice experiment, by making trade-offs when completing repeated, hypothetical choice tasks on the choice of snacks to provide to their child in: 1) non-social and 2) social condition. Choice tasks included two alternatives consisting of varying attribute (i.e. factor) levels, and an opt-out option. The order of conditions shown were randomized across participants. Multinomial logit model analyses were used to determine utility weights for each attribute. RESULTS: Two-hundred and twenty-five primary food providers completed the study, providing 1125 choice decisions per condition. In the non-social condition, the top three ranked attributes were type of food (utility weight 1.94, p < 0.001), child resistance (- 1.62, p < 0.001) and co-parent support (0.99, p < 0.001). In the social condition, top ranking attributes were child resistance (utility weight - 1.50, p < 0.001), type of food (1.38, p < 0.001) and co-parent support (1.07, p < 0.001). In both conditions, time was not a significant influence and cost was of lowest relative importance. Subgroup analyses revealed cost was not a significant influence for families from higher socio-economic backgrounds. CONCLUSIONS: Type of food, child resistance and co-parent support were of greatest relative importance in primary food providers' snack provision decision-making, regardless of social condition or socio-economic position. In designing future interventions to reduce unhealthy snacks, researchers should prioritize these influences, to better support primary food providers in changing their physical and social opportunity. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry no. ACTR N12618001173280.

A systematic evaluation of digital nutrition promotion websites and apps for supporting parents to influence children's nutrition.

BACKGROUND: Globally children's diet quality is poor. Parents are primary gatekeepers to children's food intake; however, reaching and engaging parents in nutrition promotion can be challenging. With growth in internet and smartphone use, digital platforms provide potential to disseminate information rapidly to many people. The objectives of this review were to conduct a comprehensive and systematic evaluation of nutrition promotion via websites and apps supporting parents to influence children's nutrition, from three different perspectives: 1) current evidence base, 2) end user (parent) experience and 3) current commercial offerings. METHODS: Three systematic reviews were undertaken of (1) studies evaluating the effectiveness for digital platforms for improving nutrition in children and parents, (2) studies conducting user-testing of digital tools with parents, (3) websites and apps providing lunch-provision information to parents. Searches were conducted in five databases for reviews one and two, and systematic search of Google and App Store for review three. Randomised controlled trials, cohort and cross-sectional and qualitative studies (study two only) were included if published in English, from 2013, with the intervention targeted at parents and at least 50% of intervention content focused on nutrition. Search results were double screened, with data extracted into standardised spreadsheets and quality appraisal of included search results. RESULTS: Studies evaluating digital nutrition interventions targeting parents (n = 11) demonstrated effectiveness for improving nutrition outcomes, self-efficacy and knowledge. Six of the included randomised controlled trials reported digital interventions to be equal to, or better than comparison groups. User-testing studies (n = 9) identified that digital platforms should include both informative content and interactive features. Parents wanted evidence-based information from credible sources, practical tools, engaging content and connection with other users and health professionals. Websites targeting lunch provision (n = 15) were developed primarily by credible sources and included information-based content consistent with dietary guidelines and limited interactive features. Lunchbox apps (n = 6), developed mostly by commercial organisations, were more interactive but provided less credible information. CONCLUSIONS: Digital nutrition promotion interventions targeting parents can be effective for improving nutrition-related outcomes in children and parents. As demonstrated from the lunchbox context and user-testing with parents, they need to go beyond just providing information about positive dietary changes, to include the user-desired features supporting interactivity and personalisation.

Are the nutrient and textural properties of Australian commercial infant and toddler foods consistent with infant feeding advice?

