Purpose: Early childhood physical activity (PA) interventions may help promote preschoolers’ healthy lifestyle habits and optimal development. However, effects of innovative exergaming interventions on preschool children’s PA and cognition remain largely unanswered. In response, this study was designed to examine the effectiveness of a home-based exergaming program on preschool children’s PA, sedentary behavior, and cognition in a randomized cross-over trial. 

Method: A total of thirty-two preschool children (16 boys; 59.4% Asian; M_age = 4.72, SD = ± .73) were recruited from the Twin Cities, MN in the U.S. During baseline testing, preschoolers’ percentages of time in light PA, moderate-to-vigorous PA (MVPA), sedentary behavior, and cognition were assessed via ActiGraph accelerometers and Dimensional Change Card Sort Test. Children were then randomly assigned to 1) an intervention condition: engaging in home-based LeapTV exergaming at least 30 minutes/session 5 times/week for the first 12 weeks and then resumed their regular PA patterns without exergaming during the second 12 weeks; or 2) a delayed-intervention control condition: maintaining their regular PA patterns for the first 12 weeks, and participated in the same dose of home-based exergaming during the second 12 weeks. Identical assessments were conducted at the 13th and 25th weeks. 

Results: Data were analyzed with PROC Mixed in SAS. Results suggested significant interaction effects of treatment by period for percentage of time in MVPA, F(1,26) = 1.94, p = 0.049; and cognition, F(1,28) = 2.02, p = 0.04, favoring the exergaming intervention. In addition, there was a significant sequence effect for percentage of time in MVPA, F(1,26) = 5.08, p = 0.03. No other effects were identified. For example, there were no interaction effects of treatment by period for percentage of time in light PA, F(1,28) = 1.06, p = 0.44; and in sedentary, F(1,26) = 1.02, p = 0.48.

Conclusions: Home-based exergaming has the potential to positively impact cognitive functions and percentage of time in MVPA in preschoolers, although its significant effects on light PA and sedentary behavior were not evident in this study. Thus, the novel exergaming intervention program may be a good PA alternative for home-based interventions.

Background/Aims

Promoting healthy behaviours during infancy is critical for establishing healthy growth in early childhood and the early prevention of obesity. Healthy Beginnings is an established evidence-based program in Sydney, Australia, led by child health nurses to promote and support best-practice infant feeding, nutrition and physical activity. To reduce inequalities and extend reach to culturally and linguistically diverse families, a feasibility study was conducted to culturally adapt the Healthy Beginnings program for Arabic and Chinese communities. This study aimed to explore program successes, satisfaction and suggested improvements through interviews with staff and mothers involved in the adapted program.

Methods

The culturally adapted program was piloted with 94 Arabic- and 69 Chinese-speaking women from their third trimester until their baby was aged 6 months. Mothers were offered adapted and translated health promotion materials and text messages, and telephone support from bi-cultural nurses. At program completion, all implementation staff and mothers were invited to participate in a semi-structured interview to contribute to program evaluation. Interviews were audio-recorded with consent and transcriptions were analysed using descriptive thematic analysis.

Results

10 implementation staff, 22 Arabic-speaking mothers and 19 Chinese-speaking mothers participated in individual interviews. Analysis highlighted positive factors, particularly the key role of bi-cultural nurses in providing not only quality tailored infant feeding and care advice, but also culturally sensitive support for the mother’s health and wellbeing. Suggested enhancements included greater availability of nurses to receive calls, options to connect mothers through groups or online forums, and strengthened community partnerships to support the cultural adaptation process and referrals.

Conclusions

The culturally adapted Healthy Beginnings program shows potential for continued delivery and scale-up. These qualitative findings provide opportunities to enhance the program adaptations to further the relevance among Chinese and Arabic migrant families. Learnings from this study offer insights for future cultural adaptations of maternal and child health promotion programs to reach culturally and linguistically diverse families and provide culturally appropriate support for healthy infant feeding and the early prevention of obesity.

