Hostname: page-component-5cf477f64f-fcbfl Total loading time: 0 Render date: 2025-03-25T21:21:38.597Z Has data issue: false hasContentIssue false
  • English
  • Français

Children’s adherence to a healthy and environmentally sustainable dietary pattern based on the EAT-Lancet recommendations: the role of the family environment

Published online by Cambridge University Press:  06 February 2025

Beatriz Teixeira Open the ORCID record for Beatriz Teixeira [Opens in a new window] ,
Cláudia Afonso  and
Andreia Oliveira
Beatriz Teixeira*
Affiliation:
Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto (Faculty of Nutrition and Food Sciences, University of Porto), Porto, Portugal EPIUnit ITR, Instituto de Saúde Pública da Universidade do Porto, Universidade do Porto, (EPIUnit ITR, Institute of Public Health of the University Porto, University of Porto), Porto, Portugal
Cláudia Afonso
Affiliation:
Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto (Faculty of Nutrition and Food Sciences, University of Porto), Porto, Portugal EPIUnit ITR, Instituto de Saúde Pública da Universidade do Porto, Universidade do Porto, (EPIUnit ITR, Institute of Public Health of the University Porto, University of Porto), Porto, Portugal
Andreia Oliveira
Affiliation:
EPIUnit ITR, Instituto de Saúde Pública da Universidade do Porto, Universidade do Porto, (EPIUnit ITR, Institute of Public Health of the University Porto, University of Porto), Porto, Portugal Faculdade de Medicina, Universidade do Porto (Faculty of Medicine, University of Porto), Porto, Portugal
*
Corresponding author: Beatriz Teixeira; Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

This study aimed to investigate the association between family characteristics and adherence to the EAT-Lancet dietary recommendations in 7-year-old children. This is a prospective birth cohort study with 2125 children from Generation XXI (Porto, Portugal), who provided 3-day food diaries at age 7, used to assess habitual food consumption. At the age of 4, maternal diet was assessed using a Food Frequency Questionnaire, and a diet quality score was calculated (higher scores indicating a better maternal diet), and parental–child feeding practices were assessed with the Child Feeding Questionnaire. Adherence to the EAT-Lancet dietary recommendations was evaluated using the World Index for Sustainability and Health (WISH) at the age of 7 years, previously adapted to paediatric age. Hierarchical linear regression models (consecutive addition of blocks of variables based on a theoretical framework) were employed to evaluate the associations between family characteristics and adherence to the WISH at age 7 (β regression coefficients and the respective 95 % confidence intervals (95 % CI)). Higher maternal age and education at child’s birth were associated with increased adherence to the WISH at age 7 (β = 0·018, 95 % CI 0·005, 0·031; β = 0·038, 95 % CI 0·024, 0·053, respectively). A better maternal diet quality and using more restrictive practices on child’s diet, at 4 years old, were both associated with higher scoring in the WISH at 7 years old (β = 0·033, 95 % CI 0·018, 0·049; β = 0·067, 95 % CI 0·009, 0·125, respectively). Early maternal sociodemographic and diet quality play a significant role in influencing the adherence to a healthy and environmentally sustainable dietary pattern at school-age.

Keywords

maternal characteristicsfood sustainabilityhealthy dietscohort studieschildhood
Type
Research Article
Information
British Journal of Nutrition , First View , pp. 1 - 10
Check for updates
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Nutrition Society

