A systematic review of environmental correlates of obesity-related dietary behaviors in youth

652

600

Objectives: To review associations between the family environment and young people's fruit and vegetable consumption. Design: A systematic review. Published English-language (n 60) papers were identified using electronic databases and manual searches of personal files and reference lists. Observational research reporting a measure of fruit/vegetable intake for children (aged 6-11 years) and/or adolescents (aged 12-18 years) and at least one potential family correlate of dietary intake was included. Results: Parental modelling and parental intake were consistently and positively associated with children's fruit and fruit, juice and vegetable (FJV) consumption. There were also positive associations between home availability, family rules and parental encouragement and children's fruit and vegetable consumption. Parental intake was positively associated with adolescents' fruit and vegetable consumption. There were also positive associations between parental occupational status and adolescent fruit consumption and between parental education and adolescents' FJV consumption. Conclusions: Our findings highlight the importance of targeting the family environment for the promotion of healthy eating behaviours among children and adolescents. Future interventions should encourage parents to be positive role models by targeting parental intake and to create a supportive home environment through increased encouragement and availability of fruits and vegetables and employing rules to govern eating behaviours. For adolescents, indicators of family circumstances (e.g. parental education) should be used to identify target groups for interventions aimed at promoting healthy eating. Keywords Adolescents Children Family correlates Fruit VegetablesThere is compelling evidence that diets rich in fruits and vegetables have health-protective effects (1) . While most of the research on associations between fruit and vegetable consumption and health outcomes has focused on adults, there is growing evidence that fruit and vegetable consumption in children may protect against a range of childhood illnesses (2) . Targeting young people to improve health behaviours, such as consuming the recommended amount of fruit and vegetables, is important because evidence suggests that dietary behaviours track from childhood to adolescence (3,4) and food behaviour and food choices established in childhood or adolescence may significantly track into adulthood (5) . Moreover, child fruit consumption may be protective against cancer in adulthood (6) .Recommendations vary by country but public health agendas across the globe share the common goals of increasing the consumption levels of fruit and vegetables and encouraging people to eat a variety of fruit and vegetables. Despite the health benefits of diets rich in fruits and vegetables, national health surveys indicate that children and adolescents are eating fewer fruits and vegetables than is recommended for health (7)(8)(9) . Data from the Health Behaviour in School-aged Children study (HBSC) ...

Section: Discussionsupporting

confidence: 92%

Section: Adolescents Children Family Correlates Fruit Vegetablesmentioning

confidence: 99%

Family correlates of fruit and vegetable consumption in children and adolescents: a systematic review

Pearson

Biddle

Gorely

2009

652

600

“…In addition to the supportive effect of Overt Control and Covert Control on decreasing snack (and SSB) intake, Covert Control was also supportive in increasing child fruit intake. This suggests that parents who exert higher levels of Covert Control might replace the home availability of unhealthy snacks by home availability of fruit, which is positively related to fruit intake (15,20,22,52) . Consistent with previous findings (23) , Encouragement was negatively related to child energy-dense snack intake, indicating that parental encouragement might be influenced by health beliefs: parents encourage their children's interest in and curiosity for a variety of healthy foods, resulting in the consumption of less unhealthy foods (23,49) .…”

Section: Discussionmentioning

confidence: 99%

Associations of parental feeding styles with child snacking behaviour and weight in the context of general parenting

