Search Results (439)

Background/Objectives: The aim was to identify patterns of autonomic and neuroendocrine reactivity to an immersive virtual reality (VR) social-emotional stressor and explore their associations with perceived stress and eating behavior. Methods: This one-group pretest–posttest study included 30 children and adolescents with obesity (15 boys and 15 girls), aged 8 to 17 years. The VR protocol consisted of two consecutive phases: a 5 min relaxation phase using the Forest application and a 5 min stimulation phase using a cognitively engaging VR game designed to elicit social-emotional stress. Physiological responses were measured using heart rate variability (HRV) indices and salivary stress biomarkers, including cortisol and alpha amylase. Subjective stress and eating responses were assessed via visual analogue scales (VAS) administered immediately post-exposure. The Three-Factor Eating Questionnaire (TFEQ-R21C) was used to evaluate cognitive restraint (CR), uncontrolled eating (UE), and emotional eating (EE). Results: The cortisol reactivity was blunted and may reflect both the attenuated HPA axis responsiveness characteristic of pediatric obesity and the moderate psychological challenge of the VR stressor used in this study. Two distinct autonomic response patterns were identified via exploratory factor analysis: (1) parasympathetic reactivity, associated with increased RMSSD and SDNN and decreased LF/HF, and (2) sympathetic activation, associated with increased heart rate and alpha-amylase levels and reduced RR intervals. Parasympathetic reactivity was correlated with lower perceived stress and anxiety, but also paradoxically with higher uncontrolled eating (UE). In contrast, sympathetic activation was associated with greater cognitive restraint (CR) and higher anxiety ratings. Conclusions: This study demonstrates that immersive VR game exposure elicits measurable autonomic and subjective stress responses in children and adolescents with obesity, and that individual differences in physiological reactivity are relevantly associated with eating behavior traits. The findings suggest that parasympathetic and sympathetic profiles may represent distinct behavioral patterns with implications for targeted intervention. Full article

Background/Objectives: Pseudohypoparathyroidism (PHP) is a group of genetic disorders characterized by end-organ resistance to multiple hormones, short stature, brachydactyly, subcutaneous ossifications, obesity, and developmental delays. The tissue specific imprinting of GNAS in the hypothalamus may lead to different eating behavior phenotypes in maternally inherited (PHP1A, PHP1B) vs. paternally inherited (PPHP) variants. In this exploratory study, we aimed to evaluate differences in eating behaviors in a cohort of patients with PHP1A, PPHP and PHP1B. Methods: Assessments included caregiver-reported measures (hyperphagia questionnaire, children’s eating behavior questionnaire, child feeding questionnaire) and self-reported measures (three factor eating behavior questionnaire). Results: A total of 58 patients with PHP1A, 13 patients with PPHP and 10 patients with PHP1B contributed data, along with 124 obese pediatric controls. An increased risk of obesity was found in PHP1A vs. PPHP (adult body mass index (BMI) 39.8 ± 8.7 vs. 30.2 ± 7.4 kg/m², p = 0.03). Parents reported significantly earlier onset of interest in food in children with PHP1A (2.0 ± 2.3 years) and PHP1B (1.1 ± 1.3 years) compared with controls (5.2 ± 3.2 years, p < 0.001). Measures of hyperphagia, satiety and other feeding behaviors were all similar to controls. The highest hyperphagia questionnaire scores were seen prior to adolescence. In a multi-year, longitudinal assessment of 11 pediatric patients with PHP1A, hyperphagia scores were stable and 25% showed an improvement in symptoms. Conclusion: Patients with PHP1A/1B may have hyperphagia symptoms from a young age but they do not worsen over time. Patients may overeat when allowed access to food, but do not usually have disruptive food seeking behaviors. Early diagnosis can give clinicians the opportunity to provide anticipatory diagnosis on the increased risk of obesity in PHP1A/1B and need for scheduled meals and controlled portions. Further studies with larger cohorts are needed to confirm these findings. Full article

