A New Model for Ranking Schools of Public Health: The Public Health Academic Ranking.

Objectives: As there is no ranking designed for schools of Public Health, the aim of this project was to create one. Methods: To design the Public Health Academic Ranking (PHAR), we used the InCites Benchmarking and Analytics™ software and the Web Of Science™ Core Collection database. We collected bibliometric data on 26 schools of Public Health from each continent, between August and September 2022. We included 11 research indicators/scores, covering four criteria (productivity, quality, accessibility for readers, international collaboration), for the period 2017-2021. For the Swiss School of Public Health (SSPH+), a network gathering faculties across different universities, a specific methodology was used, with member-specific research queries. Results: The five top schools of the PHAR were: London School of Hygiene and Tropical Medicine, Public Health Foundation of India, Harvard T.H. Chan School of Public Health, SSPH+, Johns Hopkins Bloomberg School of Public Health. Conclusion: The PHAR allows worldwide bibliometric ordering of schools of Public Health. As this is a pilot project, the results must be taken with caution. This article aims to critically discuss its methodology and future improvements.

Development of a diet quality score and adherence to the Swiss dietary recommendations for vegans.

BACKGROUND: Vegan diets have recently gained popularity in Switzerland as well as globally. The aim of the present study was to develop a diet quality score for vegans (DQS-V) based on the Swiss dietary recommendations for vegans. METHODS: The dataset included 52 healthy vegan adults. Dietary intake data were assessed by three-day weighed food records. Body weight and height were measured, and a venous blood sample for the analysis of vitamin and mineral status was collected. Spearman rank correlation coefficients were used due to not-normally distributed data. Dietary patterns were identified using principal component analysis (PCA). RESULTS: The DQS-V score (mean ± SD) was 48.9 ± 14.7. Most vegans adhered to the recommended portions of vegetables, vitamin C-rich vegetables, fruits, omega-3-rich nuts, fats and oils, and iodized salt. However, the intake of green leafy vegetables, vitamin C-rich fruits, wholegrains, legumes, nuts and seeds, selenium-rich nuts, zero caloric liquid, and calcium-fortified foods was suboptimal. The sample overconsumed sweet-, salty-, fried foods, and alcohol. The DQS-V had a significantly positive correlation with intakes of fibre, polyunsaturated fatty acids, potassium, zinc, and phosphorus intakes (p's < 0.05) but was negatively correlated with vitamin B12 and niacin intakes (p's < 0.05). Two dietary patterns were derived from PCA: 1) refined grains and sweets and 2) wholegrains and nuts. The correlation between the DQS-V and the first dietary pattern was negative (- 0.41, p = 0.004) and positive for the second dietary pattern (0.37, p = 0.01). The refined grains and sweets dietary pattern was inversely correlated with beta-carotene status (- 0.41, p = 0.004) and vitamin C status (r = - 0.51, p = 0.0002). CONCLUSION: The newly developed DQS-V provides a single score for estimating diet quality among vegan adults. Further validation studies examining the DQS-V in relation to an independent dietary assessment method and to biomarkers of nutritional intake and status are still needed before the general application of the DQS-V.

Usability and Overall Perception of a Health Bot for Nutrition-Related Questions for Patients Receiving Bariatric Care: Mixed Methods Study.

