Clinical Correlates and Prevalence of Food Selectivity in Children with Autism Spectrum Disorder.

OBJECTIVE: To examine clinical correlates and prevalence of food selectivity (FS) - ie, self-restricted diet, reluctance to try new foods - in children with autism spectrum disorder (ASD) ascertained from a general outpatient autism clinic. STUDY DESIGN: A multidisciplinary team (pediatric nurse practitioner, psychologist and dietitian) assessed medical and psychosocial histories and dietary habits in 103 children with ASD (mean age = 5.8 ± 2.2 years; range 2-10). Parents rated child mealtime behavior on the Brief Autism Mealtime Behavior Inventory (BAMBI) and disruptive behavior on the Aberrant Behavior Checklist (ABC). Height and weight measurements were collected. Children were classified as FS or no FS based on parent reported intake and mealtime behavior. A 24-hour dietary recall was used to record intake percentages < 80%. Logistic regression and multivariable modeling were used to evaluate clinical correlates with FS. RESULTS: Of 103 children, 45.6% (n = 47) were classified as FS; 54.4% (n = 56) no FS. After adjusting for potential confounders, the odds of FS increased by 1.91 (95% CI: 1.38, 2.64, P < .001) for every half-SD increase in BAMBI total score and by 1.35 (95% CI: 1.05, 1.74, P = .020) for every half-SD increase in ABC Hyperactivity/Noncompliance. No group differences in anthropometrics or nutritional intake were identified. CONCLUSIONS: Food selectivity (FS) in children with ASD was strongly associated with greater severity of disruptive mealtime and hyperactivity/noncompliance behaviors. FS was not associated with anthropometrics or nutritional intake.

Is the Caloric Midpoint Associated with Food Cravings and Food Intake in Pregnant Women?

Objective: The field of chrononutrition suggests that mealtime can influence food intake. Previous studies have linked the caloric midpoint - defined as the time at which 50% of the daily energy is consumed - with different aspects of food consumption. However, its relationship with food craving remains unexplored. This cross-sectional study aimed to investigate the association between caloric midpoint, food craving, and food consumption in pregnant women.Methods: The study comprised 233 pregnant women classified as early eaters (caloric midpoint ≤ 1:00pm) and late eaters (caloric midpoint >1:00pm). Food craving were assessed using Food Craving Trait and State Questionnaires. Energy and nutrient intake, as well as mealtimes, were assessed using a 24-h food recall.Results: No association between caloric midpoint and food craving was found. However, late eaters consumed more calories (2039.47 kcal vs 1843.44 kcal; p < 0.001), carbohydrates (255.06 g vs 211.12 g; p = 0.002), total fat (73.1 g vs 64.8 g; p = 0.003), monounsaturated fat (21.33 mg vs 18.59 mg; p = 0.002) and saturated fat (24.37 mg vs 22.21 mh; p = 0.01) and had higher consumption of calories and macronutrients in the first (calories: 275.63 vs 213.41, p = 0.007; carbohydrate: 170.42 vs 142.54, p = 0.01; total fat: 56.49 vs 50.17, p = 0.04) and second (calories: 213.21 vs 151.59, p = 0.04; carbohydrate: 130.44 vs 96.6, p = 0.04; protein: 15.17 vs 13.71, p = 0.03) afternoon snack, dinner (calories: 576.89 vs 412.4, p < 0.001; carbohydrate: 230.76 vs 169.45, p < 0.001; protein: 80.48 vs 68.9, p = 0.02; total fat: 212.77 vs 147.12, p < 0.001) and late-night snack (calories: 135.75 vs 68.3, p = 0.04; total fat: 13.23 vs 22.45, p = 0.04) than early eaters.Conclusion: Pregnant women who concentrate their meals at later times consumed more calories, macro and micronutrients throughout the day and in the night meals when compared to early eaters.

Eating time variation from weekdays to weekends and its association with dietary intake and BMI in different chronotypes: findings from National Health and Nutrition Examination Survey (NHANES) 2017-2018.

