Nurturing a Healthy Generation of Children: Research Gaps and Opportunities. Группа авторов

a food’s taste, texture, and appearance, and this may help identifying a child’s preferred variants. Conversely, coercive feeding practices such as the use of pressure to eat or using food as rewards should be avoided, as these can create negative associations with the food or meals and lead to food refusals. Instead, caregivers can model eating and enjoying the food. Nonfood rewards, such as praise or stickers, can also be used to encourage children to taste a food without negative outcomes. The presentation of casual reports from social media highlighted how food refusals may be an important matter of concern for parents. Finally, useful tips to avoid or cope with food pickiness were presented, which could apply in a variety of cultural contexts.

      The second session focused on What Children Eat . The session compared and contrasted what children eat in both advanced and developing nations. Unlike other regions of the world, economic growth in Asia appears to have not kept pace with the eradication of undernutrition. Christiani Jeyakumar Henry articulated the etiology and causes of undernutrition in Asia and other emerging nations. He articulated that undernutrition was due to the poor access to weaning foods with adequate energy and sufficient palatability. Using human growth during the first 6 months of life, he illustrated that, in many instances, it was not the inadequate protein content in the diet that restricted growth but the poor energy density of the meal. The presentation also focused on the provision of simple diet formulations to meet the energy and palatability of infant foods.

      In their presentation, Ciarán Forde, Anna Fogel, and Keri McCrickerd focused on how early life risk factors during the first 1,000 days of life can influence the development of childhood obesity. They focused their presentation on emphasizing the major role that caregivers and the food environment can play in the behavioral transition from the early life risk to the development of obesity. Several examples were highlighted. For example, children who ate their meal at a faster rate (g/min) consumed more energy than those that ate at a slower pace. How children’s food intake can be influenced by the availability of palatable foods was also further emphasized. The authors concluded that a holistic intervention was necessary to combat the escalating prevalence of childhood obesity.

      Alison L. Eldridge described the history and background to the FITS (Feeding Infants and Toddlers Study) and KNHS (Kids Nutrition and Health Study) program. The FITS/KNHS are cross-sectional surveys designed to investigate nutrient intakes and eating patterns in infants and children. On most occasions, data from national surveys were used for the analysis. These surveys have been conducted in Australia, China, Mexico, the Philippines, Russia, and the USA. Country presentations on the FITS/KNHS program were made for the following countries: China (Danton Wang), Mexico (Salvador Villalpando-Carrion and Alison L. Eldridge), Philippines (Imelda Angeles-Agdeppa et al.), and the USA (Regan Bailey et al.).

      Norimah A. Karim and Nurliyana Abdul Razak drew on 2 nationwide studies conducted in Malaysia, SEANUTS Malaysia (the Southeast Asian Nutrition Survey) and the MyBreakfast Study, to make their presentation. They demonstrated that 13–17% of children aged between 6 and 12 years were either overweight or obese. A majority of children attained the Malaysian recommended nutrient intake (RNI) for energy and protein. However, RNI for calcium and vitamin D was not met by more than half of the children. They also showed that only 13.4 and 9.5% met the Malaysian Dietary Guideline (MDG) for fruit and vegetable intake per day, respectively. The MyBreakfast Study showed that approximately 18% of the children consumed ready-to-eat cereal at breakfast. Milk, dairy products, and fruits and vegetables were not daily eaten; only 1 in 20 children met the MDG for milk while 1 in 10 achieved the MDG for fruits and vegetables. It was concluded that there is considerable scope for improving the fruit/vegetable and milk consumption in this age group.

      The third and final session focused on revisiting the Importance of Breakfast for Children’s Health and Development. Breakfast has long been promoted as the most important meal of the day. However, the lack of standard definitions of breakfast, breakfast consumers, and breakfast skippers, and the lack of a description of how the meal is important, especially compared with other meals, have hampered the ability to confirm this long-held belief. All of the inconsistencies in these definitions can affect how researchers, nutrition educators, and policy makers interpret data and make recommendations. Mike Gibney and Irina Uzhova’s presentation focused on dietary guidelines for breakfast intakes. Whilst there is consistent evidence on the nutritional benefits of a regular breakfast, there are few guidelines to help policy makers issue specific targets on optimal nutrient intake at breakfast or selection of foods to possibly include in the development of a nutritious breakfast. However, there is a lack of consistency in the definition of recommended food categories. Collectively, government recommendations that are currently being used highlight the need for a more scientifically rigorous approach to recommend optimal food and nutrient intakes at breakfast. Cluster analysis is one approach in determining optimal nutrient and food intake. However, there are major limitations in setting out gradations in optimal nutrient intakes for breakfast. Ultimately, meal-based advice may become the basic building block for digitally based personalized dietary analysis and guidelines.

      Leonidas Karagounis discussed the importance of dietary protein at breakfast in childhood. Proteins are the major functional and structural components of all the cells of the body and participate in virtually all biological processes occurring in the body. Dietary protein is essential in child nutrition because children are in a state of ongoing growth and development. In terms of nutrient availability, current research supports the concept of nutrient timing intake. For example, the diurnal turnover of whole body protein which in turn impacts whole body protein balance may to some extent be dictated by specific need states where macronutrient intake, such as proteins and carbohydrates, may be imperative to support healthy physical growth and development. Specifically, a typically observed overnight fast in children has recently been shown to result in a physiological state of increased catabolism as measured by increased rates of whole body protein breakdown. It is, therefore, important that specific amounts of macronutrients be consumed at breakfast in order to attenuate such losses in whole body protein and, therefore, to provide an environment that supports healthy physical growth and development.

      Theresa A. Nicklas presented 3 studies looking at breakfast skipping and body weight, breakfast patterns, and breakfast cognition. Twenty percent of US children and 32% of US adolescents skipped breakfast. Breakfast skippers had the lowest mean adequacy ratio for micronutrients compared to those who consumed breakfast. Moreover, breakfast skippers had the highest body mass index. They acknowledged a limitation of this study, which, among other similar studies, has been based on the incorrect premise that breakfast meals are homogeneous. A separate study found 12 distinct breakfast patterns in a US nationally representative sample of children. Results suggest that simply consuming breakfast was not associated with better diet quality when compared to breakfast skippers. More importantly, the specific foods/food groups consumed at breakfast influenced nutrient intake and overall diet quality. Thus, the nutrient profiles varied considerably depending on the type of breakfast pattern. The association of the breakfast patterns was not consistently associated with lower body mass index as seen in breakfast skippers. The third study was designed to address inconsistencies observed in previous studies by examining the short-term effects of breakfast consumption and fasting on neuropsychological functioning using a robust set of psychological measures of multiple domains of cognitive functioning in healthy, low- and medium-income school-age children. Breakfast consumption had no effect on neuropsychological functioning in children. More studies are needed regarding habitual breakfast consumption and its effect on neuropsychological functioning in healthy children and those with marginal or subnormal nutritional status.

      The session was concluded by Sandra I. Sünram-Lea, who reviewed the impact of breakfast-based glycemic response on cognition in children. The data suggest that a more stable blood glucose profile which avoids greater peaks and troughs in circulating glucose is associated with better cognitive function across the morning. Although the evidence to date is promising, it is currently insufficient to allow firm and evidence-based recommendations. What limits our ability to draw conclusions from previous findings is that the studies have differed widely with respect to subject characteristics, cognitive tests used, and timing of cognitive assessment. In addition, few studies have profiled glycemic response in children specifically.

      Christiani J. Henry

      Theresa A. Nicklas

      Sophie