BACKGROUND: Currently, over 4000 bariatric procedures are performed annually in Switzerland. To improve outcomes, patients need to have good knowledge regarding postoperative nutrition. To potentially provide them with knowledge between dietetic consultations, a health bot (HB) was created. The HB can answer bariatric nutrition questions in writing based on artificial intelligence. OBJECTIVE: This study aims to evaluate the usability and perception of the HB among patients receiving bariatric care. METHODS: Patients before or after bariatric surgery tested the HB. A mixed methods approach was used, which consisted of a questionnaire and qualitative interviews before and after testing the HB. The dimensions usability of, usefulness of, satisfaction with, and ease of use of the HB, among others, were measured. Data were analyzed using R Studio (R Studio Inc) and Excel (Microsoft Corp). The interviews were transcribed and a summary inductive content analysis was performed. RESULTS: A total of 12 patients (female: n=8, 67%; male: n=4, 33%) were included. The results showed excellent usability with a mean usability score of 87 (SD 12.5; range 57.5-100) out of 100. Other dimensions of acceptability included usefulness (mean 5.28, SD 2.02 out of 7), satisfaction (mean 5.75, SD 1.68 out of 7), and learnability (mean 6.26, SD 1.5 out of 7). The concept of the HB and availability of reliable nutrition information were perceived as desirable (mean 5.5, SD 1.64 out of 7). Weaknesses were identified in the response accuracy, limited knowledge, and design of the HB. CONCLUSIONS: The HB's ease of use and usability were evaluated to be positive; response accuracy, topic selection, and design should be optimized in a next step. The perceptions of nutrition professionals and the impact on patient care and the nutrition knowledge of participants need to be examined in further studies.

The Nutritional Content of Meal Images in Free-Living Conditions-Automatic Assessment with goFOODTM.

A healthy diet can help to prevent or manage many important conditions and diseases, particularly obesity, malnutrition, and diabetes. Recent advancements in artificial intelligence and smartphone technologies have enabled applications to conduct automatic nutritional assessment from meal images, providing a convenient, efficient, and accurate method for continuous diet evaluation. We now extend the goFOODTM automatic system to perform food segmentation, recognition, volume, as well as calorie and macro-nutrient estimation from single images that are captured by a smartphone. In order to assess our system's performance, we conducted a feasibility study with 50 participants from Switzerland. We recorded their meals for one day and then dietitians carried out a 24 h recall. We retrospectively analysed the collected images to assess the nutritional content of the meals. By comparing our results with the dietitians' estimations, we demonstrated that the newly introduced system has comparable energy and macronutrient estimation performance with the previous method; however, it only requires a single image instead of two. The system can be applied in a real-life scenarios, and it can be easily used to assess dietary intake. This system could help individuals gain a better understanding of their dietary consumption. Additionally, it could serve as a valuable resource for dietitians, and could contribute to nutritional research.

Home-based cooking intervention with a smartphone app to improve eating behaviors in children aged 7-9 years: a feasibility study.

Objective: To develop and evaluate the feasibility of a mobile application in Swiss households and assess its impact on dietary behavior and food acceptability between children who cooked with limited parental support (intervention group) with children who were not involved in cooking (control group). Methods: A ten-week randomized controlled trial was conducted online in 2020. Parents were given access to a mobile-app with ten recipes. Each recipe emphasized one of two generally disliked foods (Brussels sprouts or whole-meal pasta). Parents photographed and weighed the food components from the child's plate and reported whether their child liked the meal and target food. The main outcome measures were target food intake and acceptability analyzed through descriptive analysis for pre-post changes. Results: Of 24 parents who completed the baseline questionnaires, 18 parents and their children (median age: 8 years) completed the evaluation phase. Mean child baseline Brussel sprouts and whole-meal pasta intakes were 19.0 ± 24.2 g and 86.0 ± 69.7 g per meal, respectively. No meaningful differences in intake were found post-intervention or between groups. More children reported a neutral or positive liking towards the whole-meal pasta in the intervention group compared to those in the control group. No change was found for liking of Brussel sprouts. Conclusions for practice: The intervention was found to be feasible however more studies on larger samples are needed to validate feasibility. Integrating digital interventions in the home and promoting meal preparation may improve child reported acceptance of some healthy foods. Using such technology may save time for parents and engage families in consuming healthier meals.

Development and Evaluation of a Diet Quality Index for Preschool-Aged Children in an Asian population: The Growing Up in Singapore Towards Healthy Outcomes cohort.

