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Nutrients
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Dietary Behavior and Physical Activity in Children and Adolescents
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Dietary Behavior and Physical Activity in Children and Adolescents

A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (15 April 2019) | Viewed by 116581

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Dr. Antje Hebestreit

E-Mail Website
Guest Editor
Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
Interests: nutrition assessment; child and adolescent nutrition; energy intake; physical activity and sedentary behavior; obesity; non-communicable diseases
Special Issues, Collections and Topics in MDPI journals
Dr. Leonie-Helen Bogl

E-Mail Website
Guest Editor
1. Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
2. Department of Epidemiology, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
Interests: lifestyle behaviors; pediatric obesity; metabolic health; family studies; family resemblance

Special Issue Information

Dear Colleagues,

Dietary behavior, sedentary behavior and physical activity are important modifiable lifestyle behaviors that may help children and adolescents to maintain a healthy body weight and prevent health problems. Families have an important role in children's development as they shape children’s early experiences with food and provide the first opportunities for children to be physically active. As children grow older, school influences and peer relationships gain increasing importance. Emerging evidence suggests that lifestyle factors may interact with early-life and genetic risk factors that predispose certain children to obesity and related health outcomes.

This Special Issue of Nutrients, entitled “Dietary Behavior and Physical Activity in Children and Adolescents" welcomes the submission of original research on observational and intervention studies, systematic reviews, meta-analyses and studies on monitoring and surveillance in young populations. Topics of interest include, but are not limited to the following:

  • Determinants of dietary behavior and physical activity in young populations, especially their changing role during the transition from childhood to adolescence
  • Associations between dietary behavior and physical activity and
    • nutritional status
    • metabolic health
    • wellbeing/mental health
    • musculoskeletal health
    • biological markers
  • Methodological studies, such as validation studies, biomarker studies, pilot studies and studies on diet quality indices in children and adolescents
  • Novel and innovative topics including genetic determinants, gene-behavior interactions, prenatal and early life factors, gut microbiota and metabolomics

Dr. Antje Hebestreit
Dr. Leonie-Helen Bogl
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Dietary behavior
  • Physical activity
  • Determinants
  • Childhood obesity
  • Child health
  • Adolescent obesity
  • Adolescent health
  • Methodological studies
  • Biological markers

Published Papers (22 papers)

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Editorial

Jump to: Research, Review

4 pages, 174 KiB  
Editorial
Dietary Behavior and Physical Activity in Children and Adolescents
by Antje Hebestreit and Leonie H. Bogl
Nutrients 2019, 11(8), 1849; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11081849 - 09 Aug 2019
Cited by 3 | Viewed by 3323
Abstract
In recent years, diet- and lifestyle-related disorders have become a major health threat in Europe and worldwide [...] Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)

