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Reducing multifactorial stunting is a priority for the 2025 WHO Global Nutrition Target. In the plant-based complementary diets of low-income countries, deficits in several growth-limiting micronutrients may contribute to stunting. Hence the intercorrelation between multiple micronutrients in terms of their intake and impact is important. Therefore, our aim was to develop a nutrient quality score using principal component analysis (PCA) in a sample of Indonesian infants at 6, 9 and 12 months of age and to evaluate the association of the scores with linear growth and stunting. At 6 months, 217 infants were recruited from Sumedang District, West Java, with 195 and 189 followed at 9 and 12 months of age, respectively. Complementary food intakes were assessed using 2-d weighed food records. Eight correlated nutrients (vitamin A, ascorbic acid, thiamine, riboflavin, niacin, Ca, Fe and Zn) were summarised using PCA into a single nutrient pattern that explained 56-65 % of the total variability. Nutrient quality scores were related to demographic, inflammation and complementary food indicator variables in hypothesised directions. While no significant relationships were apparent with linear growth, the odds of being stunted at ages 9 and 12 months was lower for infants with a higher nutrient quality score at 9 months (OR 0·75, 95 % CI 0·59, 0·95 and OR 0·69, 95 % CI 0·55, 0·88), respectively, for the fully adjusted models. A data-driven nutrient quality score is a valid tool to assess the influence of nutrient quality on stunting in at-risk infants.

Previous studies have investigated associations between individual foods or food group intake, and breastfeeding duration, age of solid introduction and food neophobia. This study aimed to investigate associations between whole dietary patterns in young children, and breastfeeding duration, age of solid introduction and food neophobia. Parents of children (N = 234) aged 1-5 years completed an online questionnaire. Dietary risk scores were calculated using the Toddler (1-3 years) or Preschool (>3-<5 years) Dietary Questionnaires which evaluates the previous week's food-group intake (scored 0-100; higher score = higher risk of poor dietary quality). Neophobia was measured using the Child Food Neophobia scale (1.0-4.0; higher score = more neophobic). Associations were investigated using multivariable linear regression, adjusting for covariates. Children (54% female, 3.0 ± 1.4 years) were from advantaged families and were breastfed until 11.8 (5.0-16.0) months, started solids at 5.6 ± 1.4 months of age, moderately neophobic (2.1 ± 0.7) and at moderate dietary risk (29.2 ± 9.2). Shorter breastfeeding duration (β = -0.21; p = 0.001) and poorer child food neophobia scores (β = 0.36; p < 0.001) were associated with higher dietary risk scores. Age of introduction to solids showed no association with dietary risk (p = 0.744). These findings suggest that in addition to breastfeeding promotion, supporting parents to manage neophobic behaviour may be important in promoting healthy eating patterns in early childhood., (Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.)

Background: Against a background of changing family structures and socioeconomic demands in contemporary families, fathers are more actively engaged in meal preparation and feeding of their children, yet in research studies targeting improvement in nutrition and feeding practices fathers are under-represented. Among possible explanations for this bias are acceptability of research projects and accessibility to male research participants. The aims of this study were to identify (i) fathers' preferences for participation in child nutrition research and interventions and (ii) the potential to recruit fathers through their workplaces with the possibility of delivering interventions through those workplaces., Methods: This paper draws on two independent yet linked studies that explored fathers' roles in family feeding, and intervention studies aimed at supporting father's dietary knowledge and feeding practices. For Study 1 (conducted first) secondary data analysis was conducted on survey data (n = 463 fathers of preschool children) to determine preferences related to type of program, delivery mode, and location and timing. For Study 2 six focus groups and one individual interview were conducted with n = 28 fathers to determine acceptability of recruitment of fathers working in traditionally blue-collar occupations and service industries (as defined by the Australian Bureau of Statistics) and potential of intervention delivery through their workplaces., Results: Fathers were engaged in child feeding and indeed sought nutrition-related information. Fathers indicated a preference for family-focused and online delivery of interventions. Whilst potential to recruit through blue-collar workplaces was evident, participants were divided in their views about the acceptability of interventions conducted through the workplace. There was a sense of support for the logic of such interventions but the focus group participants in this study showed only modest enthusiasm for the idea., Conclusions: With limited support for the workplace as an intervention setting, further systematic exploration of technology-based intervention design and engagement is warranted. Based on findings, interventions should target a) content that is focused on the family and how to make changes at the family level, rather than the father individually; and b) online delivery, such as Apps or online video chat sessions, for convenience and to facilitate sharing of information with family members.