Evidence suggests that differences in meal timing between weekends and weekdays can disrupt the body's circadian rhythm, leading to a higher BMI. We aimed to investigate the associations between mealtime variation from weekdays to weekends (eating midpoint jetlag), dietary intake and anthropometric parameters, based on individuals' chronotype. The study utilised data from National Health and Nutrition Examination Survey 2017-2018. Food consumption was estimated by weighted average of participants' food intake on weekdays and weekends. Eating midpoint jetlag, defined as the difference between the midpoint of the first and last mealtimes on weekends and weekdays, was calculated. Chronotype was assessed by participants' mid-sleep time on weekends, adjusted for sleep debt. Linear regression analysis was conducted to investigate the associations between variables. The sample was categorised into chronotype tertiles. Among individuals in the third chronotype tertile, there was a positive association between eating midpoint jetlag and BMI (ß = 1·2; 95 % CI (1·13, 1·27)). Individuals in the first tertile showed a positive association between eating midpoint jetlag and energy (ß = 96·9; 95 % CI (92·9, 101·7)), carbohydrate (ß = 11·96; 95 % CI (11·2, 12·6)), fat (ß = 3·69; 95 % CI (3·4, 3·8)), cholesterol (ß = 32·75; 95 % CI (30·9, 34·6)) and sugar (ß = 8·84; 95 % CI (8·3, 9·3)) intake on weekends. Among individuals with an evening tendency, delaying meals on weekends appears to be linked to a higher BMI. Conversely, among individuals with a morning tendency, eating meals later on weekends is associated with higher energetic intake on weekends.

Validation of the Childhood Family Mealtime Questionnaire in Mexican Adolescents with Obesity and Their Caregivers.

BACKGROUND: Childhood obesity is a significant public health concern in Mexico, with far-reaching implications for the nation's healthcare system and economy. In light of this challenge, our study sought to validate the Childhood Family Mealtime Questionnaire (CFMQ) in Mexican adolescents living with obesity and their primary caregivers. METHODS: A sample of 56 adolescents ages 13 to 17 years and their primary caregivers from one pediatric obesity clinic participated in the study. We conducted a comprehensive assessment of the CFMQ's consistency, reliability, and construct validity among all participants. Internal consistency was determined using Cronbach's α, and the questionnaire's reliability was assessed through test-retest and intraclass correlation coefficients. Construct validity was assessed through an exploratory factor analysis. RESULTS: Our findings confirmed strong internal consistency and reliability for both adolescents and caregivers. Construct validity was established through exploratory factor analysis, refining the questionnaire while preserving its original seven dimensions. This validation of the CFMQ highlights its applicability in evaluating family mealtime experiences in this context, providing valuable insights into the dynamics that influence adolescent nutrition and health. CONCLUSION: The CFMQ proves to be a reliable tool for assessing family mealtime experiences in Mexican adolescents living with obesity and their caregivers who seek care at third-level public hospitals.

Impact of Nighttime Food Consumption and Feasibility of Fasting during Night Work: A Narrative Review.

Shift work has been associated with an increased risk of developing chronic non-communicable diseases, such as obesity. The reduction in overnight fasting and its physiological consequences seem to affect the metabolic health of shift workers, but little has been discussed regarding the feasibility and implications of maintaining a night-long fast during work. This narrative review aims to discuss the impact of eating behavior on the reduction of overnight fasting in shift workers, as well as possible nutritional strategies involving fasting that have been tested for shift workers, to contribute to the establishment of nutritional guidelines for them. We used various databases and search engines to retrieve relevant articles, reviews, and investigations. Despite the potential benefits of overnight fasting for other groups, few studies have investigated this approach in the context of shift work. Generally, it seems to be a feasible and metabolically beneficial strategy for shift workers. However, it is essential to investigate the potential risks and benefits of reducing the fasting time for shift workers, considering social, hedonic, and stress-related factors. Furthermore, randomized clinical trials are necessary to establish safe and feasible strategies for shift workers to practice different fasting windows.

Meal timing variability of rotating shift workers throughout a complete shift cycle and its effect on daily energy and macronutrient intake: a field study.