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Craigie, AM, Lake, AA, Kelly, SA, et al. (2011) Tracking of obesity-related behaviours from childhood to adulthood: a systematic review. Maturitas 70, 266–284. https://doi.org/10.1016/j.maturitas.2011.08.005 Google Scholar
Williams, J, Buoncristiano, M, Nardone, P, et al. (2020) A snapshot of European Children’s eating habits: results from the fourth round of the WHO European Childhood Obesity Surveillance Initiative (COSI). Nutrients 12, 2481. https://doi.org/10.3390/nu12082481 Google Scholar
Stehfest, E, Bouwman, L, van Vuuren, DP, et al. (2009) Climate benefits of changing diet. Clim Change 95, 83–102. https://doi.org/10.1007/s10584-008-9534-6 Google Scholar
Food Agriculture Organization (2012) Sustainable Diets and Biodiversity Directions and Solutions for Policy, Research and Action. Rome: FAO Bioversity International. E-ISBN 978–92–5–107288–2.Google Scholar
IOM (Institute of Medicine) (2014) Sustainable Diets: Food for Healthy People and a Healthy Planet: Workshop Summary. Washington, DC: The National Academies Press. ISBN-13:978–0–309–29667–0Google Scholar
Joseph, H & Clancy, K (2015) Dietary Guidelines and Sustainable Diets: Pathways to Progress. Advancing Health and Well-Being in Food Systems: Strategic Opportunities for Funders. Toronto: Global Alliance for the Future of Food. pp. 88–107.Google Scholar
Teixeira, B, Afonso, C, Rodrigues, S, et al. (2021) Healthy and sustainable dietary patterns in children and adolescents: a systematic review. Adv Nutr 13, 1144–1185. https://doi.org/10.1093/advances/nmab148 Google Scholar
Willett, W, Rockström, J, Loken, B, et al. (2019) Food in the Anthropocene: the EAT Lancet Commission on healthy diets from sustainable food systems. Lancet 393, 447–492. ––https://doi.org/10.1016/S0140–6736(18)31788–4 Google Scholar
Trijsburg, L, Talsma, EF, Crispim, SP, et al. (2020) Method for the development of WISH, a globally applicable index for healthy diets from sustainable food systems. Nutrients 13, 93. https://doi.org/10.3390/nu13010093 Google Scholar
Savage, JS, Fisher, JO & Birch, LL (2007) Parental influence on eating behavior: conception to adolescence. J Law Med Ethics 35, 22–34. https://doi.org/10.1111/j.1748-720X.2007.00111.x Google Scholar
Ventura, AK & Worobey, J (2013) Early influences on the development of food preferences. Curr Biol 23, R401–408. https://doi.org/10.1016/j.cub.2013.02.037 Google Scholar
Biagi, C, Nunzio, MD, Bordoni, A, et al. (2019) Effect of adherence to Mediterranean Diet during pregnancy on children’s health: a systematic review. Nutrients 11, 997. https://doi.org/10.3390/nu11050997 Google Scholar
Yee, AZ, Lwin, MO & Ho, SS (2017) The influence of parental practices on child promotive and preventive food consumption behaviors: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 14, 47. –––https://doi.org/10.1186/s12966-017-0501-3 Google Scholar
Vidhyashree, MD, Raveendran, SR, Priya, RL, et al. (2015) A review of family and social determinants of children’s eating patterns and diet quality. Res J Pharm Biol Chem Sci 6, 1196–1201.Google Scholar
Favara, G, Maugeri, A, San Lio, RM, et al. (2024) Exploring gene-diet interactions for mother-child health: a systematic review of epidemiological studies. Nutrients 16, 994. https://doi.org/10.3390/nu16070994 Google Scholar
Scaglioni, S, De Cosmi, V, Ciappolino, V, et al. (2018) Factors influencing children’s eating behaviours. Nutrients 10, 706. https://doi.org/10.3390/nu10060706 Google Scholar
Larsen, PS, Kamper-Jørgensen, M, Adamson, A, et al. (2013) Pregnancy and birth cohort resources in Europe: a large opportunity for aetiological child health research. Paediatr Perinat Epidemiol 27, 393–414. https://doi.org/10.1111/ppe.12060 Google Scholar
Alves, E, Correia, S, Barros, H, et al. (2012) Prevalence of self-reported cardiovascular risk factors in Portuguese women: a survey after delivery. Int J Public Health 57, 837–847. –––https://doi.org/10.1007/s00038-012-0340-6 Google Scholar
Husted, JA, Cook, RJ, Farewell, VT, et al. (2000) Methods for assessing responsiveness: a critical review and recommendations. J Clin Epidemiol 53, 459–468. https://doi.org/10.1016/s0895-4356(99)00206-1 Google Scholar
Lopes, C, Aro, A, Azevedo, A, et al. (2007) Intake and adipose tissue composition of fatty acids and risk of myocardial infarction in a male Portuguese community sample. J Am Diet Assoc 107, 276–286. https://doi.org/10.1016/j.jada.2006.11.008 Google Scholar
