Papers by Marion Hetherington
Journal of Autism and Developmental Disorders, May 23, 2019
People with developmental disorders (DD) often display high levels of selective eating, which can... more People with developmental disorders (DD) often display high levels of selective eating, which can result in micronutrient deficiencies. It is therefore essential to explore ways to increase dietary variety in this population. To identify different types of interventions promoting increased acceptance of new foods or dietary variety for DD populations and to determine their effectiveness. Thirty-six studies met criteria for inclusion in the review. Twenty-two types of intervention were identified with 34 studies being reported as effective and 33 of these incorporating components drawn from learning theory. Multicomponent interventions centred on operant conditioning, systematic desensitisation and changes to environment and familial practices were reported as effective for individuals.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Trials, Jul 26, 2021
Background: Vegetables as first complementary foods for infants may programme taste preferences t... more Background: Vegetables as first complementary foods for infants may programme taste preferences that lead to improved vegetable intake in children. Yet few studies have investigated the impact of a "vegetables first" approach to complementary feeding, especially in New Zealand. The purpose of this randomised control trial is to investigate the effect of starting complementary feeding with vegetables only on infants' later intake and liking of vegetables, compared to those starting with fruit and vegetables. Methods/design: One-hundred and twenty mother-infant pairs living in Auckland, New Zealand, will be randomised to receive either vegetables only (intervention) or fruit and vegetables (control) for 28 days, starting from the first day of complementary feeding at around 4-6 months of age. Infants will be presented with a brassica (broccoli), followed by a green leafy vegetable (spinach) and sweet fruit (pear) at 9 months of age. The primary outcome measures of intake of each food will be assessed using a weighed food diary. Secondary outcome measures of overall intake, liking and wanting of vegetables will be assessed using a food frequency questionnaire, liking tool and video coding tool, respectively, at 9, 12, and 24 months of age. Infant growth and iron status will be assessed as part of health screening and monitoring at baseline, post intervention and 9 months of age. Other biological samples to be collected include infant stool samples, vitamin D (mother and infant), iron status (mother), and mothers' diet. Discussion: This randomised, controlled trial will be the first to our knowledge to investigate a "vegetables first" approach to complementary feeding on infants' liking and intake of vegetables in New Zealand. Comparison against standard practice (fruit and vegetables as first foods) should complement other trials underway, such as the Baby's First Bites and Nordic OTIS trial. Results may contribute to the evidence supporting complementary feeding guidelines in New Zealand and worldwide.
Appetite, Feb 1, 2022
This is a repository copy of An online study examining children's selection of vegetables at meal... more This is a repository copy of An online study examining children's selection of vegetables at mealtimes: The role of meal contexts, variety and liking.
Current Nutrition Reports, Feb 12, 2022
Purpose of Review To provide a rationale for promoting a vegetables first approach to complementa... more Purpose of Review To provide a rationale for promoting a vegetables first approach to complementary feeding (CF), building on prior exposure to vegetable flavours experienced in utero and via breastfeeding (chemosensory continuity). Recent Findings Vegetables confer selective health benefits but population intakes are below recommendations globally; maternal intake of vegetables during both pregnancy and lactation promotes familiarity with some vegetable flavours. Building on this exposure, vegetables as a first food during CF further promote acceptance. However, experiments testing efficacy of a vegetables first approach to CF demonstrate increased liking and intake, some evidence of generalisability but little evidence of sustained effects beyond infancy. Summary The aim to increase the quantity and variety of vegetables eaten by children is both desirable, to improve nutrient quality of the diet, and achievable. However, longer, larger, randomised control trials are needed to evidence any longer term, sustainable benefits to liking and intake of vegetables.
Journal of Texture Studies, 2019
Food material properties play an important role in sensory perception and consumer acceptance of ... more Food material properties play an important role in sensory perception and consumer acceptance of foods. However, the actual oral processing behavior may depend on both the material properties of the food that is being consumed and individuals' oral capabilities. This study aimed to examine the relationships between intrinsic (oral capabilities of healthy participants) and extrinsic (food material properties of a set of hydrogels) variables to the real oral processing behavior. Three κ‐carrageenan hydrogels (κC), differing in fracture mechanics and oral tribology properties, were prepared: native κC, κC with added Na‐alginate, and a κC matrix with added Ca‐alginate beads of 300 μm. A composite score of eating capability (EC) was measured with non‐invasive techniques (maximum bite force and tongue pressure) using a panel of 28 untrained consumers. The oral processing behaviors (number of chews, oral residence time, and chewing rate) were analyzed with the same participants using f...
