Development of a stand-alone index for the assessment of diet quality in elementary school-aged children.

OBJECTIVE: To develop and evaluate a stand-alone Elementary School-aged Children's Index of Diet Quality (ES-CIDQ). DESIGN: In this cross-sectional study, children filled in a food frequency questionnaire (FFQ) with twenty-nine multiple-item questions on the consumption of foods, portion sizes and eating frequency and a 5-d food diary. Nutrient intakes were calculated with nutrient analysis software. FFQ questions best reflecting a health-promoting diet with reference to dietary recommendations were identified by correlations, logistic regression modelling and receiver-operating characteristics curve analysis. SETTING: Southwest and Eastern Finland. PARTICIPANTS: Healthy elementary school-aged volunteers [n 266, mean (sd) age 9·7 (1·7) years] were recruited between March 2017 and February 2018. RESULTS: A set of questions was identified from the FFQ that best depicted the children's diet quality as defined in the dietary recommendations. These fifteen questions were scored and formulated into a stand-alone index as a continuous index score (range 0-16·5 points) and a two-category score: good and poor diet quality. The cut-off score of six points for a good diet quality had a sensitivity of 0·60 and a specificity of 0·78. Children with a good diet quality (49·8 % of the children) had higher intakes of protein, dietary fibre, and several vitamins and minerals, and lower intakes of sucrose, total fat, SFA and cholesterol compared to children with a poor diet quality. CONCLUSIONS: The developed short stand-alone index depicted diet quality as defined in the dietary recommendations. Thus, ES-CIDQ may be used for assessing diet quality in Finnish elementary school-aged children in school health care and nutrition research.

Nutrition-focused group intervention with a strength-based counseling approach for people with clinical depression: a study protocol for the Food for Mind randomized controlled trial.

BACKGROUND: Depression is a highly prevalent mental disorder with major public health effects globally. It impairs the quality of life and reduces the ability to work and function, leading to increasing costs of sick leaves and disability pensions. Current treatment strategies focus on biological and psychological pathways while understating the role of lifestyle factors. Epidemiological studies have shown convincing evidence of an inverse relationship between diet quality and depression. However, only limited data are available on the therapeutic effects of diet quality improvement on depression. Using a randomized controlled trial design, our primary aim is to investigate the effectiveness and cost-effectiveness of a behavioral nutrition group intervention compared to a social support intervention in the treatment of depression. METHODS: Participants (N=144, aged 20-65 years) with a diagnosis of moderate or severe depression recruited in collaboration with outpatient care units will be randomized into two arms: Food for Mind (FM) nutrition intervention (n=72) or Bring Good Mood (BGM) social support control group (n=72). Both arms will be provided with 6 group sessions over an 8-week period. FM involves improving diet quality by applying strength-based behavioral nutrition counseling and activities facilitated by a registered dietitian. The control arm comprises a befriending protocol. During the interventions, all participants will continue their treatment for depression as usual. Longitudinal data are collected at baseline, at 8 weeks, and at 6- and 12-month follow-ups. Depressive symptoms, diet quality, eating behavior, ability to work and function, and quality of life are assessed by self-reported questionnaires. A treatment expectancy questionnaire will be administered at baseline and an acceptability questionnaire at 8 weeks. The Center for Epidemiologic Studies Depression Scale is used as the primary endpoint at 1 year. The results will be analyzed with linear mixed-effects models. Economic evaluation includes both cost-effectiveness and cost-utility analysis. Two incremental cost-effectiveness ratios will be calculated to evaluate the incremental cost per QALY and the incremental cost per improvement in CES-D. DISCUSSION: If the intervention proves to be cost-effective and acceptable, it be can be implemented in healthcare to support the treatment of depression. TRIAL REGISTRATION: ClinicalTrials.gov NCT03904771 . Retrospectively registered on 5 April 2019.

Children's Fruit and Vegetable Preferences Are Associated with Their Mothers' and Fathers' Preferences.

Children's preference for fruit and vegetables must emerge during childhood. At children's homes, mothers and fathers influence children's developing food preferences with their own preferences and actions. The purpose of the study was to reveal the association parents have with their children's fruit and vegetable preferences. The study was conducted in a sample of Finnish mothers and fathers of 3-5-year-old children. The participants were recruited, and questionnaires distributed through early childhood education and care centers in 2014 and 2015. The results showed considerable variance in the children's preferences, and were more similar with their father's, than their mother's preference. There was an association between mother's and children's preference for "strong-tasting vegetables and berries" (p = 0.005), "sweet-tasting fruit" (p < 0.001) and "common vegetables" (p = 0.037). Fathers preferences associated with children's preferences for "strong-tasting vegetables and berries" (p = 0.003). Food neophobia decreased children's "strong-tasting vegetables and berries" (p < 0.001) and "sweet-tasting fruit" (p < 0.001) preferences. The father's more relaxed attitude towards eating decreased children's preferences for "strong-tasting vegetables and berries" (p = 0.031) and "sweet-tasting fruit" (p = 0.003). These findings indicate a need for more targeted strategies for increasing children's preferences for fruit and vegetables and highlight the importance of taking both parents equally into account.