Durão, C, Severo, M, Oliveira, A, et al. (2017) Association of maternal characteristics and behaviours with 4-year-old children’s dietary patterns. Matern Child Nutr 13, e12278. https://doi.org/10.1111/mcn.12278 Google Scholar
Birch, LL, Fisher, JO, Grimm-Thomas, K, et al. (2001) Confirmatory factor analysis of the Child Feeding Questionnaire: a measure of parental attitudes, beliefs and practices about child feeding and obesity proneness. Appetite 36, 201–210. https://doi.org/10.1006/appe.2001.0398 Google Scholar
Ogden, J, Reynolds, R & Smith, A (2006) Expanding the concept of parental control: a role for overt and covert control in children’s snacking behaviour? Appetite 47, 100–106. https://doi.org/10.1016/j.appet.2006.03.330 Google Scholar
Real, H, Oliveira, A, Severo, M, et al. (2014) Combination and adaptation of two tools to assess parental feeding practices in pre-school children. Eating Behav 15, 383–387. https://doi.org/10.1016/j.eatbeh.2014.04.009 Google Scholar
Durão, C, Andreozzi, V, Oliveira, A, et al. (2015) Maternal child-feeding practices and dietary inadequacy of 4-year-old children. Appetite 92, 15–23. https://doi.org/10.1016/j.appet.2015.04.067 Google Scholar
Moreira, I, Severo, M, Oliveira, A, et al. (2016) Social and health behavioural determinants of maternal child-feeding patterns in preschool-aged children. Matern Child Nutr 12, 314–325. https://doi.org/10.1111/mcn.12132 Google Scholar
Gibson, R (2005) Principles of Nutritional Assessment, 2nd ed. Oxford; New York: Oxford University Press. ISBN: 9780195171693.Google Scholar
Onis, MD, Onyango, AW, Borghi, E, et al. (2007) Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 85, 660–667. https://doi.org/10.2471/blt.07.043497 Google Scholar
Moreira, T, Severo, M, Oliveira, A, et al. (2015) Eating out of home and dietary adequacy in preschool children. Br J Nutr 114, 297–305. https://doi.org/10.1017/S0007114515001713 Google Scholar
Goios, AC, Severo, M, Lloyd, AJ, et al. (2020) Validation of a new software eAT24 used to assess dietary intake in the adult Portuguese population. Public Health Nutr 23, 3093–3103. https://doi.org/10.1017/S1368980020001044 Google Scholar
European Food Safety Authority (2011) Report on the development of a food classification and description system for exposure assessment and guidance on its implementation and use. EFSA J 9, 2489. https://doi.org/10.2903/j.efsa.2011.2489 Google Scholar
Lopes, C, Torres, D, Oliveira, A, et al. (2018) National Food, Nutrition, and Physical Activity Survey of the Portuguese General Population (2015–2016): protocol for design and development. JMIR Res Protocols 7, e42. https://doi.org/10.2196/resprot.8990 Google Scholar
Teixeira, B, Afonso, C, Severo, M, et al. (2024) Exploring dietary patterns and their association with environmental sustainability and body mass index in children and adolescents: insights from the National Food, Nutrition and Physical Activity Survey 2015–2016. Sci Total Environ 945, 174051. https://doi.org/10.1016/j.scitotenv.2024.174051 Google Scholar
Victora, CG, Huttly, SR, Fuchs, SC, et al. (1997) The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. Int J Epidemiol 26, 224–227. https://doi.org/10.1093/ije/26.1.224 Google Scholar
World Health Organization (2010) A Conceptual Framework for Action on the Social Determinants of Health. World Health Organization. https://appswhoint/iris/handle/10665/44489 (accessed October 2023).Google Scholar
UNICEF (1990) Strategy for improved nutrition of children and women in developing countries. Indian J Pediatr 58, 13–24. https://doi.org/10.1007/BF02810402 Google Scholar
Wen, X, Kong, KL, Eiden, RD, et al. (2014) Sociodemographic differences and infant dietary patterns. Pediatrics 134, e1387–1398. –https://doi.org/10.1542/peds.2014-1045 Google Scholar
Suzuki, K, Ando, D, Sato, M, et al. (2009) The association between maternal smoking during pregnancy and childhood obesity persists to the age of 9–10 years. J Epidemiol 19, 136–142. https://doi.org/10.2188/jea.JE20081012 Google Scholar
Nagelkerke, NJD (1991) A note on a general definition of the coefficient of determination. Biometrika 78, 691–692. https://doi.org/10.1093/biomet/78.3.691 Google Scholar
Mannino, A, Sarapis, K & Moschonis, G (2022) The effect of maternal overweight and obesity pre-pregnancy and during childhood in the development of obesity in children and adolescents: a systematic literature review. Nutrients 14, 5125. https://doi.org/10.3390/nu14235125 Google Scholar