PURPOSE: To evaluate the meal timing variability of rotating shift workers throughout a complete shift schedule and its effect on daily energy and macronutrient intake. METHODS: Thirty male shift-workers from a mining company were evaluated in a complete rotation shift cycle over 240 consecutive hours (10 days; two days of morning shifts, two days of evening shifts, 24 h free, two days of night shifts and three days off). Food intake related variables [meal timing, energy (kcal) and macronutrient intake (%)] were assessed by 24 h recall by a trained nutritionist. Mixed models were used to analyze the variation in meal timing and energy and macronutrient intake throughout the shift cycle, as well as the interaction between shift and time ranges (00:00-03:59, 04:00-07:59, 08:00-11:59, 12:00-15:59, 16:00-19:59, 20:00-23:59). RESULTS: The first meal of the day was earlier on night shifts [D6 (3:44 ± 0:33) and D7 (5:52 ± 0:42)] compared to the other shifts (p < 0.001), except for D4 (evening shift; 5:51 ± 0:47) versus D7 (p = 0.999). Night shifts also showed a shorter night fasting (D5-D6, 9.3 h; D6-D7, 9.6 h) than most other nights (p < 0.05), except for the fasting between D1-D2 (11.3 h) and D3-D4 (11.2 h) (p > 0.05). There was no difference in 24 h energy intake throughout the shift cycle (p = 0.065). The analysis of interaction between shift and time ranges showed that night shift (D6) presented a higher intake of energy (441.5 ± 48.4 kcal), percentage of energy (D6: 17.8 ± 1.8%), fat (17.6 ± 2.0%), carbohydrate (17.0 ± 1.7%) and protein (16.4 ± 1.8%) between 00:00 and 03:59 compared with the other shift days (p < 0.05). CONCLUSION: Night shifts seem to contribute to a longer eating window than other shifts. Moreover, there is a higher energy and macronutrients intake during night shifts, which reduces the night fast period and could have implications for metabolic dysregulation.

Is Evening Carbohydrate Intake in Healthy Individuals Associated with Higher Postprandial Glycemia and Insulinemia When Compared to Morning Intake? A Systematic Review and Meta-Analysis of Randomized Crossover Studies.

This systematic review aimed to summarize randomized clinical trials that compared the postprandial glycemic and insulinemic metabolic response after eating isocaloric and standardized carbohydrate meals consumed at two moments: morning versus night, in healthy individuals who were not shift workers. The search strategy consisted of an electronic search using the following electronic databases: MEDLINE (via PubMed), EMBASE (via Elsevier), LILACs (Virtual Health Library - VHL), Cochrane Registers of Clinical Trials (CENTRAL, via Wiley) and gray literature (Opengray.eu). The PICO strategy was used to define the search terms (P: healthy adults, I: nocturnal intake, C: morning intake, O: area under the curve (AUC) of the postprandial glucose and insulin response). This review was reported according to the PRISMA statement. From the 3757 articles found, 412 were duplicates and excluded, totaling 3345 that had their titles and abstracts read. A total of 42 articles met the inclusion criteria and were read in full, and eight studies were included in the systematic review. The certainty of the evidence was assessed using GRADE. The results showed, with moderate quality of evidence, a postprandial response with higher glycemic values in the evening compared to the morning (SMD = 1.30; 95% CI, 1.01 to 1.59; I2 = 0%; p < 0.00001; 8 studies and 116 participants). No differences were found between insulin values at night and in the morning (SMD = 0.19; 95% CI, -0.10 to 0.49; 6 studies and 90 participants). We concluded that the intake of carbohydrates at night leads to higher glycemic, but not insulinemic, postprandial values. Revision Record: PROSPERO number CRD42019137862 available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019137862 Key teaching points and nutritional relevanceThis systematic review summarized randomized clinical trials that compared the postprandial glycemic and insulinemic response after eating carbohydrate meals in the morning versus at night.A total of eight studies were included in the systematic review; the results showed a postprandial response with higher glycemic values in the evening compared to the morning.No differences were found between insulin values at night and in the morning;• The intake of carbohydrates at night leads to higher glycemic, but not insulinemic, postprandial values.

Strategies and behaviors used by mothers in interactions with their young children during a mealtime in peri-urban areas of Huánuco, Peru.

