The impact of non-residential grandchild care on physical activity and sedentary behavior in people aged 50 years and over: study protocol of the Healthy Grandparenting Project.

BACKGROUND: Finding effective ways to support people aged > 50 years to develop adequate levels of physical activity and sedentary behavior is necessary as these behaviors are positively related to the maintenance of functional independence and health-related quality of life. Given the widespread provision of grandparental child care, examining its impact on grandparents' energy-expenditure related behavior in the broader context of health is imperative. Therefore, the Healthy Grandparenting Project will aim to investigate the levels of physical activity and sedentary behavior, body composition and health-related quality of life in grandparents caring for their grandchildren and to compare these outcomes with non-caregiving grandparents and older adults without grandchildren, both momentarily and over time. An additional purpose is to identify possible predictors of potential changes over time. METHODS: A prospective cohort study will run over a period of 2 years, including three test occasions with a one-year time interval in between (T0 = baseline, T1 = 12 months, T2 = 24 months). A total of 276 participants will be recruited in Flanders through non-probability quota sampling (50-50% men-women), of which 92 caregiving grandparents, 92 non-caregiving grandparents and 92 non-grandparents. All three subsamples will be matched for age and sex. At each test occasion, anthropometric and body composition measurements will be determined. Participants' levels of physical activity and sedentary behavior will be assessed both objectively and subjectively by means of accelerometry and self-report questionnaires. Information about their grandchildren and the provided grandparental care (if applicable) as well as their health-related quality of life will also be assessed using self-report questionnaires. Mixed modelling will be used to identify differences in physical activity, sedentary behavior, body composition and health-related quality of life between the subsamples at baseline, as well as to evaluate and compare changes in energy-expenditure related behavior over time between subsamples and to identify predictors of the detected changes. DISCUSSION: The Healthy Grandparenting Project is an innovative study examining the levels of physical activity and sedentary behavior in caregiving grandparents, non-caregiving grandparents and non-grandparents. Obtained results will help in the development of campaigns to maintain/improve health in adults at a more advanced age. TRIAL REGISTRATION: clinicaltrials.gov, Identifier: NTC04307589 . Registered March 2020.

The effect of nudges aligned with the renewed Flemish Food Triangle on the purchase of fresh fruits: An on-campus restaurant experiment.

OBJECTIVE: This study examined the effect of nudges, inspired by the recently renewed Flemish Food Triangle, on fruit sales in a Belgian on-campus university restaurant. METHODS: In this mixed-method real-life experiment, nudges were added weekly over a period of four consecutive weeks: placement of (1) Food Triangle posters in the restaurant, (2) 'green heart' icons above the fruit stands, and (3) substitution and (4) social norm messages at the fruit stands. During baseline (no intervention) and all intervention weeks, dessert sales were registered. Short interviews were used to ask customers about their perceptions regarding the intervention. Follow-up measurements (7 and 30 weeks later) evaluated the longer-term effectiveness, while all nudges remained in place. Dessert sales were analyzed separately for both sexes, students and staff categories (based on academic degree). RESULTS: Compared to baseline, the combination of the Food Triangle and the green heart intervention materials in week 2 resulted in significant increases in fruit consumption across almost all subgroups. The other intervention materials used in the current study had rather limited effects in the short term. After 7 weeks of follow-up, significant fruit sale increases were established for all subgroups compared to baseline. At 30 weeks follow-up, the effect for staff B (Bachelor's degree) disappeared. The majority of the respondents (66.4%) had noticed at least one of the nudges, while only 3.4% indicated to have adjusted their dessert choice as a result of the nudges. CONCLUSIONS: The combination of nudges was effective in the long term and increased fruit purchase in nearly all subgroups. Short interviews show that a more active approach may be needed to increase effect sizes.

The effect of a portion size intervention on French fries consumption, plate waste, satiety and compensatory caloric intake: an on-campus restaurant experiment.