Background: Skipping breakfast, a prevalent issue among children and adolescents, has been reported to be associated with academic performance and long-term health. However, less attention has been given to the types of breakfast foods consumed. Therefore, our study aims to investigate the association between breakfast variety and dietary knowledge, attitude, and practice (KAP) among preadolescents. Methods: The study included 1449 students in grades 4–6 from Zhongshan city, Guangdong province. Data were collected through face-to-face field investigation using a validated questionnaire. The questionnaire encompassed sociodemographic characteristics, as well as dietary KAP. Results: Among all participants, 1315 reported consuming breakfast daily. Dietary diversity varied significantly: 8.8% consumed only 1 type of food, 52.9% consumed 2–4 types, and 38.3% consumed ≥5 types. Students who consumed a greater variety of breakfast foods exhibited more favorable dietary and lifestyle patterns. Specifically, those who consumed ≥5 types of food showed statistically significant associations with healthier practices, including reduced intake of sugary beverages and night snacks, stronger adherence to dietary guidelines, more positive attitudes toward improving eating habits, longer sleep durations, increased participation in meal preparation, greater dish variety in meals, and higher engagement in daily physical activity. Conclusions: Breakfast variety was associated with KAP, particularly when breakfast types ≥ 5, providing more sufficient and favorable evidence for breakfast consumption. Full article

Background/Objectives: Food allergy (FA) is a growing concern in pediatric care, requiring effective avoidance strategies and timely emergency responses. The role of caregivers is central to the daily management of FA. This study aimed to assess parental knowledge, preparedness, and behaviors regarding pediatric FA management, focusing on both prevention and emergency readiness. Methods: A cross-sectional survey was conducted from December 2024 to April 2025 through the SurveyMonkey^® platform, promoted by the Italian Society of Pediatric Allergology and Immunology (SIAIP). The anonymous, structured questionnaire was distributed online and in two Italian university hospitals. A total of 129 fully completed responses from caregivers of children with FA were analyzed. The survey explored self-perceived knowledge, symptom recognition, preventive actions, emergency preparedness, and communication practices. Results: Only 9.3% of parents considered themselves “very informed,” while 54.3% reported limited or no knowledge. Just 16.0% recognized all symptoms of an allergic reaction, and only 24.0% could distinguish mild reactions from anaphylaxis. Notably, 67.4% reported not knowing how to respond to anaphylaxis, and 83.7% did not possess an epinephrine auto-injector. Preventive measures at home were inconsistently applied, and 41.1% took no precautions when eating out. Communication with external caregivers was often informal or absent. Only 33% updated physicians regularly. Conclusions: The findings reveal significant gaps in parental preparedness and highlight critical areas for educational intervention. Enhanced caregiver training, standardized communication protocols, and improved clinical follow-up are essential to strengthen pediatric FA management and safety. Full article

Background/Objectives: Screen-related parenting practices (e.g., restriction, coviewing) influence the way children use screen devices. Although children start using screen devices (e.g., televisions [TV], tablets) in the first few years of life, rigorously developed measures of screen-related parenting practices for parents of toddlers do not exist. The objective of this study was to develop culturally and contextually relevant survey measures of screen-related parenting practices for use in Mexican American families with toddlers. Methods: Measures were developed using an exploratory sequential mixed methods (qualitative → quantitative) approach. Mexican American mothers of toddlers (15–26 months of age) participated in semi-structured interviews. Using the interview findings, domains of parenting practices across screen device types were identified, and survey items were developed. Items were administered by phone to 384 Mexican American mothers. Analyses included evaluation of the factor structure and psychometric properties of nine domains of parenting practices and evaluations of correlations between each scale and demographic characteristics. Results: Factor analyses supported a one-factor solution for each parenting practice as follows: Restrict TV Time (8 items), Coview TV (10 items), Behavioral Regulation with TV (12 items), Restrict Mobile Device Time (8 items); Coview Mobile Devices (10 items); Behavioral Regulation with Mobile Devices (16 items), Restrict Screen Content (8 items), Allow Screen Use Around Sleep (6 items), and Allow Screen Use While Eating (6 items). The reliabilities were acceptable (Cronbach’s alphas > 0.80). Hispanic acculturation, maternal age, and child age were correlated with many of the scales of parenting practices. Conclusions: The measures developed in this study offer a way to evaluate the use and impact of screen-related parenting practices in Mexican American families with toddlers. The use of these measures will enable investigators to identify relationships among parenting practices, screen use, and child well-being, which could inform the design of early childhood interventions promoting healthy screen use in this population. Full article