Infant feeding guidelines worldwide recommend first foods to be Fe rich with no added sugars and that nutrient-poor discretionary foods are to be avoided. Feeding guidelines also recommend exposing infants to a variety of foods and flavours with increasingly complex textures. Here, we compare nutritional and textural properties of commercial infant and toddler foods available in Australia with established infant feeding guidelines. Nutrition information and ingredient lists were obtained from food labels, manufacturer and/or retailer websites. In total, 414 foods were identified, comprising mostly mixed main dishes, fruit and vegetable first foods and snacks. Most products were poor sources of Fe, and 80 % of first foods were fruit-based. Half of all products were purées in squeeze pouches, and one-third of all products were discretionary foods. The nutritional content of many products was inconsistent with guidelines, being low in Fe, sweet, smooth in consistency or classified as discretionary. Reformulation of products is warranted to improve Fe content, particularly in mixed main dishes, expand the range of vegetable-only foods and textural variety. Greater regulatory oversight may be needed to better inform parents and caregivers. Frequent consumption of commercial baby foods low in Fe may increase the risk of Fe deficiency. Excessive consumption of purées via squeeze pouches may also have implications for overweight and obesity risk.

Adaptation, acceptability and feasibility of a Short Food Survey to assess the dietary intake of children during attendance at childcare.

OBJECTIVE: To (i) describe the adaptation of the Short Food Survey (SFS) for assessing the dietary intake of children (2-5 years) during attendance at Early Childhood Education and Care (SFS-ECEC); (ii) determine the acceptability and feasibility of the SFS-ECEC; and (iii) compare the SFS-ECEC to direct observations for assessing dietary intake of children in care. DESIGN: The adapted forty-seven-item SFS-ECEC was completed by childcare educators to capture individual child's usual intake over the past month. Acceptability and feasibility were assessed via educator self-report and completion rates. Mean servings of food groups consumed in accordance with dietary guidelines reported in the SFS-ECEC were compared to those obtained by a single-day direct observation via visual estimation conducted by trained personnel. Mean differences, intra-class correlations, Bland-Altman plots, percentage agreement and Cohen's κ were examined. SETTING: Early Childhood Education and Care, NSW, Australia. PARTICIPANTS: Educators and children. RESULTS: 213 (98·61 %) SFS-ECECs were returned. Acceptability was high with 86·54 % of educators reporting the tool as easy to understand. Mean differences in servings of food groups between the SFS-ECEC and direct observation were statistically significantly different for five out of six foods and ranged 0·08-1·07, with intra-class correlations ranging 0·00-0·21. Agreement between the methods in the classification of children meeting or not meeting dietary guidelines ranged 42·78-93·01 %, with Cohen's κ ranging -0·03 to 0·14. CONCLUSIONS: The SFS-ECEC is acceptable and feasible for completion by childcare educators. While tool refinement and further validation is warranted, small mean differences suggest the tool may be useful in estimating group-level intakes.

Dietary assessment toolkits: an overview.

OBJECTIVE: A wide variety of methods are available to assess dietary intake, each one with different strengths and weaknesses. Researchers face multiple challenges when diet and nutrition need to be accurately assessed, particularly in the selection of the most appropriate dietary assessment method for their study. The goal of the current collaborative work is to present a collection of available resources for dietary assessment implementation.Design/Setting/ParticipantsAs a follow-up to the 9th International Conference on Diet and Physical Activity Methods held in 2015, developers of dietary assessment toolkits agreed to collaborate in the preparation of the present paper, which provides an overview of each toolkit. The toolkits presented include: the Diet, Anthropometry and Physical Activity Measurement Toolkit (DAPA; UK); the National Cancer Institute's (NCI) Dietary Assessment Primer (USA); the Nutritools website (UK); the Australasian Child and Adolescent Obesity Research Network (ACAORN) method selector (Australia); and the Danone Dietary Assessment Toolkit (DanoneDAT; France). An at-a-glance summary of features and comparison of the toolkits is provided. RESULTS: The present review contains general background on dietary assessment, along with a summary of each of the included toolkits, a feature comparison table and direct links to each toolkit, all of which are freely available online. CONCLUSIONS: This overview of dietary assessment toolkits provides comprehensive information to aid users in the selection and implementation of the most appropriate dietary assessment method, or combination of methods, with the goal of collecting the highest-quality dietary data possible.