Research

Jump to: Editorial, Review

18 pages, 797 KiB  
Article
Pediatric-Adapted Liking Survey (PALS): A Diet and Activity Screener in Pediatric Care
by Kayla Vosburgh, Sharon R. Smith, Samantha Oldman, Tania Huedo-Medina and Valerie B. Duffy
Nutrients 2019, 11(7), 1641; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11071641 - 18 Jul 2019
Cited by 7 | Viewed by 3299
Abstract
Clinical settings need rapid yet useful methods to screen for diet and activity behaviors for brief interventions and to guide obesity prevention efforts. In an urban pediatric emergency department, these behaviors were screened in children and parents with the 33-item Pediatric-Adapted Liking Survey [...] Read more.
Clinical settings need rapid yet useful methods to screen for diet and activity behaviors for brief interventions and to guide obesity prevention efforts. In an urban pediatric emergency department, these behaviors were screened in children and parents with the 33-item Pediatric-Adapted Liking Survey (PALS) to assess the reliability and validity of a Healthy Behavior Index (HBI) generated from the PALS responses. The PALS was completed by 925 children (average age = 11 ± 4 years, 55% publicly insured, 37% overweight/obese by Body Mass Index Percentile, BMI-P) and 925 parents. Child–parent dyads differed most in liking of vegetables, sweets, sweet drinks, and screen time. Across the sample, child and parent HBIs were variable, normally distributed with adequate internal reliability and construct validity, revealing two dimensions (less healthy—sweet drinks, sweets, sedentary behaviors; healthy—vegetables, fruits, proteins). The HBI showed criterion validity, detecting healthier indexes in parents vs. children, females vs. males, privately- vs. publicly-health insured, and residence in higher- vs. lower-income communities. Parent’s HBI explained some variability in child BMI percentile. Greater liking of sweets/carbohydrates partially mediated the association between low family income and higher BMI percentile. These findings support the utility of PALS as a dietary behavior and activity screener for children and their parents in a clinical setting. Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
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12 pages, 416 KiB  
Article
Use of vitamin and mineral supplements among adolescents living in Germany—Results from EsKiMo II
by Hanna Perlitz, Gert B.M. Mensink, Clarissa Lage Barbosa, Almut Richter, Anna-Kristin Brettschneider, Franziska Lehmann, Eleni Patelakis, Melanie Frank, Karoline Heide and Marjolein Haftenberger
Nutrients 2019, 11(6), 1208; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11061208 - 28 May 2019
Cited by 16 | Viewed by 6059
Abstract
Dietary supplements may contribute to nutrient intake; however, actual data on dietary supplement use among adolescents living in Germany are rare. The aim of this analysis was to describe the current use of dietary supplements, its determinants, and reasons of use. Changes in [...] Read more.
Dietary supplements may contribute to nutrient intake; however, actual data on dietary supplement use among adolescents living in Germany are rare. The aim of this analysis was to describe the current use of dietary supplements, its determinants, and reasons of use. Changes in supplement use over time were evaluated by comparing the results with those from EsKiMo I (2006). Data from the Eating Study as a KiGGS Module EsKiMo II (2015–2017) were used to analyze supplement intake according to sociodemographic, health characteristics, and physical exercise behavior of 12–17-year-olds (n = 1356). Supplement use during the past four weeks was assessed by a standardized computer assisted personal interview. Multivariable logistic regression was used to identify the association between supplement use and its determinants. Between 2015–2017, 16.4% (95%-CI: 13.0–19.7%) of the adolescents used dietary supplements, and its use decreased with lower levels of physical exercise and overweight. Most supplement users used only one supplement, often containing both vitamins and minerals. The most frequently supplemented nutrients were vitamin C and magnesium. The main reported reason to use supplements was ‘to improve health’. Prevalence of supplement use was slightly lower in 2015-2017 than in 2006 (18.5%; 95%-CI: 15.8–21.2%). The results underline the importance of including nutrient intake through dietary supplements in nutrition surveys. Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
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14 pages, 253 KiB  
Article
Mothers’ Vegetable Consumption Behaviors and Preferences as Factors Limiting the Possibility of Increasing Vegetable Consumption in Children in a National Sample of Polish and Romanian Respondents
by Barbara Groele, Dominika Głąbska, Krystyna Gutkowska and Dominika Guzek
Nutrients 2019, 11(5), 1078; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11051078 - 15 May 2019
Cited by 15 | Viewed by 3102
Abstract
Increasing the insufficient intake of vegetables in children may be difficult, due to the influence of parents and at-home accessibility. The aim of this study was to analyze the association between self-reported vegetable consumption behaviors and preferences of mothers and the behaviors and [...] Read more.
Increasing the insufficient intake of vegetables in children may be difficult, due to the influence of parents and at-home accessibility. The aim of this study was to analyze the association between self-reported vegetable consumption behaviors and preferences of mothers and the behaviors and preferences of their children, as declared by them. The nationally representative Polish (n = 1200) and Romanian (n = 1157) samples of mothers of children aged 3–10 were obtained using the random quota sampling method, and interviewed for their and their children’s general frequency of consumption and preferences of vegetables in years 2012–2014. A 24 h dietary recall of vegetable consumption was conducted for mothers and their children. Associations were observed for general number of servings consumed per day by mother–child pairs (p < 0.0001; R = 0.6522, R = 0.6573 for Polish and Romanian samples, respectively) and number of types indicated as preferred (p < 0.0001; R = 0.5418, R = 0.5433). The share of children consuming specific vegetables was 33.1–75.3% and 42.6–75.7% while their mothers also consumed, but 0.1–43.2% and 1.2–22.9% while their mothers did not. The share of children preferring specific vegetables was 16.7–74.1% and 15.2–100% when their mother shared the preference, but 1.3–46.9% and 0–38.3% when their mother did not. The mothers’ vegetable consumption behaviors and preferences may be a factor limiting the possibility of increasing vegetable consumption in their children. Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
15 pages, 238 KiB  
Article
Associations between Physical Activity and Food Intake among Children and Adolescents: Results of KiGGS Wave 2