Background/Objectives: Early childhood is a critical window of development, which is influenced by early life exposures including breastfeeding. Observational and preclinical studies have linked human milk oligosaccharides (HMOs) with neurocognitive development. However, less attention has focused on behavioral outcomes including temperament and eating behaviors. Herein, we investigated the associations between HMO consumption and child temperament and child eating behaviors through four years of age. Methods: Participants were drawn from the STRONG Kids 2 cohort. Human milk was collected at 6 weeks postpartum, and HMO relative abundances were determined by HPLC-MS. Using validated questionnaires, child temperament was assessed at 3, 18, and 48 months of age, and child eating behaviors were measured at 12, 18, 24, 36, and 48 months of age. After adjusting for covariates, multiple linear regressions were carried out to assess the relationship between HMOs and the outcome measures. Results: The HMO profile of mothers showed two distinct clusters explained by maternal secretor status. Significant associations between HMO and surgency were only found in the full cohort and secretors, while more associations between HMO and negative affectivity were observed in non-secretors. A significant number of associations was observed between HMOs and child eating behaviors in full cohort, secretors, and non-secretors. HMO diversity, total fucosylation, and total sialylation were positively associated with food responsiveness, while neutral HMOs presented negative associations. However, these associations with food responsiveness were not observed in non-secretors. Conclusions: HMO profiles were associated with behavioral outcomes in the children, with variations by child age and maternal secretor status, highlighting the potential role of HMOs within the broader context of maternal and postnatal influences. Full article

Background: This study investigates the influence of sex, age, and their interaction on health behaviors, perceived physical fitness, and attitudes toward physical activity and eating among schoolchildren. Methods: A cross-sectional analysis was conducted on 1027 students aged 8–12 years from 15 primary schools in Lleida. Participants completed the PAQ-A for physical activity, the IFIS for perceived physical fitness, the AATPA for attitudes toward physical activity, and the AATE for attitudes toward eating. Data were analyzed using regression models to assess the effects of sex, age, and their interaction. Results: Males reported higher physical activity levels and more positive attitudes toward physical activity than females (p < 0.05). Perceived physical fitness was also greater among males (p < 0.05). Age was positively associated with physical activity and attitudes toward healthy eating, with older children reporting more favorable outcomes (p < 0.01). Significant interaction effects between sex and age were observed for physical activity levels and attitudes toward eating, indicating demographic-specific trends. Conclusions: This study highlights significant sex and age differences in children’s health behaviors and attitudes. These findings underscore the need for gender-sensitive and age-appropriate interventions to promote healthier lifestyles among schoolchildren. Future research should explore longitudinal designs to confirm these relationships over time. Full article

