Screening for marginal food security in young children in primary care.

BACKGROUND: Household food insecurity (FI), even at marginal levels, is associated with poor child health outcomes. The Nutrition Screening Tool for Every Preschooler (NutriSTEP®) is a valid and reliable 17-item parent-completed measure of nutrition risk and includes a single item addressing FI which may be a useful child-specific screening tool. We evaluated the diagnostic test properties of the single NutriSTEP® FI question using the 2-item Hunger Vital Sign™ as the criterion measure in a primary care population of healthy children ages 18 months to 5 years. RESULTS: The sample included 1174 families, 53 (4.5%) of which were marginally food secure. An affirmative response to the single NutriSTEP® question "I have difficulty buying food I want to feed my child because food is expensive" had a sensitivity of 85% and specificity of 91% and demonstrated good construct validity when compared with the Hunger Vital Sign™. CONCLUSION: The single NutriSTEP® question may be an effective screening tool in clinical practice to identify marginal food security in families with young children and to link families with community-based services or financial assistance programs including tax benefits. TRIAL REGISTRATION: TARGet Kids! practice-based research network (Registered June 5, 2013 at www.clinicaltrials.gov ; NCT01869530); www.targetkids.ca.

Young Adults' Perceptions of Calcium Intake and Health: A Qualitative Study.

Many young Canadian adults are not meeting dietary calcium recommendations. This is concerning as adequate calcium is important throughout young adulthood to maximize peak bone mass for osteoporosis prevention. There are limited studies that have explored young adults' perceptions toward calcium and health. Our objectives were to determine young adults' (18-34 years) knowledge of calcium in relation to health, facilitators and barriers to adequate calcium intake, and to explore both their suggestions for individual strategies to increase calcium intake and ways to communicate calcium-related messaging to this population. Eight gender-specific focus groups (18 men; 35 women) were conducted using a semistructured interview guide, guided by social cognitive theory. Deductive thematic analysis was used to generate themes. Participants perceived adequate calcium intake to be important for children and older adults but were uncertain of the benefits for their own age group. Perceived positive outcomes (e.g., aesthetics such as strong nails) associated with adequate calcium intake were cited as a motivator to increase intake. Perceived barriers to achieving increased calcium intake included the high cost and inconvenience of milk products and negative practices of dairy farmers. Participants suggested planning healthy well-balanced meals and forming a habit of consuming calcium-rich foods as individual strategies to increase calcium intake. Strategies to convey calcium-related information to young adults included increasing awareness of the importance of calcium via credible sources of information and developing nutrition education curricula. Social media and advertising were perceived as ineffective. Our findings provide key information for nutrition education initiatives.

Food parenting practices and their association with child nutrition risk status: comparing mothers and fathers.

In Canada, little is known about how food parenting practices are associated with young children's dietary intakes and no studies have examined food parenting practices of Canadian fathers. This study aimed to examine associations between food parenting practices and preschool-age children's nutrition risk. We conducted a cross-sectional analysis of thirty-one 2-parent families; 31 mothers, 31 fathers, and 40 preschool-age children. Parents completed an adapted version of the Comprehensive Feeding Practices Questionnaire. We calculated children's nutrition risk using their NutriSTEP score. To account for sibling association, we used generalized estimating equations, adjusting for child age, sex, household income, and parental body mass index. Both mothers' and fathers' involvement of children in meal preparation were associated with lower child nutrition risk (mother [Formula: see text] = -3.45, p = 0.02; father [Formula: see text] = -1.74, p = 0.01), as were their healthy home environment scores (mother [Formula: see text] = -8.36, p < 0.001; father [Formula: see text] = -2.69, p = 0.04). Mothers' encouragement of balance and variety was associated with lower nutrition risk ([Formula: see text] = -8.88, p = 0.01), whereas mothers' use of food as a reward was associated with higher nutrition risk ([Formula: see text] = 4.67, p < 0.001). Fathers' modelling of healthy behaviours was associated with lower nutrition risk ([Formula: see text] = -2.21, p = 0.01), whereas fathers' restriction for health ([Formula: see text] = 2.21, p = 0.03) and pressure-to-eat scores ([Formula: see text] = 3.26, p = <0.001) were associated with higher nutrition risk. No associations were found between child nutrition status and parental emotion regulation, control, monitoring, or restriction for weight. In conclusion, both mothers' and fathers' food parenting practices are associated with their children's nutrition status. Fathers should be included in food parenting practices interventions.

Association between serum cholesterol and eating behaviours during early childhood: a cross-sectional study.