Proceedings of the Nutrition Society, 2018
Food Quality and Preference, 2019
As overeating, overweight and obesity remain public health concerns, it is crucial to design sati... more As overeating, overweight and obesity remain public health concerns, it is crucial to design satiety-enhancing foods that suppress appetite and lower snack intake. Existing research identifies oro-sensory targets to promote satiation and satiety, yet it remains unclear as to whether it is 'chewing' or 'oral lubrication' that might amplify satiation signals. In this study, techniques from experimental psychology, food material science and mechanical engineering have been combined to develop model foods to investigate the role of chewing and oral lubrication on food intake. Novel model gels, similar in pleasantness, were given as a preload then their effects on subjective appetite and intake of a salty snack were measured in a between-subjects design. Three mint flavoured hydrogels were engineered to vary in their texture (fracture stress) and lubrication (inverse of coefficient of friction), and a control group received mint tea. Results showed that snack intake was suppressed by 32% after eating the low chewing/high lubricating preload compared to the high chewing/low lubricating preload (p < 0.05). Hunger ratings decreased from t 1 to t 3 (p < 0.05), however differences between conditions were subtle and not significant. Thus, this proof-of-concept study demonstrates that manipulating oral lubrication is a promising new construct to reduce snack intake that merits future research in the oro-sensory satiety domain.
Food Hydrocolloids, 2019
This is a repository copy of On relating rheology and oral tribology to sensory properties in hyd... more This is a repository copy of On relating rheology and oral tribology to sensory properties in hydrogels.
Appetite, Jan 2, 2018
Food delivers energy, nutrients and a pleasurable experience. Slow eating and prolonged oro-senso... more Food delivers energy, nutrients and a pleasurable experience. Slow eating and prolonged oro-sensory exposure to food during consumption can enhance the processes that promote satiation. This systematic review and meta-analysis investigated the effects of oral processing on subjective measures of appetite (hunger, desire to eat) and objectively measured food intake. The aim was to investigate the influence of oral processing characteristics, specifically "chewing" and "lubrication", on "appetite" and "food intake". A literature search of six databases (Cochrane library, PubMed, Medline, Food Science and Technology Abstracts, Web of Science, Scopus), yielded 12161 articles which were reduced to a set of 40 articles using pre-specified inclusion and exclusion criteria. A further two articles were excluded from the meta-analysis due to missing relevant data. From the remaining 38 papers, detailing 40 unique studies with 70 subgroups, raw data were...
Food Quality and Preference, 2016
Introduction: Consumption of foods is determined in part by how much a food is liked. However, as... more Introduction: Consumption of foods is determined in part by how much a food is liked. However, assessing liking in infants is difficult. Research with infants has often relied on indirect measures such as intake or subjective ratings from mothers. Therefore the aim of the present research was to devise a tool adapted from existing techniques which can directly and systematically measure liking in infants during the weaning period. Method: A tool was developed by extracting items from previous studies. In all, 13 items were generated, which included 6 behaviours reflecting avoidance and approach: turning away, arching back, pushing spoon away, crying/fussy, leaning forward and rate of acceptance; also 7 facial expressions thought to reflect affective response; brow lowered, inner brow raised, squinting, nose wrinkling, upper lip raised, lip corners down and gaping. An e-training manual was developed with a certification test to train coders. The coding tool is based on coding the first 9 spoonfuls for each infant. 63 videos were coded by 4 raters, each video was coded by at least 2 different coders. For each spoonful the absence or presence of each item was recorded; for rate of acceptance, a four point scale was used. Results: In the certification test most cues were high in agreement for all coders. Factor analysis indicated two dimensions, one which largely captured gross behaviours and the second featuring a cluster of facial expressions. Internal consistencies of the overall scale and the behaviour and facial expression subscales were acceptable as indicated by Cronbach's alpha >0.7. Intra-class correlation indicated moderate to high inter-rater reliability and test-retest reliability for most of the cues. Spearman correlations indicated significant associations of the total number of negative behaviours with rate of acceptance and overall facial expressions. Rejection behaviours corresponded with a low rate of food acceptance and a high rate of negative facial expressions. Two parameters occurred less frequently and did not appear to provide any further discriminatory ability, namely leaning forward and crying/fussiness, these can be removed from the scale for future use. Conclusions: The Feeding Infants: Behaviour and Facial Expression Coding System (FIBFECS) is structurally valid and reliable for use by trained coders and those who are researching infant eating behaviour. The two factor structure of the tool suggests that the facial expression subscale reflects liking and the behaviour subscale wanting. The tool could also be adapted for mothers and professionals to detect liking and wanting through facial expression and behavioural cues respectively.
