Clinical Correlates and Prevalence of Food Selectivity in Children with Autism Spectrum Disorder.

OBJECTIVE: To examine clinical correlates and prevalence of food selectivity (FS) - ie, self-restricted diet, reluctance to try new foods - in children with autism spectrum disorder (ASD) ascertained from a general outpatient autism clinic. STUDY DESIGN: A multidisciplinary team (pediatric nurse practitioner, psychologist and dietitian) assessed medical and psychosocial histories and dietary habits in 103 children with ASD (mean age = 5.8 ± 2.2 years; range 2-10). Parents rated child mealtime behavior on the Brief Autism Mealtime Behavior Inventory (BAMBI) and disruptive behavior on the Aberrant Behavior Checklist (ABC). Height and weight measurements were collected. Children were classified as FS or no FS based on parent reported intake and mealtime behavior. A 24-hour dietary recall was used to record intake percentages < 80%. Logistic regression and multivariable modeling were used to evaluate clinical correlates with FS. RESULTS: Of 103 children, 45.6% (n = 47) were classified as FS; 54.4% (n = 56) no FS. After adjusting for potential confounders, the odds of FS increased by 1.91 (95% CI: 1.38, 2.64, P < .001) for every half-SD increase in BAMBI total score and by 1.35 (95% CI: 1.05, 1.74, P = .020) for every half-SD increase in ABC Hyperactivity/Noncompliance. No group differences in anthropometrics or nutritional intake were identified. CONCLUSIONS: Food selectivity (FS) in children with ASD was strongly associated with greater severity of disruptive mealtime and hyperactivity/noncompliance behaviors. FS was not associated with anthropometrics or nutritional intake.

Eating time variation from weekdays to weekends and its association with dietary intake and BMI in different chronotypes: findings from National Health and Nutrition Examination Survey (NHANES) 2017-2018.

Evidence suggests that differences in meal timing between weekends and weekdays can disrupt the body's circadian rhythm, leading to a higher BMI. We aimed to investigate the associations between mealtime variation from weekdays to weekends (eating midpoint jetlag), dietary intake and anthropometric parameters, based on individuals' chronotype. The study utilised data from National Health and Nutrition Examination Survey 2017-2018. Food consumption was estimated by weighted average of participants' food intake on weekdays and weekends. Eating midpoint jetlag, defined as the difference between the midpoint of the first and last mealtimes on weekends and weekdays, was calculated. Chronotype was assessed by participants' mid-sleep time on weekends, adjusted for sleep debt. Linear regression analysis was conducted to investigate the associations between variables. The sample was categorised into chronotype tertiles. Among individuals in the third chronotype tertile, there was a positive association between eating midpoint jetlag and BMI (ß = 1·2; 95 % CI (1·13, 1·27)). Individuals in the first tertile showed a positive association between eating midpoint jetlag and energy (ß = 96·9; 95 % CI (92·9, 101·7)), carbohydrate (ß = 11·96; 95 % CI (11·2, 12·6)), fat (ß = 3·69; 95 % CI (3·4, 3·8)), cholesterol (ß = 32·75; 95 % CI (30·9, 34·6)) and sugar (ß = 8·84; 95 % CI (8·3, 9·3)) intake on weekends. Among individuals with an evening tendency, delaying meals on weekends appears to be linked to a higher BMI. Conversely, among individuals with a morning tendency, eating meals later on weekends is associated with higher energetic intake on weekends.

Exploring unequal class logics of mealtime food socialisation. An ethnography of family meals in France and Australia.

Regular family mealtimes are occasions to model food consumption and have been associated with health and well-being benefits for children. This study aimed to investigate children's mealtime food socialisation in socially diverse households. Nine families from France and five from Australia were recruited, ranging from lower middle-class to upper-class positions, with children mostly between the ages of five to eight. The data is composed of the observations of 47 mealtimes and semi-directive interviews with both parents. The results showed that food socialisation and parents' understanding of children's taste development were linked to the household's social class position as well as to the temporal, cognitive and emotional resources parents possessed at mealtimes, in a similar manner across France and Australia. The more capital and resources the parents had, the more they were able to perform an intensive food socialisation style, which led them to prepare balanced menus and get children to eat the food served. The less capital and resources the parents had, the more they engaged in a hands-off food socialisation style, leading them to serve more child-oriented and less diverse menus. Importantly, all parents strived to serve healthy food, but limited resources prevented some of them from doing so. These food socialisation styles were also connected to the development of different social skills in children: with the intensive model, children were closely managed by their parents at the table but also learnt negotiation skills, whereas with the hands-off style, children learnt to be quite autonomous in their eating. The findings presented here contribute to Hays' intensive mothering concept and to Lareau's class-based parenting models. They also challenge Bourdieu's differentiation between a taste of necessity and a taste of luxury.

