The Longitudinal Study of Australian Children Annual statistical report 2013

6 Eating behaviour: Socio-economic determinants and parental influence

Galina Daraganova, Australian Institute of Family Studies, and Lukar Thornton, Deakin University

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6.1 Introduction

Low intake of fruit and vegetables, along with a high intake of energy-dense, nutrient-poor food (such as fast food and processed snack foods), is a major public health concern in Australia and internationally. According to the World Health Organization (WHO, 2011), low intake of fruit and vegetables is among the top 10 factors contributing to global mortality. Research suggests that low consumption of fruit and vegetables increases the risk of cancers and cardiovascular disease, while excessive energy intake, which can occur through overeating and/or eating foods high in fat, sugar and salt and low in micronutrients, is a key mechanism for weight gain and developing type 2 diabetes (Begg, Vos, Barker, Stanley, & Lopez, 2008; National Health and Medical Research Council [NHMRC], 2013; Rangan, Randall, Hector, Gill and Webb, 2008).

Among children, healthy eating provides nutrients and dietary fibre and is crucially important for optimal growth and development. Research suggests that poor diet among children might affect specific areas of their physical development, motor skills and cognitive functioning (Bryan et al., 2004; McGartland et al., 2004; Nicklas, Bao, Webber, & Berenson, 1993; Richardson & Montgomery, 2005; Richardson & Puri, 2002).

There is also strong evidence that children's intake of fruit, vegetables and energy-dense foods tracks into adolescence, and those food preferences tend to be maintained in adulthood (Craigie, Lake, Kelly, Adamson, & Mathers, 2011; Magarey, Daniels, Boulton, & Cockington, 2003). Therefore, promoting a high intake of fruit and vegetables and low intake of energy-dense foods as part of a healthy diet is critically important and should take place as early as possible in a child's life.

Despite the recognised importance of healthy eating among children, recent surveys have revealed that only a few children consume the recommended daily intake of fruit, vegetables and energy-dense foods. Moreover, as children get older they consume even less fruit and vegetables and more soft drinks, sweets and/or high-fat snacks (Bell, Kremer, Magarey, & Swinburn, 2005; Rangan, & Hector, 2010). According to the 2007-08 Australian Bureau of Statistics (ABS) National Health Survey, 98% of children aged 5-7 years and 99% aged 8-11 years met their recommended daily intake of one serve of fruit, but this proportion decreased to 23% of children aged 12-15 years and even further to 18% of children aged 16-17 years, for whom three serves of fruit is considered adequate (ABS, 2009). A smaller proportion of children were meeting the guidelines for vegetable intake. Around six in ten children aged 5-7 years (57%) met the recommended daily intake of two serves of vegetables, whereas only three in ten children aged 8-11 years (33%) met the recommended intake of three serves. The proportion of older children meeting their recommended intake of vegetables (four serves or more) decreased to 15% in children aged 12-15 years and 16% in children aged 16-17 years.

In Australia, energy-dense food and drink (which includes snack foods as well as items such as soft drinks, margarine and salad dressing) contributes 41% of all daily energy intake in children (Rangan et al., 2008). Among Australian children aged 5-12 years, over 90% had high-energy snack foods in their lunchboxes (Rangan, Schindeler, Hector, Gill, & Webb, 2009; Sanigorski, Bell, & Swinburn, 2007). Energy-dense foods are estimated to contribute more than 40% of the total fat, saturated fat and sugar in children's diets, and only around 20% of micronutrients, further highlighting the poor nutritional quality of snack foods (Rangan et al., 2008, 2009). Reducing the intake of snack foods is likely to result in decreased energy intake and reduced obesity rates.

In order to effectively promote healthy eating among children and adolescents, further insight into the key determinants of their eating habits is needed. There is cross-sectional evidence that the eating behaviours of children are socio-economically patterned, with those of lower socio-economic position (SEP) having less healthy dietary patterns (Cameron et al., 2012; van Stralen et al., 2012).

The amount of fruit and vegetables eaten by children has also been closely linked to parents' intake of fruit and vegetables and the overall healthiness of their lifestyle (Cislak, Safron, Pratt, Gaspar, & Luszczynska, 2012; Pearson, Biddle, & Gorely, 2009). Additionally, children whose parents were exercising, not smoking and not binge drinking reported higher levels of fruit and vegetable consumption (Lien, Jacobs, & Klepp, 2002). Parental influences are further evidenced by studies that have demonstrated that family feeding practices have a bearing on children's fruit and vegetable intake (Bere, & Klepp, 2002; Hanson, Neumark-Sztainer, Eisenberg, Story, & Wall, 2005; Longbottom, Wrieden, & Pine, 2002). For example, children who were breastfed at 6 months old and had their meals with parents had a higher intake of fruit and vegetables (Neumark-Sztainer, Wall, Perry, & Story, 2003). It has also been found that on average girls consume more fruit and vegetables than boys (CSIRO Preventative Health National Research Flagship, & the University of South Australia, 2008), while boys consume more energy-dense food than girls (Rangan & Hector, 2010).

The majority of research exploring the determinants discussed so far has been based on cross-sectional surveys. But to assist tailoring future dietary interventions it is important to establish the longitudinal patterns of eating habits as well as determine the long-term role of socio-economic influences and family context on children's diet (Bambra, Hillier, Moore, & Summerbell, 2012). Using the information in children's food diaries collected in Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC), this chapter provides insight into the eating habits of children as they grow up, and also explores factors that might be associated with the persistence of low intake of fruit and vegetables and high intake of energy-dense foods. In particular, this chapter addresses the following questions:

  • How many children are eating according to the healthy eating guidelines?
  • How do family demographic background, feeding practices and mother's lifestyle influence the persistence of low intake of fruit and vegetables and high intake of energy-dense foods?
  • Are eating behaviour patterns, measured by fruit, vegetable and energy-dense food intake, associated with family socio-economic position?

6.2 Sample and measures

This section provides a brief discussion of the data and definitions employed in the chapter.

Sample

This chapter uses LSAC data from the B cohort at Waves 2 to 4 (children 2-3 to 6-7 years) and from the K cohort at Waves 1 to 4 (children 4-5 to 10-11 years). Wave 1 data for the B cohort (0-1 years) were not used, as children were too young for the food diary that the parents (and older children) completed at later waves. Given that the focus of the chapter is on changes in eating habits as children grow up, only children who participated at all waves (Waves 2-4 for B cohort and Waves 1-4 for K cohort) were included in the sample. There were 3,997 B cohort and 3,940 K cohort children who participated at all waves of interest.