by Kristin Manz, Gert B. M. Mensink, Jonas D. Finger, Marjolein Haftenberger, Anna-Kristin Brettschneider, Clarissa Lage Barbosa, Susanne Krug and Anja Schienkiewitz
Nutrients 2019, 11(5), 1060; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11051060 - 11 May 2019
Cited by 43 | Viewed by 4785
Abstract
A balanced diet and sufficient physical activity are essential for the healthy growth of children and adolescents and for obesity prevention. Data from the second wave of the population-based German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2; 2014–2017) [...] Read more.
A balanced diet and sufficient physical activity are essential for the healthy growth of children and adolescents and for obesity prevention. Data from the second wave of the population-based German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2; 2014–2017) were used to analyse the association between food intake and physical activity among 6- to 17-year-old children and adolescents (n = 9842). Physical exercise (PE) and recommended daily physical activity (RDPA) were assessed with self-administered questionnaires and food intake by a semi-quantitative food frequency questionnaire. Multivariable logistic regression was used to analyse the association between food group intake (dependent variable) and level of PE or RDPA. High levels of physical activity (PE or RDPA) were associated with higher consumption of juice, water, milk, dairy products, fruits, and vegetables among both boys and girls, and among boys with a higher intake of bread, potatoes/pasta/rice, meat, and cereals. Higher PE levels were also less likely to be associated with a high soft drink intake. High levels of RDPA were associated with high intake of energy-dense foods among boys, which was not observed for PE. This study indicates that school-aged children and adolescents with higher levels of physical activity consume more beneficial foods and beverages compared to those with lower physical activity levels. Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
13 pages, 576 KiB  
Article
Combined Longitudinal Effect of Physical Activity and Screen Time on Food and Beverage Consumption in European Preschool Children: The ToyBox-Study
by María L. Miguel-Berges, Alba M. Santaliestra-Pasias, Theodora Mouratidou, Pilar De Miguel-Etayo, Odysseas Androutsos, Marieke De Craemer, Sonya Galcheva, Berthold Koletzko, Zbigniew Kulaga, Yannis Manios, Luis A. Moreno and on behalf of the ToyBox-study group
Nutrients 2019, 11(5), 1048; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11051048 - 10 May 2019
Cited by 18 | Viewed by 3974
Abstract
Lifestyle behavioral habits such as excess screen time (ST), a lack of physical activity (PA), and high energy-dense food consumption are associated with an increased risk of children being overweight or obese. This study aimed to (1) track longitudinal adherence to PA and [...] Read more.
Lifestyle behavioral habits such as excess screen time (ST), a lack of physical activity (PA), and high energy-dense food consumption are associated with an increased risk of children being overweight or obese. This study aimed to (1) track longitudinal adherence to PA and ST recommendations at baseline (T0) and follow-up (T1) and (2) assess the association between changes in adherence to PA and ST recommendations and food and beverage consumption at follow-up. The present study included 2321 preschool children (3.5 to 6) participating in the multicenter ToyBox-study. A lineal mixed effects model was used to examine the association between different types of food and beverages and their relationship with changes in adherence to PA and ST recommendations. Approximately half of the children (50.4%) did not meet the PA and ST recommendations at both baseline and follow-up. However, only 0.6% of the sample met both PA and ST recommendations. Preschool children who met both recommendations consumed fewer fizzy drinks, juices, sweets, desserts, and salty snacks and consumed more water, fruits and vegetables, and dairy products than did those not meeting both recommendations. In conclusion, the proportion of European preschool children adhering to both PA and ST recommendations was very low and was associated with a low consumption of energy-dense foods. Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
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16 pages, 596 KiB  
Article
Association of Infant Feeding Patterns with Taste Preferences in European Children and Adolescents: A Retrospective Latent Profile Analysis
by Elida Sina, Christoph Buck, Hannah Jilani, Michael Tornaritis, Toomas Veidebaum, Paola Russo, Luis A. Moreno, Denes Molnar, Gabriele Eiben, Staffan Marild, Valeria Pala, Wolfgang Ahrens and Antje Hebestreit
Nutrients 2019, 11(5), 1040; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11051040 - 09 May 2019
Cited by 13 | Viewed by 5899
Abstract
The aim was to investigate associations between the duration of infant feeding practices (FP) and taste preferences (TP) in European children and adolescents. A total of 5526 children (6–16 years old) of the I.Family study completed a Food and Beverage Preference Questionnaire to [...] Read more.
The aim was to investigate associations between the duration of infant feeding practices (FP) and taste preferences (TP) in European children and adolescents. A total of 5526 children (6–16 years old) of the I.Family study completed a Food and Beverage Preference Questionnaire to measure their preferences for sweet, fatty and bitter tastes. Mothers retrospectively reported the FPs duration in months: exclusive breastfeeding (EBF), exclusive formula milk feeding (EFMF), combined breastfeeding (BF&FMF) and the age at the introduction of complementary foods (CF). Using logistic regression analyses and latent class analysis (latent profiles of FP and CF were identified), we explored associations between profiles and TP, adjusting for various covariates, including the Healthy Diet Adherence Score (HDAS). A total of 48% of children had short durations of EBF (≤4 months) and BF&FMF (≤6 months) and were introduced to CF early (<6 months). No significant relationship was observed between the single FPs and TP, even when considering common profiles of FP. HDAS was inversely associated with sweet and fatty TP, but positively with bitter TP. Contrary to our hypotheses, we did not observe associations between FP and children’s TP later in life. Further studies with higher FP variation and longitudinal design are needed to investigate the causal associations between infant FP and taste preferences later in life. Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
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20 pages, 1055 KiB  
Article
The Association of Breakfast Frequency and Cardiovascular Disease (CVD) Risk Factors among Adolescents in Malaysia
by Norashikin Mustafa, Hazreen Abd Majid, Zoi Toumpakari, Harriet Amy Carroll, Muhammad Yazid Jalaludin, Nabilla Al Sadat and Laura Johnson
Nutrients 2019, 11(5), 973; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11050973 - 28 Apr 2019
Cited by 21 | Viewed by 6417
Abstract
