Search Results (181)

Background: Nutrition problems among primary school children increase the risk of illness, reduce school attendance, and impair academic performance. The Indonesian national school feeding program (ProGAS—Program Gizi Anak Sekolah) was developed to address these issues through the provision of healthy breakfast, nutrition education, and character building. Methods: This study employed a mixed-methods design involving 454 primary school students aged 8–14 years from 24 schools across four provinces. Data collection included structured questionnaires, 24 h dietary recalls, and anthropometric measurements. In-depth interviews with school principals, teachers, cooking teams, parents, students, nutritionists, and district education office staff were conducted to capture experiences and opinions on the ProGAS implementation. Results: ProGAS significantly improved students’ dietary diversity, meal frequency, handwashing with soap, and nutrition knowledge, alongside a positive trend in school attendance. Improvements included higher mean dietary diversity, increased proportion of students eating ≥3 meals/day, greater correct responses on balanced nutrition, and higher rates of handwashing before meals (all p < 0.01). Children also developed positive behaviors such as praying before meals, queuing, and taking responsibility for cleaning dishes. However, students’ breakfast habits did not significantly improve, the delivery of nutrition education was suboptimal, and no significant changes were observed in nutrient intakes or nutritional status based on BMI-for-age. While the energy and protein contributions of the ProGAS menu met the recommended 25–30% of daily requirements for breakfast, its micronutrient contributions remained below the recommended levels. Key management gaps include the delivery of nutrition education to students and the monitoring of implementation by local and national authorities. Conclusions: ProGAS demonstrated positive impacts on some dietary and hygiene practices as well as learning environment. To achieve greater improvements in breakfast habits, nutrient intake and nutritional status, it is recommended to strengthen the school feeding menus not only for dietary diversity but also for nutrient density, enhance capacity building for teachers, deliver regular and engaging nutrition education, and reinforce program monitoring. Full article

Background: Late preterm delivery accounts for approximately 5% of all births. Although there is a growing body of literature recognizing that children born late preterm are at risk for mild neurodevelopmental issues, these children are often excluded from follow-up programs. From a preventive perspective, it could be useful to promote protective factors for child development. Among these, human milk feeding is highly recommended due to its advantages for child health and development. However, there is limited research on the complex interactions between late preterm birth, human milk feeding, and subsequent cognitive and emotional development. This paper aims to explore these interactions. Methods: This study focuses on late preterm children aged 8 to 12 years who are attending school. A trained psychologist conducted assessments of cognitive development using the Wechsler Intelligence Scale for Children-III (WISC-III). Additionally, the family pediatrician gathered neonatal and current growth data, while parents completed the Child Behavior Checklist 6–18 (CBCL) regarding their child’s emotional and behavioral profile. Results: A significant impact of early nutrition on children’s cognitive development was observed, with those fed human or formula milk scoring higher than those in the mixed milk group. Additionally, early feeding, high maternal and low paternal perception of externalizing difficulties significantly predicted children’s cognitive development. Conclusions: The study suggests the potential role of early nutrition and externalizing difficulties in the cognitive development of late preterm children at school age. Therefore, the inclusion of protective factors such as breastfeeding should be encouraged in future research. Full article

Background: Parents’ dietary strategies shape children’s eating habits. This study investigated socio-demographic determinants of maternal feeding practices among school-aged children in the Pomeranian province of Poland. Using a cross-sectional survey conducted in July 2025, we compared feeding strategies based on family structure, maternal employment, and number of children, and identified distinct parenting profiles through cluster analysis. Methods: A cross-sectional survey was conducted in July 2025 among 719 mothers of elementary school children in Pomeranian Voivodeship, using a convenience sampling design. An abbreviated version of the Comprehensive Feeding Practices Questionnaire (CFPQ) with 16 items across eight subscales was used. ANOVA compared feeding strategies between groups, Spearman correlations examined associations, and k-means cluster analysis identified maternal parenting profiles. Results: Encouragement and modeling were the most frequent strategies, while monitoring was least common. Mothers raising children with a partner and those employed used monitoring, modeling, and encouragement more often. Single or non-working mothers relied more on food as a reward and for emotion regulation. Mothers of only children applied control and monitoring less intensively than mothers with multiple children. All strategies were positively correlated. Cluster analysis identified three parenting profiles: intensely directive, moderate, and emotional-supportive. Conclusions: Maternal feeding strategies vary with socio-demographic factors. Educational interventions promoting healthy eating should be tailored to family structure and mothers’ employment status. Full article