A varied and diverse diet in childhood supports optimum long-term preferences and growth. Previous analysis from 14-month-old Australian children in the NOURISH and South Australian Infants Dietary Intake (SAIDI) studies found higher formula intake was associated with lower dietary diversity. This analysis investigated whether formula intake and dietary diversity at 14 months of age is associated with dietary quality at 24 months. This is a secondary analysis of intake data from NOURISH and SAIDI cohorts. Scores for dietary diversity, fruit variety, vegetable variety and meat/alternative variety were combined using structural equation modelling to form the latent variable 'Dietary quality' (DQ) at age 24 months. A longitudinal model examined influence of formula (grams), cow's milk (grams) and dietary diversity at 14 months and covariates, on DQ. At age 24 months (n = 337) 27% of children obtained a maximum dietary diversity score (5/5). Variety scores were relatively low - with mean variety scores (and possible range) being four for fruit (0-30); five for vegetables (0-36); and three for meat/alternatives (0-8). Dietary diversity at 14 months (β = 0.19, p = 0.001), maternal age (β = 0.24, p < 0.001) and education (β = 0.22, p < 0.001) predicted DQ at 24 months while Child Food Neophobia Score was negatively associated with DQ (β = -0.30, p < 0.001). Formula intake was negatively associated with diversity at 14 months, but not DQ at 24. Diversity and variety were limited despite sociodemographic advantage of the sample. Diversity at 14 months, degree of neophobia and sociodemographic factors predicted DQ at 24 months. There is an ongoing need to emphasise the importance of repeated early exposure to healthy foods, such that children have the opportunity to learn to like a range of tastes and texture, thereby maximising dietary diversity and quality in infancy and early toddlerhood., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Concerns about fussy eating are common amongst parents of young children. However, studies of the long-term impact of fussy eating show mixed results with regard to adequacy of dietary intake and child growth. This may be in part because there is no accepted definition of fussy eating and studies measure the construct in different ways, commonly relying on parent perception. This longitudinal analysis explores maternal and child characteristics associated with maternal perception of her toddler as a fussy eater in early toddlerhood and subsequent use of feeding practices at 2 years., Methods: Mothers completed a self-administered questionnaire at child age 14 months, describing perception of their child as fussy/not fussy and child behaviour. Intake was assessed using a single 24-h recall and weight was measured by research staff. At child age 2 years mothers completed the validated 28-item Feeding Practices and Structure Questionnaire (FPSQ-28). Weight-for-age z-score (WAZ) was derived from WHO standards. Gram daily intake of fruit, vegetables and meat/alternative and a dietary diversity score were determined. Maternal/child characteristics independently associated (p ≤ 0.05) with perception of child as a fussy eater were determined using logistic regression. Variables were combined in a structural equation model assessing the longitudinal relationship between child/maternal characteristics, perception of child as a fussy eater and eight FPSQ factors., Results: Mothers' (n = 330) perception of her child as a fussy eater at age 14 months, was associated with higher frequency of food refusal and lower WAZ (R 2  = 0.41) but not dietary intake. Maternal perception as fussy (age 14 months) was associated with four FPSQ factors at 2 years (n = 279) - Reward for Eating, Reward for Behaviour, Persuasive Feeding and Overt Restriction, x 2 /df = 1.42, TLI = 0.95, CFI = 0.95, RMSEA = 0.04(0.03-0.05), PCLOSE = 0.99., Conclusions: Lower relative child weight and food refusal prompted mothers to perceive their child as fussy. These behaviours in healthy weight children most likely reflect self-regulation of energy intake and neophobia. This perception was prospectively associated with use of non-responsive feeding practices, which may increase obesity risk. Future interventions could directly address perceptions of growth and fussiness, supporting parents to understand food refusal as developmentally appropriate behaviour in healthy young children., Trial Registration: ACTRN12608000056392 . Registered 29 January 2008.