Breakfast frequency is associated with cardiovascular disease (CVD) risk in Western populations, possibly via the types of food eaten or the timing of food consumption, but associations in Malaysian adolescents are unknown. While the timing of breakfast is similar, the type of food [...] Read more.
Breakfast frequency is associated with cardiovascular disease (CVD) risk in Western populations, possibly via the types of food eaten or the timing of food consumption, but associations in Malaysian adolescents are unknown. While the timing of breakfast is similar, the type of food consumed at breakfast in Malaysia differs from Western diets, which allows novel insight into the mechanisms underlying breakfast–CVD risk associations. We investigated foods eaten for breakfast and associations between breakfast frequency and CVD risk factors in the Malaysian Health and Adolescents Longitudinal Research Team study (MyHeARTs). Breakfast (frequency of any food/drink reported as breakfast in 7-day diet history interviews) and CVD risk factors (body mass index (BMI), waist circumference, fasting blood glucose, triacylglycerol, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and systolic and diastolic blood pressure) were cross-sectionally associated using linear regression adjusting for potential confounders (n = 795, age 13 years). Twelve percent of adolescents never ate breakfast and 50% ate breakfast daily, containing mean (SD) 400 (±127) kilocalories. Commonly consumed breakfast foods were cereal-based dishes (primarily rice), confectionery (primarily sugar), hot/powdered drinks (primarily Milo), and high-fat milk (primarily sweetened condensed milk). After adjustment, each extra day of breakfast consumption per week was associated with a lower BMI (−0.34 kg/m2, 95% confidence interval (CI) −0.02, −0.66), and serum total (−0.07 mmol/L 95% CI −0.02, −0.13) and LDL (−0.07 mmol/L 95% CI −0.02, −0.12) cholesterol concentrations. Eating daily breakfast in Malaysia was associated with slightly lower BMI and total and LDL cholesterol concentrations among adolescents. Longitudinal studies and randomized trials could further establish causality. Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
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12 pages, 1270 KiB  
Article
Melanocortin-4 Receptor and Lipocalin 2 Gene Variants in Spanish Children with Abdominal Obesity: Effects on BMI-SDS after a Lifestyle Intervention
by Lydia Morell-Azanza, Ana Ojeda-Rodríguez, Johanna Giuranna, Mª Cristina Azcona-SanJulián, Johannes Hebebrand, Amelia Marti and Anke Hinney
Nutrients 2019, 11(5), 960; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11050960 - 26 Apr 2019
Cited by 10 | Viewed by 3618
Abstract
Mutations leading to a reduced function of the melanocortin-4 receptor (MC4R) exert a major gene effect on extreme obesity. Recently it was shown that the bone derived hormone lipocalin 2 (LCN2) binds to the MC4R and activates a MC4R dependent anorexigenic pathway. We [...] Read more.
Mutations leading to a reduced function of the melanocortin-4 receptor (MC4R) exert a major gene effect on extreme obesity. Recently it was shown that the bone derived hormone lipocalin 2 (LCN2) binds to the MC4R and activates a MC4R dependent anorexigenic pathway. We identified mutations in both genes and screened the effects of MC4R and LCN2 mutations on eating behavior and weight change after a lifestyle intervention. One hundred and twelve children (11.24 ± 2.6 years, BMI-SDS 2.91 ± 1.07) with abdominal obesity participated in a lifestyle intervention. MC4R and LCN2 coding regions were screened by Sanger sequencing. Eating behavior was assessed at baseline with the Children Eating Behavior Questionnaire (CEBQ). We detected three previously described non-synonymous MC4R variants (Glu42Lys, Thr150Ile, and Arg305Gln) and one non-synonymous polymorphism (Ile251Leu). Regarding LCN2, one known non-synonymous variant (Thr124Met) was detected. Eating behavior was described in carriers of the MC4R and LCN2 mutation and in non-carriers. MC4R and LCN2 mutations were detected in 2.42% and 0.84%, respectively, of Spanish children with abdominal obesity. A number of subjects with functional mutation variants in MC4R and LCN2 were able to achieve a reduction in BMI-SDS after a lifestyle intervention. Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
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22 pages, 4044 KiB  
Article
Socioeconomic Disparities in Diet Vary According to Migration Status among Adolescents in Belgium
by Manon Rouche, Bart de Clercq, Thérésa Lebacq, Maxim Dierckens, Nathalie Moreau, Lucille Desbouys, Isabelle Godin and Katia Castetbon
Nutrients 2019, 11(4), 812; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11040812 - 10 Apr 2019
Cited by 16 | Viewed by 5245
Abstract
Little information concerning social disparities in adolescent dietary habits is currently available, especially regarding migration status. The aim of the present study was to estimate socioeconomic disparities in dietary habits of school adolescents from different migration backgrounds. In the 2014 cross-sectional “Health Behavior [...] Read more.
Little information concerning social disparities in adolescent dietary habits is currently available, especially regarding migration status. The aim of the present study was to estimate socioeconomic disparities in dietary habits of school adolescents from different migration backgrounds. In the 2014 cross-sectional “Health Behavior in School-Aged Children” survey in Belgium, food consumption was estimated using a self-administrated short food frequency questionnaire. In total, 19,172 school adolescents aged 10–19 years were included in analyses. Multilevel multiple binary and multinomial logistic regressions were performed, stratified by migration status (natives, 2nd- and 1st-generation immigrants). Overall, immigrants more frequently consumed both healthy and unhealthy foods. Indeed, 32.4% of 1st-generation immigrants, 26.5% of 2nd-generation immigrants, and 16.7% of natives consumed fish ≥two days a week. Compared to those having a high family affluence scale (FAS), adolescents with a low FAS were more likely to consume chips and fries ≥once a day (vs. <once a day: Natives aRRR = 1.39 (95%CI: 1.12–1.73); NS in immigrants). Immigrants at schools in Flanders were less likely than those in Brussels to consume sugar-sweetened beverages 2–6 days a week (vs. ≤once a week: Natives aRRR = 1.86 (95%CI: 1.32–2.62); 2nd-generation immigrants aRRR = 1.52 (1.11–2.09); NS in 1st-generation immigrants). The migration gradient observed here underlines a process of acculturation. Narrower socioeconomic disparities in immigrant dietary habits compared with natives suggest that such habits are primarily defined by culture of origin. Nutrition interventions should thus include cultural components of dietary habits. Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
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13 pages, 569 KiB  
Article
Different Socio-Demographic and Lifestyle Factors Can Determine the Dietary Supplement Use in Children and Adolescents in Central-Eastern Poland