Background: Angle’s dental class asymmetries not associated with crossbite are malocclusions that are often underestimated in pediatric patients. However, they may be associated with alterations in the development of the stomatognathic system. Objective: The objective of this study was to evaluate the prevalence of Angle’s class asymmetries without crossbite in primary-school-aged children and to investigate possible associations with perinatal, clinical, and functional variables. Materials and Methods: This cross-sectional observational study analyzed a sample of 391 children aged 6 to 11 years, attending a primary school in the metropolitan area of Milan, Italy. Data were systematically collected through both clinical examination and patient history, with the aim of identifying significant correlations with the occurrence of dental asymmetries in the absence of crossbite. Results. The results revealed a higher prevalence of occlusal asymmetries associated with factors such as oral breathing, low tongue posture, type of delivery, formula feeding, and systemic diseases during the first three years of life. Advanced carious lesions and inclination of the occlusal plane were significantly associated with asymmetry. Conclusions: The study highlights the importance of early diagnosis and a multidisciplinary approach to prevent malocclusions and complex craniofacial dysfunctions later in life. Full article

Background: Food and Nutrition Security (FNS) policies in Brazil aim to ensure a broad spectrum of rights and were formulated based on the complex relationship among the State, Society, and Market in the capitalist order. The human right to adequate food (HRAF) is reflected in the guidelines of the National School Feeding Program (Programa Nacional de Alimentação Escolar—PNAE), which is implemented and monitored by the National Education Development Fund (Fundo Nacional de Desenvolvimento da Educação—FNDE). The PNAE consolidates part of the strategies adopted by the Brazilian State to combat hunger among children and adolescents and promote healthy habits by offering food in schools. However, there is no recent evaluation on the aspects of management, financing, and monitoring of the PNAE in the Brazilian Federal District. Objective: This study aims to contribute to the debate on health promotion and the right to adequate food by analyzing documents and legislation in force until 2024 related to the PNAE, as well as those that maintain a correlation with food and nutritional security policies in Brazil, verifying the scope and guarantee of rights and their applicability based on a critical analysis of the selected database. Methods: Brazilian official documents and legislation related to FNS and school meals were reviewed for inclusion in the database. The historical-dialectical materialist method was employed for content analysis, and the analyzed documents underwent a critical reading and the coding process, grouping common themes, utilizing MaxQda^® software for support. Results: The word cloud (20 words) shows that the document groups emphasize food as a right, with 6038 occurrences found and relating to the “rights” approach with 2365 occurrences found, highlighting words related to FNS policies. Public actions to achieve health and food supply were expressed through the words “public” (381 occurrences) and “DHAA” (510 occurrences). The code cloud highlights social control as the most frequently attributed code in the set of documents, with 105 codified segments, indicating that democratic control and societal participation are crucial for achieving the PNAE’s objectives. Conclusions: The analyses underscored the importance of social control, as evidenced by the exploration of the research corpus and demonstrated in the code cloud. The role of monitoring and social control falls to the School Feeding Council (CAE), being the body responsible for verifying compliance with the Program’s objectives, enabling the adoption of timely measures to correct the PNAE’s course and contribute to achieving its objectives. Full article

The dehesa, as a socio-ecological system and cultural landscape, is a strategic resource for environmental education, territorial sustainability, and the intergenerational transmission of knowledge. This study analyzes the perception of primary school students in Extremadura regarding this environment, using a mixed methodology that combines statistical, semantic, and spatial analysis. The results show a generally positive assessment of the dehesa heritage, although accompanied by a disconnect between this symbolic assessment and direct experience of the territory, especially in urban contexts. It identifies significant differences between students from rural and urban environments in terms of their knowledge of trades, products, and dehesa spaces, as well as their preferred activities in the dehesa. While rural students show greater interest in operational activities and direct contact with the environment (such as feeding livestock and milking), urban students lean toward sensory or symbolic experiences (such as consuming products or occasional harvesting), reflecting different ways of connecting with the territory. Spatial analysis reveals that more than 80% of schools are located less than 5 km from well-preserved dehesa areas, which represents an opportunity to integrate these landscapes into formal education. However, inequalities in access from special education centers have been detected, posing challenges in terms of territorial and educational equity. This study concludes that the dehesa should be recognized as an open classroom, capable of fostering roots, ecological literacy, and cultural sustainability through contextualized and territory-sensitive pedagogical approaches. Full article

