International Journal of Child Health and Nutrition

129-134

Authors: Vesal Moeeni, Pardis Shojaee, Hamidreza Kianifar, Tony Walls, Philip Pattemore, Andrew S. Day

Aims: Patients with Cystic Fibrosis (CF) have increased risk of malnutrition. Early detection of nutritional deterioration enables prompt intervention and correction. The aims of this project were to define the nutritional status of CF patients in Iran and New Zealand, compare and contrast the McDonald Nutritional Risk Screening (NRS) tool with the Australasian Guidelines for Nutrition in Cystic Fibrosis, and validate these results with each patient’s evaluation by their CF clinical team. Methods:Children with CF (2 - 18 years) were assessed during routine outpatient visits over one year. Anthropometric measurements were obtained. Both tools were applied and the results compared to their clinical evaluation (as gold standard) with calculation of specificity and sensitivity. Results:Under-nutrition was seen more frequent in the 33 Iranian children than in the 36 New Zealand (NZ) patients (39% versus 0%, p=0.0001), whereas over-nutrition was more prevalent in NZ children (9% versus 17%, p=0.05). At the first visit, both guidelines were able to recognize 77% and 61% of under-nourished Iranian patients, respectively. The mean sensitivity and specificity for all visits for the McDonald tool were 83% & 73% (Iran) and 65% & 86% (NZ). Sensitivity and specificity for the Australasian guidelines were 79% & 79% (Iran) and 70% & 90% (NZ). Conclusions: Both tools successfully recognised patients at risk of malnutrition. The McDonald tool had comparable sensitivity and specificity to that described previously, especially in Iranian patients. This tool may be helpful in recognizing at risk CF patients, particularlyin developing countries with fewer resources.

141-150

Authors: Ping Hu Johnson, Deanne Gerson, Kandice Porter, Jane Petrillo

Background: School lunches that are part of the National School Lunch Program must meet specific nutrition requirements. It is unknown whether students eat school lunches in a balanced manner. This study examined which lunch food items children eat/toss, and consumption differences between sexes, and between students at a Non-Title 1 school where most students purchase school lunches and a Title 1 school where most students receive free or reduced-priced lunches. Methods:Students in both schools were observed unobtrusively for five consecutive days. Trained observers recorded the discarded food items on a checklist listing the menu items for the day. The final analyses (t- tests, z tests) included data from 2,826 student-meals. Results:Entrees similar to those offered in fast food restaurants (i.e., chicken nuggets, pizza, nachos, corndogs) were favored by most students. Fresh fruits and vegetables were not selected or consumed frequently. Boys consumed more food in the fast food, starches, and dessert categories, while girls consumed more soup, salads, and vegetables. Title 1 school students consumed more food in all categories except bread, pasta, and sandwiches than Non-Title 1 school students. Conclusions:Students’ preference of unhealthy lunch items may decrease the health benefits that school lunches attempt to provide.

163-173

Authors: Paul Branscum, Alexandra Housley

Sugar-sweetened beverage (SSB) consumption among children and adolescents is a public health concern, as up to 88% consume them on a daily basis. While much research has been done regarding what types of foods parents feed their children and how that is linked to various health outcomes, research determining how parents monitor there children’s SSB consumption has not been well studied. Identifying important environmental and psychosocial determinants of parental-monitoring behaviors is a greatly needed area for investigation. The purpose of this study was to develop and validate a theory-based instrument related to this parenting practice. Initially, a 41-item instrument was developed and face and content validity were established using a panel of 6 experts. Next, the survey was administered to 270 parents (29 parents completed the survey twice). Psychometric properties tested of the instrument included construct validity, using the maximum likelihood extraction method of factor analysis, internal consistency reliability, using Cronbach’s alpha, and test-retest reliability using Pearson-product moment correlations between instrument results taken at two separate occasions. Initial results suggested some scales required re-specification, which included removing weak and/or non-related items. Results from this study can be used to assist future health professionals and researchers for measuring theory-based determinants of parental practices related to monitoring SSB consumption. This process can also be replicated to construct instruments measuring other critical obesogenic behaviors, such as monitoring fruit and vegetable consumption, or physical activity.

180-193

Authors: Paloma Rohlfs Domínguez

Objective:The objective wasto reviewthe literature on school-based interventions during compulsory education (published in 2009-2013) that may be effective in increasing healthful nutritional outcomes in children. Specific strategies and their limitations will be identified. Methods: A qualitative systematic analysis of seventeen school-based interventions applied to six-eleven year-old children, and published in peer-reviewed journals from 2009-2013 was carried out. Results: These studies taken as a whole used a variety of fourteen strategies, such as provision of nutritional and gardening education; repeated exposure to vegetables (V); peer and adult modelling; chefs going into schools to teach healthy nutritional issues. These studies showed four types of limitations: limitations derived from the experimental designs and experimental procedures used and limitations affecting participant samples and data collection. Fifteen recommendations for overcoming the targeted research limitations were identified, such as applying the intervention during longer time intervals; examining the effectiveness of these interventions in different ethnicities and socioeconomic groups; including larger participant samples; using randomized designs. Finally, six new working hypotheses to guide future studies are proposed here. For example, a small number of V offered might lead to insufficient opportunities to learn to like the flavour of V; schools’ previous experience with these interventions might distort children’s post-intervention data related to their nutritional outcomes; providing children with nutritional and gardening education might increase their fruit (F) selection, consumption and preferences and application of evaluative conditioning under more appropriate experimental conditions might increase child V consumption. Conclusion:seventeen school-based interventions were included. These studies taken as a whole used a variety of strategies (fourteen), and showed four types of limitations. Fifteen recommendations for overcoming the targeted research limitations as well as six new hypotheses are proposed here. Future research in this field should focus on overcoming its research limitations, such as the ones highlighted here, and building new working hypotheses, such as those proposed here