Measures of eating behaviour

In LSAC, the eating habits of the study children were measured by the intake of fruit, vegetables and energy-dense foods, using 24-hour dietary recall.1 For children aged 2-9 years, parents were asked to report on how often their children had eaten fruit, vegetables and energy-dense foods within the last 24 hours. Children aged 10-11 years reported themselves on how often they had eaten each type of food within the last 24 hours. Different response options were used to measure food intake across waves. At Waves 1 and 2, responses on fruit, vegetable and energy-dense food intake were recorded in three categories: 0 = not at all, 1 = once, and 2 = twice or more; while at Waves 3-4 responses were recorded in four categories: 0 = not at all, 1 = once, 2 = twice, and 3 = three times or more.

LSAC participants were only asked how often they ate a particular food, not how many serves were consumed each time they ate. For the purposes of this analysis, the number of times the study child ate a specific food is equated with the number of serves consumed. However, it must be noted that the study child may have actually eaten more or less than one serve of the food on each occasion. This is a limitation of the analysis.

The cut-off points used to categorise the recommended age-specific daily servings of fruit, vegetables and energy-dense foods were based on guidelines proposed by the NHMRC (2005; see Table 6.1).2 For the purpose of the analyses presented, children were considered to meet the guidelines if:

  • their intake of fruit and vegetables was at or above the recommended amount per day; and
  • their intake of energy-dense foods was at or below the maximum recommended amount per day.
Table 6.1: Recommended daily serves of fruit, vegetables and energy-dense foods, by age
Age of child Serves of fruit (minimum) Serves of vegetables (minimum) Serves of energy-dense foods (maximum)
2-3 years 1 2 1-2
4-5 years 1 2 1-2
6-7 years 1 2 1-2
8-9 years 1-2 3 1-2
10-11 years 2 3 1-2

Source: NHMRC, 2005

Measure of fruit intake

Fruit intake was derived from a single question:3 "In the last 24 hours how often did the child eat fresh fruit?" The three-category responses for Waves 1-2 and four-category responses for Waves 3-4 on these questions were combined and categorised into a three-category response option (0 = not at all, 1 = once and 2 = twice or more).

Information on fruit intake included information on fresh fruit only. Information on mixed dishes containing fruit and dried or preserved fruit was not collected. Fruit juice was not considered as part of fruit intake as high intake of fruit juice contributes to a high intake of sugar that might lead to poor dental health (Joint WHO/FAO Expert Consultation, 2003).

Children were considered to have eaten enough fruit if they were eating daily at least one serve of fruit at 2-7 years and at least two serves at 8-11 years (see Table 6.1).

Measure of vegetable intake

Vegetable intake was derived from the combination of two questions: (a) "In the last 24 hours how often did the child eat fresh vegetables?" and (b) "In the last 24 hours how often did the child eat cooked vegetables?" The three-category responses for Waves 1-2 and four-category responses for Waves 3-4 on these questions were combined and categorised into four response categories: 0 = not at all, 1 = once, 2 = twice and 3 = three or more.

Information on vegetable intake did not include fried potatoes, hot chips and similar potato products, as these foods were not considered to be part of a healthy vegetable intake. Information on vegetable juice intake was not collected.

Children were considered to have eaten enough vegetables if they were eating at least two serves of vegetables per day when aged 2-7 years and at least three serves when aged 8-11 years (see Table 6.1).

Measure of energy-dense food intake

Energy-dense food intake information was divided into three categories: (a) non-sweet energy-dense foods, (b) sweet energy-dense foods, and (c) soft drinks. Non-sweet energy-dense foods include meat pies, hamburgers, hot dogs, sausages or sausage rolls, hot chips or French fries, potato crisps, or savoury snacks such as Twisties®. Sweet energy-dense food includes biscuits, doughnuts, cakes, pies or chocolate. Soft drinks include any non-diet soft drink or cordial. For the three types of energy-dense foods the three-category response option was used across all waves for both cohorts (0 = not at all, 1 = once and 2 = twice or more).

Children were considered to be within the recommended guidelines for energy-dense foods if their combined intake of non-sweet energy-dense foods, sweet energy-dense foods and soft drinks was two serves per day or less (see Table 6.1).

Measures of socio-demographic and family factors

As outlined in the introduction, there are a range of factors that may be associated with unhealthy diets. These include socio-demographic characteristics, family financial situation, family feeding practices and the healthiness of mother's lifestyle. The explanatory variables were derived from LSAC Wave 4 data unless stated otherwise and are presented in Table 6.2.

Table 6.2: Variables for demographic and family characteristics
Variable Question & response % of "1" responses
B cohort K cohort
Socio-demographic characteristics
Parental education Whether mother or father had a university degree or higher
1 = no university degree or higher
0 = university degree or higher
47 43
Family type Number of parents living with the study child in the same household at the time of the study
1 = one parent
0 = two parents
12 14
Mother's working status Mother's current labour force status
1 = not working (maternity leave, unemployed and looking for work, or not in labour force)
0 = working (full-time or part-time)
31 23
Regional status Current place of residence
1 = metropolitan
0 = rural
61 60
Family financial situation
Household income Household income
1 = low income (the bottom 25% of the income distribution)
0 = average/high income (the top 75% of the income distribution)
17 19
Family financial stress How family was getting along financially
1 = in financial stress (just getting along, poor or very poor)
0 = not in financial stress (prosperous/very comfortable/reasonably comfortable)
23 23
Family feeding practices
Family meals How often mother and child had evening meals together
1 = daily
0 = a few times a week/a few times a month/rarely/not at all
83 81
Breastfeeding Was the child breastfed at 6 months old?
1 = yes
0 = no
58 59
Healthiness of mother's lifestyle a
Physical activity How many times the mother was exercising per week
1 = 3+ times per week
0 = < 3 times per week
55 57
Smoking How often the mother was smoking
1 = at least once per day
0 = not at all or occasionally
17 17
Binge drinking How often the mother was drinking
1 = 5+ drinks in a sitting, two or more times per month
0 = < 5 drinks in a sitting
12 13
Fruit intake How many serves of fruit the mother was eating
1 = 2+ serves per day
0 = < 2 serves per day
48 49
Vegetable intake How many serves of vegetables the mother was eating
1 = 5+ serves per day
0 = < 5 serves per day
8 8

Note: a Due to a high level of missing data on fathers' reports only mothers' reports were used.