Background/Objective: Postoperative dysphagia is a common cause of postoperative pulmonary complications (PPCs) following esophagectomy for esophageal cancer. Although the reclining posture is effective for general dysphagia, its effectiveness after esophagectomy remains unclear. Therefore, we aimed to explore effective approaches in the management of dysphagia after esophagectomy. Methods: This study included patients who underwent esophagectomy at the Department of Surgery, Hamamatsu University School of Medicine Hospital between January 2018 and March 2021. For the postoperative swallowing evaluation, the patients underwent a videofluoroscopic swallowing study by drinking 30 mL of liquid in two postures, a 45-degree reclining position (45°R) and a 90-degree upright position (90°U), and assessments were performed using the Penetration–Aspiration Scale. Results: Eighty-seven patients participated in the study. Laryngeal penetration and aspiration were, respectively, observed in 19 (21.8%) and 21 patients (24.1%) at 90°U, and in 14 (16.1%) and five patients (5.7%) at 45°R (p < 0.05). PPCs occurred in 10 patients (11.5%), and vocal cord paralysis occurred in 22 patients (25.3%). However, after adjusting the feeding conditions based on the results of the swallowing assessment, PPCs after meal initiation occurred in only five of these 10 patients (5.7%). Conclusions: Although dysphagia after esophagectomy is observed in approximately half of the patients, including those with minor dysphagia, the risk of aspiration can be reduced by changing the patient’s posture during food consumption. Thus, postural changes may be a useful approach for reducing the risk of PPCs. Full article

Background/Aim: Nutrition plays a pivotal role in development, not only in the early stages of life but also during adolescence, a period marked by vulnerability to the onset of overweight, obesity and eating disorders, with repercussions for reproductive and bone health. This narrative review aims to explore how parenting style, parental feeding practices and social media exposure influence eating behaviors in children and adolescents. Methods: A narrative review of the literature was performed through the PubMed and Scopus databases, including studies on participants aged 0–18 years. Both observational and interventional studies focusing on parenting approaches and the impact of social media on dietary behaviors were included. Given the narrative design, studies were selected based on conceptual relevance rather than formal inclusion or exclusion criteria, and on their contribution to understanding the multifactorial determinants of eating behavior. Results: A substantial body of research has demonstrated the critical influence of the family in cultivating positive eating habits and fostering a healthy relationship with food in children, serving as a role model and through responsive and authoritative parenting. Conversely, controlling or restrictive styles may contribute to dysfunctional eating patterns. Social media can positively and negatively influence children’s eating behaviors and parental feeding practices, promoting nutritional awareness or exposure to unhealthy food marketing and unrealistic body ideals. Conclusions: Healthcare professionals should promote an educational, trust-based approach to nutrition, empowering parents and youth for responsible digital engagement. Integrating family, school and media education is essential for preventing obesity and eating disorders in the digital age. Full article

Background/Objectives: Social Media Use has become an integral part of contemporary motherhood, with potential effects on maternal mental health and breastfeeding behaviors. This study aimed to examine the relationship between problematic social media use, anxiety levels, infant feeding attitudes, and feeding intentions among social media-native mothers. Methods: A mixed-methods design was used with 222 mothers. Quantitative data were collected using the Trait Anxiety Inventory (STAI-T), Social Media Disorders Scale (SMDS-9), Iowa Infant Feeding Attitude Scale (IOWA), and Newborn Feeding Intention Scale (IFI). Qualitative data were obtained through semi-structured interviews. Quantitative analyses explored associations between problematic social media use, anxiety, and feeding-related outcomes, while qualitative data were analyzed thematically. Results: SMDS-9 scores were generally low; only 2.7% of participants reported low feeding intention. No significant association was found between problematic social media use and breastfeeding intention or attitudes. Mothers with strong breastfeeding intentions demonstrated significantly more positive attitudes toward nursing than those with lower intentions. Higher problematic social media use was observed among high school graduates and those from high-income groups. Qualitative analysis identified two main themes of Negative Impacts and Positive Impacts, as well as five sub-themes of comparison and inadequacy, information overload, breastfeeding mistakes, anxiety, and social support. Conclusions: Problematic social media use did not directly affect breastfeeding intentions or attitudes; however, high school-educated and high-income mothers were more likely to report higher usage. Incorporating social media literacy into prenatal education and adapting tools for assessing postpartum anxiety to include indicators for problematic social media use, particularly for these at-risk groups, may support early detection, reduce stress, and promote positive breastfeeding practices. Full article