Protective role of family mealtime frequency against disordered eating behaviors: Racial and ethnic differences.

Family mealtimes have been recognized for their positive effect on child and adolescent health outcomes. Frequent family meals have been shown to have protective effects in reducing disordered eating behaviors, but the variability of these effects across different racial and ethnic backgrounds has been less explored. To address the gap, the current study utilizes a sample of 33,417 families with children (ages 6-17) in the United States who participated in the 2022 National Surveys of Children's Health (NSCH). Logistic regressions were conducted to examine the association between family mealtime frequency and the manifestation of disordered eating across youth from diverse racial/ethnic backgrounds. Our findings revealed that frequent family mealtimes are associated with a lower risk of engaging in disordered eating behaviors in youth. However, there were disparities in the associations between family mealtime frequency and the prevalence of disordered eating behaviors among children from different racial/ethnic backgrounds. Youth who never participated in family mealtimes were at a greater risk of engaging in disordered eating behaviors among those identifying as non-Hispanic Black or of 'other' racial groups. In youth identifying with multiple races, the frequency of family was not associated with the odds of disordered eating behaviors. The results provide insights into the nuanced influence of family mealtime frequency on disordered eating based on diverse racial/ethnic groups. This highlights the need for future studies to identify factors associated with racial/ethnic identities that may contribute to disordered eating behaviors in youth to identify the unique needs and challenges faced by families in leveraging the protective effect of family mealtimes.

Parental verbal communication and modeling behavior during mealtimes shape offspring eating behavior - A systematic review with a focus on clinical implications for eating disorders.

OBJECTIVE: The aim of this review is to provide an overview of parental communication patterns during mealtimes, with a special emphasis being placed on the differences between families with and without a history of eating disorders. METHODS: The systematic review was conducted according to the PRISMA statement. A systematic literature search was carried out in PubMed, PubPsych and PsycINFO and the results were assessed for eligibility by two independent raters using the PICOS criteria. Only studies that included a mealtime observation were considered suitable for analysis of both explicit and implicit parental communication. RESULTS: The results of the review suggest that mothers communicate more, with more complexity, and with a greater variety of words with their children during mealtimes compared to fathers. The intention and type of communication is diverse and heterogeneous. In general, parents often tried to encourage their children to eat. Verbal modeling and co-eating appeared to be common behaviors. Mothers with a history of eating disorders expressed more negative emotions during eating than mothers without eating disorders. Findings regarding the use of positive comments and controlling speech are contradicting. DISCUSSION: The review outlines major fields of parent-child communication and modeling behavior around family meals which might be relevant to investigate and integrate into models of intergenerational transmission of eating behavior and disordered eating.

Shaping a moral body in family dinner talk: Children's socialization to good manners concerning bodily conduct.

The family meal has been extensively investigated as a site for children's acquisition of eating-related behaviors and attitudes, as well as culture-specific rules and assumptions. However, little is known about children's socialization to a constitutive dimension of commensality and even social life: good manners concerning bodily conduct. Drawing on 20th century scholarship on body governmentality and good manners, and building on recent studies on family meal as a socialization site, the article sheds light on this overlooked dimension of family commensality. Based on a corpus of more than 20 h of videorecorded family dinner interactions collected in Italy, and using discourse analysis, the article shows that family mealtime constitutes a relevant arena where parents control their children's conduct through the micro-politics of good manners. By participating in mealtime interactions, children witness and have the chance to acquire the specific cultural principles governing bodily conduct at the table, such as "sitting properly", "eating with cutlery", and "chewing with mouth closed". Yet, they are also socialized to a foundational principle of human sociality: one's own behavior must be self-monitored according to the perspective of the generalized Other. Noticing that forms and contents of contemporary family mealtime talk about good manners are surprisingly similar to those described by Elias in his seminal work on the social history of good manners, the article documents that mealtime still constitutes a privileged cultural site where children are multimodally introduced to morality concerning not only specific table manners, but also more general and overarching assumptions, namely the conception of the body as an entity that should be (self)monitored and shaped according to moral standards.