BACKGROUND: One of the driving factors of dietary overconsumption throughout the last decennia is the increase of food portion sizes. Larger portions induce higher daily energy intake, so reducing portion size may reduce intake of excess calories. However, real-life studies about the effects of portion size reduction are lacking. Therefore, this study examined the effect of a French fries portion size reduction on French fries consumption, French fries plate waste, satiety and caloric intake during the subsequent afternoon among university students and employees in a Belgian on-campus restaurant setting. Moreover, this study evaluated consumers' perception about the portion size reduction. METHODS: The study took place over a two-time (i.e. baseline and intervention week) 4-day period (Tuesday-Friday) in the on-campus restaurant where ±1200 meals are served every day. French fries' portions were reduced by 20% by replacing the usual porcelain bowl served during the baseline week (±200 g) with smaller volume paper bags during the intervention week (±159 g) in a pre-post real-life experiment. French fries consumption and plate waste were measured in 2056 consumers at baseline and 2175 consumers at intervention. Additionally, interviews were conducted directly after lunch and again between 4 and 6 p.m. on the same day to assess satiety and caloric intake at pre and post in a small subsample of both French fries consumers (n = 19) and non-French fries consumers (n = 14). Post-intervention, the same subsample was interviewed about their perception of the portion size reduction (n = 28). RESULTS: Total French fries intake decreased by 9.1%, and total plate waste decreased by 66.4%. No differences were found in satiety or caloric intake between baseline and intervention week among the French fries' consumers. The majority (n = 24, 86%) of French fries consumers noticed the reduction in portion size during the intervention. Although most participants (n = 19, 68%) perceived the reduced portion size as sufficient, only a minority of participants (n = 9, 32%) indicated post-intervention that they would agree with a permanent implementation. CONCLUSIONS: Reducing portion size may lead to reduced caloric intake, without changing perceived levels of satiety.

A within-subject examination of grandparents' physical activity and sedentary behavior levels in the presence or absence of grandchild care provision.

BACKGROUND: This study aimed to examine within-subject differences in levels of physical activity (PA) and sedentary behavior (SB) among Flemish grandparents aged 50 years and older during a day of providing versus not providing grandchild care. Additionally, grandparents' PA and SB levels of the specific caregiving moment within the included care day were also compared with those of the corresponding specific time frame on the matching non-care day. METHODS: Data were obtained and pooled from three assessment time points of the Healthy Grandparenting Project. Objectively measured PA and SB levels were assessed through ActiGraphs wGT3x(+) worn during waking hours for seven consecutive days and expressed relative to the total wear time of the selected days or moments (i.e., percentage of time per day or per moment). Generalized linear mixed models were used to evaluate the within-subject differences in grandparents' light intensity PA (LIPA), moderate-to-vigorous intensity PA (MVPA) and SB levels between a care and non-care day as well as between the care and non-care moment of those respective days. RESULTS: A total of 92 grandparents (64.6 ± 4.8 years, 67.4% women) were included in the analyses. During the care day and care moment, grandparents showed higher relative levels of LIPA (∆=4.0% and ∆=7.9%, respectively) and lower relative levels of SB (∆=3.7% and ∆=6.7%, respectively) as compared to their respective non-care day and non-care moment (all p < 0.001). While there was no significant difference in relative MVPA levels between a day of providing versus not providing grandchild care (∆=0.3%, p = 0.500), the grandparents showed significantly lower relative levels of MVPA during the specific care moment against the non-care moment (∆=1.3%, p = 0.029). CONCLUSIONS: The higher percentage of time of LIPA and lower percentage of time spent on SB during a care day and care moment compared to a non-care day and non-care moment, highlight the positive impact of grandchild care provision on grandparents' activity levels, potentially improving other health-related outcomes. Furthermore, grandparents seem to compensate for their lower MVPA levels during the actual care moment since no differences in MVPA levels were found at day level when compared to a day without grandchild care. TRIAL REGISTRATION: clinicaltrials.gov, Identifier: NTC04307589. Registered March 2020.

Determinants of caregiving grandparents' physical activity and sedentary behavior: a qualitative study using focus group discussions.