by Ewa Sicińska, Barbara Pietruszka, Olga Januszko and Joanna Kałuża
Nutrients 2019, 11(3), 658; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11030658 - 18 Mar 2019
Cited by 18 | Viewed by 3701
Abstract
Vitamin/mineral supplement (VMS) use has become increasingly popular in children and adolescents; however, different predictors may be associated with their usage. Therefore, the aim of this study was to compare determinants of VMS use in 1578 children and adolescents. Data was collected among [...] Read more.
Vitamin/mineral supplement (VMS) use has become increasingly popular in children and adolescents; however, different predictors may be associated with their usage. Therefore, the aim of this study was to compare determinants of VMS use in 1578 children and adolescents. Data was collected among parents of children (≤12 years old) and among adolescents (>12 years old) who attended public schools by a self-administered questionnaire. Multivariate-adjusted logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for determining the predictors of VMS use. In children, the following determinants of VMS use were indicated: socioeconomic status (average vs. very good/good; OR: 1.69, 95% CI: 1.16–2.48), physical activity (1–5 vs. <1 h/week; OR: 1.44, 95% CI: 1.02–2.04), BMI (≥25 vs. 18.5–24.9 kg/m2; OR: 0.67, 95% CI: 0.46–0.98), and presence of chronic diseases (yes vs. no; OR: 2.32, 95% CI: 1.46–3.69). In adolescents, gender (male vs. female; OR: 0.56, 95% CI: 0.37–0.87), residential area (rural vs. urban; OR: 0.63, 95% CI: 0.40–0.99), BMI (<18.5 vs. 18.5–24.9 kg/m2; OR: 0.35, 95% CI: 0.17–0.73), and health status (average/poor vs. at least good; OR: 1.96, 95% CI: 1.13–3.39) were factors of VMS use. In both groups, the mother’s higher educational level, fortified food consumption and diet modification towards better food choices were predictors of VMS use. In conclusion, most of the predictors of VMS use were different in children and adolescents. Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
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14 pages, 256 KiB  
Article
The Family Mealtime Observation Study (FaMOS): Exploring the Role of Family Functioning in the Association between Mothers’ and Fathers’ Food Parenting Practices and Children’s Nutrition Risk
by Kathryn Walton, Emma Haycraft, Kira Jewell, Andrea Breen, Janis Randall Simpson and Jess Haines
Nutrients 2019, 11(3), 630; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11030630 - 15 Mar 2019
Cited by 18 | Viewed by 4592
Abstract
This cross-sectional study explores associations between mothers’ and fathers’ food parenting practices and children’s nutrition risk, while examining whether family functioning modifies or confounds the association. Home observations assessed parents’ food parenting practices during dinnertime (n = 73 families with preschoolers). Children’s [...] Read more.
This cross-sectional study explores associations between mothers’ and fathers’ food parenting practices and children’s nutrition risk, while examining whether family functioning modifies or confounds the association. Home observations assessed parents’ food parenting practices during dinnertime (n = 73 families with preschoolers). Children’s nutrition risk was calculated using NutriSTEP®. Linear regression models examined associations between food parenting practices and NutriSTEP® scores. An interaction term (family functioning × food parenting practice) explored effect modification; models were adjusted for family functioning to explore confounding. Among mothers, more frequent physical food restriction was associated with higher nutrition risk in their children (β = 0.40 NutriSTEP® points, 95% Confidence Interval (CI) = 2.30, 7.58) and among both mothers and fathers, positive comments about the target child’s food were associated with lower nutrition risk (mothers: β = −0.31 NutriSTEP® points, 95% CI = −0.54, −0.08; fathers: β = −0.27 NutriSTEP® points, 95% CI = −0.75, −0.01) in models adjusted for parent education and child Body Mass Index (BMI) z-score. Family functioning did not modify these associations and they remained significant after adjustment for family functioning. Helping parents to use positive encouragement rather than restriction may help to reduce their children’s nutrition risk. Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
20 pages, 879 KiB  
Article
Clustering of Multiple Energy Balance-Related Behaviors in School Children and its Association with Overweight and Obesity—WHO European Childhood Obesity Surveillance Initiative (COSI 2015–2017)
by Silvia Bel-Serrat, Ana Ojeda-Rodríguez, Mirjam M. Heinen, Marta Buoncristiano, Shynar Abdrakhmanova, Vesselka Duleva, Victoria Farrugia Sant’Angelo, Anna Fijałkowska, Tatjana Hejgaard, Constanta Huidumac, Jolanda Hyska, Enisa Kujundzic, Sanja Musić Milanović, Guljemal Ovezmyradova, Napoleón Pérez-Farinós, Ausra Petrauskiene, Ana Isabel Rito, Lela Shengelia, Radka Taxová Braunerová, Harry Rutter, Celine M. Murrin, Cecily C. Kelleher and João Bredaadd Show full author list remove Hide full author list
Nutrients 2019, 11(3), 511; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11030511 - 27 Feb 2019
Cited by 39 | Viewed by 6894
Abstract
It is unclear how dietary, physical activity and sedentary behaviors co-occur in school-aged children. We investigated the clustering of energy balance-related behaviors and whether the identified clusters were associated with weight status. Participants were 6- to 9-year-old children (n = 63,215, 49.9% [...] Read more.
It is unclear how dietary, physical activity and sedentary behaviors co-occur in school-aged children. We investigated the clustering of energy balance-related behaviors and whether the identified clusters were associated with weight status. Participants were 6- to 9-year-old children (n = 63,215, 49.9% girls) from 19 countries participating in the fourth round (2015/2017) of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative. Energy balance-related behaviors were parentally reported. Weight and height were objectively measured. We performed cluster analysis separately per group of countries (North Europe, East Europe, South Europe/Mediterranean countries and West-Central Asia). Seven clusters were identified in each group. Healthier clusters were common across groups. The pattern of distribution of healthy and unhealthy behaviors within each cluster was group specific. Associations between the clustering of energy balance-related behaviors and weight status varied per group. In South Europe/Mediterranean countries and East Europe, all or most of the cluster solutions were associated with higher risk of overweight/obesity when compared with the cluster ‘Physically active and healthy diet’. Few or no associations were observed in North Europe and West-Central Asia, respectively. These findings support the hypothesis that unfavorable weight status is associated with a particular combination of energy balance-related behavior patterns, but only in some groups of countries. Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
