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      Gibney, M.J.; Uzhova, I. (Ireland)

       The Importance of Dietary Protein at Breakfast in Childhood

      Karagounis, L.G. (Switzerland)

       Breakfast Consumption versus Breakfast Skipping: The Effect on Nutrient Intake, Weight, and Cognition

      O’Neil, C.E.; Nicklas, T.A. (USA)

       Breakfast, Glycemic Index, and Cognitive Function in School Children: Evidence, Methods, and Mechanisms

      Sünram-Lea, S.I. (UK)

       Summary on Importance of Breakfast for Children’s Health and Development

      Nicklas, T.A. (USA)

       Subject Index

      For more information on related publications, please consult the NNI website: www.nestlenutrition-institute.org

Preface

      Optimal growth is a central theme in human nutrition. Growth is a proxy indicator of health and well-being. Adequate food intake is crucial for growth. Nurturing a healthy generation of children is a social imperative. This formed the title of the workshop. Much remains to be learned on the factors that limit and enhance food intake in children. Hence, the workshop focused on research gaps and opportunities. The workshop covered 3 sessions that involved an excellent array of presentations. The first session was entitled “Early Eating Behavior and Taste Development Influence in Children.”

      According to the World Health Organization (WHO), the global number of children aged from 0 to 5 years with overweight or obesity has increased from 32 million in 1990 to 41 million in 2016. This trend concerns most countries around the globe, although we may see obesity rates stabilizing in some countries, such as in northwestern Europe [NCD Risk Factor Collaboration: Lancet 2017; 390: 2627–2642]. Obesity is associated with comorbidities, placing children at a greater risk of developing type 2 diabetes, cardiovascular disease, and even psychological disorders such as low self-esteem. In this context, the WHO has developed a framework to prioritize 6 actions that could help put an end to childhood obesity [Commission on Ending Childhood Obesity: Report of the Commission on Ending Childhood Obesity, 2016]. The importance of nutrition for children is present in 3 of these actions, which relate to the content of this workshop: (1) the promotion of healthy food intake, (2) early childhood diet and physical activity, and (3) health, nutrition, and physical activity for schoolage children. In this context, it is more topical than ever to ensure children receive the best nutrition from the start of life, and even before, and develop healthy eating habits which could be maintained throughout life. In relation to these issues, in the first session of the workshop entitled Nurturing a Healthy Generation of Children: Research Gaps and Opportunities , the development of eating behaviors in the early years of life has been addressed from the very early months of postnatal life according to several themes related to modifiable factors: the role of sensory inputs, the role of dietary experience, and the effect of parental feeding practices.

      Sophie Nicklaus et al. focused on the development of taste and flavor preferences and its consequences on children’s eating behaviors. After birth, when foods are orally exposed, infants discover the intrinsic properties of foods, with a variety of tastes, flavors, textures, as well as energy densities. Here, the focus was on deciphering the involvement of taste and olfaction in the early establishment of eating behavior based on data collected in the OPALINE birth cohort (Observatory of Food Preferences in Infants and Children), which was followed up in the area of Dijon (France). Taste and flavor preferences were studied in those children in relation to food acceptance over the first 2 years of life. The data show that both taste and flavor preferences evolve during this period: for instance, saltiness acceptance increased sharply between 3 and 12 months, while rejection of unpleasant food odors developed between 8 and 22 months. At the beginning of the complementary feeding period, a higher preference for some basic tastes (sweet, sour, and umami tastes) was associated with a higher acceptance of foods with similar tastes (sweet, sour, and umami, respectively); and, similarly, rejection of the odor of trimethylamine and dimethyl disulfide were related to the rejection of fish and sulfurous cheeses, respectively. Further in development, at 20 months, food neophobia was associated with flavor differential reactivity (within-subject variability across flavors) but not to taste differential reactivity (within-subject variability across tastes), underlying the importance of olfaction in the development of neophobic reactions. Altogether, these data highlighted the sensitivity of infants and toddlers to the sensory inputs from foods, which also contribute to the pleasure of eating.

      Andrea Maier-Nöth highlighted some mechanisms by which infants and toddlers learn to like vegetables, which is a critical issue given that children’s vegetable consumption falls below current recommendations in many countries. The first approach to increase acceptance of vegetables was based on offering infants a variety of vegetables (purée changed every day for 10 days vs. 3 days and no change) at the beginning of weaning. Such an experience with a variety of foods as of the beginning of weaning is associated with a higher acceptance of new vegetables and new foods from other groups, which persisted for several weeks, and to a higher liking and a higher consumption of new vegetables up to the age of 6 years. The acceptance of new vegetables was also higher in infants who had been breastfed, i.e., who had been likely exposed to a variety of flavors in breast milk. The second approach to increase acceptance is based on repeated exposures to an initially disliked vegetable. This experience markedly increases the acceptance of this vegetable, which becomes as liked as an initially liked vegetable. This presentation revealed the plasticity of young children to the food experience they receive in their first years and the long-term effect of this experience in shaping healthy eating habits.

      Kimberley Mallan and Narissa Miller addressed another facet of the parentchild interaction in terms of feeding, focusing in particular on eating behaviors related to appetite regulation and obesity risk, and on parental feeding practices likely to alter appetite regulation, namely nonresponsive feeding practices, which can be of many types. In this area, most of the previous research has been cross-sectional, whereas a bidirectional relationship between parent feeding and child eating has been proposed more recently. The aspects of child eating behaviors discussed in relation to obesity risk were eating in the absence of hunger (which can be measured experimentally), food responsiveness, or satiety responsiveness (which can be measured with an instrument such as the Child Eating Behavior Questionnaire). The presented review summarized findings related to feeding practices that may support (e.g., being responsive to a child’s cues or providing mealtime structure) or undermine (e.g., pressure to eat, instrumental emotional feeding, or restriction) children’s eating behaviors. In summary, this review confirmed that parents’ feeding practices do impact on children’s eating behaviors, but also that children’s eating behaviors influence the feeding practices parents use. Moreover, the presentation was ended by useful tips for responsive feeding practices that were successfully tested in the frame of the NOURISH study conducted in Australia.

      The session was concluded by Lisa Fries and Klazine van der Horst who addressed “picky eating” in children, and how it is likely to be modified by parental feeding practices. Picky eating is a broad construct that relates to the perception of a limited diet or food refusals. A recent review of the literature found that picky eaters display several different types of behaviors, among which the most common are neophobia, lower fruit and vegetable intake, food refusals, less enjoyment of eating, and sensory sensitivities. Parental feeding practices may be usefully applied to overcome picky eating behavior in children. For instance, parents could be encouraged to keep trying after a food is refused, as children may need to be exposed to a food several times before it is accepted. Varying the

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