The influence of early and current feeding practices, eating behaviors, and screen time on dietary patterns in Polish toddlers - A cross-sectional study.

Early nutrition has an important influence on a child's proper health and development, and understanding factors that may be related to desirable dietary patterns is key to improving the diet of future generations. The aim of this study was to assess whether early and current feeding practices, eating behaviors, and screen time viewing are associated with toddlers' dietary patterns. A cross-sectional sample of 467 mothers of toddlers (aged 1 year to 3) was surveyed between 2020 and 2022. Food consumption was evaluated by the Food Frequency Questionnaire (FFQ). The k-means algorithm was used to define dietary patterns on the basis of data collected from the FFQ and mealtime environment patterns, based on the data about practices during meals consumption. The odds of following a prohealth dietary pattern among early feeding factors were lower when infants ate commercial complementary foods more often. Distracted mealtime environment pattern increased the odds of following a non-eaters pattern, and commercial complementary foods pattern increased the odds of following a processed pattern. Currently, the odds of following a processed dietary pattern were higher when children were not breastfed and had higher screen time. Toddlers who ate during distraction and were more fussy had lower odds of following a prohealth dietary pattern, whereas higher enjoyment of food and satiety responsiveness increased the odds. The results indicate the need to increase parents' awareness about the importance of early factors in establishing dietary patterns.

"Still work?" Design and effect of interventions used to modify feeding problems in children with autism: A systematic review of studies employing group designs.

BACKGROUND: Feeding problems in children with autism jeopardize the well-being of both children with autism and their families. Mixed findings were reported from previous interventions, which were mostly evaluated by single subject research design (SSRD) studies. Moreover, feasibility assessment and social validity measurement were unaddressed by these SSRD studies. To fill this substantial knowledge gap, the present review systematically summarized and evaluated feeding interventions implemented in children with autism, which were assessed by studies employing group designs. METHOD: An extensive literature search in eight established online databases was conducted, and a total of 17 eligible studies published in 2009-2021 were included for further analysis. A descriptive account of the features of the investigations is provided, including assessment of study quality. RESULTS: A total of 449 children with autism and 203 parents/caregivers participated in the included studies. The multiple use of five strategic intervention components were highlighted in this review, including nutrition education/consultations, environmental modifications, sensory exposure, cognitive components, and behaviour interventions. The reviewed interventions showed a preliminarily positive effect for modifying feeding problems in children with autism. Furthermore, the evaluation based on the RE-AIM framework (reach, efficacy, adoption, implementation, and maintenance) demonstrated that an interdisciplinary multi-component intervention strategy may achieve high effectiveness and feasibility in improving feeding problems in a wide range of children with autism. CONCLUSIONS: This review found that interventions achieved and maintained a positive effect on modification of feeding problems in groups of children with autism. Information and gaps identified and summarized in the implementation process may assist both researchers and stakeholders to further support these vulnerable children.

Assessing eating ability and mealtime behaviors of persons living with dementia: A systematic review of instruments.

This systematic review aimed to describe the characteristics of instruments that assess eating ability and/or mealtime behaviors in persons living with dementia, and evaluate their psychometric properties. Five databases were searched for relevant records between 1/1/1980 and 5/25/2023. Records included instruments assessing eating ability and/or mealtime behaviors of people with dementia. The psychometric quality of the instruments was evaluated using the Psychometric Assessment for Self-report and Observational Tools (PAT). 45 eligible instruments were identified from 115 records. While 38 instruments were scored as having low psychometric quality, 7 had moderate quality. Edinburgh Feeding Evaluation in Dementia (EdFED), Mealtime Difficulty Scale for older adults with Dementia (MDSD), and Dementia Hyperphagic Behavior Scale (DHBS) were scored as having the highest quality (total PAT score = 9). Further refinement of existing instruments and additional psychometric testing in larger, diverse samples will improve pragmatic use in dementia mealtime care research and practice.

An observational study of parental language during play and mealtime in toddlers at variable likelihood for autism.