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14 pages, 681 KiB  
Article
Sugar-Sweetened Beverage Consumption and Associated Factors in School-Going Adolescents of New Caledonia
by Guillaume Wattelez, Stéphane Frayon, Yolande Cavaloc, Sophie Cherrier, Yannick Lerrant and Olivier Galy
Nutrients 2019, 11(2), 452; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11020452 - 21 Feb 2019
Cited by 25 | Viewed by 4814
Abstract
This cross-sectional study assessed sugar-sweetened beverage (SSB) consumption and its associations with the sociodemographic and physical characteristics, behavior and knowledge of New Caledonian adolescents. The survey data of 447 adolescents from ages 11 to 16 years were collected in five secondary public schools [...] Read more.
This cross-sectional study assessed sugar-sweetened beverage (SSB) consumption and its associations with the sociodemographic and physical characteristics, behavior and knowledge of New Caledonian adolescents. The survey data of 447 adolescents from ages 11 to 16 years were collected in five secondary public schools of New Caledonia between July 2015 and April 2016. These data included measured height and weight, SSB consumption, sociodemographic characteristics, body weight perception, physical activity, and knowledge (sugar quantity/SSB unit; energy expenditure required to eliminate a unit) and opinions about the SSB‒weight gain relationship. Ninety percent of these adolescents declared regularly drinking SSBs. Quantities were associated with living environment (1.94 L·week−1 in urban environment vs. 4.49 L·week−1 in rural environment, p = 0.001), ethnic community (4.77 L·week−1 in Melanesians vs. 2.46 L·week−1 in Caucasians, p < 0.001) and knowledge about energy expenditure (6.22 L·week−1 in unknowledgeable adolescents vs. 4.26 L·week−1 in adolescents who underestimated, 3.73 L·week−1 in adolescents who overestimated, and 3.64 L·week−1 in adolescents who correctly responded on the energy expenditure required to eliminate an SSB unit, p = 0.033). To conclude, community-based health promotion strategies should (1) focus on the physical effort needed to negate SSB consumption rather than the nutritional energy from SSB units and (2) highlight how to achieve sustainable lifestyles and provide tools for greater understanding and positive action. Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
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14 pages, 542 KiB  
Article
Development of a Quality Score for the Home Food Environment Using the Home-IDEA2 and the Healthy Eating Index-2010
by Sarah K. Hibbs-Shipp, Richard E. Boles, Susan L. Johnson, Morgan L. McCloskey, Savannah Hobbs and Laura L. Bellows
Nutrients 2019, 11(2), 372; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11020372 - 12 Feb 2019
Cited by 3 | Viewed by 4114
Abstract
The home food environment (HFE) is an important factor in the development of food preferences and habits in young children, and the availability of foods within the home reflects dietary intake in both adults and children. Therefore, it is important to consider the [...] Read more.
The home food environment (HFE) is an important factor in the development of food preferences and habits in young children, and the availability of foods within the home reflects dietary intake in both adults and children. Therefore, it is important to consider the holistic quality of the HFE. The purpose of this study was to apply the Healthy Eating Index (HEI; a measure of diet quality in conformance to the Dietary Guidelines for Americans) algorithm to the Home-IDEA2, a valid and reliable food inventory checklist, to develop a Home-IDEA2 HEI Score. After an initial score was developed, it was psychometrically tested for content, criterion, and construct validity. Content validity testing resulted in 104 foods being retained. Internal criterion testing demonstrated that 42 foods (40%) changed component scores by >5%; however, no single food changed a total Home-IDEA2 HEI score by >5%. Testing of hypothetical HFEs resulted in a range of scores in the expected directions, establishing sensitivity to varied HFEs. This study resulted in a validated methodology to assess the overall quality of the HFE, thus contributing a novel approach for examining home food environments. Future research can test interventions modifying the HFE quality to improve individual dietary intake. Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
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17 pages, 341 KiB  
Article
Emotional Eating, Health Behaviours, and Obesity in Children: A 12-Country Cross-Sectional Study
by Elli Jalo, Hanna Konttinen, Henna Vepsäläinen, Jean-Philippe Chaput, Gang Hu, Carol Maher, José Maia, Olga L. Sarmiento, Martyn Standage, Catrine Tudor-Locke, Peter T. Katzmarzyk and Mikael Fogelholm
Nutrients 2019, 11(2), 351; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11020351 - 07 Feb 2019
Cited by 35 | Viewed by 7883
Abstract
Eating in response to negative emotions (emotional eating, EE) may predispose an individual to obesity. Yet, it is not well known how EE in children is associated with body mass index (BMI) and health behaviours (i.e., diet, physical activity, sleep, and TV-viewing). In [...] Read more.
Eating in response to negative emotions (emotional eating, EE) may predispose an individual to obesity. Yet, it is not well known how EE in children is associated with body mass index (BMI) and health behaviours (i.e., diet, physical activity, sleep, and TV-viewing). In the present study, we examined these associations in a cross-sectional sample of 5426 (54% girls) 9–11-year-old children from 12 countries and five continents. EE, food consumption, and TV-viewing were measured using self-administered questionnaires, and physical activity and nocturnal sleep duration were measured with accelerometers. BMI was calculated using measured weights and heights. EE factor scores were computed using confirmatory factor analysis, and dietary patterns were identified using principal components analysis. The associations of EE with health behaviours and BMI z-scores were analyzed using multilevel models including age, gender, and household income as covariates. EE was positively and consistently (across 12 study sites) associated with an unhealthy dietary pattern (β = 0.29, SE = 0.02, p < 0.0001), suggesting that the association is not restricted to Western countries. Positive associations between EE and physical activity and TV viewing were not consistent across sites. Results tended to be similar in boys and girls. EE was unrelated to BMI in this sample, but prospective studies are needed to determine whether higher EE in children predicts the development of undesirable dietary patterns and obesity over time. Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
12 pages, 690 KiB  
Article
Evaluation of the Effect of a Growing up Milk Lite vs. Cow’s Milk on Diet Quality and Dietary Intakes in Early Childhood: The Growing up Milk Lite (GUMLi) Randomised Controlled Trial