BACKGROUND: Modifiable behaviours during early childhood may provide opportunities to prevent disease processes before adverse outcomes occur. Our objective was to determine whether young children's eating behaviours were associated with increased risk of cardiovascular disease in later life. METHODS: In this cross-sectional study involving children aged 3-5 years recruited from 7 primary care practices in Toronto, Ontario, we assessed the relation between eating behaviours as assessed by the NutriSTEP (Nutritional Screening Tool for Every Preschooler) questionnaire (completed by parents) and serum levels of non-high-density lipoprotein (HDL) cholesterol, a surrogate marker of cardiovascular risk. We also assessed the relation between dietary intake and serum non-HDL cholesterol, and between eating behaviours and other laboratory indices of cardiovascular risk (low-density lipoprotein [LDL] cholesterol, apolipoprotein B, HDL cholesterol and apoliprotein A1). RESULTS: A total of 1856 children were recruited from primary care practices in Toronto. Of these children, we included 1076 in our study for whom complete data and blood samples were available for analysis. The eating behaviours subscore of the NutriSTEP tool was significantly associated with serum non-HDL cholesterol (p = 0.03); for each unit increase in the eating behaviours subscore suggesting greater nutritional risk, we saw an increase of 0.02 mmol/L (95% confidence interval [CI] 0.002 to 0.05) in serum non-HDL cholesterol. The eating behaviours subscore was also associated with LDL cholesterol and apolipoprotein B, but not with HDL cholesterol or apolipoprotein A1. The dietary intake subscore was not associated with non-HDL cholesterol. INTERPRETATION: Eating behaviours in preschool-aged children are important potentially modifiable determinants of cardiovascular risk and should be a focus for future studies of screening and behavioural interventions.

Air displacement plethysmography for fat-mass measurement in healthy young women.

PURPOSE: Dual energy X-ray absorptiometry (DXA) and air displacement plethysmography (ADP) are commonly used to assess body composition. Accurate body fat measures are valuable in a variety of populations. Because DXA, the reference standard, is expensive and labour-intensive, determining whether these two methods are interchangeable is important. METHODS: Forty-five female undergraduate students aged 21 to 33 with body mass indexes of 18.3 to 28.6 kg/m² were recruited from the University of Guelph. Each participant underwent one full-body DXA scan and one ADP assessment, to determine total percent fat mass (%FM). RESULTS: The Pearson's correlation between %FM(DXA) (27.1 ± 4.8) and %FM(ADP) (26.1 ± 5.5) indicated good association (r=0.88, p<0.01). While Bland-Altman analysis revealed no systematic bias between the two methods (R2=0.07, p=0.08), large intraindividual variation occurred (95% confidence interval: -5.86% to 4.11%); this was related to height, weight, body-surface area, and lung volume. CONCLUSIONS: The two methods were significantly correlated. Mean %FM was not significantly different and no systematic bias between methods was observed. These findings indicate that ADP and DXA may be used interchangeably for determining %FM at the group level in healthy young women; a large intraindividual variation between the methods precludes interchangeability at the individual level.

Effect of the transition from high school to university on anthropometric and lifestyle variables in males.

The obesity epidemic in North America has focused attention on the health risks of excess weight gain. The transition from high school to university is a critical period for weight gain, commonly referred to as the Freshman 15. The purpose of this study was to investigate the effect of the transition from high school to university on anthropometrics and physical and sedentary activities in males. A total of 108 males completed 3 study visits: the summer prior to first year university, and the ends of the first and second semesters. Outcome measures were body mass, height, body mass index (BMI), body fat, waist circumference, hip circumference, waist:hip ratio, dietary intake, and participation in physical and sedentary activities. Between the summer prior to and the end of first year university, male students experienced a significant weight gain, of 3.0 kg, with significant increases in BMI, body fat, waist circumference, hip circumference, and waist:hip ratio. Energy and nutrient intake did not change. Final body mass was significantly predicted by intention for body mass to stay the same, relative to weight loss intention. Fast aerobic physical activity significantly decreased between the summer prior to and the end of first year university, while slow aerobic physical activity, strength training, and flexibility training did not change. Computer and studying time significantly increased, while television time and hours of nightly sleep significantly decreased between the summer prior to and the end of first year university. Weekly alcoholic drinks and binge drinking frequency significantly increased over this time period. In conclusion, between the summer prior to and the end of first year university, male students gained an average of 3.0 kg, with increases in related anthropometrics. These changes may be due to body mass change intention and (or) the observed decreased physical and increased sedentary activities, but appear to be unrelated to dietary intake.

Body weight and percent body fat increase during the transition from high school to university in females.

A critical period for weight gain may occur during the transition from high school to university. This descriptive, noncontrolled cohort study of 116 healthy females examined the effect of this transition over three study visits in first year university. The main outcome measure was body weight; others were height, body composition, waist circumference, dietary intake, and participation in physical and sedentary activities. Difference among study visits was determined by repeated measures analysis of variance; multiple regression examined changes in energy intake and physical and sedentary activities as predictors of final weight. Weight increased (P<0.001) by 2.4 kg (61.4 to 63.8 kg) during the entire course of the study. Other increases (P<0.001) included: body mass index (calculated as kg/m(2)), 22.3 to 23.1; percent body fat, 23.8% to 25.6%; and waist circumference, 76.9 to 79.4 cm. Dietary energy intake did not increase; vigorous physical, but not strength building, activities increased; television use decreased; and computer use increased (P<0.03 for all): however, these changes were not predictive of final weight. A change (decrease) in moderate physical activity was, however, an important predictor of final weight. Females making the transition to university gained 2.4 kg; weight gain during this formative period may be modified by lifestyle activities.