BACKGROUND: Evidence on the factors influencing physical activity (PA) and sedentary behavior (SB) in middle-aged and older adults taking care of their grandchild(ren) is limited, even though this knowledge seems imperative when considering the unique relationship between grandparents and their grandchild(ren) as well as the rising popularity of intergenerational interventions targeting these energy-expenditure related behaviors. Therefore, this explorative qualitative study aimed to identify the determinants of PA and SB levels among Flemish caregiving grandparents in the presence of their grandchild(ren) aged between 0-5 years. METHODS: Six online focus group discussions were conducted via Microsoft Teams, all of which were audio- and videotaped with permission granted by the participating grandparents. In total, nine caregiving grandfathers and 28 caregiving grandmothers (overall mean age = 60.9 ± 4.1y) participated in this study. An inductive content analysis approach was used to derive subcategories, categories and themes from the verbatim transcribed data using NVivo R1. RESULTS: Caregiving grandparents' levels of PA and SB were both influenced by personal determinants (e.g., physical health, grandparental perceptions and responsibilities), interpersonal determinants (e.g., characteristics of the grandchild(ren), such as age-related physical/motor development and family interaction), and environmental determinants (e.g., weather and seasonal circumstances). PA levels of caregiving grandparents were further affected by additional personal determinants (e.g., age of the grandparent, planning and location) and interpersonal determinants (e.g., characteristics of the grandchild(ren), such as new experiences of the grandchild(ren)). Additionally, some personal determinants (e.g., perception of educational value) and interpersonal determinants (e.g., characteristics of the grandchild(ren), such as age-related cognitive development and health of the grandchild(ren)) were strictly mentioned to influence caregiving grandparents' SB. CONCLUSIONS: Acknowledging the unique relationship between grandparents and their grandchild(ren), the current study identified specific factors determining grandparents' PA and SB levels during the provision of grandchild care. Besides, it turned out of importance to take the interplay between the different determinants into account. Especially, for those grandparents with older grandchild(ren), within the studied 0-5 years age range, more attention should be paid to grandchild characteristics as part of the interpersonal determinants when setting up interventions to improve levels of PA and SB in caregiving grandparents.

Nutritional Content, Labelling and Marketing of Breakfast Cereals on the Belgian Market and Their Reformulation in Anticipation of the Implementation of the Nutri-Score Front-Of-Pack Labelling System.

OBJECTIVE: Breakfast cereals are frequently consumed in Belgium, especially among children. We investigated the nutritional content, labelling and marketing of breakfast cereals and the changes in nutrient content and reformulation in anticipation of the implementation of the Nutri-Score front-of-pack label. DESIGN: Pictures were taken of cereal packages. The WHO-Europe nutrient profiling tool was used to classify cereals into 'permitted'/'not-permitted' to be marketed to children, while the nutritional quality was assessed using Nutri-Score. The proportion of cereals with nutrition and health claims and/or promotional characters on the front-of-pack was compared between permitted and not-permitted cereals and between different Nutriscore categories using Chi-squared tests. The average nutrient contents per 100g were compared between 2017 and 2018 using paired t-tests. SETTING: Belgium. PARTICIPANTS: All breakfast cereals in the major supermarkets (n = 7) in 2017 and 2018. RESULTS: Overall, 330 cereals were included. About 77.2% of cereals were not permitted to be marketed to children but, of those, 22.0% displayed promotional characters. More claims (68.9% of all claims) were found on 'not-permitted' compared with 'permitted' cereals, particularly nutrition claims. Most claims were displayed on cereals with the allocated Nutri-Score A (42.0%) and C (37.0%). A significant reformulation of cereals was found between 2017 and 2018, with reductions in total sugar (-5%) (p < 0.001) and sodium (-20%) (p = 0.002) and increases in fibre (+3%) (p = 0.012) and proteins (+2%) (p = 0.002). CONCLUSION: Breakfast cereals on the Belgian market are predominantly unhealthy and frequently carry claims and promotional characters. Minimal reformulation occurred over one year. Policy recommendations include restrictions on claims and marketing for not-permitted cereals.

Consumers' food choices, understanding and perceptions in response to different front-of-pack nutrition labelling systems in Belgium: results from an online experimental study.

BACKGROUND: Front-of-pack nutrition labels (FoPLs) are increasingly implemented by governments internationally to support consumers to make healthier food choices. Although the Nutri-Score FOPL has officially been implemented in Belgium since April 2019, no study has been conducted before its implementation to compare the effectiveness of different FOPLs. METHODS: The aim of this study was to compare food choices, objective understanding and perceptions of Belgian consumers in response to five different FOPLs, currently implemented in different countries internationally, namely the Health Star Ratings (HSR), the Multiple Traffic Lights (MTL), Nutri-Score, Guideline Daily Amounts (GDA), and Warning symbols. During the summer 2019, 1007 Belgian consumers were recruited and randomized to one of the five different FOPLs. Through an online questionnaire they were asked to choose one of three different foods within each of three categories (pizzas, cakes, breakfast cereals), as well as rank those same three foods according to nutritional quality, in the condition without as well as with FOPL. In addition, various questions were asked on their perceptions in relation to the FOPL they were exposed to. RESULTS: Perceptions of consumers were favorable for all FOPLs with no significant differences between the different FOPLs. There were no significant differences in food choices among the different FOPLs, but Nutri-Score performed best for ranking food products according to nutritional quality. CONCLUSIONS: While there were no significant differences among different FOPLs for food choices and perceptions, the Nutri-Score was the most effective FOPL in informing Belgian consumers of the nutritional quality of food products.