Parental language input influences child language outcomes but may vary based on certain characteristics. This research examined how parental language differs during two contexts for toddlers at varying likelihood of autism based on their developmental skills. Parental language (quantity, quality, and pragmatic functions) was analyzed during dyadic play and mealtime interactions as a secondary data analysis of observational data from a study of toddlers at elevated and lower likelihood of autism. Child developmental skills and sensory processing were also assessed. Parents used more words per minute, directives, and verbs during play and more adjectives, descriptions, and questions during mealtime. Parental language differed based on child fine motor skills, receptive language, and levels of sensory hyporesponsiveness but not autism likelihood. Overall, this study found that parental language varies based on context and child developmental skills. Future research examining parental language should include pragmatic functions and context across developmental trajectories.

"Savoring the Past, Nourishing the Present": Uncovering the Essence of Multicultural Mealtime Experiences in Senior Living Facilities.

Mealtimes are crucial markers of daily schedules and hold significant meaning for older adults in senior living facilities worldwide, extending beyond the food served. Utilizing Moustakas' transcendental phenomenological approach, this study explores the lived experiences and multifaceted meanings of mealtimes for older adults from multicultural backgrounds in senior living facilities in Malaysia. In six urban senior living facilities, 28 older adults from Malaysia's three major ethnic groups, namely Bumiputera Malays, Chinese, and Indians were interviewed through semi-structured one-on-one interviews. Five discernible themes beyond tangible aspects emerged: mealtimes as cultural bridges, memories and palate, emotional bonds through food, quality control and consumption, and comfort through personalized dining experience. This study raises awareness among senior-living facilitators, family caregivers, academics, and policymakers to acknowledge the evident complexities of mealtimes for older adults living away from the comfort of familiarity. Future research should consider the active involvement of all stakeholders in co-creating and implementing interventions that enhance older adults' mealtime experiences in senior-friendly establishments.

Meal timing variability of rotating shift workers throughout a complete shift cycle and its effect on daily energy and macronutrient intake: a field study.

PURPOSE: To evaluate the meal timing variability of rotating shift workers throughout a complete shift schedule and its effect on daily energy and macronutrient intake. METHODS: Thirty male shift-workers from a mining company were evaluated in a complete rotation shift cycle over 240 consecutive hours (10 days; two days of morning shifts, two days of evening shifts, 24 h free, two days of night shifts and three days off). Food intake related variables [meal timing, energy (kcal) and macronutrient intake (%)] were assessed by 24 h recall by a trained nutritionist. Mixed models were used to analyze the variation in meal timing and energy and macronutrient intake throughout the shift cycle, as well as the interaction between shift and time ranges (00:00-03:59, 04:00-07:59, 08:00-11:59, 12:00-15:59, 16:00-19:59, 20:00-23:59). RESULTS: The first meal of the day was earlier on night shifts [D6 (3:44 ± 0:33) and D7 (5:52 ± 0:42)] compared to the other shifts (p < 0.001), except for D4 (evening shift; 5:51 ± 0:47) versus D7 (p = 0.999). Night shifts also showed a shorter night fasting (D5-D6, 9.3 h; D6-D7, 9.6 h) than most other nights (p < 0.05), except for the fasting between D1-D2 (11.3 h) and D3-D4 (11.2 h) (p > 0.05). There was no difference in 24 h energy intake throughout the shift cycle (p = 0.065). The analysis of interaction between shift and time ranges showed that night shift (D6) presented a higher intake of energy (441.5 ± 48.4 kcal), percentage of energy (D6: 17.8 ± 1.8%), fat (17.6 ± 2.0%), carbohydrate (17.0 ± 1.7%) and protein (16.4 ± 1.8%) between 00:00 and 03:59 compared with the other shift days (p < 0.05). CONCLUSION: Night shifts seem to contribute to a longer eating window than other shifts. Moreover, there is a higher energy and macronutrients intake during night shifts, which reduces the night fast period and could have implications for metabolic dysregulation.

Screen use while eating is associated with lower intuitive eating and higher disordered eating in Chinese adult men and women.