6.3 Fruit and vegetable intake

The section examines patterns of fruit and vegetable intake as children grow up, and reports the proportion of children who consumed adequate amounts of fruit and vegetables across waves. Changes in intake are analysed according to the amount of fruit and vegetables eaten per day and the proportions of children eating enough fruit and vegetables. Factors associated with low fruit and vegetable intake across all waves are also examined. While interpreting the results, it should be kept in mind that children aged 10-11 years provided dietary information themselves, whereas parents provided dietary information for children aged 2-9 years.

Amount of fruit and vegetables consumed by children at different ages

Fruit

Figure 6.1 presents the amount of fruit and vegetables consumed by children at different ages.

First, for B cohort children, regardless of age, around 10% did not have any fruit per day. For those aged 2-3 years, 23% had one serve of fruit and 66% were eating two or more serves per day. At 4-5 years, 17% were eating one serve of fruit per day and 75% were eating at least two serves. Twenty-two per cent of those aged 6-7 years were eating one serve of fruit per day and 68% were eating at least two serves.

As K cohort children were growing up, the proportion of children not eating any fruit remained about the same (12-13%), while the proportion of children who were eating two or more serves decreased at 10-11 years. At 4-7 years, one in four children were eating one serve of fruit per day and three in five children were eating at least two serves. At 8-9 years, children were on average eating similar amounts of fruit as when they were 6-7 years. At 10-11 years, more children reported having only one serve of fruit daily and fewer children reported having two or more serves, compared to when they were younger. The proportion of children eating two or more serves of fruit decreased (from 65% at 8-9 years to 55% at 10-11 years), while the proportion eating one serve of fruit increased (from 23% at 8-9 years to 32% at 10-11 years). It should be kept in mind that at 10-11 years, children were reporting on their own fruit intake. Therefore, it is difficult to determine whether the differences in the amount of fruit consumed are due to true age differences or rather are a reflection of the accuracy of different respondents (child cf. parent report).

Overall, the proportions of children aged 4-7 years eating fruit was slightly greater among B cohort than K cohort of children.

Figure 6.1: Fruit and vegetable intake, by cohort and age

Fruit and vegetable intake, by cohort and age

Notes: Percentage may not total exactly 100% due to rounding.

Vegetables

The proportions of B cohort children eating vegetables was similar across all ages. Around 87% of these children were eating at least one serve of vegetables per day at any age. At 2-3 years, 38% of B cohort children had one serve of vegetables, 32% had two and 16% of children had three or more. At 4-7 years the amounts of vegetables consumed were similar to those at 2-3 years. On average, across the ages 4-5 and 6-7, four out of ten children were eating one serve of vegetables (40% at 4-5 years and 37% at 6-7 years), three out of ten children were eating two servings (28% at 4-7 years) and two out of ten children were eating three or more servings per day (19% at 4-5 years and 21% at 6-7 years).

Among K cohort children aged 4-5 years, 16% of children were not eating any vegetables, 40% were eating one serve, 29% were eating two serves and 14% were eating three or more serves per day. As children grew older, the same number of children were not eating any vegetables (15%), and a slightly greater proportion of them were eating two or more serves. At 6-9 years, around four in ten children were eating one serve of vegetables, three in ten children were eating two serves, and two in ten were eating three or more serves per day. Noticeable differences in vegetable intake emerged when children were 10-11 years old. At 10-11 years, children were eating more vegetables compared to when they were younger. While the proportions of children who were eating at least one serve of vegetables remained similar (84% at 4-5 years to 82% at 10-11 years), the proportions of children who were eating three or more serves of vegetables increased from 14% at 4-5 years to 32% at 10-11 years. Yet it is important to keep in mind that for children aged 2-9 years dietary information was provided by the parents, and for children aged 10-11 years dietary information was provided by the children themselves. Therefore, it is possible that parents were under-reporting or that children were over-reporting the amount of fruit and vegetables children were eating.

There were no apparent differences in the proportions of children eating vegetables among same-aged children of B and K cohorts.

Proportion of children eating enough fruit and vegetables

The vast majority of children were eating some fruit and vegetables, but not all of them were eating the recommended amounts. Table 6.3 presents the proportion of children aged 2-11 years who were eating the recommended amounts of fruit and vegetables.

Table 6.3: Children eating the recommended amount of fruit and vegetables, by cohort and age
Age of child B cohort K cohort
Fruit Vegetables Both Fruit Vegetables Both
2-3 years % 89.2 48.6 45.9 NA NA NA
Total (N) 3,988 3,980 3,975 NA NA NA
4-5 years % 92.5 47.4 45.8 87.9 42.9 40.2
Total (N) 3,993 3,991 3,989 3,923 3,903 3,891
6-7 years % 90.8 49.8 47.6 86.9 48.4 45.3
Total (N) 3,984 3,985 3,981 3,925 3,929 3,916
8-9 years % NA NA NA 65.2 17.8 17.1
Total (N) NA NA NA 3,926 3,927 3,919
10-11 years % NA NA NA 55.0 32.1 23.7
Total (N) NA NA NA 3,881 3,880 3,880

Note: Total number of observations varies due to item non-response.

On average, nine in ten children aged 2-7 years were eating the recommended amount of fruit (at least one serve of fruit per day). As children grew older, the proportions who were eating enough fruit decreased substantially. At 8-9 and 10-11 years, only 65% and 55% respectively were eating according to the healthy eating guidelines (at least two serves of fruit per day). While these lower proportions of children meeting the guidelines may be partly due to the increase in the recommended fruit intake (from one serve at 2-7 years to two serves from 8-11 years), the proportion reduces further among 10-11 year olds (55%), indicating that consumption decreases with age.

Across all ages, children were less likely to eat enough vegetables than to eat enough fruit. Fewer than half of the children aged 2-7 years were eating the recommended number of vegetable servings per day (B cohort: 49% at 2-3 years, 47% at 4-5 years, 50% at 6-7 years; K cohort: 43% at 4-5 years, 48% at 6-7 years). For 8-9 and 10-11 year olds, this proportion dropped substantially to only 18% and 32% respectively. While the proportion of children meeting the healthy eating guidelines for vegetables was lowest at 8-9 years, it is worth noting that this coincides with the period when recommendations increase from 2 serves to 3 serves per day. However, this finding should not be dismissed on this basis, as the increase in recommended serves is in line with the amount of vegetables required for the child's optimal growth and development.

For both fruit and vegetables combined, overall 40-48% of children aged 2-7 years were meeting the recommendations (B cohort: 46% at 2-5 years and 48% at 6-7 years; K cohort: 40% at 4-5 years and 45% at 6-7 years). As they grew older, fewer children were eating enough fruit and vegetables (only 17% and 24% of children aged 8-9 and 10-11 years respectively).