This study aimed to gain an in-depth understanding about different strategies used by mothers to feed their 6-23-month-old children, as well as to learn about mothers' behaviors in response to situations of food refusal by her child, in order to generate evidence that contributes to the information gap on responsive feeding in Peru. The study was conducted in the city of Huánuco, a peri-urban area of Peru, with mothers of children in the complementary feeding stage participating. An in-depth 5-hour home observation was conducted in eight mother-child dyads. Both the mothers' and children's mealtime and food-related behaviors were coded and an inductive thematic analysis was applied. The primary objective of many of the strategies used by the mothers was to get their child to eat a little more. Six strategies were identified: pressure, encouragement, facilitating intake, acceptance, negotiation and reasoning. Certain differences were found in the strategies employed by the mother according to the age of her child, with mothers of younger children using more encouragement and mothers of older children using more pressure for their child to eat. The mothers' behavior in response to the child's refusal of food was both responsive and non-responsive (controlling), depending on the reason for the refusal. The findings are of great value for understanding about the feeding interactions of mother-child dyads in Peru and they start to address the information gap and can support the development of nutritional intervention strategies for use with children.

Cultural Influences on Family Mealtime Routines in Mexico: Focus Group Study with Mexican Mothers.

Mexico's obesity rates are alarming, and experts project drastic increases in the next thirty years. There is growing interest in understanding how remote acculturation and globalization processes influence health behaviors. The present study used focus group data from a central state, San Luis Potosí, in Mexico to explore mothers' perspectives on factors that influence family mealtime routines. Thematic analysis was used to identify barriers and facilitators to healthy mealtime routines and diet within families. Twenty-one mothers participated in the focus groups; 76% were full-time stay at home mothers, the majority were low-income (65%), and fewer than half reached a high school education. Three major themes emerged: (1) mothers do most of the visible work involving mealtime routines; (2) family meals are different today, and globalization is a contributing factor; and (3) family mealtimes are shifting to weekend events. Empowering mothers to negotiate diet with family members to build healthy routines, navigate challenges due to changing environments, and set family boundaries around technology use during mealtimes should be taken into consideration when promoting healthy behaviors with Mexican families.

Role of chronotype in dietary intake, meal timing, and obesity: a systematic review.

CONTEXT: Recent studies show that dietary habits and obesity seem to be influenced by chronotype, which reflects an individual's preference for the timing of sleeping, eating, and activity in a 24-hour period. OBJECTIVE: This review aimed to analyze the association of chronotype with dietary habits, namely energy and macronutrient intakes, meal timing, and eating patterns, as well as with obesity. DATA SOURCES: PubMed/MEDLINE, LILACS, and Google Scholar databases were searched between 2004 and 2020. Study selection was performed by 2 authors independently; disagreements on eligibility of articles were resolved by a third author. After assessment of 12 060 abstracts, 43 studies (21 articles on obesity; 13 on food consumption, meal timing, and eating patterns; and 9 that addressed both obesity and dietary behavior) were included. DATA EXTRACTION: A standard form was used to extract study design, country, number of participants, method of chronotype determination, and main findings. DATA ANALYSIS: Approximately 95% of included studies showed an association between eveningness and at least 1 unhealthy eating habit. Morningness was associated with regular consumption of fresh and minimally processed foods. In addition, about 47% of studies showed a higher association between late types and obesity. CONCLUSION: Late types are more likely to present unhealthy eating habits, such as eating late at night, skipping breakfast often, and eating processed/ultraprocessed foods, while early types are more likely to have healthy and protective habits, such as eating early and eating predominantly fresh/minimally processed foods. Intermediate types tend to have a pattern of health and eating more similar to early types than to late types. Late types are also more likely to present higher weight and body mass index than early or intermediate types. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42021256078.

Time-Related Eating Patterns Are Associated with the Total Daily Intake of Calories and Macronutrients in Day and Night Shift Workers.