Liberali, R, Kupek, E & Assis, MAA (2020) Dietary patterns and childhood obesity risk: a systematic review. Child Obes 16, 70–85. https://doi.org/10.1089/chi.2019.0059 Google Scholar
Suzuki, K, Sato, M, Ando, D, et al. (2013) Differences in the effect of maternal smoking during pregnancy for childhood overweight before and after 5 years of age. J Obstet Gynaecol Res 39, 914–921. https://doi.org/10.1111/jog.12025 Google Scholar
Dugas, C, Perron, J, Kearney, M, et al. (2017) Postnatal prevention of childhood obesity in offspring prenatally exposed to gestational diabetes mellitus: where are we now. Obes Facts 10, 396–406. https://doi.org/10.1159/000477407 Google Scholar
Juton, C, Lerin, C, Homs, C, et al. (2021) Prospective associations between maternal and child diet quality and sedentary behaviors. Nutrients 13, 1713. https://doi.org/10.3390/nu13051713 Google Scholar
Johnson, SL (2016) Developmental and environmental influences on young children’s vegetable preferences and consumption. Adv Nutr 7, 220s–231s. https://doi.org/10.3945/an.115.008706 Google Scholar
Barbosa, C, Lopes, C, Costa, A, et al. (2023) Parental child-feeding practices at 4 years of age are associated with dietary patterns of 7-year-olds. J Hum Nutr Diet 36, 1339–1348. https://doi.org/10.1111/jhn.13151 Google Scholar
Gubbels, JS, Kremers, SP, Stafleu, A, et al. (2009) Diet-related restrictive parenting practices. Impact on dietary intake of 2-year–old children and interactions with child characteristics. Appetite 52, 423–429. https://doi.org/10.1016/j.appet.2008.12.002 Google Scholar
Gubbels, JS, Kremers, SP, Stafleu, A, et al. (2011) Association between parenting practices and children’s dietary intake, activity behavior and development of body mass index: the KOALA Birth Cohort Study. Int J Behav Nutr Phys Act 8, 18. https://doi.org/10.1186/1479-5868-8-18 Google Scholar
Quah, PL, Ng, JC, Fries, LR, et al. (2019) Longitudinal analysis between maternal feeding practices and Body Mass Index (BMI): a study in Asian Singaporean preschoolers. Front Nutr 6, 32. https://doi.org/10.3389/fnut.2019.00032 Google Scholar
Beckers, D, Karssen, LT, Vink, JM, et al. (2021) Food parenting practices and children’s weight outcomes: a systematic review of prospective studies. Appetite 158, 105010. https://doi.org/10.1016/j.appet.2020.105010 Google Scholar
Loth, KA, MacLehose, RF, Fulkerson, JA, et al. (2014) Are food restriction and pressure-to-eat parenting practices associated with adolescent disordered eating behaviors? Int J Eat Disord 47, 310–314. https://doi.org/10.1002/eat.22189 Google Scholar
Instituto Nacional de Estatística (2011) Maternal Age at Birth. Instituto Nacional de Estatística. https://wwwinept/xportal/xmain?xpid=INE&xpgid=ine_indicadores&indOcorrCod=0008219&contexto=bd&selTab=tab2&xlang=pt (accessed July 2023).Google Scholar
Instituto Nacional de Estatística (2011) Rate of Higher Education Enrollment among Women Aged between 25 and 34 years. https://wwwinept/xportal/xmain?xpid=INE%26xpgid=ine_indicadores%26contecto=pi%26indOcorrCod=0006400%26selTab=tab0 (accessed July 2023).Google Scholar
Pinto, E, Severo, M, Correia, S, et al. (2010) Validity and reproducibility of a semi-quantitative food frequency questionnaire for use among Portuguese pregnant women. Matern Child Nutr 6, 105–119. –https://doi.org/10.1111/j.1740-8709.2009.00199.x Google Scholar
Kimberlin, CL & Winterstein, AG (2008) Validity and reliability of measurement instruments used in research. Am J Health Syst Pharm 65, 2276–2284. https://doi.org/10.2146/ajhp070364 Google Scholar
Cohen, JFW, Hecht, AA, McLoughlin, GM, et al. (2021) Universal school meals and associations with student participation, attendance, academic performance, diet quality, food security, and body mass index: a systematic review. Nutrients 13, 911. https://doi.org/10.3390/nu13030911 Google Scholar
Burrows, TL, Martin, RJ & Collins, CE (2010) A systematic review of the validity of dietary assessment methods in children when compared with the method of doubly labeled water. J Am Diet Assoc 110, 1501–1510. https://doi.org/10.1016/j.jada.2010.07.008 Google Scholar
Supplementary material: File

Teixeira et al. supplementary material

Teixeira et al. supplementary material
Download Teixeira et al. supplementary material(File)
File 43.6 KB