Nutrients, Dec 4, 2019
Large portion sizes have been identified as contributing to overweight and obesity, particularly ... more Large portion sizes have been identified as contributing to overweight and obesity, particularly in children and adolescents. This study examined predictors of portion sizes of high energy snack foods eaten by children aged 1.5-18 years. Specifically, we examined whether portion sizes were adjusted for age, and what external features of the environment might be linked to large portion sizes. Portion sizes were derived from four-day food diaries that form the UK National Diet and Nutrition Survey. Diaries from 5942 children were examined and multilevel models were used to discover whether age, gender, location, time of day, household income, and watching TV while eating predicted portion sizes of savoury snacks, chocolate, confectionery and biscuits. Portion sizes of all the target foods were predicted by age. Boys had larger portions, and portion sizes were larger when target foods were consumed later in the day. Portion sizes were larger outside the home, for example in leisure venues, but the target foods were eaten more frequently in the home. As dietary patterns change to include more snack intake outside the home, these locations could be an important space to target for interventions for portion control.
Trials, Aug 1, 2022
Background: Childhood obesity rates more than double during primary school in England. Acquiring ... more Background: Childhood obesity rates more than double during primary school in England. Acquiring competent cooking skills is a key part of children's education that can lead to improved knowledge of a healthy lifestyle and dietary behaviours. Evaluation of the impact of 'PhunkyFoods' , a school-based food and nutrition education programme, will assess food literacy, cooking skills and dietary behaviour in primary-school children. A cluster randomised controlled trial will be undertaken in 28 primary schools in North Yorkshire, UK, including a total population of children aged 7-9 years (n = 420). The trial has two arms: (a) the intervention group receiving PhunkyFoods programme (n = 210) and (b) the wait-list control group receiving the usual school curriculum (n = 210). The intervention 'PhunkyFoods' will be delivered by Purely Nutrition Ltd. The participating school staff are supported with training, policy development and access to resources to improve the delivery of nutrition education. Children participate through whole school assemblies, classroom activities, and after-school clubs about food preparation, cooking healthy meals and healthy living. Schools, parents and children have access to healthy meal recipes through the PhunkyFoods website. The primary outcomes are differences in food literacy and cooking skills scores between control and intervention arms after 12 months of the intervention and adjusted for baseline values. The secondary outcome is differences in fruit and vegetable intake between the arms after 12 months (adjusted for baseline). Treatment effects will be examined using mixed ANOVA and regression analysis. Primary analyses will adjust for baseline food literacy and cooking skills scores and secondary analysis will adjust for pre-specified baseline school and child level covariates. The PhunkyFoods programme is a flexible menu of options for schools to choose from, making this a highly complex intervention. Following Medical Research Council guidance, research perspectives will focus on effectiveness and theory-based approaches: to what extent the intervention produces the intended outcomes in realworld settings and what works in which circumstances.