The aim of the study was to investigate whether time-related eating patterns are associated with the daily intake of calories and macronutrients in Brazilian male military police officers (n = 81; 29-day and 52-night workers; mean age: 36.4 ± 0.9 and 38.5 ± 0.7 years, respectively). Energy and macronutrient intake were determined by a non-consecutive 3-day food recall. Time-related eating patterns, such as the time of the first and the last meals, eating duration, and caloric midpoint, were evaluated. Individuals were classified as "early" or "late" eaters according to the median caloric midpoint. Night shift workers showed a later eating time for the last meal (p < 0.001), longer eating duration (p < 0.001), and later caloric midpoint (p = 0.037) than day workers. Late eaters from both workgroups consumed more 24 h energy (p = 0.028), fat in calories (p = 0.006) and protein (calories: p < 0.001; percentage of total calories: p = 0.042), and less carbohydrates in calories (p = 0.010) intake than early eaters. The time of the first meal was negatively correlated with 24 h energy (p = 0.024) and carbohydrate (p = 0.031) intake only in day workers. The time of the last meal was positively correlated with 24 h energy (day workers: ß = 0.352; p = 0.044; night workers: ß = 0.424; p = 0.002) and protein (day workers: ß = 0.451; p = 0.013; night workers: ß = 0.536; p < 0.001) intake for both shift workers, and with carbohydrate (ß = 0.346; p = 0.016) and fat (ß = 0.286; p = 0.042) intake only in night workers. Eating duration was positively correlated with energy (day workers: ß = 0.473; p = 0.004; night workers: ß = 0.320; p = 0.023) and carbohydrate (day workers: ß = 0.418; p = 0.011; night workers: ß = 0.364; p = 0.010) intake in both groups. Thus, time-related eating patterns indicative of intake later at night are associated with increased daily energy and macronutrient intake.

The association between maternal features and nutritional problems in children with autism spectrum disorder / Associação entre características maternas e problemas nutricionais em crianças com transtorno do espectro do autismo

ABSTRACT Objective In the literature, there is almost no data on the relationship between autistic children's nutritional problems and their mothers' demographic and nutritional characteristics. Therefore, this study aimed to evaluate whether there was a relationship between maternal features and nutritional problems in autistic children. Methods This study was conducted with the participation of 58 autistic children (6-19 years) and their mothers. Descriptive data were obtained with a general questionnaire. For the evaluation of children's nutritional status, anthropometric measurements and 24-hour dietary recall were used. Also, the Brief Autism Mealtime Behavior Inventory and ORTO-15 questionnaires were used to evaluate the meal behavior of children and orthorexia tendency of mothers, respectively. Results No significant correlation was found between the Brief Autism Mealtime Behavior Inventory scores in children of mothers with high and low orthorexia tendency. There were also no statistically significant differences between the children of mothers with high and low educational level in terms of Brief Autism Mealtime Behavior Inventory scores. Only the dietary vitamin B6 intake was significantly higher in the children of mothers with high educational level. Maternal age was associated with the dietary energy and protein intake, unlike, maternal orthorexia tendency was not associated with the nutritional status and meal behavior of children. The abdominal pain experience in the last one month was found to be significantly higher in the children of employed mothers than children of unemployed mothers. Conclusion It is thought that the maternal characteristics are not effective on meal behavior in children and also maternal age and educational status have a very limited effect on the nutritional status of children.

RESUMO Objetivo Na literatura, quase não existem dados sobre a relação entre os problemas nutricionais de crianças autistas e as características demográficas e nutricionais de suas mães. Portanto, este estudo teve como objetivo avaliar se havia relação entre características maternas e problemas nutricionais em crianças autistas. Métodos Este estudo foi realizado com a participação de 58 crianças autistas (6-19 anos) e suas mães. Os dados descritivos foram obtidos em questionário geral. Para a avaliação do estado nutricional das crianças, medidas antropométricas e rec24h foram utilizados. Além disso, os questionários Brief Autism Mealtime Behavior Inventory e ORTO-15 foram utilizados para avaliar o comportamento alimentar das crianças e a tendência à ortorexia das mães, respectivamente. Resultados Não foi encontrada correlação significativa entre os escores do Brief Autism Mealtime Behavior Inventory nos filhos de mães com alta e baixa tendência à ortorexia. Também não houve diferenças estatisticamente significativas entre os filhos de mães com nível educacional alto e baixo em termos de pontuação no Brief Autism Mealtime Behavior Inventory. Somente a ingestão alimentar de vitamina B6 foi significativamente maior nos filhos de mães com alto nível educacional. A idade materna foi associada à ingestão energética e proteica, diferentemente da tendência à ortorexia materna, não associada ao estado nutricional e ao comportamento das refeições. A experiência de dor abdominal no último mês foi significativamente maior nos filhos de mães que trabalham do que nos filhos de mães que não trabalham. Conclusão Acredita-se que as características maternas não influenciam o comportamento alimentar das crianças e também que a idade e o estado educacional da mãe têm um efeito muito limitado no estado nutricional das crianças.