BACKGROUND: Diet quality indexes are useful tools to measure diet quality because they compare dietary intakes against recommendations. A dietary quality index for Asian preschool-aged children is lacking. OBJECTIVE: The aims of this study were to develop and evaluate a dietary quality index for preschool-aged children (ie, the DQI-5) based on Singapore dietary recommendations and to examine diet quality in a cohort of 5-year-old children. An additional aim was to assess associations between sociodemographic characteristics and DQI-5 scores. DESIGN: A secondary analysis was conducted using dietary intake of children from the Growing Up in Singapore Towards healthy Outcomes mother-offspring cohort assessed in 2015-2016 using a validated food frequency questionnaire. The sociodemographic data were assessed at recruitment between June 2009 and September 2010. The DQI-5 was evaluated using a construct validity approach, whereby nutrition parameters associated with diet quality were studied. PARTICIPANTS AND SETTING: Participants were 767 Singaporean children aged 5 years of Chinese, Malay, or Indian ethnicity. MAIN OUTCOME MEASURES: The main outcome measures were the DQI-5 scores and the sociodemographic characteristics associated with diet quality. STATISTICAL ANALYSES PERFORMED: Kruskal-Wallis tests were used to evaluate differences in adherence to dietary recommendations across DQI-5 tertiles. Linear multiple regression analysis was performed to identify sociodemographic characteristics that were associated with diet quality in the children. RESULTS: The DQI-5 consists of 12 food and nutrient components, with a minimum score of zero and a maximum score of 110 points. The higher scores indicate a healthier diet, the mean ± SD DQI-5 score for the children was 61.6 ± 13.2. DQI-5 components with low scores included whole grains, vegetables, and fatty acid ratio, whereas total rice and alternatives and milk and dairy products components were overconsumed by 18% and 24.4% of children, respectively. Children with higher scores were more likely to meet dietary recommendations and had higher intake of nutrients such as dietary fiber, iron, vitamin A, and beta carotene. Children whose mothers were of Malay ethnicity and whose mothers had low income, an education below university, and shared primary caregiver responsibilities were more likely to have lower DQI-5 scores. CONCLUSIONS: The DQI-5 scores revealed diets to be low for several components and excessive for a few. The DQI-5 developed for preschool-aged children in Singapore had adequate construct validity.

Development of the Cook-EdTM Matrix to Guide Food and Cooking Skill Selection in Culinary Education Programs That Target Diet Quality and Health.

Culinary education programs are generally designed to improve participants' food and cooking skills, with or without consideration to influencing diet quality or health. No published methods exist to guide food and cooking skills' content priorities within culinary education programs that target improved diet quality and health. To address this gap, an international team of cooking and nutrition education experts developed the Cooking Education (Cook-EdTM) matrix. International food-based dietary guidelines were reviewed to determine common food groups. A six-section matrix was drafted including skill focus points for: (1) Kitchen safety, (2) Food safety, (3) General food skills, (4) Food group specific food skills, (5) General cooking skills, (6) Food group specific cooking skills. A modified e-Delphi method with three consultation rounds was used to reach consensus on the Cook-EdTM matrix structure, skill focus points included, and their order. The final Cook-EdTM matrix includes 117 skill focus points. The matrix guides program providers in selecting the most suitable skills to consider for their programs to improve dietary and health outcomes, while considering available resources, participant needs, and sustainable nutrition principles. Users can adapt the Cook-EdTM matrix to regional food-based dietary guidelines and food cultures.

The Human Factor in Automated Image-Based Nutrition Apps: Analysis of Common Mistakes Using the goFOOD Lite App.

