Maternal concern and perception about child overweight risk, maternal feeding practices, and child eating behaviors: A cross-sectional study.

Abundant efforts have been directed to understand the global obesity epidemic and related obesogenic behaviors. However, the relationships of maternal concern and perception about child weight with child eating behaviors in Saudi Arabia have not been investigated. Therefore, this study aimed to examine the associations of maternal concern and perception about child overweight risk with maternal feeding practices and child eating behaviors among mothers and their children in Saudi Arabia. Mothers of 115 children aged 3-5 years old were recruited from eight preschools. Child eating behaviors (enjoyment of food, responsiveness to foods, food fussiness, satiety responsiveness, and slowness in eating) and maternal feeding practices (restriction, monitoring, and using food as a reward), maternal concern about child weight, and maternal perception about child overweight risk were assessed using validated questionnaires. Multiple linear regression models, adjusted for maternal body mass index (BMI) and child's BMI-z score and sex, were tested to examine the independent associations of maternal concern and perception about child overweight risk with child eating behaviors and maternal feeding practices. Maternal concern about child weight was positively associated with food enjoyment in children (B = 0.14 [95% confidence intervals = 0.02,0.27]) and responsiveness to food (B = 0.16 [0.03,0.29]), whereas a negative association with child food fussiness was observed (B = -0.19 [-0.33, -0.04]). Maternal perception about child overweight risk and child slowness in eating were negatively associated (B = -0.72 [-0.16 to -0.28]). Maternal concern and perception about child overweight risk were not associated with maternal feeding practices. In conclusion, maternal concern and perception about child overweight risk were found to be associated with food approach eating behavior traits but not with maternal feeding practices. Mothers who are concerned about child weight or perceive their children as overweight may need guidance and support to promote healthy eating behaviors among their children. Future cross-cultural studies are needed to understand the underlying mechanisms for the influence of maternal concern and perception about child overweight risk on maternal feeding practices, child eating behaviors, and weight status of children.

Fruit and vegetable consumption among children in Saudi Arabia: Predictors and associations with dietary intake.

BACKGROUND: Data exploring factors related to the consumption of fruits and vegetables (F&V) among children in Saudi Arabia are lacking. The present study aimed to evaluate F&V consumption among Saudi children. Predictors of F&V intake and associations with dietary intake were also explored. METHODS: Cross-sectional data of 424 Saudi children (6-12 years) were collected from their mothers using an online survey. Phone interviews were conducted with mothers and children to provide data on dietary intake of children. RESULTS: Most children included in the study (92.2%, n = 391) consumed less than five servings of F&V per day. Region of residency (B = -0.14, SE = 0.06, 95% confidence interval [CI] = -0.25 to -0.02, p = 0.019), paternal education level (B = 0.52, SE = 0.14, 95% CI = 0.24-0.79, p < 0.001) and family monthly income (B = 0.15, SE = 0.07, 95% CI = 0.01-0.29, p = 0.034) predicted the intake of F&V. Food neophobia and food pickiness also predicted the intake of F&V (B = -0.16, SE = 0.06, 95% CI = -0.27 to -0.05, p = 0.005 and B = -0.24, SE = 0.06, 95% CI = -0.36 to -0.12, p < 0.001, respectively). Children's intake of F&V positively predicted the intake of fibre, potassium, phosphorus, magnesium, iodine and vitamin C. CONCLUSIONS: Limited intake of F&V was observed among Saudi children. F&V consumption was found to be associated with a number of sociodemographic factors, including region of residency, paternal education level and family income, as well as children's food neophobia and pickiness. Children's intake of F&V predicted higher intake of fibre, potassium, phosphorus, magnesium, iodine and vitamin C, suggesting that F&V consumption may contribute to improved intake of key nutrients in children.

Sources of free sugar in the diet of Saudi children.