Rodenburg

Kremers

Oenema

et al. 2013

115

Objective: To examine cross-sectional and longitudinal (one-year follow-up) associations of parental feeding styles with child snacking behaviour and weight in the context of general parenting, taking into account the multidimensionality of the controlling feeding style. Design: Linear regression analyses were performed. Parents completed a questionnaire to measure five feeding style dimensions (Instrumental Feeding, Emotional Feeding, Encouragement, Overt Control and Covert Control) and children's fruit, energy-dense snack and sugar-sweetened beverage (SSB) intakes. Children's height and weight were measured to calculate their BMI Z-scores.Moderation by parenting style was tested by adding interaction terms to the regression analyses. Setting: Observational study in the Netherlands. Subjects: Parent-child dyads (n 1275) participating in the INPACT (IVO Nutrition and Physical Activity Child cohorT) study; children were (on average) 9 years of age. Results: Instrumental Feeding and Emotional Feeding were negatively related to child fruit intake one year later and positively to (changes in) child energy-dense snack intake. Encouragement was negatively related to child energy-dense snacking and SSB intake one year later. Overt Control was cross-sectionally and prospectively related to (changes in) child energy-dense snacking and SSB intake in a negative direction. Covert Control showed similar associations with child energy-dense snacking and SSB intake as Overt Control. Although Covert Control was also positively related to child fruit intake and (changes in) child BMI Z-score, bootstrapping analyses revealed only a differential effect of Overt Control and Covert Control on child BMI Z-score one year later, with Covert Control displaying a stronger, positive association. Moderation analyses showed that some significant associations between parental feeding styles and outcome measures were dependent on the degree of psychological control and behavioural control.

“…where the healthy behavioural options are more and unhealthy options are less easily available and accessible (13)(14)(15) . For adolescents a supportive and facilitating home environment is likely to be of crucial importance where dietary behaviour is concerned (16) .…”

mentioning

confidence: 99%

Differential effects of the computer-tailored FATaintPHAT programme on dietary behaviours according to sociodemographic, cognitive and home environmental factors

Ezendam

Brug

Borsboom

et al. 2012

Objective: To explore whether the effects on dietary behaviours of a computertailored intervention aimed to prevent excessive weight gain among adolescents, FATaintPHAT, were moderated by sociodemographic, cognitive and home environmental factors. Design: A two-group cluster randomized trial. Potential moderation of the outcome measures (consumption of sugar-sweetened beverages, snacks, fruits and vegetables) was studied by gender, education level, ethnicity, awareness of risk behaviour, intention and home availability. Setting: Twenty schools in the Netherlands. Subjects: Students (n 883) aged 12-13 years. Results: Of the twenty-four interactions tested, only three were significant. The intervention effect on sugar-sweetened beverages was moderated by level of education (P 5 0?009); intervention effects were found only among academic preparatory students. The intervention effects on fruit and vegetable intake were moderated by awareness of fruit intake (P , 0?001) and home availability of vegetables (P 5 0?007); an effect on fruit intake was found only among students who were aware of their low fruit intake at baseline and an effect on vegetable consumption was found only among students who reported that vegetables were always available at their home. Conclusions: The effects of the intervention generally did not differ between sociodemographic subgroups. The moderation by home availability illustrates that the environment may influence the effects of educational interventions.It is essential to understand for whom and in what circumstances behaviour change interventions are effective in order to increase the understanding of behavioural change processes, identify underserved populations and be able to optimize interventions (1)(2)(3) . Studies investigating potential moderators of intervention effects are needed to provide such information (1,2) . A moderator is a variable that can influence the magnitude of this effect across different sub-populations or circumstances (4) . To contribute to the evidence regarding moderators of computer-tailored interventions, moderation of the effects of the computertailored FATaintPHAT intervention on dietary behaviours by sociodemographic, cognitive and home environmental factors was investigated.FATaintPHAT is a school-based intervention that consists of eight modules on energy balance-related behaviours (5) . The dietary behaviours addressed in separate modules include the consumption of sugar-sweetened beverages, high-energy snacks, fruits and vegetables. Each intervention module consists of a brief introduction to the topic with information about the behaviour-health link, an assessment of behaviour and determinants, individually tailored feedback on behaviour and determinants, and an option to formulate an implementation intention to prompt specific goal setting and action planning. The intervention was found to be effective in improving sugar-sweetened beverage (OR 5 0?54 for drinking .400 ml/d), snack (regression coefficient b 5 20?81 snacks/d) and vegetable