by Amy L. Lovell, Tania Milne, Yannan Jiang, Rachel X. Chen, Cameron C. Grant and Clare R. Wall
Nutrients 2019, 11(1), 203; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11010203 - 20 Jan 2019
Cited by 12 | Viewed by 5013
Abstract
Summary scores provide an alternative approach to measuring dietary quality. The Growing Up Milk-Lite (GUMLi) Trial was a multi-centre, double-blinded, randomised controlled trial of children randomised to receive a reduced protein GUM (GUMLi) or unfortified cow’s milk (CM). In a secondary analysis of [...] Read more.
Summary scores provide an alternative approach to measuring dietary quality. The Growing Up Milk-Lite (GUMLi) Trial was a multi-centre, double-blinded, randomised controlled trial of children randomised to receive a reduced protein GUM (GUMLi) or unfortified cow’s milk (CM). In a secondary analysis of the GUMLi Trial, we used the Probability of Adequate Nutrient Intake (PANDiet) to determine the nutritional adequacy of the diets of participating children living in Auckland. The PANDiet was adapted to the New Zealand Nutrient Reference Values and data from four 24 h Recalls (24HR) collected at months 7, 8, 10, and 11 post-randomisation were used. Differences between randomised groups (GUMLi vs. CM) of the PANDiet and its components were made. Eighty-three Auckland participants were included in the study (GUMLi n = 41 vs. CM n = 42). Total PANDiet scores were significantly higher in the GUMLi group (p < 0.001), indicating better overall nutrient adequacy and diet quality. Dietary intakes of children in both groups met the recommendations for fat, total carbohydrates and most micronutrients; however, protein intakes exceeded recommendations. Consumption of GUMLi was associated with higher nutritional adequacy, with an increased likelihood of meeting nutrient requirements; however, the impact of the family diet and GUMLi on dietary diversity requires further evaluation. Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
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13 pages, 256 KiB  
Article
Parents’ Reports of Preschoolers’ Diets: Relative Validity of a Food Frequency Questionnaire and Dietary Patterns
by Liisa Korkalo, Henna Vepsäläinen, Carola Ray, Essi Skaffari, Reetta Lehto, Helena Henrietta Hauta-alus, Kaija Nissinen, Jelena Meinilä, Eva Roos and Maijaliisa Erkkola
Nutrients 2019, 11(1), 159; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11010159 - 13 Jan 2019
Cited by 26 | Viewed by 5020
Abstract
The accurate assessment of food consumption is crucial in nutritional studies. Since modern nutrition science has become more interested in diet as a whole, studies validating food frequency questionnaires (FFQs) and exploratory dietary patterns are needed. We aimed at examining the relative validity [...] Read more.
The accurate assessment of food consumption is crucial in nutritional studies. Since modern nutrition science has become more interested in diet as a whole, studies validating food frequency questionnaires (FFQs) and exploratory dietary patterns are needed. We aimed at examining the relative validity of a 47-item FFQ against three-day food records among three- to six-year-old Finnish children, as well as investigating the consistency of the dietary patterns derived using the principal component analysis (PCA), with food record and FFQ data as inputs. We conducted the PCA without forcing the food record data to match the FFQ items. Altogether, 75% or more of the participants were classified into the same or adjacent quarter of vegetables and fruits as well as sugary food consumption. Furthermore, the intake of folate and vitamin C increased linearly in the quarters of vegetable and fruit consumption, as did the intake of sucrose in quarters of sugary food consumption. Three fairly similar dietary patterns were identified from food records and FFQ data. Concerning the patterns, more than 70% of the participants were classified into the same or adjacent quarter. However, the Spearman correlation coefficients between the respective pattern scores were low (0.25–0.33). The FFQ showed acceptable validity when ranking food group consumption compared to food records. Additionally, the FFQ-derived dietary patterns were consistent with those derived using food record data. Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
19 pages, 983 KiB  
Article
Dietary Patterns in Primary School are of Prospective Relevance for the Development of Body Composition in Two German Pediatric Populations
by Maike Wolters, Gesa Joslowski, Sandra Plachta-Danielzik, Marie Standl, Manfred J. Müller, Wolfgang Ahrens and Anette E. Buyken
Nutrients 2018, 10(10), 1442; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10101442 - 05 Oct 2018
Cited by 8 | Viewed by 4465
Abstract
This study performed comparative analyses in two pediatric cohorts to identify dietary patterns during primary school years and examined their relevance to body composition development. Nutritional and anthropometric data at the beginning of primary school and two or four years later were available [...] Read more.
This study performed comparative analyses in two pediatric cohorts to identify dietary patterns during primary school years and examined their relevance to body composition development. Nutritional and anthropometric data at the beginning of primary school and two or four years later were available from 298 and 372 participants of IDEFICS-Germany (Identification and prevention of Dietary-induced and lifestyle-induced health Effects In Children and infants Study) and the KOPS (Kiel Obesity Prevention Study) cohort, respectively. Principal component analyses (PCA) and reduced rank regression (RRR) were used to identify dietary patterns at baseline and patterns of change in food group intake during primary school years. RRR extracted patterns explaining variations in changes in body mass index (BMI), fat mass index (FMI), and waist-to-height-ratio (WtHR). Associations between pattern adherence and excess gain in BMI, FMI, or WtHR (>75th percentile) during primary school years were examined using logistic regression. Among PCA patterns, only a change towards a more Mediterranean food choice during primary school years were associated with a favorable body composition development in IDEFICS-Germany (p < 0.05). In KOPS, RRR patterns characterized by a frequent consumption of fast foods or starchy carbohydrate foods were consistently associated with an excess gain in BMI and WtHR (all p < 0.005). In IDEFICS-Germany, excess gain in BMI, FMI, and WtHR were predicted by a frequent consumption of nuts, meat, and pizza at baseline and a decrease in the consumption frequency of protein sources and snack carbohydrates during primary school years (all p < 0.01). The study confirms an adverse impact of fast food consumption on body composition during primary school years. Combinations of protein and carbohydrate sources deserve further investigation. Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
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Review