Recent years have witnessed a concerning rise in early-onset eating disorders (EDs), prompting a re-evaluation of their etiology, diagnosis, and treatment within pediatric populations. This perspective article synthesizes emerging evidence on the multifactorial origins of EDs in children, emphasizing a biopsychosocial framework that integrates genetic, epigenetic, psychological, and environmental factors. While early manifestations often diverge from adolescent or adult profiles—marked by somatic complaints, selective eating, and ritualistic behaviors—the disorders significantly interfere with developmental milestones. The COVID-19 pandemic has further exacerbated vulnerabilities, acting as a catalyst for disordered eating behaviors through increased familial stress, isolation, and disrupted routines. Central to this framework is the role of parental psychopathology and parent–child feeding interactions, which profoundly shape children’s emotional regulation and attachment patterns. Recent studies also underscore genetic susceptibilities—especially variants in the DRD4 and DAT1 genes—and epigenetic modifications that may mediate the transmission of risk across generations. The article reviews evidence from observational and genomic studies, highlighting how altered gene expression linked to early environmental stress contributes to the heterogeneity of EDs. Finally, it evaluates prevention and intervention strategies, including family-based treatments, digital health tools, and school-based programs. These strategies are essential for timely detection, individualized care, and reducing long-term impairment. Overall, the paper advocates for a nuanced understanding of EDs in children—recognizing their complex origins and developmental implications—to inform clinical practice, public health policy, and future research in pediatric mental health. Full article

Background: Protein substitutes are essential in the dietary management of phenylketonuria (PKU). Transition from first-stage phenylalanine (Phe)-free infant formula to second- and third-stage protein substitutes is carefully managed to meet a child’s evolving nutritional needs, feeding abilities, and developmental progression. However, clinical protocols, product access, and reimbursement vary globally. This study assessed international transition practices. Methods: A cross-sectional online survey explored health professionals’ practices on transition timing, influencing factors, product forms, casein-glycomacropeptide (cGMP) use, and perceived barriers and facilitators. Results: A total of 106 professionals from 32 countries participated: Europe (67%), Asia (12%), North America (10%), South America (8%), and Oceania (3%). Dietitians led transitions in 83% of centers. First-stage Phe-free infant formula was typically discontinued at 1–2 years (66%). Second-stage substitutes were introduced at 6–12 months in Europe (61%) and Oceania (100%), but after age one in Asia (69%), North America (72%), and South America (100%). Influencing factors included weaning alignment (46%) and nutritional needs (42%). Semi-solids were preferred in Europe (56%) and Oceania (67%), while powdered drinks dominated in Asia (62%), North America (82%), and South America (100%). Third-stage protein substitutes were introduced at 3–5 years (45%), with later transitions more common in South America (88%) and North America (63%). Ready-to-drink forms were frequent in Oceania (100%), Asia (92%), and Europe (85%). cGMP was prescribed by 61%, mainly guided by preference, Phe tolerance, and adherence; 26% reported no access. Key facilitators for transition included motivation (79%) and sensory properties (69%); barriers included aversion (70%) and poor taste/texture (69%). School involvement was reported by 32%. Conclusions: Protein substitute transition practices in PKU vary globally. International guidance and equitable product access are needed. Full article

Background/Objective: Pediatric feeding problems are becoming more widespread. They represent a synthesis of social, behavioral, and biological issues. Inevitably, the multifaceted nature of these problems has to be evaluated through one multidimensional tool. The Pediatric Assessment Scale for Severe Feeding Problems is designed to assess these complex issues and represents the first attempt to associate these factors into a single multidimensional measure. The aim of this study is to translate and culturally adapt the Pediatric Assessment Scale for Severe Feeding Problems into Greek and to assess its psychometric properties for use among a Greek Cypriot pediatric sample. Methods: This study involved 142 parents of children with symptoms of feeding problems. It included parents of children who were oral-fed (n = 65), partially oral-fed with supplementation (n = 62), and tube-fed (n = 15). The sample of parents was recruited from mainstream and special education schools in Cyprus and were asked to complete a Greek-translated version of the PASS-FP. Results: The PASS-FP-Gr demonstrated excellent psychometric properties. Internal consistency was good, and test–retest reliability showed a perfect Spearman’s rank correlation with high significance. The tool exhibited strong discriminatory ability, with statistically significant differences in median scores across the three feeding groups. Conclusions: The PASS-FP appears sensitive to the Greek Cypriot population and presents satisfactory psychometric features. It demonstrated excellent discriminatory ability, as evidenced by the participants’ consistent response patterns. Full article