OBJECTIVE: We aimed to explore the potential associations between screen use while eating and intuitive eating and disordered (thinness-oriented and muscularity-oriented) eating behaviors. METHODS: Analyses included 600 Chinese adults (50% women; Mage = 30.67, SD = 8.08) recruited online. The use of four major screen devices was captured, including cell phones, tablets, computers, and TVs. Three types of eating behaviors were examined, namely intuitive eating, thinness-oriented disordered eating, and muscularity-oriented disordered eating. Pearson correlation and hierarchical regression analyses were conducted separately for men and women to examine the sex-specific associations between screen use while eating and intuitive eating, thinness-oriented disordered eating, and muscularity-oriented disordered eating. RESULTS: In both men and women, more screen use while eating was significantly associated with lower intuitive eating, higher thinness-oriented disordered eating, and higher muscularity-oriented disordered eating, above and beyond total screen time and social media use. DISCUSSION: We found preliminary evidence for the significant links between screen use while eating and intuitive eating and disordered eating. Given the global increases in screen use, continued research is warranted to further explore the role of screen use while eating in the development and maintenance of intuitive eating and disordered eating. PUBLIC SIGNIFICANCE: Much remains unknown regarding screen use while eating and eating behaviors. We found that in both Chinese men and women, more screen use while eating was significantly and uniquely associated with lower intuitive eating, higher thinness-oriented disordered eating, and higher muscularity-oriented disordered eating. Findings highlight the importance of incorporating screen use while eating in future research on intuitive eating and disordered eating.

Hospital-based higher calorie refeeding and mealtime distress in adolescents and young adults with anorexia nervosa or atypical anorexia nervosa.

OBJECTIVE: The StRONG study demonstrated that higher calorie refeeding (HCR) restored medical stability faster in patients hospitalized with anorexia nervosa (AN) and atypical AN (AAN), with no increased safety events compared with standard-of-care lower calorie refeeding (LCR). However, some clinicians have expressed concern about potential unintended consequences of HCR (e.g., greater mealtime distress). The purpose of this study was to examine patient treatment preference and compare mealtime distress, food refusal, and affective states between treatments. METHOD: Participants (N = 111) in this multisite randomized clinical trial were ages 12-24 years, with AN or AAN, admitted to hospital with medical instability who received assigned study treatment (HCR or LCR). Treatment preference was assessed prior to randomization in the full sample. In a subset of participants (n = 45), linear mixed effect models were used to analyze momentary ratings of mealtime distress (pre, during, and post-meals) and daily affective state during the hospitalization. RESULTS: About half (55%) of participants reported a preference for LCR. Treatment assignment was not associated with food refusal, mealtime distress, or affective states in the subsample. Food refusal increased significantly over the course of refeeding (p = .018). Individuals with greater depression experienced more negative affect (p = .033), with worsening negative affect over time for individuals with higher eating disorder psychopathology (p = .023). DISCUSSION: Despite understandable concerns about potential unintended consequences of HCR, we found no evidence that treatment acceptability for HCR differed from LCR for adolescents and young adults with AN and AAN. PUBLIC SIGNIFICANCE: The efficacy and safety of higher calorie refeeding in hospitalized patients with anorexia nervosa has been demonstrated. However, it is not known whether higher calorie refeeding (HCR) increases meal-time distress. This study demonstrated that HCR was not associated with increased mealtime distress, food refusal, or affective states, as compared with lower calorie refeeding. These data support HCR treatment acceptability for adolescents/young adults with anorexia nervosa and atypical anorexia nervosa.

Mealtime interactions between nursing home staff and residents with dementia: a behavioral analysis of Language characteristics.