Caloric midpoint is associated with total calorie and macronutrient intake and body mass index in undergraduate students.

Studies have suggested that eating at later times may be a risk factor for being overweight. The aim of this study was to investigate the association of caloric midpoint on the anthropometric profile and calorie and macronutrient intake during the day. The study included 718 Brazilian undergraduate students (20.5 ± 2.9 years old; 67% women). Dietary intake was assessed by 24-h recall and the diurnal variation of calorie consumption was evaluated by caloric midpoint average time at which 50% of daily energy were consumed. Participants were classified into two groups according to caloric midpoint median; early eaters (caloric midpoint ≤ 3:00 pm) or late eaters (caloric midpoint > 3:00 pm). Body weight and waist circumference were measured and body mass index (BMI) was determined. Generalized linear models adjusted for confounding variables were used to determine the association between variables. The late eaters presented higher BMI when compared to early eaters (23.0 kg/m2 ± 0.3 vs. 22.1 kg/m2 ± 0.2, respectively; p = .02). Late eaters reported a higher total daily consumption of energy (p < .001) and proportion consumed after 9:00 pm (p < .001), as well as total daily carbohydrate (p < .001), protein (p < .001), fat (p < .001), saturated fat (p < .001), and cholesterol (p = .04) intake when compared with early eaters. We conclude that concentrating food intake later in the day is associated with higher total energy and macronutrient intake as well as a higher average BMI.

Relación entre tiempos de alimentación, composición nutricional del desayuno y estado nutricional en estudiantes universitarios de Valparaíso, Chile / Relationship between feeding schedule, nutritional composition of breakfast and nutritional status among university students in Valparaíso, Chile

RESUMEN Se han descrito estilos de vida poco saludables en estudiantes universitarios, como omisión del desayuno, alto consumo de comida rápida y horarios dispersos. El objetivo de este trabajo fue relacionar distintas características de la ingesta alimentaria con el estado nutricional en este grupo. Se realizó un estudio observacional analítico, donde participaron 130 jóvenes sedentarios. Se evaluó el estado nutricional y la ingesta alimentaria. Un 25% de la muestra presentó malnutrición por exceso (IMC), mientras que el 50% presentó exceso de grasa corporal. Los hombres con exceso de grasa corporal mostraron un porcentaje de adecuación significativamente menor en el aporte energético al desayuno (p= 0.021) y los sujetos (ambos sexos) con exceso de grasa corporal presentaron un porcentaje de adecuación también menor en la ingesta calórica al almuerzo en comparación con los sujetos con bajas reservas energéticas (p=0.004), y su vez, todos los sujetos consumían un exceso de energía en la merienda, independiente de su estado nutricional. Se observó también una relación dependiente entre horarios de alimentación y el porcentaje de grasa corporal (p= 0.044). Una baja ingesta energética al desayuno junto con una alta ingesta durante la merienda con intervalos de ayuno mayores a 4 horas al menos una vez al día, podrían estar asociados a un exceso de grasa corporal en estudiantes universitarios sedentarios.