Purpose

Parents are key decision makers and role models in establishing and maintaining healthy behaviours in preschool-aged children. Interventions involving parents have been shown to be more effective than those that do not. However, there are barriers to group participation, which telephone-based and online programs have the potential to overcome. Efficacy trials have previously been conducted on two such interventions - Healthy Habits (telephone-based) and Time2bHealthy (online) with promising results. Further research is now required to determine their effectiveness and cost-effectiveness in a real-world context.

Methods

Time for Healthy Habits is a three-arm partially randomised preference trial to evaluate the effectiveness of two theory-based healthy eating and active living programs for parents of 2- to 6-year-old children (Healthy Habits Plus (telephone) and Time2bHealthy (online)), compared to a comparison group (written materials). It is planned to recruit 636 participants primarily from five Local Health Districts in New South Wales, Australia. The partially randomised preference design initially allows for participants to decide to be randomised or select their preferred intervention, a design recommended to test effectiveness in a real-world setting. Interventions provide practical information on healthy eating, physical activity, sedentary behaviour and sleep over 12 weeks. Outcomes are assessed post-intervention and at 6-month follow-up. Participants also complete a process evaluation questionnaire post-intervention. Outcomes include fruit and vegetable intake (primary outcome), discretionary food intake, weight status, physical activity, sedentary behaviour, and sleep habits.

Results/Findings

Of the 218 participants who had a strong preference for study group, 61% chose the online intervention, 29% chose written materials and 10% chose the telephone intervention. A limited number of participants have completed the interventions at the time of submitting this abstract. Post-intervention outcome and process results for participants who have completed the intervention will be presented at the ISBNPA meeting.

Conclusions

To our knowledge, this is the first translational research trial evaluating the effectiveness of a healthy eating and active living intervention in the 2- to 6-year age group. Results will build the evidence base regarding the translation of effective childhood obesity prevention interventions and inform the implementation and delivery of publicly funded childhood obesity prevention programs. 

Purpose: Fundamental movement skills (FMS) are the foundational building blocks for lifetime participation in physical activity (PA). However, with less than half of Australian children proficient in FMS, there is a need for effective interventions to promote FMS. To date, programs to promote FMS development have been primarily delivered in child care and school-based settings. To our knowledge, no studies have evaluated the effectiveness of an interactive digital platform, designed to be co-used by the parent and child, to increase FMS proficiency in preschool-aged children. Therefore, the current study evaluated the effectiveness of a digital platform application known as Moovosity™ to promote FMS in 3- to 6-year-old children.

Methods: A RCT was conducted involving 34 parent-child dyads randomly assigned to either the 8-week intervention (n=17) or wait-list control (n=17) condition. Participants completed assessments of FMS proficiency (TGMD-2), PA (Burdette Checklist), and parental support for PA (Trost et al. 2003) at baseline (prior to randomization) and 8-weeks follow-up. Participants randomized to the intervention were given access to freely use Moovosity™ over a period of 8 weeks. Wait-listed controls were given free access to the app at the end of the 8-week intervention period. Group differences in post-test scores for object control, locomotor skills, parental support for PA, and child PA were evaluated for statistical significance using analysis of covariance (ANCOVA), adjusting for baseline values and child age.

Results: Children randomized to the intervention exhibited significantly higher post-test scores for object control [28.0 vs. 22.6; mean difference = 5.4, 95% CI = 1.4 - 9.4]. Intervention children exhibited higher locomotor standard scores than wait list controls [34.1 vs. 30.7]; however, the p-value for the difference [3.42 (95% CI = -7.2 – 0.34) was marginally significant (P=0.07). No significant differences were observed for child PA or parental support for PA.

Conclusions: An 8-week exposure to a digital platform to promote motor competence within a family environment was effective in improving FMS proficiency in preschool-aged children, in particular, object control skills.  The results are encouraging and warrant further investigation in larger trials involving more families, objective measures of PA, and longer follow-up periods.