It is important to highlight that in the LSAC sample, the proportions of children who were eating any fruit and vegetables and the amount of fruit and vegetables that was eaten by children did not change substantially with age (as seen in Figure 6.1). However, given that the amount of fruit and vegetables recommended for children's optimal growth and development increases as children grow up, the proportion of K cohort children who were eating enough fruit and vegetables decreased with age.

Consumption of recommended amounts of fruit and vegetables across multiple waves

Table 6.4 shows the proportions of children who were meeting the recommendations for fruit and vegetable intake across multiple waves.

Table 6.4: Children eating the recommended intake of fruit and vegetables across multiple waves, 6-7 year olds (B cohort) and 10-11 year olds (K cohort)
Number of waves 6-7 years (B cohort) (%) 10-11 years (K cohort) (%)
4 NA 2.9
3 20.3 12.8
2 25.1 22.7
1 28.2 31.6
0 26.4 30.0
No. of observations 3,958 3,816

Among B cohort children, 20% were eating the recommended amount of fruit and vegetables at all three waves, 25% were eating enough at any two waves and 28% were following the guidelines at one wave only. Twenty-six per cent of the children did not eat enough fruit and vegetables at any of the three waves.

Among K cohort children, only 3% ate the recommended amount of fruit and vegetables across all four waves, 13% ate enough across any three waves, 23% across any two waves and 32% in any one wave. Thirty per cent of K cohort children did not eat according to the recommended healthy eating guidelines at any of the four waves. The proportion of children eating enough fruit and vegetables across all waves was lower among K cohort than B cohort children (3% vs 20% respectively). This discrepancy is likely to be due to the age differences and the number of waves used in the analysis (given that the B cohort is younger, and compliance with recommended fruit/vegetable intake in the K cohort showed a decrease with age).

By the age of 6-7 years, 26% of B cohort children were consistently not eating fruit and vegetables within the recommended guidelines, and by the age of 10-11 years, 30% of K cohort children consistently did not meet the guidelines. These children have an increased risk of adverse health conditions resulting from their dietary behaviours. Identification of factors that are associated with these eating patterns may help in the development of interventions to counter such behaviours in the future.

Factors associated with low intake of fruit and vegetables across all waves

The analysis presented below examines factors that might be associated with persistent low intake of fruit and vegetables (26% of B cohort and 30% of K cohort children). At Wave 4, B cohort children aged 6-7 and K cohort children aged 10-11 years were considered to have persistent low intake of fruit and vegetables if they ate less than the recommended amounts across all waves (Waves 2-4 for B cohort and Waves 1-4 for K cohort) (see Table 6.5). All factors are examined independently; however, significant differences are also discussed after adjusting for all factors collectively.4

In the B cohort, gender differences were evident. Boys were more likely than girls to eat low amounts of fruit and vegetables across all waves (29% vs 24% respectively, p < .001). In the K cohort, there were no significant differences between boys and girls.

Table 6.5: Children eating low amounts of fruit and vegetables across all waves by socio-demographic and family characteristics, 6-7 and 10-11 year olds
Socio-demographic and family characteristics 6-7 years (B cohort) 10-11 years (K cohort)
% p % p
Study child gender
Male 28.9 *** 31.3 ns
Female 23.9 28.5
Family socio-demographic characteristics
Parental education
No university degree or higher 31.2 *** 33.6 ***
University degree or higher 19.3 23.7
Family type
Two-parent family 25.2 *** 29.5 ns
Single-parent family 33.4 32.2
Mother's working status
Non-working 27.4 ns 29.0 ns
Working 25.8 30.3
Region of residence
Rural 30.0 ** 31.7 ns
Metropolitan 24.5 29.0
Family financial situation
Household income
Average/high income 25.4 *** 29.5 ns
Low income 32.8 32.0
Family financial stress
No 25.2 ** 29.4 ns
Yes 30.1 31.8
Family feeding practices
Daily evening meals with mother
No 31.7 ** 32.2 ns
Yes 25.4 29.5
Breastfeeding at 6 months
No 31.8 *** 36.8 ***
Yes 22.1 34.2
Healthiness of mother's lifestyle
Physical activity (3+ times per week)
No 27.5 ns 31.3 ns
Yes 25.7 28.6
Smoking (at least once a day)
No 26.2 *** 28.9 *
Yes 35.3 33.8
Binge drinking (5+ drinks, 2+ times per month)
No 26.2 *** 29.9 ns
Yes 35.3 32.6
Fruit intake (2+ serves per day)
No 33.9 *** 36.4 ***
Yes 19.9 23.6
Vegetable intake (5+ serves per day)
No 27.2 *** 30.7 ***
Yes 17.4 19.7
No. of observations 3,958 3,816

Notes: *** p < .001; ** p < .01; * p < .05; ns = not statistically significant.

A number of socio-demographic factors were found to be important correlates of low fruit and vegetable intake. In the B cohort, 31% of children of parents with no university degree were eating less than the recommended amounts of fruit and vegetables across all waves, compared to 19% of children of parents with a university degree (p < .001). The same relationship was observed for the K cohort (34% vs 24% respectively, p < .001). Whether children lived in a single-parent family or in a rural area were significantly and positively associated with reporting low fruit and vegetable intake across all waves, but only for B cohort children. Thirty-three per cent of children from single-parent families and 30% of children from rural areas ate less than the recommended amounts of fruit and vegetables across all three waves, compared to 25% of children from two-parent families and 25% of metropolitan children. Mother's working status was not associated with low fruit and vegetable intake in either cohort.

Family financial situation was associated with low fruit and vegetable intake across all waves in the B cohort only. A higher proportion of children from families with low household income reported inadequate fruit and vegetable intake across all waves compared to children from average/high income families (33% vs 25% respectively; p < .001). Also, children whose families experienced financial stress were more likely to report inadequate fruit and vegetable intake across all waves compared to children whose families were not in financial stress (30% vs 25% respectively; p < .01).

Whether children were eating evening meals with their mother daily was significantly associated with the prevalence of low fruit and vegetable intake across waves in the B cohort. About 32% of children who did not have daily evening meal with their mother were not meeting fruit and vegetables guidelines at any age, compared to 25% of children who had daily mother-child evening meals (p < .01). Breastfeeding at 6 months was also associated with low fruit and vegetable intake across all waves. In the B cohort, 22% of children who were breastfed at 6 months did not eat enough fruit and vegetables at any wave, compared to 32% of children who were not breastfed (p < .001). In the K cohort, these proportions were 34% and 37% respectively (p < .001).