Sensory-based food education in early childhood education and care, willingness to choose and eat fruit and vegetables, and the moderating role of maternal education and food neophobia.

OBJECTIVE: To investigate the association between sensory-based food education implemented in early childhood education and care (ECEC) centres and children's willingness to choose and eat vegetables, berries and fruit, and whether the mother's education level and children's food neophobia moderate the linkage. DESIGN: The cross-sectional study involved six ECEC centres that provide sensory-based food education and three reference centres. A snack buffet containing eleven different vegetables, berries and fruit was used to assess children's willingness to choose and eat the food items. The children's parents completed the Food Neophobia Scale questionnaire to assess their children's food neophobia. SETTING: ECEC centres that provide sensory-based food education and reference ECEC centres in Finland. SUBJECTS: Children aged 3-5 years in ECEC (n 130) and their parents. RESULTS: Sensory-based food education was associated with children's willingness to choose and eat vegetables, berries and fruit. This association was stronger among the children of mothers with a low education level. A high average level of neophobia in the child group reduced the children's willingness to choose vegetables, berries and fruit. No similar tendency was observed in the group that had received sensory-based food education. Children's individual food neophobia had a negative association with their willingness to choose and eat the vegetables, berries and fruit. CONCLUSIONS: Child-oriented sensory-based food education seems to provide a promising method for promoting children's adoption of vegetables, berries and fruit in their diets. In future sensory food education research, more focus should be placed on the effects of the education at the group level.

[Update on Current Care guidelines: obesity (children)]. / Käypä hoito -suosituksen päivitystiivistelmä: Lihavuus (lapset).

Childhood obesity is an increasing health problem. There may be possibilities to prevent obesity in childhood, and efficient interventions to treat obese children have been published. Local and regional strategies to prevent and to treat childhood obesity are needed.

Impact of childhood obesity treatment on body composition and metabolic profile.

BACKGROUND: Childhood obesity is associated with adverse changes in cardiometabolic risk factors. A family-oriented group program stressing a health-promoting lifestyle has been more effective than routine counselling in the treatment of obesity in school children. The aim of the present study was to compare the impact of group program and routine councelling on body composition and metabolic profile, and to evaluate the associations of changes in adiposity with levels of cardiometabolic risk factors. METHODS: Seventy obese prepubertal children were randomized into family-oriented group program (15 sessions for parents and children) and routine counselling (2 appointments for children). Body mass index (BMI), body composition and different metabolic risk factors were assessed before and after the 6-month intervention. RESULTS: Waist/height decreased more in the children attending the group treatment, but there were no significant differences between treatment arms in the changes of metabolic risk factors. When the arms were analyzed as combined, serum triglycerides decreased significantly if BMI standard deviation score (BMI-SDS) decreased ≥ 0.5. Serum fasting insulin decreased if BMISDS decreased ≥ 0.25. CONCLUSIONS: Obesity-related metabolic risk factors reduced in prepubertal children if BMI-SDS decreased substantially. This result was not dependent on which intervention, family-oriented group program or routine counselling, was used.

Cost-effectiveness of routine and group programs for treatment of obese children.

BACKGROUND: Cost-effectiveness analyses facilitate the allocation of health care resources. The aim of the study was to compare the cost-effectiveness of group treatment, already known to be more effective, with routine counseling in obese children. METHOD: A prospective 6-month intervention assessed family-based group treatment (15 separate sessions for parents and children) and routine counseling (two appointments for children). Children's weights and heights were measured at baseline, at the end of the intervention and at follow up 6 months later, and the changes in weight for height and body mass index standard deviations scores (BMI-SDS) were calculated and used as main outcome measures. The mean costs and effects of the programs were analyzed to produce the incremental cost-effectiveness ratio, which is an estimate of the additional costs per 1% decrease in weight for height or 0.1 decrease in BMI-SDS. Cost-effectiveness analysis was performed from the perspective of the service provider. RESULTS: At the end of the intervention, group treatment costs were 1.4-fold (non-calculable 6 months later) when counted per 1% weight for height decrease, and 3.5-fold (2.8-fold 6 months later) when counted per 0.1 BMI-SDS decrease. Incremental cost-effectiveness ratio estimates were euro 53 when calculated for 1% weight for height decrease, and euro 266 (euro 275 6 months later) when calculated for 0.1 BMI-SDS decrease. CONCLUSIONS: Family-based group treatment is more costly compared with individual routine counseling. Salaries form most of the total costs.