BACKGROUND: Technological advancements have enabled nutrient estimation by smartphone apps such as goFOOD. This is an artificial intelligence-based smartphone system, which uses food images or video captured by the user as input and then translates these into estimates of nutrient content. The quality of the data is highly dependent on the images the user records. This can lead to a major loss of data and impaired quality. Instead of removing these data from the study, in-depth analysis is needed to explore common mistakes and to use them for further improvement of automated apps for nutrition assessment. OBJECTIVE: The aim of this study is to analyze common mistakes made by participants using the goFOOD Lite app, a version of goFOOD, which was designed for food-logging, but without providing results to the users, to improve both the instructions provided and the automated functionalities of the app. METHODS: The 48 study participants were given face-to-face instructions for goFOOD Lite and were asked to record 2 pictures (1 recording) before and 2 pictures (1 recording) after the daily consumption of each food or beverage, using a reference card as a fiducial marker. All pictures that were discarded for processing due to mistakes were analyzed to record the main mistakes made by users. RESULTS: Of the 468 recordings of nonpackaged food items captured by the app, 60 (12.8%) had to be discarded due to errors in the capturing procedure. The principal problems were as follows: wrong fiducial marker or improper marker use (19 recordings), plate issues such as a noncompatible or nonvisible plate (8 recordings), a combination of various issues (17 recordings), and other reasons such as obstacles (hand) in front of the camera or matching recording pairs (16 recordings). CONCLUSIONS: No other study has focused on the principal problems in the use of automatic apps for assessing nutritional intake. This study shows that it is important to provide study participants with detailed instructions if high-quality data are to be obtained. Future developments could focus on making it easier to recognize food on various plates from its color or shape and on exploring alternatives to using fiducial markers. It is also essential for future studies to understand the training needed by the participants as well as to enhance the app's user-friendliness and to develop automatic image checks based on participant feedback.

Development of the Home Cooking EnviRonment and Equipment Inventory Observation form (Home-CookERITM): An Assessment of Content Validity, Face Validity, and Inter-Rater Agreement.

INTRODUCTION: Quantifying Home Cooking EnviRonments has applications in nutrition epidemiology, health promotion, and nutrition interventions. This study aimed to develop a tool to quantify household cooking environments and establish its content validity, face validity, and inter-rater agreement. METHODS: The Home Cooking EnviRonment and equipment Inventory observation form (Home-CookERI™) was developed as a 24-question (91-item) online survey. Items included domestic spaces and resources for storage, disposal, preparation, and cooking of food or non-alcoholic beverages. Home-CookERITM was piloted to assess content validity, face validity, and usability with six Australian experts (i.e., dietitians, nutrition researchers, chefs, a food technology teacher, and a kitchen designer) and 13 laypersons. Pilot participants provided feedback in a 10 min telephone interview. Home-CookERI™ was modified to an 89-item survey in line with the pilot findings. Inter-rater agreement was examined between two trained raters in 33 unique Australian households. Raters were required to observe each item before recording a response. Home occupants were instructed to only assist with locating items if asked. Raters were blinded to each other's responses. Inter-rater agreement was calculated by Cohen's Kappa coefficient (κ) for each item. To optimize κ, similar items were grouped together reducing the number of items to 81. RESULTS: Home-CookERITM had excellent content and face validity with responding participants; all 24 questions were both clear and relevant (X2 (1, n = 19; 19.0, p = 0.392)). Inter-rater agreement for the modified 81-item Home-CookERI™ was almost-perfect to perfect for 46% of kitchen items (n = 37 items, κ = 0.81-1), moderate to substantial for 28% (n = 23, κ = 0.51-0.8), slight to fair for 15% (n = 12, κ = 0.01-0.5), and chance or worse for 11% of items (n = 9, κ ≤ 0.0). Home-CookERITM was further optimized by reduction to a 77-item version, which is now available to researchers. CONCLUSION: Home-CookERI™ is a comprehensive tool for quantifying Australian household cooking environments. It has excellent face and content validity and moderate to perfect inter-rater agreement for almost three-quarters of included kitchen items. To expand Home-CookERI™ applications, a home occupant self-completion version is planned for validation.

Consumer Understanding, Perception and Interpretation of Serving Size Information on Food Labels: A Scoping Review.