Mothers' unhealthy lifestyle was a significant risk factor for children's low fruit and vegetable intake across all waves. Mothers' fruit and vegetable intake was significantly associated with children's fruit and vegetable intake. Children were less likely to consume a low amount of fruit and vegetables if their mother was eating the recommended amounts. This association was evident across all waves. Among families with a mother who was eating the recommended amount of fruit and vegetables, only 20% of B cohort and 24% of K cohort children were not eating enough fruit, and 17% and 20% of B and K cohort children respectively were not eating enough vegetables. In comparison, among families with a mother who was not eating the recommended amount of fruit and vegetables, 34% of B cohort and 36% of K cohort children were not eating enough fruit and 27% and 31% of B and K cohort children respectively were not eating enough vegetables. Mother's smoking behaviour was also associated with children's eating habits across all waves. In families with a mother who smoked, 35% of B cohort and 34% of K cohort children were not eating enough fruit and vegetables across all waves compared to 26% and 29% of B and K cohort children with a non-smoking mother. The proportion of children who did not eat according to the guidelines was larger for B cohort children only among families with a binge-drinking mother (35%) compared to those with a non-binge-drinking mother (26%). Mothers' physical activity was not associated with children's fruit and vegetable intake across waves in children of either cohort.

In the analysis above, the relationships between socio-demographic and family characteristics on fruit and vegetable intake were examined independently of each other. However, it is important to understand whether these relationships held after controlling for all the factors examined. Table 6.6 reports only the relationships that remained significant after adjusting for all of the examined factors. It can be seen that B cohort children who were boys, had parents without an university degree, were from low-income families, who were not breastfed at 6 months, or had a mother who failed to meet the recommended intake of fruit and vegetables were likely to experience low fruit and vegetable intake across all waves. In the K cohort, the same relationships were observed, but there were no differences between boys and girls and between children from families with different household incomes.

Table 6.6: Association between low fruit and vegetable intake across all waves and different factors, adjusting for other characteristics, 2-7 and 4-11 year olds
Socio-demographic and family characteristics 2-7 years (B cohort) 4-11 years (K cohort)
Study child female - ns
Parents with no university degree + +
Low household income + ns
Breastfeeding at 6 months - -
Mother with recommended fruit intake - -
Mother with recommended vegetable intake - -

Note: + = positive significant relationship; - = negative significant relationship, ns = no significant relationship.

6.4 Energy-dense food intake

This section examines the differences in energy-dense food and soft drink intake as children grow up, and the prevalence of high energy-dense food intake across waves. Changes are analysed according to the proportions of children eating sweet and non-sweet energy-dense foods and drinking soft drinks, as well as the amounts of these foods eaten per day. The section also explores the persistence of high energy-dense food intake and factors associated with such intake across all waves. Note that in this section the focus is on children eating at or below the recommended maximum amounts of any energy-dense foods (i.e., no more than two serves per day).

Amount of energy-dense foods and soft drinks consumed at different ages

Figure 6.2 describes the consumption of different types of energy-dense foods by children aged 2-11 years.

Figure 6.2: Consumption of sweet and non-sweet energy-dense foods and soft drinks, by cohort and age

Consumption of sweet and non-sweet energy-dense foods and soft drinks, by cohort and age

Sweet energy-dense foods

The most common type of energy-dense food consumed by children of different ages was sweet energy-dense foods, such as biscuits, chocolate, lollies, etc. Within the B cohort of children aged 2-5 years, three in ten children did not eat any sweet energy-dense foods, one in two children ate one serve per day and one in five children ate two or more serves. At 6-7 years, only a quarter of the children did not eat any sweet energy-dense foods, the proportion who ate one serve per day remained the same (51%), and the proportion who ate two or more serves increased to 24%.

Within the K cohort, 27-30% of children aged 4-11 years did not eat any sweet energy-dense foods, 50-52% ate one serve per day and 20-21% ate two or more serves.

Overall, there were no apparent differences in the amount of sweet energy-dense foods consumed by children across age groups or the cohorts.

Non-sweet energy-dense foods

A different trend was observed for the consumption of non-sweet energy-dense foods (such as meat pies, hamburgers, hot dogs, sausages or sausage rolls, hot chips or French fries). The proportion of children eating at least one serve of non-sweet energy-dense foods increased with age, from 55% at 2-3 years to 65% at 6-7 years for the B cohort, and from 63% at 4-5 years to 75% at 10-11 years for the K cohort.

Over half of the children in the B cohort aged 2-5 years were eating non-sweet energy-dense foods each day, with 20% consuming two or more serves. At 6-7 years, while the proportion of the B cohort children eating one serve did not change (37%), there were fewer children who were not eating any (36%) and more children eating two or more serves per day (28%).

Among the K cohort children aged 4-9 years, 35-37% were not eating any non-sweet energy-dense foods, 37-39% were eating only one serve and 26-28% were eating two or more serves per day. The greatest increase in the consumption of non-sweet energy-dense foods was observed when children were 10-11 years old. At this age only 25% of the children were not eating any non-sweet energy-dense foods, while 75% were eating at least one serve per day. Out of those who were consuming non-sweet energy-dense foods, 72% were eating at least two serves per day (43% out of all children) and 28% were eating one serve (32% out of all children).

Soft drinks

Between the ages of 2 and 7 years, 66-71% of B cohort children reported not drinking any soft drinks, 17-23% were drinking one serve per day and 11-12% at least two. A slightly different trend in the consumption of soft drinks was observed among the K cohort children. At 4-5 years, one in two children were not drinking any soft drinks, one in four were drinking one serve per day and one in five were drinking at least two serves per day. At 6-9 years, more children were not drinking any soft drinks (60% at 6-7 years and 62% at 8-9 years) and fewer children were drinking two or more serves (16% at 6-7 years and 13% at 8-9 years). However, at 10-11 years more than half of children were drinking soft drinks (53%): 33% had one serve a day and 21% had two or more serves. Caution should be taken in interpreting the differences between the younger and older children given that children self-reported their dietary intake from the age of 10 years onwards.

Consumption of energy-dense foods at or below the recommended guidelines

Consumption by age of child

According to the NHMRC (2005) guidelines, children from the age of 2 years should on average consume no more than two serves of energy-dense foods per day. Table 6.7 presents the proportions of children in each age group who were eating two serves or fewer of any energy-dense foods (including soft drinks) per day. Between the ages of 2 and 9 years, parents reported that more than half of the children from both cohorts met these guidelines.

