Objective: To compare, specifically by age group, proxy-reported food group estimates obtained from the food frequency section of the Children's Eating Habits questionnaire (CEHQ-FFQ) against the estimates of two non-consecutive 24h dietary recalls (24-HDR). Design: Estimates of food group intakes assessed via the forty-three-food-group CEHQ-FFQ were compared with those obtained by a computerized 24-HDR. Agreement on frequencies of intakes (equal to the number of portions per recall period) between the two instruments was examined using crude and de-attenuated Pearson's correlation coefficients, cross-classification analyses, weighted kappa statistics (kappa(w)) and Bland-Altman analysis. Setting: Kindergartens/schools from eight European countries participating in the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS) Study cross-sectional survey (2007-2008). Subjects: Children aged 2-9 years (n 2508, 50.4% boys). Results: The CEHQ-FFQ provided higher intake estimates for most of the food groups than the 24-HDR. De-attenuated Pearson correlation coefficients ranged from 0.01 (sweetened fruit) to 0.48 (sweetened milk) in children aged 2-<6 years (mean = 0.25) and from 0.01 (milled cereal) to 0.44 (water) in children aged 6-9 years (mean = 0.23). An average of 32 % and 31 % of food group intakes were assigned to the same quartile in younger and older children, respectively, and classification into extreme opposite quartiles was <= 12 % for all food groups in both age groups. Mean kappa(w) was 0.20 for 2-<6-year-olds and 0.17 for 6-9-year-olds. Conclusions: The strength of association estimates assessed by the CEHQ-FFQ and the 24-HDR varied by food group and by age group. Observed level of agreement and CEHQ-FFQ ability to rank children according to intakes of food groups were considered to be low.
Exploring changes in children's diet over time and the relationship between these changes and socio-economic status (SES) may help to understand the impact of social inequalities on dietary patterns. The aim of the present study was to describe dietary patterns by applying a cluster analysis to 9301 children participating in the baseline (2-9 years old) and follow-up (4-11 years old) surveys of the Identification and Prevention of Dietary-and Lifestyle-induced Health Effects in Children and Infants Study, and to describe the cluster memberships of these children over time and their association with SES. We applied the K-means clustering algorithm based on the similarities between the relative frequencies of consumption of forty-two food items. The following three consistent clusters were obtained at baseline and follow-up: processed (higher frequency of consumption of snacks and fast food); sweet (higher frequency of consumption of sweet foods and sweetened drinks); healthy (higher frequency of consumption of fruits, vegetables and wholemeal products). Children with higher-educated mothers and fathers and the highest household income were more likely to be allocated to the healthy cluster at baseline and follow-up and less likely to be allocated to the sweet cluster. Migrants were more likely to be allocated to the processed cluster at baseline and follow-up. Applying the cluster analysis to derive dietary patterns at the two time points allowed us to identify groups of children from a lower socio-economic background presenting persistently unhealthier dietary profiles. This finding reflects the need for healthy eating interventions specifically targeting children from lower socio-economic backgrounds.
Objective: To assess the relationship between parental education level and the consumption frequency of obesity-related foods in European children. Design: The analysis was based on data from the cross-sectional baseline survey of a prospective cohort study. The effects of parental education on food consumption were explored using analysis of covariance and logistic regression. Setting: Primary schools and pre-schools of selected regions in Italy, Estonia, Cyprus, Belgium, Sweden, Hungary, Germany and Spain. Subjects: Participants (n 14 426) of the IDEFICS baseline cohort study aged 2 to 9 years. Results: Parental education level affected the intake of obesity-related foods in children. Children in the low and medium parental education level groups had lower odds of more frequently eating low-sugar and low-fat foods (vegetables, fruits, pasta/noodles/rice and wholemeal bread) and higher odds of more frequently eating high-sugar and high-fat foods (fried potatoes, fruits with sugar and nuts, snacks/desserts and sugared beverages; P<0.001). The largest odds ratio differences were found in the low category (reference category: high) for vegetables (OR=0.56; 95% CI 0.47, 0.65), fruits (OR=0.56; 95% CI 0.48, 0.65), fruits with sugar and nuts (OR=2.23; 95% CI 1.92, 2.59) and sugared beverages (OR=2.01; 95% CI 1.77, 2.37). Conclusions: Low parental education level was associated with intakes of sugar-rich and fatty foods among children, while high parental education level was associated with intakes of low-sugar and low-fat foods. These findings should be taken into account in public health interventions, with more targeted policies aiming at an improvement of children's diet.