Objective: To describe the dietary intake of a sample of Australian children., Methods: Three days (1×24 hour recall, 2×24 hour records) of dietary intake data were collected from 409 and 363 mother-child dyads (resident in Brisbane and South Australia) at 14 (T2) and 24 (T3) months of age respectively as part of the NOURISH and SAIDI studies. Data presented include foods consumed by ≥10% of children, number of consumers and median serve size., Results: Thirteen of 25 vegetables consumed by more than 10% of children at T2 were consumed by a lower proportion at T3 (9:1-5% less consumers; 4: 10-16% less). Eleven discretionary foods were consumed by greater than 10% of children at T2, and by T3, this number had almost doubled., Conclusions: Increased exposure to discretionary food and decreased exposure to vegetables is occurring in the transition toward family food, during a time of increasing independence and emerging neophobia. Implications for Public Health: The age-related decline in dietary quality is of concern, with potential concurrent impact on nutritional adequacy, development of food preferences and later eating patterns. Serve size data could be used to inform serve sizes for toddlers in future editions of the Australian Guide to Healthy Eating., (© 2016 The Authors.)

Meat/meat alternatives (M/MA) are key sources of Fe, Zn and protein, but intake tends to be low in young children. Australian recommendations state that Fe-rich foods, including M/MA, should be the first complementary foods offered to infants. The present paper reports M/MA consumption of Australian infants and toddlers, compares intake with guidelines, and suggests strategies to enhance adherence to those guidelines. Mother-infant dyads recruited as part of the NOURISH and South Australian Infants Dietary Intake studies provided 3 d of intake data at three time points: Time 1 (T1) (n 482, mean age 5·5 (SD 1·1) months), Time 2 (T2) (n 600, mean age 14·0 (SD 1·2) months) and Time 3 (T3) (n 533, mean age 24 (SD 0·7) months). Of 170 infants consuming solids and aged greater than 6 months at T1, 50 (29%) consumed beef, lamb, veal (BLV) or pork on at least one of 3 d. Commercial infant foods containing BLV or poultry were the most common form of M/MA consumed at T1, whilst by T2 BLV mixed dishes (including pasta bolognaise) became more popular and remained so at T3. The processed M/MA increased in popularity over time, led by pork (including ham). The present study shows that M/MA are not being eaten by Australian infants or toddlers regularly enough; or in adequate quantities to meet recommendations; and that the form in which these foods are eaten can lead to smaller M/MA serve sizes and greater Na intake. Parents should be encouraged to offer M/MA in a recognisable form, as one of the first complementary foods, in order to increase acceptance at a later age.

This cross-sectional study examined the association between controlling feeding practices and children's appetite traits. The secondary aim studied the relationship between controlling feeding practices and two proxy indicators of diet quality. Participants were 203 Australian-Indian mothers with children aged 1-5 years. Controlling feeding practices (pressure to eat, restriction, monitoring) and children's appetite traits (food approach traits: food responsiveness, enjoyment of food, desire to drink, emotional overeating; food avoidance traits: satiety responsiveness, slowness in eating, fussiness and emotional undereating) were measured using self-reported, previously validated scales/questionnaires. Children's daily frequency of consumption of core and non-core foods was estimated using a 49-item list of foods eaten (yes/no) in the previous 24 hours as an indicator of diet quality. Higher pressure to eat was associated with higher scores for satiety responsiveness, slowness in eating, fussiness and lower score for enjoyment of food. Higher restriction was related to higher scores for food responsiveness and emotional overeating. Higher monitoring was inversely associated with fussiness, slowness in eating, food responsiveness and emotional overeating and positively associated with enjoyment of food. Pressure to eat and monitoring were related to lower number of core and non-core foods consumed in the previous 24 hours, respectively. All associations remained significant after adjusting for maternal and child covariates (n = 152 due to missing data). In conclusion, pressure to eat was associated with higher food avoidance traits and lower consumption of core foods. Restrictive feeding practices were associated with higher food approach traits. In contrast, monitoring practices were related to lower food avoidance and food approach traits and lower non-core food consumption., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: The role of fathers in shaping their child's eating behaviour and weight status through their involvement in child feeding has rarely been studied. This study aims to describe fathers' perceived responsibility for child feeding, and to identify predictors of how frequently fathers eat meals with their child., Methods: Four hundred and thirty-six Australian fathers (M age = 37 years, SD = 6 years; 34% university educated) of a 2-5-year-old child (M age = 3.5 years, SD = 0.9 years; 53% boys) were recruited via contact with mothers enrolled in existing research projects or a university staff and student email list. Data were collected from fathers via a self-report questionnaire. Descriptive and hierarchical linear regression analyses were conducted., Results: The majority of fathers reported that the family often/mostly ate meals together (79%). Many fathers perceived that they were responsible at least half of the time for feeding their child in terms of organizing meals (42%); amount offered (50%) and deciding if their child eats the 'right kind of foods' (60%). Time spent in paid employment was inversely associated with how frequently fathers ate meals with their child (β = -0.23, P < 0.001); however, both higher perceived responsibility for child feeding (β = 0.16, P < 0.004) and a more involved and positive attitude toward their role as a father (β = 0.20, P < 0.001) were positively related to how often they ate meals with their child, adjusting for a range of paternal and child covariates, including time spent in paid employment., Conclusions: Fathers from a broad range of educational backgrounds appear willing to participate in research studies on child feeding. Most fathers were engaged and involved in family meals and child feeding. This suggests that fathers, like mothers, should be viewed as potential agents for the implementation of positive feeding practices within the family., (© 2013 John Wiley & Sons Ltd.)