Supporting healthy lifestyle behaviours in families attending community playgroups: parents' perceptions of facilitators and barriers.

BACKGROUND: Establishing healthy nutrition, activity, and sleep behaviours early in life is a key strategy in childhood obesity prevention. Parents are the primary influence on the development and establishment of obesity-related behaviours in young children. There is evidence that autonomy supporting parenting practices are crucial for the development of self-regulation and the internalisation of healthy behaviours in children. It is therefore imperative that parenting practices are targeted as part of an obesity prevention intervention. However, there is limited understanding of barriers and facilitators to parents using autonomy supporting parenting practices with their children aged 0-5 years. Therefore, the aim of the study was to identify barriers and facilitators to using autonomy supporting parenting practices. A secondary aim was to determine parent preferences in respect to an intervention program to be delivered in community playgroups. METHODS: Parents were recruited through Playgroup Queensland (PGQ), a not-for-profit organisation in Brisbane, Australia, to attend a focus group during their usual playgroup session. The focus group interview guide was designed to promote discussion among the participants in respect to their shared experiences as parents of young children. The focus group transcripts were coded and analysed using qualitative content analysis. Five focus groups with parents (n = 30) were conducted in May 2018. Most of the participants were mothers [1], and the majority (76%) had a child at playgroup aged between 2 and 4 years. RESULTS: The support and guidance received from other parents at playgroup was a facilitator to autonomy supporting parenting practices. Barriers included beliefs around the need to use rewards to encourage child eating, beliefs around the need for screens as babysitters, and feeling disempowered to change sleep behaviours. Parents were enthusiastic about a potential program that would leverage off the existing playgroup support networks, but they did not want to be "educated", or to lose their "playgroup time" to an intervention. Rather they wanted strategies and support to deal with the frustrations of food, screen and sleep parenting. CONCLUSION: These results will be used to inform the development of a childhood obesity prevention intervention to be delivered in a community playgroup setting.

Evaluation of Simulation Models that Estimate the Effect of Dietary Strategies on Nutritional Intake: A Systematic Review.

Background: Dietary simulation modeling can predict dietary strategies that may improve nutritional or health outcomes.Objectives: The study aims were to undertake a systematic review of simulation studies that model dietary strategies aiming to improve nutritional intake, body weight, and related chronic disease, and to assess the methodologic and reporting quality of these models.Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided the search strategy with studies located through electronic searches [Cochrane Library, Ovid (MEDLINE and Embase), EBSCOhost (CINAHL), and Scopus]. Study findings were described and dietary modeling methodology and reporting quality were critiqued by using a set of quality criteria adapted for dietary modeling from general modeling guidelines.Results: Forty-five studies were included and categorized as modeling moderation, substitution, reformulation, or promotion dietary strategies. Moderation and reformulation strategies targeted individual nutrients or foods to theoretically improve one particular nutrient or health outcome, estimating small to modest improvements. Substituting unhealthy foods with healthier choices was estimated to be effective across a range of nutrients, including an estimated reduction in intake of saturated fatty acids, sodium, and added sugar. Promotion of fruits and vegetables predicted marginal changes in intake. Overall, the quality of the studies was moderate to high, with certain features of the quality criteria consistently reported.Conclusions: Based on the results of reviewed simulation dietary modeling studies, targeting a variety of foods rather than individual foods or nutrients theoretically appears most effective in estimating improvements in nutritional intake, particularly reducing intake of nutrients commonly consumed in excess. A combination of strategies could theoretically be used to deliver the best improvement in outcomes. Study quality was moderate to high. However, given the lack of dietary simulation reporting guidelines, future work could refine the quality tool to harmonize consistency in the reporting of subsequent dietary modeling studies.