Frontiers in Psychology
Evidence confirms that parents know that they should limit non-core foods for their children sinc... more Evidence confirms that parents know that they should limit non-core foods for their children since these tend to be high in energy density (HED), fat, salt and sugar. However, it is unclear how knowledge of portion size limits, such as the 100 kcal guide from Public Health England are applied in practice. To observe in real-time children’s home food environment related to portion control and to explore with parents their reported portion size strategies, a mixed methods study was designed. Families with children aged 1–5 years were recruited (n = 21) to a three-part study: (1) to complete questionnaires and interviews on household food intake and portion control; (2) to report daily food intake for 4 days (n = 13) for one parent and their child(ren); (3) to observe home-based food provisioning via videorecording during dinner, breakfast and snack time (n = 6). Although the problem of large portion sizes of HED foods was recognised by mothers, strategies to downsize portions were not...
La diversification alimentaire : the importance of "pleasure" and "taste education... more La diversification alimentaire : the importance of "pleasure" and "taste education" during weaning of infants in France. Workshop OPALINE: Understanding the early development of food preferences and eating behaviour in childre
Additional file 1. Information Sheet.
Appetite, 2021
A variety of factors can influence satiation, and individual differences in reasons for meal term... more A variety of factors can influence satiation, and individual differences in reasons for meal termination may help to explain variability in food intake and susceptibility to overconsumption. We developed and validated a questionnaire to characterize the Reasons Individuals Stop Eating (RISE-Q). The initial RISE-Q was created by reviewing the published literature and identifying 47 reasons why individuals might stop eating. The RISE-Q asks respondents to rate how often each reason influences why they stop eating at a typical dinner meal by using a seven-point scale. Adults (N=477, 77% women) from a participant database completed a survey online that included the initial RISE-Q and the satiation-related Satiety Responsiveness and Food Responsiveness scales of the Adult Eating Behaviour Questionnaire (AEBQ). Self-reported height and weight were collected to calculate body mass index (BMI). The survey also assessed self-reported typical meal size. After factor analysis, the RISE-Q retained 31 items and identified five distinct scales of reasons for stopping eating: Decreased Food Appeal (mean±SD: 2.6±0.05, Cronbach's α=0.89), Physical Satisfaction (5.0±0.04, α=0.85), Planned Amount (4.4±0.05, α=0.82), Self-Consciousness (2.4±0.05, α=0.88), and Decreased Priority of Eating (2.3±0.04, α=0.69). Thus, the most frequently reported reasons for meal termination were related to Physical Satisfaction and Planned Amount. Each RISE-Q scale was significantly correlated with at least one of the satiation-related AEBQ scales, suggesting that the RISE-Q has construct validity. RISE-Q scales were also correlated with BMI and measures of typical meal size. The RISE-Q provides a novel tool to assess differences across individuals in reported reasons for eating cessation. The RISE-Q can aid in further understanding risk factors for overconsumption and has potential clinical utility in the design of targeted weight-management interventions.
Handbook of Eating and Drinking, 2020
Food Quality and Preference, 2021
Nudge theory predicts that consumers will select smaller portions of high energy density (HED) fo... more Nudge theory predicts that consumers will select smaller portions of high energy density (HED) foods and drinks when packaging presents physical or other limits. To test the feasibility and acceptability of packaging concepts designed to limit portion sizes for children, two mixed methods studies were conducted. Packaging with functional serving size reminders, visual narrative, and metaphor were developed using 3-D prototypes. In each study, packaging prototypes were assessed, either in person (Study 1, n = 50) or via an online survey (Study 2, n = 297). In Study 1, parents visiting a Science museum poured servings for their children of HED foods/drinks and provided feedback on prototypes designed to limit portions of these items. Responses were recorded via questionnaire and interview. In Study 1, parents significantly adjusted amount poured for children based on age and in alignment with recommended portion sizes; they reported that the packaging prototypes would facilitate portion control through education, convenience and autonomy but raised concerns about costs and recyclable/reusable materials. In Study 2 parents responded to the same prototypes online providing measures of willingness to pay (WTP), forced choice and open-ended feedback for each concept. Parents were WTP more for downsizing packaging concepts, choosing them over their regular brand in most cases and confirming a generally positive view of the designs. However, WTP magnitude depended on consumer segmentation (price concerns, health motives). Innovative design concepts can be used to nudge towards smaller portions, but this depends on parental motivation.
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Papers by Marion Hetherington