The increase in packaged food and beverage portion sizes has been identified as a potential factor implicated in the rise of the prevalence of obesity. In this context, the objective of this systematic scoping review was to investigate how healthy adults perceive and interpret serving size information on food packages and how this influences product perception and consumption. Such knowledge is needed to improve food labelling understanding and guide consumers toward healthier portion size choices. A search of seven databases (2010 to April 2019) provided the records for title and abstract screening, with relevant articles assessed for eligibility in the full-text. Fourteen articles met the inclusion criteria, with relevant data extracted by one reviewer and checked for consistency by a second reviewer. Twelve studies were conducted in North America, where the government regulates serving size information. Several studies reported a poor understanding of serving size labelling. Indeed, consumers interpreted the labelled serving size as a recommended serving for dietary guidelines for healthy eating rather than a typical consumption unit, which is set by the manufacturer or regulated in some countries such as in the U.S. and Canada. Not all studies assessed consumption; however, larger labelled serving sizes resulted in larger self-selected portion sizes in three studies. However, another study performed on confectionary reported the opposite effect, with larger labelled serving sizes leading to reduced consumption. The limited number of included studies showed that labelled serving size affects portion size selection and consumption, and that any labelled serving size format changes may result in increased portion size selection, energy intake and thus contribute to the rise of the prevalence of overweight and obesity. Research to test cross-continentally labelled serving size format changes within experimental and natural settings (e.g., at home) are needed. In addition, tailored, comprehensive and serving-size-specific food literacy initiatives need to be evaluated to provide recommendations for effective serving size labelling. This is required to ensure the correct understanding of nutritional content, as well as informing food choices and consumption, for both core foods and discretionary foods.

Consistency Between Parent-Reported Feeding Practices and Behavioral Observation During Toddler Meals.

OBJECTIVE: To assess whether feeding questionnaire responses reflect observed mealtime behavior. DESIGN: Cross-sectional associations between self-reported and observed behaviors. SETTING: Participants' homes. PARTICIPANTS: Parents (n = 75) of toddlers (mean age = 24.7 months) in the US. MAIN OUTCOME MEASURES: Feeding behavior questionnaires and coded videos of children's dinner meals. ANALYSIS: Parents' questionnaire responses of "never" (or "rarely") considered consistent with video observation if behavior was not observed; responses of "always" (or "most of the time") if behavior observed at least once. Proportion (%) of participants observed performing each behavior was calculated for the groups of parents reporting that they "never," "sometimes," or "always" used that feeding practice. These were compared across the 3 response groups. RESULTS: Parents reported 6 behaviors consistently (≥70% agreement): allowing child to eat as much as wanted, helping child eat, prompting child to eat, television/screens on during meal, nonfood rewards, and hurrying child. The remaining 8 behaviors fell below the threshold. For many behaviors, all response groups (never, sometimes, always) had similar rates of participants demonstrating the behavior. Only 5 behaviors had observed rates falling in the expected direction (frequency of always > sometimes > never). For some behaviors, the "sometimes" group had a higher (eg, clean plate) or lower (praise) frequency than the other 2 groups. CONCLUSIONS AND IMPLICATIONS: Self-reported questionnaire responses predicted whether some, but not all, behaviors were observed. Parents' use of "sometimes" remains difficult to interpret as parents may use "sometimes" inconsistently across behaviors and perhaps to mitigate socially undesirable responses. Self-reports of "sometimes" performing a behavior may have limited utility for prediction of behavior and likely requires additional exploration with the respondent.

Art on a Plate: A Pilot Evaluation of an International Initiative Designed to Promote Consumption of Fruits and Vegetables by Children.

OBJECTIVE: To evaluate the 2016 International Chefs Day cooking workshops Art on a Plate. DESIGN: Nonexperimental pretest-posttest design SETTING: Art on a Plate workshops with children from 14 countries in Asia, America, and Europe. PARTICIPANTS: A total of 433 workshop participants aged 4-14 years (mean age, 8.6 years). INTERVENTION: Instructed by a chef, children in the workshops created a self-chosen design on their plate with a spinach-fruit salad. MAIN OUTCOME MEASURES: Before and after the workshop, a questionnaire assessing liking and willingness to eat or taste; hunger was assessed using the Teddy the Bear method and emotions were assessed using the Self-assessment Manikin. The event coordinator evaluated salad intake. ANALYSIS: Linear and generalized linear (logit) mixed models were used to test statistical differences before and after the workshop. RESULTS: The workshop resulted in a small increase in liking (n = 409; P = .02) and person control (n = 375; P < .001) and a decrease in hunger (n = 379; P < .001). A total of 30% of children increased their liking scores, 18% decreased them, and 52% did not change them. Significant associations of liking and change in liking with salad intake were in the expected direction. CONCLUSION AND IMPLICATIONS: This study showed the positive effect of a cooking workshop on children's salad liking across a selection of countries worldwide. Further research and novel methods are needed to evaluate the long-term effectiveness of cooking activities in real-life settings across countries.