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24 pages, 1637 KiB  
Review
International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE): Contributions to Understanding the Global Obesity Epidemic
by Peter T. Katzmarzyk, Jean-Philippe Chaput, Mikael Fogelholm, Gang Hu, Carol Maher, Jose Maia, Timothy Olds, Olga L. Sarmiento, Martyn Standage, Mark S. Tremblay and Catrine Tudor-Locke
Nutrients 2019, 11(4), 848; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11040848 - 15 Apr 2019
Cited by 47 | Viewed by 12063
Abstract
The purpose of this review is to summarize the scientific contributions of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) in extending our understanding about obesity in children from around the world. ISCOLE was a multi-national study of 9 to [...] Read more.
The purpose of this review is to summarize the scientific contributions of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) in extending our understanding about obesity in children from around the world. ISCOLE was a multi-national study of 9 to 11 year-old children from sites in 12 countries from all inhabited continents. The primary purpose was to investigate relationships between lifestyle behaviors and obesity, and the influence of higher-order characteristics such as behavioral settings, and physical, social and policy environments. ISCOLE has made several advances in scientific methodology related to the assessment of physical activity, dietary behavior, sleep and the neighborhood and school environments. Furthermore, ISCOLE has provided important evidence on (1) epidemiological transitions in obesity and related behaviors, (2) correlates of obesity and lifestyle behaviors at the individual, neighborhood and school levels, and (3) 24-h movement behaviors in relation to novel analytical techniques. A key feature of ISCOLE was the development of a platform for international training, data entry, and data quality for multi-country studies. Finally, ISCOLE represents a transparent model for future public-private research partnerships across low, middle and high-income countries. Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
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26 pages, 900 KiB  
Review
Interventions Aimed at Increasing Dairy and/or Calcium Consumption of Preschool-Aged Children: A Systematic Literature Review
by Victoria Srbely, Imtisal Janjua, Andrea C. Buchholz and Genevieve Newton
Nutrients 2019, 11(4), 714; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11040714 - 27 Mar 2019
Cited by 16 | Viewed by 4226
Abstract
Dairy product consumption is important during childhood, as dairy products provide nutrients to support growth and development. However, a high proportion of children globally are not meeting recommended daily intakes, which may have long-term health implications. Accumulating evidence suggests that interventions aimed at [...] Read more.
Dairy product consumption is important during childhood, as dairy products provide nutrients to support growth and development. However, a high proportion of children globally are not meeting recommended daily intakes, which may have long-term health implications. Accumulating evidence suggests that interventions aimed at instilling healthy lifestyle habits are most effective when initiated during the preschool years. Therefore, the purpose of the review was to identify the characteristics of effective dairy and/or calcium interventions targeting preschool-aged children. A systematic literature review identified 14 intervention studies published between 1998–2018 addressing dairy/calcium intakes in the preschool population (1.5 to 5 years). Intervention reporting was assessed using intervention intensity, behavior change techniques and Workgroup for Intervention Development and Evaluation Research (WIDER), with the quality of studies evaluated using risk of bias and Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Five of the 14 studies included in the review reported significant improvements in children’s dairy (4/5) or calcium (1/5) intake. Characteristics that may enable intervention effectiveness include the delivery of interventions in one setting (preschool facility), using specific behavior change techniques (environmental restructuring and teach to use prompts/cues), and targeting both parent and child. Overall, the interventions assessed demonstrated variable success and highlighted the need for developing effective interventions designed to increase dairy and/or calcium intakes in preschool-aged children. Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
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14 pages, 424 KiB  
Review
Design, Development and Construct Validation of the Children’s Dietary Inflammatory Index
by Samira Khan, Michael D. Wirth, Andrew Ortaglia, Christian R. Alvarado, Nitin Shivappa, Thomas G. Hurley and James R. Hebert
Nutrients 2018, 10(8), 993; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10080993 - 30 Jul 2018
Cited by 43 | Viewed by 6645
Abstract
Objective: To design and validate a literature-derived, population-based Children’s Dietary Inflammatory Index (C-DII)TM. Design: The C-DII was developed based on a review of literature through 2010. Dietary data obtained from children in 16 different countries were used to create a reference [...] Read more.
Objective: To design and validate a literature-derived, population-based Children’s Dietary Inflammatory Index (C-DII)TM. Design: The C-DII was developed based on a review of literature through 2010. Dietary data obtained from children in 16 different countries were used to create a reference database for computing C-DII scores based on consumption of macronutrients, vitamins, minerals, and whole foods. Construct validation was performed using quantile regression to assess the association between C-reactive protein (CRP) concentrations and C-DII scores. Data Sources: All data used for construct validation were obtained from children between six and 14 years of age (n = 3300) who participated in the U.S. National Health and Nutrition Examination Survey (NHANES) (2005–2010). Results: The C-DII was successfully validated with blood CRP concentrations in this heterogeneous sample of 3300 children from NHANES (52% male; 29% African American, 25% Mexican American; mean age 11 years). The final model was adjusted for sex, age, race, asthma, body mass index (BMI), and infections. Children in level 3 (i.e., quartiles 3 and 4 combined) of the C-DII (i.e., children with the most pro-inflammatory diets) had a CRP value 0.097 mg/dL higher than that in level 1 (i.e., quartile 1) for CRP values at the 75th percentile of CRP using quantile regression (p < 0.05). Conclusion: The C-DII predicted blood CRP concentrations among children 6–14 years in the NHANES. Further construct validation with CRP and other inflammatory markers is required to deepen understanding of the relationship between the C-DII and markers of inflammation in children. Full article
(This article belongs to the Special Issue Dietary Behavior and Physical Activity in Children and Adolescents)
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