Objective: In youth and adult populations, physical activity is positively associated with physical health and psychosocial health outcomes, including health-related quality of life (HRQoL). Limited research has measured the effect of physical activity (PA) interventions on HRQoL among pre-school aged children. The Activity Begins in Childhood (ABC) is a cluster-randomized controlled trial designed to increase physical activity in the early years (ages 3-5). This study evaluates the effect of the ABC trial on changes in HRQoL.

Methods: ABC was a three-armed trial in which 18 daycares were randomized; for the current study the two PA groups were combined (PA; 1. PA information delivered to daycare providers 2. PA information delivered to daycare providers and parents) and a standard daycare curriculum group (3. Control; C). The secondary analysis included 215 children (PA n=161, C n=54). Parents completed the proxy Generic Core Scale (PedsQLTM 4.0) to measure HRQoL at baseline and at the end of the 6-month trial. Scores were analyzed in three domains: physical, psychosocial, and total. Mean changes in scores [95% confidence intervals] were measured using absolute values. A within-between ANOVA for repeated measures was performed to test group differences over time.  Bonferroni correction was used for multiple comparisons. Statistical significance was accepted as p<0.05.

Results: At baseline, there were no group differences for the physical- (PA=90.72±12.54, C=93.55±7.29, p=0.12) and psychosocial-related HRQoL scores (PA=82.79±11.03, C=85.58±8.58, p=0.09), however total HRQoL score was higher in the C group (PA=84.82±11.97, C=88.51±7.29, p=0.034). A significant time (p=0.031; np²=0.022) and group effect (p=0.008, np²=0.032) for psychosocial HRQoL scores were observed. Multiple comparisons showed that only the PA group improved psychosocial-HRQoLscores after 6-months (PA mean difference=2.178 [0.205, 4.152], p=0.031; C mean difference=2.051 [-1.031, 5.132], p=0.188). For the total HRQoL score, a significant time effect was found after correcting for baseline between-group differences (p<0.001; n²=0.791). The multiple comparisons showed that total score improved for the PA group only (PA mean difference=2.834 [1.827, 3.840], p<0.001; C mean difference=0.192 [-1.773, 2.157], p=0.845).

Conclusion: Results of this secondary analysis suggest that introducing a physical activity intervention early by incorporating the daycare and home environment may increase children’s HRQoL.

Purpose: Breakfast skipping is a public health issue which affects the nutrient intake among adolescents worldwide. However, there have been few reports comparing intake and reference values to assess the deficiency of nutrient intake between breakfast consumers and skippers. Therefore, this study aimed to examine the relationship between breakfast skipping and adequacy of total habitual nutrient intake among junior high school female students.

Methods: The participants were 516 Japanese female junior high school students. Frequency of breakfast, lunch, dinner and snack eating per week were asked in the lifestyle questionnaire. The participants were classified into two groups according to the frequency of breakfast eating: breakfast consumers (7 times/week, n=427) and breakfast skippers (0-6 times/week, n=89). Dietary habits during the preceding month were assessed using a brief self-administered diet history questionnaire (BDHQ15y). Inadequacy of each nutrient intake was assessed by the cut-point method, based on the estimated average requirement (EAR) for 14 nutrients (protein, vitamin A, vitamin B₁, vitamin B₂, niacin expressed as niacin equivalents, vitamin B₆, vitamin B₁₂, folate, vitamin C, calcium, magnesium, iron, zinc, and copper) and on dietary goal (DG) values for five nutrients (total fat, carbohydrate, total dietary fibre, salt-equivalents, and potassium) in the Dietary Reference Intakes for Japanese, 2015 version (DRIs).

Results: Breakfast consumers were likely to have lunch and dinner every day in comparison with breakfast skippers (both p<0.001). Additionally, the proportion of students eating snacks before dinner every day was significantly higher in breakfast consumers than in breakfast skippers (p=0.003). Adequacy of vitamin A, vitamin B₁, vitamin B₂, vitamin C, calcium, iron, zinc, and potassium were significantly higher among breakfast consumers than among skippers (all p<0.05). The total number of nutrients not meeting EAR among breakfast consumers was lower than that among breakfast skippers, while the total number of nutrients not meeting DG did not differ significantly between the two groups.