Introduction: Data concerning sources of free sugar (FS) in the diet of Saudi children are limited. Identification of the top sources of FS would permit to develop tailored interventions that aid in meeting the recommendations of the World Health Organization for FS (≤ 25 g/day). This study aimed to investigate sources of FS in children's diet. Methods: A cross-sectional data of healthy children ages between 6 and 12 years who reside in Saudi Arabia were gathered from their mothers using online platforms (WhatsApp, Facebook, and X) (n = 424; 210 boys and 214 girls). An interview was conducted through the phone with the mother and her child to collect data pertaining FS intake using a validated food frequency questionnaire. Results: The primary sources of FS were Sweetened Beverages, followed by Sugars, Sweet Bakery Products, Other Desserts, and Candies, of which the added sugar consisted mostly of its total sugar. The consumption of FS coming from solid food sources for the highest quartile of children almost doubled the amount of FS coming from liquid food sources. Compared to boys, girls in the top quartile of FS intake consumed significantly higher amounts of solid sugars (p = 0.030). Only the intake of FS coming from Sweetened Beverages was associated negatively with age of children (p = 0.032). Discussion: Public health interventions should emphasize the necessity of reducing the consumption of the top sources of FS to practically achieve the recommendations of FS intake.

Behaviors Related to Limiting Fat Intake among Young Adults in Saudi Arabia.

Young adults tend to frequently consume foods that are high in fat. Efforts to limit the consumption of fat among the Saudi population have been initiated; however, data concerning current behaviors related to limiting fat intake are lacking. We aimed to explore behaviors related to limiting fat intake and to investigate the association with fat intake among young adults in Saudi Arabia. In this cross-sectional study, a total of 305 students aged ≥19 years were recruited from Taibah University, Madinah. Face-to-face interviews were conducted to collect data concerning sociodemographic status, behaviors related to limiting fat intake, and fat intake. The median score of behaviors related to limiting fat intake was significantly higher among females and supplement users compared to other groups. Healthy weight, overweight, and obese students reported a significantly higher score of behaviors related to limiting fat intake, compared to underweight students. Males who reported making an effort to limit the consumption of fatty foods consumed less total fat, saturated fat, monounsaturated fat, and polyunsaturated fat, while those who reported reading the nutrition fact labels of food products consumed more polyunsaturated fat. Females who reported reading nutrition fact labels consumed less saturated fat. Efforts to limit fat intake have been noted especially among females; however, these efforts were not linked to fat intake among young adults in Saudi Arabia.

Appetite as a predictor of malnutrition in end-stage renal disease patients in Saudi Arabia.

BACKGROUND AND OBJECTIVES: Patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) are at high risk for malnutrition. This study aimed to 1) Investigate the prevalence of malnutrition among CKD patients undergoing maintenance HD; 2) Assess level of knowledge and appetite among patients; 3) Identify potential predictors of malnutrition. METHODS AND STUDY DESIGN: This cross-sectional study included 71 CKD patients on HD who were recruited from two principal outpatient dialysis centers located in Jeddah, Saudi Arabia. Data were collected using an interviewer-administered questionnaire which included sociodemographic and health characteristics, nutritional status (assessed using the Patient-Generated Subjective Global Assessment [PG-SGA]), biochemical data, nutritional knowledge, and appetite status (assessed using Council of Nutrition Appetite Questionnaire [CNAQ]). RESULTS: Forty-four percent of patients included in this study were malnourished, and over half of the patients had limited nutritional knowledge and appetite. Hemoglobin level and the CNAQ score were found to be independently negatively associated with the PG-SGA score (B: -1.03 [95% confidence interval (CI): -1.99, - 0.08] and B: -0.37 [95% CI: -0.64, -0.11], respectively). CONCLUSIONS: Renal healthcare professionals should assess the nutritional status of HD patients and identify barriers to adequate nutrition. Patients with poor appetite should specifically be targeted for nutrition-focused evaluation and management.

Picky Eating in School-Aged Children: Sociodemographic Determinants and the Associations with Dietary Intake.