Objective: To describe the quantity and diversity of food and beverage intake in Australian children aged 12-16 months and to determine if the amount and type of milk intake is associated with dietary diversity., Methods: Mothers participating in the NOURISH and South Australian Infant Dietary Intake (SAIDI) studies completed a single 24-hour recall of their child's food intake, when children (n=551) were aged 12-16 months. The relationship between dietary diversity and intake of cow's milk, formula or breastmilk was examined using one-way ANOVA., Results: Dairy and cereal were the most commonly consumed food groups and the greatest contributors to daily energy intake. Most children ate fruit (87%) and vegetables (77%) on the day of the 24-hour recall while 91% ate discretionary items. Half the sample ate less than 30 g of meat/alternatives. A quarter of the children were breastfeeding while formula was consumed by 32% of the sample, providing 29% of daily energy intake. Lower dietary diversity was associated with increased formula intake., Conclusions: The quality of dietary intake in this group of young children is highly variable. Most toddlers were consuming a diverse diet, though almost all ate discretionary items. The amount and type of meat/alternatives consumed was poor., Implications: Health professionals should advise parents to offer iron-rich foods, while limiting discretionary choices and use of formula at an age critical in the development of long-term food preferences., (© 2014 Public Health Association of Australia.)

Background/objectives: Previous research has shown, in predominantly European populations, that dietary patterns are evident early in life. However, little is known about early-life dietary patterns in Australian children. We aimed to describe dietary patterns of Australian toddlers and their associations with socio-demographic characteristics and adiposity., Subjects/methods: Principal component analysis was applied to 3 days (1 × 24-h recall and 2 × 24-h record) data of 14 (n=552)- and 24 (n=493)-month-old children from two Australian studies, NOURISH and South Australian Infant Dietary Intake (SAIDI). Associations with dietary patterns were investigated using regression analyses., Results: Two patterns were identified at both ages. At 14 months, the first pattern was characterised by fruit, grains, vegetables, cheese and nuts/seeds ('14-month core foods') and the second pattern was characterised by white bread, milk, spreads, juice and ice-cream ('basic combination'). Similarly, at 24 months the '24-month core foods' pattern included fruit, vegetables, dairy, nuts/seeds, meat and water, whereas the 'non-core foods' included white bread, spreads, sweetened beverages, snacks, chocolate and processed meat. Lower maternal age and earlier breastfeeding cessation were associated with higher 'basic combination' and 'non-core foods' pattern scores, whereas earlier and later solid introduction were associated with higher 'basic combination' and '24-month core foods' pattern scores, respectively. Patterns were not associated with body mass index (BMI) z-score., Conclusions: Dietary patterns reflecting core and non-core food intake are identifiable in Australian toddlers. These findings support the need to intervene early with parents to promote healthy eating in children and can inform future investigations on the effects of early diet on long-term health.