Background/Objectives: This study assesses the prevalence of diabulimia in Greek children and adolescents with Type 1 Diabetes Mellitus (T1DM) by using the Diabetes Eating Problem Survey—Revised (DEPS-R) questionnaire and addresses a gap in the literature on eating disorders (EDs) and disordered eating behaviors (DEBs) in this population. The DEPS-R threshold score of ≥20, although originally established in international studies, has also been applied in Greek adult validation studies. However, it has not yet been formally validated in Greek youth. Methods: Participants aged 9–18 years, diagnosed with T1DM a minimum of one year before the start of the study, were recruited from three pediatric departments in Thessaloniki and were asked to complete the Greek version of the DEPS-R questionnaire. Appropriate statistical analysis was employed to investigate the association of the DEPS-R score with anthropometric, demographic, and glycemic variables derived from the clinical assessment and the patient’s medical records. Results: Girls had significantly higher DEPS-R scores compared with boys. Significant positive associations were observed between the DEPS-R score and both age (r = 0.212, p = 0.020) and Body Mass Index (BMI) (r = 0.419, p < 0.001). A significant association with Glycated Hemoglobin (HbA1c) (r = 0.182, p = 0.047) suggested that poorer glycemic control may be linked to disordered eating, although no significant associations were identified with physical activity or type of insulin therapy. Conclusions: Older age, higher Body Mass Index (BMI) and elevated Glycated Hemoglobin (HbA1c) levels are associated with increased risk of disordered eating in youth with T1DM, especially in girls. Therefore, the implementation of early screening and targeted interventions is imperative. Full article

Background/Objectives: Emotional eating has been recognized as the tendency to eat in response to emotions, being recognized as a crucial risk factor for recurrent weight gain. Emotional eating has been interrelated with obesity/overweight, depression, anxiety, stress, and specific dietary habits at any stage of human life, negatively affecting human quality of life. The present study aims to summarize and explore the effects of emotional eating on children and how these effects may, in turn, influence their mental and physical health at the next stages of their lives. Methods: This is a narrative review of the presently existing clinical evidence concerning the impact of emotional eating in children. A comprehensive search of the most reliable online databases, e.g., PubMed, Scopus, Web of Science, and Google Scholar, was performed utilizing relevant keywords. Several inclusion and exclusion criteria were used to collect only cross-sectional, longitudinal, descriptive, and case–control surveys in children’s populations. Results: The current clinical evidence suggests that parental behavior may increase the risk of emotional eating in children. Several pieces of evidence also implied potential associations of emotional eating with overweight/obesity and mental disorders in children. Children’s dietary habits may also affect their risk of developing emotional eating. Conclusions: The prevalence of emotional eating is gradually increasing in the general population, and especially in children. Public strategies should be performed to educate parents to recognize potential emotional eating behaviors in their children and to adopt more healthy dietary habits for their children, even in the first months of their life. Educational programs should be organized in school communities to directly educate children on the benefits of healthy dietary patterns. Full article

Background/Objectives: Recent decades have seen a remarkable westernization of diets and a decline in adherence to the Mediterranean diet (MD). This study examined the eating habits of a representative sample of Italian university students to identify the determinants of adherence to the MD and the most relevant actions to improve their well-being. Methods: The Mediterranean Diet Quality Index for Children and Adolescents (KIDMED) and Sustainable Healthy Diet (SHED) index questionnaires were used to explore MD adherence as the primary outcome, and dietary behavior sustainability, respectively. Sociodemographic, anthropometric, and lifestyle information was also collected. Results: The final sample included 1434 subjects (18–24; 60% female). The median (IQR) KIDMED score was 6.0 (4.0–8.0) and 33% showed a high adherence to the MD. Having breakfast, eating fruit and vegetables at least once a day, consuming pasta or other grains almost daily, and using olive oil at home were among the most common positive aspects of students’ diets. However, regular consumption of fish, nuts, legumes, dairy products, and a second serving of fruit and vegetables was less prevalent. Having an active lifestyle, eating more plant products, and having more sustainable dietary behaviors in terms of the SHED index, were the main determinants of a high KIDMED score. Likewise, graduate students, daily consumers of plant-based meat alternatives, and students attending university canteens daily were more likely to adopt healthier diets. Conclusions: Future actions are crucial to create a food environment that facilitates healthy and sustainable dietary choices among young adults, such as improving the nutritional quality of processed products and regulating their promotion, as well as implementing initiatives to improve university food services and encourage the use of campus dining facilities. Full article