ABSTRACT Unhealthy lifestyles, such as omission of breakfast, high intake of fast food, and lack of mealtime schedules, have been described among university students. The aim of this study was to relate different characteristics of food intake with the nutritional status of university students. An analytical observational study was conducted among 130 sedentary young people. Nutritional status (weight, height and body fat percentage) and food intake (24h food recall and eating habits survey) were assessed. One quarter of the sample had overweight or obesity (BMI), while 50% had excess body fat. Men with excess body fat had a lower energy intake at breakfast (p= 0.021) and the subjects (both sexes) with excess body fat had a lower calorie intake at lunch compared to subjects with low energy reserves (p= 0.004). Moreover, all subjects consumed excess energy at teatime, independent of body composition. A dependent relationship between feeding schedules and body fat percentage was observed (p= 0.044). Low energy intake at breakfast along with a high intake during teatime, with fasting intervals of more than 4 hours between meals at least once a day, could be associated with excess body fat in sedentary university students.

Comparing parents' and overweight adolescents' reports on parent mealtime actions.

This study aimed to compare answers given by parents and their adolescent children to the Portuguese version of the Parent Mealtime Action Scale (PMAS) and to assess associations among the reported behaviors. To compare these answers, a cross-sectional study was conducted in a sample of 72 patients of the Obesity Clinic of the Division of Nutrology of the Pediatrics Department at the Federal University of São Paulo (Unifesp), Brazil. These patients were aged from 10 years to 19 years and 11 months, and their parents or legal guardians also participated. First, parents were interviewed and instructed to answer how often they perform each behavior measured by the PMAS (never, sometimes or always). Next, the same questions were answered by the adolescents. The general linear model (GLM) showed the effects of the interviewees and of the interaction between interviewees and sex. We also observed a triple interaction effect (sex x interviewees x categorized age). The internal reliability of the PMAS was higher for parental answers than for those given by the children. This finding is probably observed because the scale has been developed and validated to evaluate the pattern of parental responses concerning their eating practices during their children's meals. In addition, although parents believe they are engaging in certain behaviors, the effectiveness of these strategies may not be recognized by their children. Very low intraclass correlation coefficients were observed between parents' and children's answers to the original domains of the PMAS (ICC: 0.130-0.578), suggesting that the factorial structure of the PMAS may only be used to assess parental behavior, as it is not sufficiently accurate to assess the children's understanding of parent mealtime actions.

Influence of mealtime habits on the risk of weight gain and obesity in Mexican adults.

OBJECTIVE: To prospectively examine the extent to which mealtime habits influences the risk of weight gain and obesity in Mexican adults. DESIGN: We performed a prospective cohort study. The Mealtime Habits Quality (MHQ) scale was used for assessing participants' MHQ; the outcomes of interest were gain ≥5 % of body weight, developing overweight/obesity and abdominal obesity, after 7 years of follow-up. In order to estimate the independent effect of MHQ on anthropometric indicators, generalized linear models were computed to obtain adjusted relative risks (95 % CI). SETTING: The state of Morelos, Mexico. SUBJECTS: Mexican adults (n 837) aged 18-70 years participating in a cohort study. RESULTS: Compared with participants classified in the higher MHQ category, individuals in the middle and lower MHQ groups had a 4·1 (2·5, 6·7) and 6·2 (3·9, 9·7) fold greater risk of gain ≥5 % of body weight, respectively; 6·6 (2·8, 15·5) and 8·6 (3·7, 19·8) fold greater risk of becoming overweight/obese, respectively; and 3·8 (2·0, 7·3) and 5·3 (2·8, 9·8) fold greater risk of developing abdominal obesity, respectively. CONCLUSIONS: This study provides evidence about the influence of a set of mealtime habits on obesity indicators, showing that greater adherence to unadvisable mealtime habits increases the risk of developing unhealthy anthropometric indicators. Since the meal is one of the most important sources of food intake, and consequently weight status, the MHQ scale can be a useful population tool to predict weight gain and obesity.

Mealtime habits and risk of developing the metabolic syndrome or insulin resistance among Mexican adults.