Conclusions: Our findings suggest that breakfast skipping was related to deficiencies in vitamin and mineral intakes among Japanese female junior high school students.

Purpose:  Difficulty with appetite (food-related) self-regulation (ASR) has been recognised as a possible pathway in the development of overweight or obesity in some children. ASR research and theory has begun to draw on the constructs, evidence, theories and methodologies associated with general self-regulation (GSR, i.e., self-regulation of emotions, behaviours and cognitions). However, despite some cross-fertilisation, there is no systematic comparison of research and theory from ASR and GSR, and this is an impediment to research and theory on ASR. The purpose of this narrative review was to conduct a reciprocal analysis of self-regulation in the food and non-food domains in childhood through an examination of (1) key concepts and processes in ASR and GSR, (2) evidence about the possibility of common processes underpinning ASR and GSR, and (3) the extent to which GSR could be implicated in ASR-related outcomes.

Methods: Databases and major journals were searched using terms such as self-regulation, appetite self-regulation, or self-regulation of energy intake, together with associated constructs (e.g., Executive Function, Effortful Control, delay-of-gratification). This was followed by backward and forward snowballing.  Articles were mainly limited to those that addressed children or childhood, with a focus from infancy to age 6 or 7 years.

Results/findings: The review suggests there are some overlaps between ASR and GSR including in the overall meaning of self-regulation, in the application of constructs such as Executive Function, Effortful Control and delay-of-gratification, and the recursive interplay between bottom-up (reactive, emotion driven, approach or avoidance) and top-down (cognitive, conscious decision-making) processes. However there are also factors unique to ASR that are associated with psychological, biological and neurological responses to food and bottom-up processes. 

Conclusions: Research and theory about GSR and ASR should be integrated, with ASR included as a domain under the umbrella of GSR along with existing domains (i.e., behaviours, cognitions and emotions). This will generate a cross-fertilisation of areas of research that have the potential, in turn, to advance knowledge about both GSR and ASR which could inform intervention and prevention efforts in childhood.

Purpose:  Women frequently make dietary adaptations during pregnancy.  Diet is thought to play a critical role in the development and management of gestational diabetes mellitus (GDM).  This study is the first to explore differences in dietary patterns and dietary adaptations among pregnant women with and without GDM in New Zealand.

Methods: Pregnant women participating in the Growing Up in New Zealand study completed a 44 item food frequency questionnaire and questions relating to dietary changes and information received during pregnancy.  Dietary patterns were previously identified using principle component analysis.  Diagnosis of GDM was determined using coded clinical data and plasma glucose results meeting the New Zealand Society for the Study of Diabetes diagnostic criteria.  Data on dietary patterns, reported dietary changes and sources of information leading to dietary change were compared between women with GDM (n=280) and women without GDM (n=5104) and between women with GDM diagnosed before (n=124) and after (n=109) the antenatal interview. 

Results: Women with GDM had lower adherence scores than women without GDM for ‘Junk’ (mean (SD) score -0.28 (0.95) versus 0.02 (1.01) p<0.0005) and ‘Traditional/White bread’ dietary patterns (-0.18 (0.93) versus 0.01 (1.01) p=0.002).  A greater proportion of women with GDM than women without GDM reported avoiding foods high in fat and sugar (25.3% versus 5.7%, p<0.0005) and adding milk and milk products (53.4% versus 36.6%, p<0.0005).  More women with GDM reported receiving information from a dietitian or nutritionist (27.0% versus 1.7%, p<0.0005) or obstetrician (12.6% versus 7.5%, p=0.007) compared to women without GDM.  Differences were greater in women diagnosed before compared to those diagnosed after the antenatal interview (46.9% versus 6.0%, p<0.0005 for information received from a dietitian or nutritionist).  More women with GDM reported to trust information from these health professionals and fewer trusted ‘other’ sources of information.

Conclusions: Dietary patterns and dietary adaptations are different in women with and without GDM.  Women with GDM appear to trust and respond to dietary advice received from health professionals. 