Parental Feeding Practices and Associations with Children's Food Acceptance and Picky Eating.

Picky eating, which includes behaviors such as limited dietary variety, neophobia, food refusals, and sensory sensitivities, can be a source of stress for families. Parents can influence their children's mealtime behavior through the feeding practices they use when offering foods. Some practices are counterproductive to establishing healthy eating habits and should be avoided, but caregivers need alternative behaviors to replace them. Parents should be encouraged to keep trying after a food is refused, as children may need to be exposed to a food several times before it is accepted. Varying the preparation changes the taste, texture, and appearance of food, and children may prefer some variants to others. Some children refuse foods to express independence; thus, providing choices between two healthy options may allow children to express a preference without saying "no" altogether. Coercive feeding practices such as the use of pressure to eat or using food as rewards should be avoided, as these can create negative associations with the food or meals and lead to food refusals. Instead, caregivers can model eating and enjoying the food. Nonfood rewards, such as praise or stickers, can also be used to encourage children to taste a food without negative outcomes.

Association between Anaemia in Children 6 to 23 Months Old and Child, Mother, Household and Feeding Indicators.

In Low and Lower-Middle-Income countries, the prevalence of anaemia in infancy remains high. In early childhood anaemia cause irreversible cognitive deficits and represents a higher risk of child mortality. The consequences of anaemia in infancy are a major barrier to overcome poverty traps. The aim of this study was to analyse, based on a multi-level approach, different factors associated with anaemia in children 6⁻23 months old based on recent available Standard Demographic Health Surveys (S-DHS). We identified 52 S-DHS that had complete information in all covariates of interest in our analysis between 2005 and 2015. We performed traditional logistic regressions and multilevel logistic regression analyses to study the association between haemoglobin concentrations and household, child, maternal, socio-demographic variables. In our sample, 70% of the 6⁻23 months-old children were anaemic. Child anaemia was strongly associated with maternal anaemia, household wealth, maternal education and low birth weight. Children fed with fortified foods, potatoes and other tubers had significantly lower rates of anaemia. Improving overall household living conditions, increasing maternal education, delaying childbearing and introducing iron rich foods at six months of age may reduce the likelihood of anaemia in toddlerhood.

The effect of the labelled serving size on consumption: A systematic review.

Guidance for food consumption and portion control plays an important role in the global management of overweight and obesity. Carefully conceptualised serving size labelling can contribute to this guidance. However, little is known about the relationship between the information that is provided regarding serving sizes on food packages and levels of actual food consumption. The aim of this systematic review was to investigate how serving size information on food packages influences food consumption. We conducted a systematic review of the evidence published between 1980 and March 2018. Two reviewers screened titles and abstracts for relevance and assessed relevant articles for eligibility in full-text. Five studies were considered eligible for the systematic review. In three of the included studies, changes in serving size labelling resulted in positive health implications for consumers, whereby less discretionary foods were consumed, if serving sizes were smaller or if serving size information was provided alongside contextual information referring to the entire package. One study did not find significant differences between the conditions they tested and one study suggested a potentially negative impact, if the serving size was reduced. The influence of labelled serving size on consumption of non-discretionary foods remains unclear, which is partially due to the absence of studies specifically focusing on non-discretionary food groups. Studies that investigate the impact of serving size labels within the home environment and across a broad demographic cross-section are required.

Snacking Patterns in Children: A Comparison between Australia, China, Mexico, and the US.