Meals are an important source of food intake, contributing to body weight and health status. Previous studies have examined the relationship between isolated mealtime behaviours and the metabolic syndrome (MetS). The aim of this study was to examine the influence over time of ten interrelated mealtime habits on the risk of developing the MetS and insulin resistance (IR) among Mexican adults. We conducted a prospective cohort study with a sample of 956 health workers. The Mealtime Habits Quality (MHQ) scale is based on four mealtime situations (availability of time to eat, distractions while eating, environmental and social context of eating, and familiar or cultural eating habits), which were used to assess the participants' MHQ at the baseline (2004-2006) and follow-up (2010-2012) evaluations. The MetS was assessed using criteria from the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) and the International Diabetes Federation (IDF). IR was defined using the homoeostasis model assessment. Crude and adjusted relative risks were calculated to estimate the relationship between MHQ and the risk of developing the MetS or IR. Participants classified in the lower MHQ category had an 8·8 (95 % CI 3·1, 25) and 11·1 (95 % CI 3·4, 36·1) times greater risk of developing the MetS (using the NCEP-ATP III and IDF criteria, respectively), and an 11·2 times (95 % CI 3·9, 31·5) greater likelihood of developing IR, compared with those in the higher MHQ group. This prospective study reveals that individuals who engaged in more undesirable than recommended mealtime behaviours had a >10-fold risk of developing the MetS or IR.

Intakes of Energy and Discretionary Food in Mexico Are Associated with the Context of Eating: Mealtime, Activity, and Place.

BACKGROUND: The prevalence of obesity and the intake of discretionary foods [high saturated fat and/or added sugar (HSFAS) products and sugar-sweetened beverages (SSBs)] are high in Mexico. It is important to understand whether the intakes of HSFAS products and SSBs are associated with the context in which they are consumed. OBJECTIVE: Our aim was to estimate the associations between total energy and discretionary food (HSFAS products and SSBs) intakes and the context of eating (mealtime, activity, and place). METHODS: We used data from 10,087 participants aged ≥1 y from the Mexican National Health and Nutrition Survey 2012. Dietary intake was estimated through a 24-h dietary recall that included questions on mealtime, activity, and place in which each food item was consumed. The associations between energy and discretionary food intakes and the context of eating were estimated by using multiple linear regression stratified by age group and adjusted for sociodemographic variables. RESULTS: Compared with breakfast, the percentage of energy that HSFAS products contributed was 16-29 (range in all age groups) percentage points higher during midafternoon snacks and 16-23 percentage points lower at lunch and almuerzo (Mexican brunch); the percentage of energy from SSBs was 3.4-7.6 percentage points higher during midmorning snacks (P < 0.05). In many age groups and mealtimes, we found that compared with eating only while seated, the percentage of energy as HSFAS was 5.3-14 percentage points higher when watching television (P < 0.05). Compared with eating at home, the percentage of energy from HSFAS was 12-26 percentage points higher on the street and the percentage of energy from SSBs was 3.4-6.0 percentage points higher at school and 2.9-15 percentage points higher at work (P < 0.05). CONCLUSIONS: These results highlight the need to promote healthier food selection among the Mexican population when snacking and watching television and healthier food environments at work, school, and on the street.

Feeding dysfunction in children with single ventricle following staged palliation.

OBJECTIVE: To determine the prevalence of feeding dysfunction in children with single ventricle defects and identify associated risk factors. STUDY DESIGN: Patients aged 2-6 years with single ventricle physiology presenting for routine cardiology follow-up at the Children's Hospital of Wisconsin were prospectively identified. Parents of the patients completed 2 validated instruments for assessment of feeding dysfunction. Chart review was performed to retrospectively obtain demographic and diagnostic data. RESULTS: Instruments were completed for 56 patients; median age was 39 months. Overall, 28 (50%) patients had some form of feeding dysfunction. Compared with a normal reference population, patients with single ventricle had statistically significant differences in dysfunctional food manipulation (P < .001), mealtime aggression (P = .002), choking/gagging/vomiting (P < .001), resistance to eating (P < .001), and parental aversion to mealtime (P < .001). Weight and height for age z-scores were significantly lower in subjects with feeding dysfunction (-0.84 vs -0.33; P < .05 and -1.46 vs -0.56; P = .001, respectively). Multivariable analysis identified current gastrostomy tube use (P = .02) and a single parent household (P = .01) as risk factors for feeding dysfunction. CONCLUSION: Feeding dysfunction is common in children with single ventricle defects, occurring in 50% of our cohort. Feeding dysfunction is associated with worse growth measures. Current gastrostomy tube use and a single parent household were identified as independent risk factors for feeding dysfunction.