BACKGROUND: Quality staff-resident communication is crucial to promote outcomes in nursing home residents with dementia requiring assistance during mealtimes. Better understanding of staff-resident language characteristics in mealtime interactions help promote effective communication, yet evidence is limited. This study aimed to examine factors associated with language characteristics in staff-resident mealtime interactions. METHODS: This was a secondary analysis of 160 mealtime videos involving 36 nursing staff and 27 residents with moderately severe to severe dementia in 9 nursing homes. Mixed-effects models was used to examine the relationships between factors and language characteristics in staff-resident mealtime interactions. The independent variables were speaker (resident vs. staff), utterance quality (negative vs. positive), intervention (pre- vs. post-communication intervention), and resident dementia stage and comorbidities. The dependent variables were expression length (number of words in each utterance) and addressing partner by name (whether staff or resident named their partner in each utterance). All models included staff, resident, and staff-resident dyad as random effects. RESULTS: Staff (utterance n = 2990, 99.1% positive, mean = 4.3 words per utterance) predominated conversations and had more positive, longer utterances than residents (utterance n = 890, 86.7% positive, mean = 2.6 words per utterance). As residents progressed from moderately severe to severe dementia, both residents and staff produced shorter utterances (z=-2.66, p = .009). Staff (18%) named residents more often than residents (2.0%; z = 8.14, p < .0001) and when assisting residents with more severe dementia (z = 2.65, p = .008). CONCLUSIONS: Staff-resident communication was primarily positive, staff-initiated, and resident-oriented. Utterance quality and dementia stage were associated with staff-resident language characteristics. Staff play a critical role in mealtime care communication and should continue to initiate resident-oriented interactions using simple, short expressions to accommodate resident declining language abilities, particularly those with severe dementia. Staff should practice addressing residents by their names more frequently to promote individualized, targeted, person-centered mealtime care. Future work may further examine staff-resident language characteristics at other levels of language using more diverse samples.

Associations between feeding coparenting and food parenting practices: An observational study.

Feeding coparenting, defined as the way that parents work together and support each other in food parenting, is an emerging area of research. Understanding how feeding coparenting may influence the practices parents use when feeding children can help to inform strategies to support positive food parenting. The objective of this study was to examine the associations between observed feeding coparenting and observed food parenting practices among 68 families with children 18 months to 5 years of age. Videos of mealtimes were used to assess observed feeding coparenting and food parenting practices. Observed feeding coparenting was coded using the Observed Feeding Coparenting Tool and observed food parenting practices were coded using the Family Mealtime Coding System. Linear regressions were used to examine associations between observed feeding coparenting and observed food parenting practices. Higher total feeding coparenting scores were associated with less frequent verbal restriction from mothers, more positive comments about food from fathers, and better mealtime tone. Higher supportive feeding was associated with less frequent verbal restrictions from mothers, more frequent physical pressure to eat from fathers, and more positive comments from fathers about food. Higher meal enjoyment among fathers was associated with better mealtime tone. Results of this study highlight the importance of assessing feeding coparenting in studies exploring food parenting and family meals, and the potential value of developing interventions that aim to support parents in working together at mealtime and in feeding.

Maternal responsiveness and toddler body mass index z-score: Prospective analysis of maternal and child mealtime interactions.

Responsive feeding, where parents are guided by children's hunger and satiation cues and provide appropriate structure and support for eating, is believed to promote healthier weight status. However, few studies have assessed prospective associations between observed parental feeding and toddler growth. We characterized toddler growth from 18 to 36 months and, in a subset of families, examined whether observed maternal responsiveness to toddler satiation cues and encouraging prompts to eat at 18 and 24 months were associated with toddler body mass index z-score (BMIz) from 18 to 36 months. Participants included 163 toddlers and their mothers with overweight/obesity who had participated in a lifestyle intervention during pregnancy. Anthropometrics were measured at 18, 24, and 36 months. In a subsample, mealtime interactions were recorded in families' homes at 18 (n = 77) and 24 (n = 75) months. On average, toddler BMIz remained stable from 18 to 36 months with 31.3% (n = 51) categorized with a healthy weight, 56.4% (n = 92) with at risk for overweight and 12.3% (n = 20) with overweight. Fewer maternal prompts to eat at 18 months was associated with both higher probability of having at risk for overweight/overweight (p < .05), and higher child 36-month BMIz (p = .002). Higher child weight status at 12 months was also associated with both higher probability of having at risk for overweight/overweight (p < .05), and higher child 36-month BMIz (p < .001). Neither 24-month maternal prompts nor 18 or 24 month responsiveness to satiation cues were associated with toddler BMIz. In this diverse sample, weight status was relatively stable from 18 to 36 months. Maternal prompts to eat measured earlier in toddlerhood and prior child weight status were associated with toddler BMIz.

Sequential relationships of food intake in nursing home residents with dementia: Behavioural analyses of videotaped mealtime observations.