Snacking is common in children and influenced by many factors. The aim of this study is to provide insight of both common and country-specific characteristics of snacking among 4-13 year old children. We analyzed snacking prevalence, energy and nutrient contributions from snacking across diverse cultures and regions, represented by Australia, China, Mexico, and the US using data from respective national surveys. We found that the highest prevalence of snacking was in Australia and the US (over 95%) where snacking provided one-third and one-quarter of total energy intake (TEI), respectively, followed by Mexico (76%, provided 15% TEI) and China (65%, provided 10% TEI). Compared to 4-8 year-olds, the consumption of fruits and milk was lower in 9-13 year-old children, with a trend of increasing savory snacks consumption in China, Mexico, and the US. The nutrient density index of added sugars and saturated fat was higher, especially in Australia, Mexico, and the US. Results suggested that snacking could be an occasion to promote fruit and vegetable consumption in all countries, especially for older children. Snacking guidelines should focus on reducing consumption of snacks high in saturated fat and added sugars for Australia, Mexico, and the US, whereas improving dairy consumption is important in China.

Parenting styles, feeding styles and food-related parenting practices in relation to toddlers' eating styles: A cluster-analytic approach.

INTRODUCTION: Toddlers' eating behaviors are influenced by the way parents interact with their children. The objective of this study was to explore how five major constructs of general parenting behavior cluster in parents of toddlers. These parenting clusters were further explored to see how they differed in the use of feeding strategies (i.e. feeding styles and food parenting practices) and by reported child eating styles. METHODS: An online survey with 1005 mothers/caregivers (legal guardians) with at least one child between 12 and 36 months old was conducted in the United States in 2012, assessing general parenting behavior, feeding style, food parenting practices and the child eating styles. RESULTS: A three cluster solution of parenting style was found and clusters were labelled as overprotective/supervising, authoritarian, and authoritative. The clusters differed in terms of general parenting behaviors. Both overprotective and authoritative clusters showed high scores on structure, behavioral control, and nurturance. The overprotective cluster scored high on overprotection. The 'authoritarian' cluster showed lowest levels of nurturance, structure and behavioral control. Overprotective and authoritative parents showed very similar patterns in the use of food parenting practices, e.g. monitoring food intake, modeling, and promoting healthy food intake and availability at home. Overprotective parents also reported higher use of pressure to eat and involvement. Authoritarian parents reported high use of giving the child control over their food behaviors, emotion regulation, using food as a reward, and controlling food intake for weight control. Children's eating styles did not largely vary by parenting cluster. CONCLUSION: This study showed that a relatively new parenting style of overprotection is relevant for children's eating behaviors. Overprotective parents reported food parenting practices that are known to be beneficial for children's food intake, such as modelling healthy food intake, as well as more unfavorable practices such as pressure. Longitudinal data on parenting practices and their relation to healthy eating in children is needed to inform communication and interventions for parents, reinforcing key feeding strategies which have positive effects on child eating behaviors and addressing parenting styles that have unintended negative effects.

Parent-child mealtime interactions associated with toddlers' refusals of novel and familiar foods.

Parents' feeding practices have been associated with children's dietary quality and food acceptance, but previous studies have largely relied exclusively on questionnaires to assess both parent and child behavior. The current study explored the relationships between parents' reported and observed feeding practices and toddlers' food refusals. Sixty families with toddlers (12-36months-old) video recorded their children's dinners at home as well as a separate meal in which they offered the child a novel fruit or vegetable. Parents completed questionnaires about their feeding practices and children's picky eating and food neophobia. Videos were coded for parents' observed feeding practices at mealtimes and children's food refusals. Parents' feeding practices and children's food refusals were compared in families with children reported to be more picky and less picky eaters. The relationships between reported and observed feeding practices with observed food refusals were also assessed. It was hypothesized that parents' use of controlling and coercive prompts to eat would be associated with children's food refusals. Parent-reported picky eating was not associated with an increase in children's total food refusals, although reported neophobia was associated with more uses of crying, pushing food away, or verbally refusing a new food. More prompts to eat of any kind were associated with more food refusals. In regression models, more observed coercive-controlling prompts used by parents were associated with more food refusals by children. Parents of pickier eaters tended to use a lower proportion of autonomy-supportive prompts to eat, and these families also showed a stronger association between the use of controlling prompts and food refusals. These families may benefit the most from interventions aiming to reduce the use of controlling practices. Models using observed feeding practices were more strongly associated with children's food refusals than were parents' reported feeding practices. This highlights the importance of behavioral observation in this field.