Background: In adults, coffee, sugar-sweetened beverage (SSB) and high energy drink (HED) consumption have been related to increases in risky behaviour, including smoking. However, these relationships are not well understood during adolescence. Further, limited work has been done to examine the strength of the relationship between different types of caffeinated/sugar-sweetened beverages and smoking behaviour (including e-cigarette use). The purpose of this study was to examine the relationships between beverage consumption and nicotine use among Canadian adolescents.

Methods: Using data from the COMPASS study (2016-2017; n=30,454), four models were developed to investigate whether beverage consumption explained variability in smoking behaviour in adolescence (age=15.7±1.2)); 1) smoking status; 2) e-cigarette status; 3) days smoking cigarettes per month; and 4) days using an e-cigarette per month. Models were corrected for demographic factors. Model 1 and 2 used multiple logistic regression, while models 3 and 4 used multiple linear regression.

Results: Irrespective of the model, there was an association between the frequency an individual consumed SSBs, coffee/tea or HEDs and nicotine use. The greater the beverage consumption, the higher the odds of being a current smoker (OR= 2.46 (2.02, 2.99)), a former smoker, (OR=2.50 (1.53, 4.08)), currently using an e-cigarette (OR = 4.66 (3.40, 6.40)) with the best predictor in all models being drinking HEDs on 4 or 5 days of the school week. Higher beverage consumption is also associated with more days smoking/using an e-cigarette per month (OR= 2.67 (1.92, 3.70) and 3.45 (2.32, 5.12), respectively).

Conclusion: There was a clear and consistent relationship between high consumption of SSB, HEDs and coffee/tea and increased the likelihood of being a current smoker or e-cigarette user and frequency of smoking/using an e-cigarette per month among adolescents. Future work should examine the directionality of this relationship and explore further the potential mechanisms contributing to this relationship.  Given the health consequences of smoking and excessive SSB consumption, policy initiatives to prevent smoking initiation and restrict access to SSB and especially HEDs.

Purpose: Poor dietary habits in children are associated with an increased risk for adult obesity. The purpose of this study was to assess the association between sociodemographic variables, body composition and intake from healthy and unhealthy food groups among young children in the North West Province, South Africa.

Methods: In this cross-sectional study 1065 children aged 5-9 years were selected from eight schools, stratified according to sex, race and socio-economic status. Frequency of intake from healthy (meats, milk, fruit, vegetables) and unhealthy food groups (fast food, cold sugar sweetened beverages (SSB), hot sweetened beverages, salty snacks, sweets/candy, cookies) was assessed. Height, weight and socio-demographic information were collected and body mass index (BMI) z-scores were calculated based on the WHO reference. Physical fitness was assessed using a pacer test to determine number of 20m laps successfully completed. Principal components analysis was applied to identify food group patterns. Associations between these food pattern scores, sociodemographic variables and BMI z-scores were assessed using multivariable regression analysis.

Results: Most of the children had normal weight, while more children were overweight/obese (19.4%) than underweight (3.8%). The median frequency of intake from healthy food groups was 3-4 days/week, for unhealthy food groups it was 1-2 days/week, except for SSBs (5-6 days/week), while staple foods were eaten daily. Three food group patterns were identified, namely ‘Animal source protein foods-SSBs’, ‘Fast food-Snacks’ and ‘Fruit-Vegetables’. Positive associations between household income and ‘Animal source protein foods-SSBs’, as well as ‘Fruit-Vegetables’ patterns were found, while household income was negatively associated with scores on the ‘Fast food-Snacks’ pattern. Household income and child age were positively associated with BMI z-score, whereas physical fitness and ‘Fruit-Vegetables’ pattern score were negatively associated with BMI z-score.

Conclusions: Low household income limits access to more expensive foods, such as meats, dairy products, fruit and vegetables, rich in nutrients for child development, but not to cheaper snacks and fast foods. Physical activity and fitness among young school-age children contribute to lower BMI z-scores.