Objective: To evaluate the fruit and vegetable intakes of Australian adults aged 19-64 years., Methods: Intake data were collected as part of the National Nutrition Survey 1995 representing all Australian States and Territories, including city, metropolitan, rural and remote areas. Dietary intake of 8,891 19-to-64 year-olds was assessed using a structured 24-hour recall. Intake frequency was assessed as the proportion of participants consuming fruit and vegetables on the day prior to interview and variety was assessed as the number of subgroups of fruit and vegetables consumed. Intake levels were compared with the recommendations of the Australian Guide to Healthy Eating (AGHE)., Results: Sixty-two per cent of participants consumed some fruit and 89% consumed some vegetables on the day surveyed. Males were less likely to consume fruit and younger adults less likely to consume fruit and vegetables compared with females and older adults respectively. Variety was primarily low (1 subcategory) for fruit and medium (3-4 subcategories) for vegetables. Thirty-two per cent of adults consumed the minimum two serves of fruit and 30% consumed the minimum five serves of vegetables as recommended by the AGHE. Eleven per cent of adults met the minimum recommendations for both fruit and vegetables., Conclusion: A large proportion of adults have fruit and vegetable intakes below the AGHE minimum recommendations., Implications: A nationally integrated, long-term campaign to increase fruit and vegetable consumption, supported by policy changes to address structural barriers to consumption, is vital to improve fruit and vegetable consumption among adults.

Coronary heart disease is a major disease leading to early morbidity and mortality in the UK. The causes are multifactorial, a combination of modifiable and non-modifiable risk factors. Although recent statistics show a reduction in the coronary heart disease mortality rate, the disease continues to be a major focus in health care, with strategies being developed to improve prevention and treatment. Dietary modification has a role to play in both primary and secondary prevention.

Objective: To evaluate the fruit and vegetable intakes of 2 to 18-year-old Australians., Methods: Intake data were collected as part of the National Nutrition Survey 1995 representing all Australian States and Territories, urban, rural and remote areas. Dietary intake of 3,007, two to 18-year-olds was assessed using a 24-hour structured diet recall method. Intake frequency was assessed as the percentage of participants consuming fruit and vegetables on the surveyed day, and variety was assessed as the number of sub-groups of fruit and vegetables eaten. Intake levels were compared with the recommendations of the Australian Guide to Healthy Eating, the 1993 Goals and Targets for Australia's Health in 2000 and beyond, and intakes of the 1985 National Dietary Survey., Results: One-quarter of children and adolescents did not eat fruit on the day of survey and one fifth did not eat vegetables. Adolescents were less likely to include fruit (65%) than young children (80%) but slightly more adolescents (85%) included vegetables than young children (77%). Less than 50% of all participants (<25% of adolescents) had an adequate fruit intake, and only one-third of children and adolescents met the vegetable intake recommendations., Conclusions: Fruit and vegetable intakes of Australian children and adolescents fall well below recommendations and appear to have declined in the past 10 years., Implications: Strategic approaches involving a broad range of sectors are urgently needed to create a supportive environment for consuming recommended levels of a wide variety of fruit and vegetables.

Purpose: To determine the proportion of Australian adults >65 years with nutrient intakes less than 70% of the current national RDIs and investigate associated differences in both diet quality and quantity., Method: Intake data were collected as part of the National Nutrition Survey 1995 representing all areas of Australia. Dietary intake of 1960 (902 males) adults >65 years was assessed using a structured 24-hour diet recall. Intakes of 12 micronutrients were compared with current Australian recommended dietary intakes (RDIs) and assessed as > RDI, < RDI but > 70% RDI, and < 70% RDI., Results: Intakes of vitamin A, magnesium, potassium and calcium were < 70% RDI in 12-24% males and 14-61% females. In addition 10% and 43% females had low intakes of folate and zinc respectively. None of the participants had intakes of niacin or vitamin C < 70% RDI, and few males had low thiamin intakes. Specific nutrient density and energy intake (kJ/kg) were significantly less in those with intakes < 70% RDI for eight of the 12 nutrients studied., Conclusions: In general the low nutrient intakes reported here can be attributed to diets of poor quality, in terms of low nutrient density, and quantity of food eaten. Age-specific targeted nutrition promotion strategies are required to improve overall health of older Australians.