Table 6.7: Children eating at or below the recommended amount of energy-dense foods, by cohort and age
Age of child B cohort K cohort
% Total (N) % Total (N)
2-3 years 66.9 3,980 NA NA
4-5 years 66.5 3,984 53.3 3,903
6-7 years 57.1 3,985 56.0 3,932
8-9 years NA NA 58.4 3,923
10-11 years NA NA 45.2 3,877

Note: Total numbers of observations vary due to missing responses.

Low intake of energy-dense foods was reported for fewer children in the K cohort. At 4-5 years, 53% of children were consuming no more than two serves per day, which increased to 58% for children aged 8-9 years and then dropped to 45% for 10-11 year old children.

Consumption across multiple waves

Table 6.8 presents the proportion of children who were eating at or below the recommended amount of energy-dense foods across multiple waves. Out of all B cohort children, 36% were eating no more than two serves of energy-dense foods at all three waves, 30% at any two waves and 22% at any one wave. Different proportions were observed for the K cohort, among whom only 16% were eating no more than two serves of energy-dense foods across all four waves, 25% across any three waves, 27% across any two waves and 22% at only one wave. As for fruit and vegetable intake, the proportion of children eating the recommended amount of energy-dense foods across all waves was substantially lower in the K cohort than the B cohort (16% compared to 36% respectively). The difference is likely to be due to the age of the children and the number of waves used in the analysis rather than other factors.

Table 6.8: Children eating at or below the recommended intake of energy-dense foods across multiple waves, 6-7 year olds (B cohort) and 10-11 year olds (K cohort)
Number of waves 6-7 years (B cohort) (%) 10-11 years (K cohort) (%)
4 NA 16.0
3 36.4 24.8
2 29.9 26.6
1 21.5 21.5
0 12.2 11.2
No. of observations 3,953 3,789

Note: Total numbers of observations vary due to item non-response.

By the age of 6-7 years, 12% of B cohort children exceeded the guidelines for energy-dense food intake over the three waves (i.e., were eating more than two serves per day), and by the age of 10-11 years, 11% of K cohort children exceeded the guidelines over four waves. As high consumption of energy-dense food is a key mechanism of weight gain, these children are likely to be at the greatest risk of obesity. Therefore, to develop targeted interventions it is important to identify the factors associated with these unhealthy eating behaviours.

Factors associated with persistent high intake of energy-dense foods

The analysis presented below examines factors that might be associated with persistent high intake of energy-dense foods for children aged 6-7 and 10-11 years at Wave 4 (12% of the B cohort and 11% of the K cohort respectively). These children were considered to have persistent high intake if they were eating above the recommended amount over all three and four waves respectively. Results of the analysis are presented in Table 6.9. As emphasised in the previous section, due to the different ages and different respondents in the B and K cohorts, the results are not compared across waves.

Table 6.9: Children eating high amounts of energy-dense foods across all waves by socio-demographic and family characteristics, 6-7 and 10-11 year olds
Socio-demographic and family characteristics 6-7 years (B cohort) 10-11 years (K cohort)
% p % p
Study child gender
Male 12.8 ns 12.3 *
Female 11.5 9.7
Family socio-demographic characteristics
Parental education
No university degree or higher 16.3 *** 13.8 ***
University degree or higher 6.0 6.2
Family type
Two-parent family 11.4 * 10.5 *
Single-parent family 16.7 13.8
Mother's working status
Non-working 16.3 *** 12.9 ns
Working 9.8 10.4
Region of residence
Rural 15.3 *** 11.8 ns
Metropolitan 10.4 10.6
Family financial situation
Household income
Average/high income 9.7 *** 10.6 ns
Low income 19.3 12.7
Family financial stress
No 10.1 *** 10.2 *
Yes 17.9 13.6
Family feeding practices
Daily evening meals with mother
No 12.6 ns 13.9 *
Yes 12.1 10.3
Breastfeeding at 6 months
No 16.7 *** 13.8 ***
Yes 8.8 8.9
Healthiness of mother's lifestyle
Physical activity (3+ times per week)
No 12.5 ns 13.2 ***
Yes 11.6 9.1
Smoking (at least once a day)
No 10.1 *** 9.6 ***
Yes 19.2 16.2
Binge drinking (5+ drinks, 2+ times per month)
No 11.2 ns 9.6 ***
Yes 13.2 18.6
Fruit intake (2+ serves per day)
No 13.8 ** 13.1 ***
Yes 10.2 8.8
Vegetable intake (5+ serves per day)
No 12.2 ns 11.3 **
Yes 8.1 6.0
No. of observations 3,953 3,789

Note: *** p < .001; ** p < .01; * p < .05; ns = not statistically significant.

There were no significant differences between the boys and girls in the B cohort (13% boys and 12% girls) who were eating high amounts of energy-dense foods across all waves. A larger proportion of K cohort boys (12%) were eating too much energy-dense food across all waves compared to girls (10%, p < .05).

A high intake of energy-dense foods was significantly associated with parental education. Children from families with at least one parent with a university degree were less likely to have three or more serves of energy-dense foods per day compared to children from families without a university degree (6% vs 16% in the B cohort and 6% vs 14% in the K cohort, respectively). This pattern was observed across all waves. A larger proportion of B and K cohort children were eating too much energy-dense food across all waves if they were from one-parent compared to two-parent families (17% vs 11% in the B cohort and 14% vs 11% in the K cohort). Mother's working status and region of residence was also associated with the prevalence of high energy-dense food intake across all waves, but only for the B cohort. Children of non-working mothers (16%) and living in rural areas (15%) were more likely to consume high amounts of energy-dense foods compared to children with a working mother (10%) and metropolitan children (10%). Experiencing financial difficulty was also associated with a high energy-dense food intake across all waves. While household income was significantly associated with the prevalence of high intake for B cohort children only, the family's financial stress was a significant correlate for both cohorts. The proportion of children consistently eating high amounts of energy-dense foods, was larger for B cohort low-income families (19%) compared to average/high income families (10%), and larger for families in both cohorts who experienced financial stress (18% in the B cohort and 14% in the K cohort) compared to families not in financial stress (10% in each cohort).

Children in the K cohort who were having daily evening meals with their mother were significantly less likely to eat high amounts of energy-dense foods across all waves (14%) compared to those who did not have daily evening meals with their mother (10%). A larger proportion of children who were eating too much energy-dense food were not breastfed at 6 months (17% for the B cohort and 14% for the K cohort) compared to those who were breastfed (9% for each cohort).