Substrate is an important component of a fish’s habitat environment. Fish preferences for substrate influence their growth and development, feeding, hiding, schooling, and reproduction. To explore the habitat preference of Brachymystax tsinlingensis, this study was conducted on the preferences of B. pre-smolts, post-smolts, and juveniles for three substrate colors, white, blue, and black, and four substrate types, sand (<0.5 cm in diameter), small gravel (1–2 cm in diameter), medium gravel (5–7 cm in diameter), and large gravel (12–16 cm in diameter), which were investigated in light (10–60 lx) and dark (no light) environments. The results showed that the individual populations of B. tsinlingensis in three periods of time had a clear preference for substrate color, preferring black substrate and staying away from blue substrate under both light and dark environmental conditions; B. tsinlingensis pre-smolts and post-smolts preferred sandy substrate, and juveniles preferred medium gravel substrate. The choice of substrate color and substrate type by B. tsinlingensis is a manifestation of the living environment characteristics of this species, which is conducive to their hiding, better avoidance of enemies, and improvement of their survival rate. Based on the research results and the early biological characteristics of B. tsinlingensis, it is recommended to use black or dark substrate during the cultivation of B. tsinlingensis fry. During the larval fish stage, a sandy substrate environment should be provided. During the juvenile fish stage, a medium-gravel environment should be provided. Full article

Background: A national study from China in 2023 predicted that the prevalence of overweight and obesity among children aged 7–18 will increase from 23.4% in 2019 to 32.7% by 2030. Objectives: This study aimed to investigate the longitudinal association between parental feeding practices and children’s body composition and weight status, and to assess the mediation effect of parental feeding practices in the relationship between socioeconomic status and childhood body composition. Methods: This longitudinal observational study was conducted between September and November 2021 in eight primary schools located in Luohu District, Shenzhen. Baseline and two follow-up surveys were administered annually during the same period from 2021 to 2023 (with one-year intervals). A total of 620 third-grade students (aged 8–10 years at baseline) and their parents were ultimately included in the study. Associations between parental feeding practices and children’s weight status and body composition were analyzed using mixed-effects models. The mediation effect of parental feeding practices on the relationship between socioeconomic status and childhood body composition was assessed through bootstrapping analysis. Results: At follow-up, a significant upward trend in the prevalence of central obesity among children was observed. Among all parental feeding dimensions, perceived child weight (PCW) demonstrated a strong association with central obesity after Bonferroni correction (OR = 1.33, 95% CI = 1.16, 1.51); similarly, monitoring (MN) and concern about child weight (CN) were both significantly associated with central obesity as risk factors for central obesity (OR = 1.14, 95% CI = 1.06, 1.23; OR = 1.16, 95% CI = 1.07, 1.27), both p < 0.001. These associations were modified by baseline child sex, parental BMI, and maternal and paternal education levels. However, restriction (RST) was not significantly associated with either body composition or weight status. The relationship between family socioeconomic status (SES) and childhood overweight and obesity was mediated by pressure to eat (PE) (p < 0.05). Conclusions: MN, PCW, and CN are associated with an increased risk of obesity in children. However, no significant association was found between parental feeding practices and changes in children’s body composition. Full article

Background: Childhood obesity disproportionately affects Hispanic families in the U.S. Although parenting practices and interventions appear to be viable approaches to lower the risk of childhood obesity, there is limited information on which parenting practices would be relevant and culturally appropriate for Hispanic families. This study aimed to document the health-related factors that impact Hispanic parenting practices to inform evidence-based parenting interventions to improve child health outcomes and reduce the risk of childhood obesity. Methods: We conducted cross-sectional, formative research guided by the COREQ checklist. Hispanic parents of elementary school-aged children were recruited using purposive and snowball sampling. Eligible parents completed a brief sociodemographic survey, the Comprehensive Feeding Practices Questionnaire (CFPQ), and an individual semi-structured interview. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using a coding-based thematic approach. Results: Seventeen parents (88.2% female) participated in the study, and the majority reported Spanish as their preferred language (70.6%). According to parent-reported data, the children’s (52.9% female) mean age was 8.4 ± 1.5 years, and over half were classified as having overweight or obesity. The CFPQ analysis indicated that parents scored highest on subscales related to encouraging healthy eating and eating variety, a finding that was reinforced by interview data. Qualitative analysis identified four key themes: 1. parenting roles, routines, and strategies for promoting culturally appropriate and healthy meals; 2. beliefs of children’s health and weight; 3. beliefs on physical activity and screen time; and 4. environmental and social factors affecting access to healthy food and physical activity. Conclusions: Both quantitative and qualitative results emphasize that parents engage in healthy eating guidance and eating variety and are aware of the factors that impact parenting practices and their children’s health. To improve child health outcomes and reduce the risk of childhood obesity among Hispanic families, parenting interventions need to be culturally responsive and address the factors that influence parenting practices. The findings from this study highlight four key areas to prioritize when designing or adapting parenting interventions to lower the risk of childhood obesity among Hispanic families. Full article