AIMS AND OBJECTIVES: This study examined the sequential relationships of food intake and the moderating role of the characteristics of intake and resident conditions. BACKGROUND: Nursing home residents commonly experience insufficient food intake. While multilevel factors influence intake, evidence on sequential relationships is lacking. DESIGN: The study was an observational study using secondary, behavioural analyses following the STROBE Statement. METHODS: Videotaped observations (N = 160) collected from a dementia communication trial during 2011-2014 were coded using the refined Cue Utilisation and Engagement in Dementia Mealtime Video-coding Scheme during 2018-2019. The 160 videos involved 27 residents living with dementia and 36 staff in 9 nursing homes. Independent variables were the state (solid intake, liquid intake, no intake) of an intake episode occurring during mealtime (current episode), eating technique (resident-initiated, staff-facilitated) used in the next episode occurring after the current episode (subsequent episode), interval between adjacent episodes, and resident comorbidities and dementia stage. The dependent variable was the state of subsequent episode. RESULTS: Successful liquid and solid intake increased odds of subsequent liquid and solid intake. Comorbidities were associated with decreased odds of subsequent liquid and solid intake for staff-facilitated episodes. When liquid intake occurred, staff-facilitation decreased odds of subsequent liquid intake; longer intervals between adjacent episodes increased odds of subsequent solid intake. CONCLUSION: Food intake was strongly and sequentially associated, and such temporal relationships were dependent on characteristics of the intake process and resident conditions. RELEVANCE TO CLINICAL PRACTICE: The study findings supported that initiating successful intake facilitates continuity of successful intake during mealtime. Behavioural interventions tailored by comorbidities that modify characteristics of the food intake process may improve food intake.

The five aspects mealtime environment observation instrument for assessing mealtime environments in nursing homes: Development and validation.

AIMS AND OBJECTIVES: To further develop and validate the Mealtime instrument, an observational instrument for assessing mealtime environments in nursing homes originating from the theoretical framework: Five Aspects Meal Model (FAMM). METHODOLOGICAL DESIGN AND JUSTIFICATION: A mealtime experience is significant for a sense of well-being. In nursing homes, residents' personal preferences, combined with their diagnoses and different stages of illness, influence their mealtime experience and provide a complexity that has been found difficult to assess. Using FAMM, a theoretical framework as its base, this study, attempts to look at different parts of the mealtime environment. FAMM structures the mealtime environment in to five aspects: room, meeting, product, management control system and atmosphere. This study's design includes instrument development and validation. ETHICAL ISSUES AND APPROVAL: This study has been approved by the Swedish Ethical Review Authority (dnr 2019-05477). DESIGN: Methodological study. RESEARCH METHOD: An existing instrument, the Mealtime instrument with FAMM as a theoretical framework, was used as a foundation for the development of the Five Aspects Mealtime Environment Observation Instrument (FAME-OI). Content validity index (CVI) was used to validate FAME-OI. RESULTS: FAME-OI's item-CVI, scale-CVI and modified Kappa displayed high validity. Changes were made in its structure and phrasing. These developments resulted in having a distinct structure in FAME-OI, in reference to FAMM. CONCLUSION: FAME-OI is applicable for clinical use in nursing homes and in research; however, adjustments may be needed before its use in other health care facilities.

Effects of mealtime assistance in the nutritional rehabilitation of eating disorders.

PURPOSE: The aim of the study was to examine the effects of meal supervision, provided by health professionals, volunteers or family members, on anthropometric, nutritional, psychological, and behavioural outcomes in patients with eating disorders (EDs). METHODS: The present systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The last search was conducted in three databases (PubMed, Scopus, and the Cochrane library). Inclusion criteria considered paediatric and adult patients suffering from EDs, regardless of ethnicity, and treated in different therapeutic settings. The quality of the studies was evaluated using the Newcastle Ottawa Scale (NOS) adapted for cross-sectional studies and Version 2 of the Cochrane risk-of-bias assessment tool for randomised trials. RESULTS: 3282 articles were retrieved, out of which only 6 met the eligibility criteria. A marked heterogeneity in definitions and approaches to supervised mealtime was observed. This variability emerged in the methodologies used in the supervised meal, and in the reference values for the outcome measures that were used, such as the analysis of different parameters. Based on these observations, mealtime assistance provided to patients with EDs shows an overall positive effect on eating behaviour and dysfunctional attitudes. Future research should be prompted to provide a thorough definition of a structured procedure for meal assistance to be potentially and systematically included in the nutritional rehabilitation protocols for patients with EDs. LEVEL OF EVIDENCE: Level IV systematic reviews of uncontrolled trials.