Mother's healthy lifestyle was a protective factor against high energy-dense food intake across all waves. For the K cohort children, having a mother who reported higher levels of physical activity, not smoking, not binge drinking and healthy eating habits was associated with a lower prevalence of high energy-dense food intake for each characteristic across all waves. For the B cohort, having a mother who did not smoke or reported an adequate fruit intake was negatively associated with children's high energy-dense food intake across all waves, while physical activity, drinking behaviour and vegetable intake were not significant factors. Of those children whose mother smoked, 19% of B cohort children and 16% of K cohort children were eating too much energy-dense food across all waves, compared to 10% with non-smoking mothers in both cohorts. Among those children whose mother was not eating enough fruit, 14% (B cohort) and 13% (K cohort) were eating energy-dense foods above the recommendations across all waves, compared to 10% (B cohort) and 9% (K cohort) among children whose mother was eating enough fruit. The proportion of K cohort children who were eating too much energy-dense food across all waves was significantly higher among children with a mother who was exercising less than three days per week (13%), was binge drinking (19%) and was not eating enough vegetables (11%), compared to children with mothers who were physically active (9%), not drinking (10%) and eating enough vegetables (6%).

The relationships presented above are raw figures. After adjusting for all the factors, only a few relationships remained statistically significant: no university degree for either parent and no breastfeeding at 6 months old for both cohorts; not sharing evening meals with mother and mother's binge drinking for K cohort children; and low household income, living in a metropolitan area and mother smoking for the B cohort (Table 6.10).

Table 6.10: Association between high energy-dense food intake across all waves and different factors, adjusting for other characteristics, 2-7 and 4-11 year olds
2-7 years (B cohort) 4-11 years (K cohort)
Parent with no university degree + +
Metropolitan residence - ns
Low household income + ns
Evening meals with mother ns -
Breastfeeding at 6 months - -
Mother smoking + ns
Mother binge drinking ns +

Note: + = positive significant relationship; - = negative significant relationship, ns = no significant relationship.

6.5 Eating behaviour patterns of children from different socio-economic groups

Descriptive analyses presented in this chapter suggest that low fruit and vegetable intake and high energy-dense food intake are independently associated with family characteristics. Previous research suggests that health behaviour patterns, as measured by fruit and vegetable intake in combination with energy-dense food intake, are not random throughout the population, with specific eating patterns being common for individuals from different socio-economic backgrounds (Friestad & Klepp, 2006; WHO, 2006). This section aims to examine the prevalence of different eating behaviour patterns among children from different socio-economic groups.

Typology of eating behaviour

Eating patterns of children were derived according to their intake of fruit, vegetables and energy-dense foods (Cameron et al., 2010). Depending on whether children were meeting recommended guidelines on the selected foods, their eating behaviour patterns were classified as follows:

  • not meeting guidelines - children who were not eating enough fruit/vegetables and consuming too much energy-dense food (three or more serves) per day;
  • meeting one guideline - children who were either not eating enough fruit/vegetables and eating two serves or fewer of energy-dense foods per day, or eating enough fruit/vegetables and more than the recommended energy-dense foods; and
  • meeting both guidelines - children who were eating enough fruit and vegetables and no more than two serves of energy-dense foods per day.

Table 6.11 presents the proportion of children who met or did not meet the recommended guidelines, by age and cohort. Among B cohort children, regardless of age, meeting one guideline was the most common pattern of eating behaviour. At 2-5 years, around half of the children were meeting only one guideline. When children were 6-7 years old, the corresponding proportion decreased slightly to 45%. The second most common pattern of eating behaviour at 6-7 years was meeting both guidelines. At 2-5 years, 33% of children were eating the recommended amount of fruit and vegetables and no more than two serves of energy-dense foods per day. At 6-7 years, the corresponding proportion dropped slightly, with three in ten children meeting both guidelines. One in five children aged 2-5 years and one in four aged 6-7 years were not meeting guidelines at all.

Table 6.11: Whether children's eating patterns meet recommended guidelines, by age and cohort
Eating behaviour pattern 2-3 years (%) 4-5 years (%) 6-7 years (%) 8-9 years (%) 10-11 years (%)
B cohort
Not meeting guidelines 19.5 19.7 25.1 NA NA
Meeting one guideline 47.1 47.7 45.2 NA NA
Meeting both guidelines 33.3 32.7 29.8 NA NA
No. of observations 3,965 3,979 3,977 NA NA
K cohort
Not meeting guidelines NA 29.6 26.6 35.3 40.1
Meeting one guideline NA 44.6 44.6 53.5 50.8
Meeting both guidelines NA 24.8 28.5 11.1 9.0
No. of observations NA 3,866 3,912 3,912 3,876

Among K cohort children aged 4-11 years meeting one guideline was also the most common eating pattern (4-7 years: 45%; 8-9 years: 54%; 10-11 years: 51%). The second most common pattern was not meeting the guidelines. At 4-5 years, 30% of children were eating too much energy dense food and not enough fruit and vegetables required for their optimal growth and development. As children grew up the corresponding proportion increased to 40% at 10-11 years. At the same time, the proportions of children who were meeting both guidelines decreased substantially from 25% at 4-5 years to 9% at 10-11 years.

Prevalence of children's eating behaviour patterns by socio-economic position

The socio-economic position of families was derived using highest parental education, parental income and occupational prestige of parents, and divided into three categories: (a) low SEP households, in the bottom quartile (25%) of the SEP distribution; (b) average SEP households, in the middle 50% of the SEP distribution; and (c) high SEP households, in the top quartile (25%) of the SEP distribution.

Figure 6.3 and Figure 6.4 describe the prevalence of eating behaviour patterns of B and K cohort children from different SEP families. Among B and K cohort children, the prevalence of those who were meeting one guideline was similar between children from low-, average- and high-SEP families. Across both cohorts and for all SEP groups, the proportion of children aged 2-11 years who were meeting one guideline varied between 43% and 58%.