Children exhibiting picky eating behavior often demonstrate strong food preferences and rejection of particular foods or food texture, which may lead to limited dietary variety and possibly inadequate or unhealthy diet. Yet, the relationship between picky eating and nutrient intake in school-aged children has not been established previously. This study aimed to investigate the sociodemographic determinants of picky eating and the associations between picky eating and dietary intake in children. Data of 424 healthy Saudi children aged 6-12 years were collected from their mothers. A child's picky eating habits were captured using a validated questionnaire. Sociodemographic characteristics of the children were assessed. Dietary data, including 24 h dietary recalls and frequency of fruit, vegetable, and milk consumption, were collected by dietetic professionals using phone-administered interviews. Compared to those of normal-weight mothers, children of mothers with obesity had higher odds of being in the highest tertile of picky eating (OR = 1.93; 95% CI 1.02, 3.63). Children exhibiting higher levels of picky eating consumed less fruits (B = -0.03; 95% CI -0.06, -0.01), vegetables (B = -0.05; 95% CI -0.07, -0.02), and protein (B = -0.21; 95% CI -0.33, -0.09), and had higher consumption of trans fatty acid intake (B = 1.10; 95% CI 0.06, 2.15). Children with higher levels of picky eating presented unhealthy dietary behaviors. Future studies are needed to examine the long-term effect of picky eating on cardiovascular health. Dietary behaviors of mothers with obesity must be taken into consideration when designing intervention programs aiming to improve eating behaviors of children.

Nutrient Intakes of Children: Associations with Maternal Use of Pressure to Eat and a Healthy Home Food Environment.

Maternal feeding practices have been shown to have a powerful influence on shaping dietary behaviors of children. Nonetheless, the association with the nutrient intake of children has not been previously explored. This study aimed to investigate the associations of maternal use of pressure to eat (PE) and a healthy home food environment (HHFE) with nutrient intakes in children (6-12 years old). Data of 424 mother-child dyads were included. Maternal use of PE and a HHFE were assessed using a validated questionnaire. Child food intake was collected using telephone-administered 24 h recalls. Multivariate linear regression analyses were conducted to investigate the associations of maternal feeding practices with energy and nutrient intakes of children. Maternal use of PE predicted higher children's intake of carbohydrate (B = 0.90, 95% confidence interval (CI) 0.19 to 1.62) and dietary fiber (B = 1.25, 95% CI 0.32 to 2.18) and lower fat intake (B = -0.74, 95% CI -1.37 to -0.11). Maternal use of a HHFE was significantly positively associated with protein intake (B = 0.99, 95% CI 0.53 to 1.46) and negatively associated with free sugar intake in children (B = -3.56, 95% CI -5.03 to -2.09). Our findings indicate that nutrient intakes of children are linked to feeding practices employed by mothers. Further studies are warranted to gain a more contextualized understanding of mother-child feeding interactions and to develop effective interventions.

Development of a Food Frequency Questionnaire for Assessing Habitual Intake of Free Sugar Among Children in Saudi Arabia.

The World Health Organization emphasizes the urgency to assess and limit the intake of free sugar (FS) among individuals in order to prevent several non-communicable diseases. However, data regarding intake of FS are lacking in Saudi Arabia and in the Middle East. A reliable valid tool is needed to assess children's habitual intake of FS. Thus, we aimed to develop and validate a food frequency questionnaire (FFQ) that assesses children's habitual intake of FS in Saudi Arabia. In this cross-sectional study, 424 healthy Saudi children ages 6-12 years were included using river sampling method. Sociodemographic data and contact information were collected from mothers using an online survey. Dietary data were collected using 24-h dietary recalls (reference method) and a semi-quantitative FFQ through phone interviews. Items and food groups included in the initial draft of the FFQ were adopted from previous work. Content validity was done to the FFQ with total of 12 food groups and 41 food items. Next, a pilot study was conducted to estimate the sample size needed for the study and to ensure that all items reported in the 24-h dietary recalls were included in the final draft of the FFQ. Finally, data were collected to assess the validity and reliability of the FFQ at the population level. Mean intake of FS assessed by the FFQ was significantly higher than that assessed by the 24-h dietary recalls. Spearman's correlation between total FS assessed by the FFQ and 24-h dietary recall was positively low (r s = 0.30, p < 0.001). The coefficient alpha indicated an acceptable level of internal consistency (α = 0.74, p < 0.001). Test-retest reliability for total FS intake assessed by the FFQ was positively high (r s = 0.82). A slight agreement between FS intake assessed by the FFQ and the 24-h dietary recall was seen among the study sample (κ = 0.21, p < 0.001). The newly developed FFQ was found to be reasonably valid in assessing children's habitual intake of FS in Saudi Arabia. Validating the instrument among older population in Saudi Arabia is warranted.

The Relationships between Maternal Feeding Practices and Food Neophobia and Picky Eating.