Introduction: People with disabilities are characterized by suboptimal health and lower self-rating health. Their need for health care is greater, they often have a higher prevalence of health problems and they have more difficulty accessing health care. The aim of this study was to assess the health behaviors and health indicators of 12–18-year-old young people with intellectual disabilities and autism spectrum disorder, and to explore their school-related perceptions in the Northern Great Plain region of Hungary. Materials and Methods: A cross-sectional questionnaire survey was conducted with the participation of 185 young people. A custom questionnaire was used, based on the Health Behavior in School-aged Children (HBSC) survey, assessing eating habits, oral care, physical activity, mental well-being, and self-reported health status. The sample was categorized into three groups: the ID1 (Intellectual Disability level 1) group, encompassing young individuals with mild intellectual disability; the ID2 group, encompassing young people with moderate intellectual disability; and the ID+ASD group, encompassing young individuals affected by both intellectual disability and autism spectrum disorder. Results: Consumption of various food types was below optimal levels. Low intake of fruits and vegetables was common, with only 21.6% of the respondents consuming fruit daily and 23.8% consuming vegetables daily. ID1 group reported significantly higher rates of nervousness several times a week (17.8% vs. 5.6% and 6.9%, p < 0.001), sleep difficulties (28.8% vs. 7.4% and 15.5%, p = 0.032), and dizziness (9.6% vs. 1.9% and 3.4%, p = 0.022) compared to the other two groups. A third school-related factor, related to negative emotions, showed a near-significant difference (p = 0.064), suggesting that students with both autism spectrum disorder and intellectual disability perceive lower levels of acceptance from teachers. On school-free days, computer usage was significantly highest in the ID+ASD group; 50% of them used a computer for at least 4 h per day. Conclusions: To improve mental well-being among affected children, psychological support and the implementation of mental health programs are recommended. In addition to teaching stress management techniques and coping mechanisms, integrating relaxation techniques into comprehensive developmental programs—both individually and in groups—is advised. For teachers, it is recommended to acquire disability-specific communication strategies. Full article

Background/Objectives: Increasing screen time in childhood has been suggested to impact physical health, eating behaviors, and well-being. This study investigated how screen time affects mindfulness, mindful eating, and diet quality in Turkish adolescents aged 9–12 years. Methods: One hundred thirty-seven participants completed surveys on anthropometry, screen time, the Godin Leisure-Time Exercise Questionnaire, the Mediterranean Diet Quality Index, the Mindful Eating Questionnaire for Children, and the Child and Adolescent Mindfulness Measure. Results: The average screen time was 4.43 ± 2.37 h/day. Significant negative correlations emerged between screen time and mindfulness (r = −0.471, p < 0.001), as well as between screen time and diet quality (r = −0.244, p < 0.05). A regression analysis revealed significant associations only for mindfulness (B = −0.158, p < 0.001) and age (B = 0.636, p = 0.002). Conclusions: Higher mindfulness and younger age correlated with lower screen time, suggesting mindfulness interventions in schools may reduce screen use. Full article