Figure 6.3: Prevalence of children's eating behaviour patterns, by socio-economic position, B cohort (2-7 years)

Prevalence of children’s eating behaviour patterns, by socio-economic position, B cohort (2–7 years)

Figure 6.4: Prevalence of children's eating behaviour patterns, by socio-economic position, K cohort (4-11 years)

Prevalence of children’s eating behaviour patterns, by socio-economic position, K cohort (4–11 years)

The apparent differences between different SEP groups were observed in the prevalence rates of those not meeting guidelines and meeting both guidelines. From a very early age (2-3 years) a higher proportion of children from low-SEP families were not meeting guidelines compared to children from average- and high-SEP families. At 2-3 years, 33% of children from low-SEP families were not meeting guidelines, compared to 17% and 10% of children from average- and high-SEP families respectively. As children grew up, the discrepancy between children from low-SEP families and those from average- and high-SEP families persisted, even though the proportion of children not eating according to the dietary requirements increased across all SEP groups. When children were 10-11 years old, 48% and 40% of children from low and average socio-economic backgrounds respectively were eating too much energy-dense food and not enough fruit and vegetables compared to 28% of children from high-SEP families.

Conversely, children aged 2-3 years from high SEP-families (45%) were more likely to meet both guidelines compared to children from average- and low-SEP families (35% and 21%, respectively). Similar differences were apparent at all ages and across both cohorts. At 10-11 years, 16% of children from high-SEP families were meeting both guidelines compared to only 5% and 9% of children from average- and low-SEP respectively.

The above analysis has confirmed a substantial socio-economic gradient in children's eating behaviour patterns at 2-11 years, with children from the lowest socio-economic quartile being more likely to not meet the dietary requirements for fruit, vegetables and energy-dense food intake, and children from the highest socio-economic quartile more likely to meet the dietary requirements for the intake of fruit, vegetables and energy-dense foods.

6.6 Conclusion

This study investigated the consumption of fruit, vegetables and energy-dense foods and factors that influence these eating behaviours. Before we discuss the main findings of this study, it is crucial to re-iterate that LSAC participants were only asked how often they ate a particular food, not how many serves were consumed each time they ate, meaning that the study child may have actually eaten more or less than one serve of the food on each occasion. However, for the purposes of this analysis, the number of times the study child ate a specific food was equated with the number of serves consumed. This limitation should be taken into account while interpreting the findings.

Importantly, it was found that approximately 90% of children between the ages of 2 and 7 years ate the recommended servings of fruit daily, though this figure dropped to just 55% among those aged 10-11 years. Vegetable consumption was a more pressing concern, with fewer than half of the children aged 2-7 years meeting the recommended servings of vegetables each day. The figure dropped substantially among older age groups, with only 18% of 8-9 year olds and 32% of 10-11 year olds meeting the recommended intake. Although the reporting protocol for those aged 10-11 changed (from parent-report to self-report), the most important factor here is likely to be that the recommended number of servings for this age group is higher for both fruit (2 serve vs 1) and vegetables (3 serves vs 2) than for younger children. Vegetable serving recommendations for those aged 8-9 years are also higher (3 serves vs 2). These differences in recommendations are reflected strongly in the results, indicating that this may be a critical period during which to engage parents and schools to make them aware of opportunities to increase the number of daily servings during this life stage.

In both cohorts, groups of children whose daily consumption remained below the recommended servings of fruit and vegetables (combined) during all waves of data collection were identified. This situation was reported for 26% of the B cohort and 30% of the K cohort. These children represent a target group of particular interest as they have unhealthy eating habits that have been persistent for many years, and therefore are likely to track through to adolescence and adulthood. Further analysis revealed these children were more likely to be male, from low income families, single-parent families, rural areas, have parents with no University degree, were not breastfed at 6 months of age, and have mothers with less healthy eating and lifestyle practices.

With regard to energy-dense foods, two-thirds of the B cohort children aged 2-5 years were eating at or below the recommended intake levels, dropping slightly to 43% among those aged 6-7 years. Within the K cohort, more than half of the 4-9 year old children were at or below the recommended intake levels; however, this dropped among the 10-11 year olds to 45%. Again, this may be a function of the change to self-report measures among this older age group.

However, as with fruit and vegetables, these figures demonstrate that a significant proportion of children were not meeting the daily guidelines for energy-dense foods. This presents a potentially important area for intervention, as it may be easier for parents to encourage and supply a lower amount of energy-dense foods than to have children eat more vegetables, though both are equally important.

In the B cohort, 12% of the children exceeded the recommended energy-dense food intake across the three waves and in the K cohort this figure was 11% across four waves. A higher proportion of these children were identified among boys, single-parent families, those from rural areas, households with lower socio-economic characteristics, those who did not eat evening meals with their mothers, were not breastfed at 6 months, and had mothers who had less healthy behaviours with regard to physical activity, smoking, drinking and fruit and vegetable intake.

Dietary patterns related to the consumption of both fruit and vegetables and energy-dense foods were also assessed in this chapter. In the B cohort children, the proportion of children who were not meeting guidelines increased from 20% to 25% between the ages 2-3 years and 6-7 years, whereas the proportion of children who were meeting both guidelines remained fairly stable across different ages (30%). Among K cohort children, the proportion who were not meeting guidelines increased from 30% to 40% between the ages of 4-5 years and 10-11 years, whereas the proportion who were meeting both guidelines fell from 25% to 9% in the same period. The dietary patterns were again socio-economically patterned, with lower SEP families reporting less healthy diets, as indicated by the consumption of fruit, vegetables, and energy-dense foods.

As with previous research, the findings highlight that socio-economic disparities in eating behaviours exist, with those from a lower socio-economic background being less likely to consume diets in line with recommended guidelines. Researchers and policy makers must continue in their pursuit of factors that encourage healthier eating among this group (Ball et al., 2012). A number of factors related to the mother's lifestyle were also identified as potential indicators of increased risk of unhealthy diets. These findings support evidence from a number of previous studies (Cameron et al., 2010; Lien et al., 2002) and highlight the important role mothers and families have in establishing healthy behaviours among their children.

6.7 References

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Endnotes

1 The consumption of dairy products, water and fruit juices was also measured in LSAC; however, these eating habits were not explored in this chapter.

2 New guidelines were released in 2013; however, for the current analyses, the guidelines that were relevant at the time of data collection were used.

3 A question regarding food intake varied slightly across waves: "In the last 24 hours has child had the following foods and drinks once, more than once, or not at all: Fresh fruit" (Wave 1, K cohort), "In the last 24 hours how often did the child eat fresh fruit?" (Wave 2), "In the last 24 hours how often did child have fresh fruit?" (Waves 3 and 4) or "Thinking about yesterday, how often did you have fresh fruit?" (asked of the child).

4 Given that the K cohort measure was derived using both parent and child responses, and children's ages varied from 2 to 7 years for the B cohort and from 4 to 11 years for the K cohort, comparisons between cohorts were not possible.

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