Food neophobia and picky eating (FNPE) are dietary behaviors that have been frequently reported to coexist in children. Parental concerns about these dietary behaviors may influence the feeding practices employed. In this cross-sectional study, we investigated the bidirectional associations of maternal feeding practices with children's FNPE behaviors. Using a convenience sampling technique, mothers of 195 healthy children aged 1-7 years were invited to complete a sociodemographic questionnaire, rate their child's FNPE, and rate the extent to which each feeding practice was employed with the child. Maternal reports indicated that 37.4% (n = 73) of the children exhibited severe FNPE. Multiple linear regression analyses showed positive two-way associations between the "pressure to eat" feeding strategy and FNPE, and negative two-way associations between a healthy home food environment and FNPE. However, maternal practices of teaching and monitoring were not found to be associated with FNPE. Given the bidirectional relationships observed between FNPE and maternal feeding practices, primary health care providers should address the feeding practices used with a child and indicate that coercive feeding practices are counterproductive. Intervention studies targeting mothers of children with FNPE are needed to investigate whether specific maternal practices are more effective than others.

Plasma concentrations of vitamin A and E and risk of dysglycemia in first-trimester pregnant Saudi women.

BACKGROUND: Existing evidence suggest that low concentrations of vitamin A and E may have a contribution to the development of diabetes complications; however, data regarding the status of vitamin A and E among individuals with prediabetes are lacking. This study aimed to examine the association of plasma concentrations of vitamin A and E with the glycemic control status among first trimester pregnant Saudi women. METHODS: In this cross-sectional study, 1102 first trimester pregnant Saudi women were recruited from antenatal clinics. Sociodemographic and anthropometric information were collected, and laboratory analyses of blood glycated hemoglobin (A1C) and plasma vitamins A and E were performed. Subjects were classified as normoglycemic, prediabetic, or undiagnosed diabetic. Multinomial regression models adjusted for age estimated the adjusted odds ratios (aORs) and [95% confidence intervals (CIs)]. RESULTS: Among the sample, 78.8% (n = 868) had normal glycemic control, while 19.1% (n = 211) had prediabetes and 2.1% (n = 23) had undiagnosed diabetes. Plasma concentrations of vitamin A and E of prediabetic participants were at a level midway between that of normoglycemic and diabetic participants (p < 0.01). Compared to subjects with normoglycemic status, those with higher concentrations of vitamin A and E had lower odds of being prediabetic (aOR = 0.27 [0.21-0.35] and aOR = 0.95 [0.94-0.96], respectively) or diabetic (aOR = 0.18 [0.13-0.24] and aOR = 0.93 [0.92-0.94], respectively). CONCLUSIONS: Our findings indicate a possible contribution of vitamins A and E to the progression of prediabetes to diabetes. Future longitudinal studies are needed to elucidate the association between the antioxidant status and dysglycemia. Clinicians should monitor the glycemic and the antioxidant status closely and provide dietary guidance where needed.

Food neophobia and pickiness among children and associations with socioenvironmental and cognitive factors.

Food neophobia and picky eating are common behaviors exhibited among children that may impact their nutritional health. Due to the limited data available regarding food neophobia and pickiness in Saudi Arabia, this study aimed to estimate the prevalence of picky eating and food neophobia among Saudi children and to examine the association of socioenvironmental and cognitive factors with food neophobia and pickiness. The study included 216 healthy children with no known allergy, aged 3-7 years old, recruited from six schools in Jeddah, Saudi Arabia. A questionnaire was utilized to collect sociodemographic information from parents. Food neophobia and pickiness were evaluated using 2 separate scales. Socioenvironmental factors that may contribute to the development of food neophobia and pickiness were evaluated, such as breastfeeding duration and weaning practices, parental strategies, peer modeling, and social facilitation. Sensory sensitivity and disgust were also evaluated to assess the association with cognitive factors. Linear regression analysis with 95% confidence intervals was used to test the associations with the selected socioenvironmental and cognitive factors. The majority of children showed moderate to severe food neophobia and pickiness (98.6% and 89.8%, respectively). The socioenvironmental factors of peer modeling and selected parental strategies were found to have a significant association with food neophobia and pickiness. Assessed cognitive factors were found to be associated with food neophobia and pickiness. Future studies investigating causes of food neophobia and food pickiness among children are warranted.