Children with Down syndrome often face significant feeding difficulties and health comorbidities that may contribute to undernutrition or obesity. This study assessed dietary habits and nutritional status among 104 children with Down syndrome in Croatia, representing 11.5% of this population. Results showed that over 30% of children aged 1 to 15 were overweight. Over 60% never consumed whole grain bread, while more than 50% avoided fish, nuts, or seeds. Despite rural families more frequently producing their own food (meat p = 0.009; fruits/vegetables p = 0.035), no significant improvement was observed in the children’s diets compared to their urban counterparts. Urban children consumed milk (p = 0.008) and fermented dairy (p = 0.005) more often. Children of university-educated mothers had higher vegetable (p = 0.031), meat (p = 0.025), olive oil (p = 0.003), and nut (p = 0.029) consumption, and a lower intake of processed meats (p = 0.008) and salty snacks (p = 0.040). Families spending less than 50% of income on food also showed significantly healthier dietary patterns. Feeding difficulties in children with Down syndrome are commonly associated with sensory sensitivities, oral-motor impairments, and comorbid medical conditions. These challenges are often intensified by parental anxiety, delayed introduction of diverse foods, and inadequate professional support. Collectively, these factors contribute to selective eating, poor nutrient intake, and disordered eating behaviors. This study underscores the need for individualized nutritional interventions that address the unique physiological and sensory requirements of both children and adults with Down syndrome. Effective strategies should extend beyond general dietary recommendations to include early exposure to a variety of food textures, specialized feeding support, and the management of coexisting health conditions. Family education and engagement play a crucial role in achieving positive nutritional outcomes. Empowering parents and caregivers—especially those in socioeconomically disadvantaged or rural communities—can facilitate the alignment of food accessibility with healthy dietary practices. The findings of this research offer valuable guidance for the development and implementation of national strategies aimed at enhancing the nutrition and long-term health of individuals with Down syndrome. Full article

Background/Objectives: Appetitive traits may contribute to early feeding challenges by shaping children’s emerging dietary patterns. While food approach traits have been linked to excess weight, their role in influencing food type and quality during toddlerhood remains underexplored. This study aimed to examine associations between appetitive traits and dietary patterns in children aged 12 to 36 months. Methods: This cross-sectional study collected data from a university hospital and the metropolitan area of Guadalajara, Mexico. A survey was conducted through direct interviews with primary caregivers, which included the Child Eating Behavior Questionnaire for Toddlers (CEBQ-T) and a qualitative food group frequency questionnaire. Dietary patterns were determined using principal component analysis. Statistical analyses were performed to identify associations between six appetitive traits and dietary patterns. Results: Three dietary patterns were identified: “Processed”, “Healthy” and “Dietary Transition/Modern Mexican”. Higher scores for Food Responsiveness and Emotional Overeating traits were associated with greater adherence to the Processed dietary pattern. Increased scores in Enjoyment of Food were associated with higher adherence to a Healthy dietary pattern. Children with higher scores in Food Fussiness exhibited lower adherence to the Healthy dietary pattern and were more likely to follow a Dietary Transition/Modern Mexican pattern. Between 12 and 36 months of age, appetitive traits may influence the development of more or less healthy dietary patterns. Conclusions: These findings underscore the importance of early identification of appetite-related behavioral tendencies as part of a broader understanding of feeding challenges in early childhood. Full article

Background: This project focuses on the relevance of using a health literacy approach to educating children about obesity prevention. The Habits of Health and Habits of Mind© model was used to write Electronic Texts for Health Literacy© to encourage actions that support obesity prevention. Guided by the Integrative Theory of Behavioral Prediction, the design template for a new genre of digital texts called Electronic Texts for Health Literacy© emerges for exploring children’s frame of mind, health literacy skills, and behavioral intentions toward obesity prevention. Methods: Online materials from selected websites were strategically reviewed for improving obesity prevention and child health literacy. The digital resources were juxtaposed with the Electronic Texts for Health Literacy©, with the latter written by and for children. Discussion: Health educators who use a constructivist pedagogy can help students to write health literacy narratives about obesity prevention, then read and talk about their multimodal compositions to further the practice and development of their health literacy skills. Children with obesogenic body frames can also gain from cowriting visual–textual–gestural health narratives with their peers or health professionals. Co-constructed narratives can help children make deeper connections about their identity, frame of mind, and social agency. Summary: Although this untested resource is available as a new genre of digital text, health educators could nudge children toward developing a stronger frame of mind and behavioral intentions toward obesity prevention when they write health literacy narratives that focus on decision making, goal setting, and communication in the context of eating nutritious foods and participating in physical activities. Full article