Mixed foods are similarly categorized by

NIH Public Access Author Manuscript Appetite Author manuscript; available in PMC 2009 March NIH-PA Author Manuscript Published in final edited form as: Appetite 2008 ; 50(2-3): 316–324 MIXED FOODS ARE SIMILARLY CATEGORIZED BY – 13 YEAR OLD CHILDREN Alicia Beltran1, Karina Knight Sepulveda2, Kathy Watson3, Tom Baranowski4, Janice Baranowski5, Noemi Islam6, and Mariam Missaghian7 Baylor College of Medicine, 1100 Bates Street, Room 2025H, Houston, Texas 77030-2600, U.S.A., abeltran@bcm.tmc.edu Baylor College of Medicine, 1100 Bates Street, Room 2025H, Houston, Texas 77030-2600, U.S.A., ksepulve@bcm.tmc.edu Baylor College of Medicine, 1100 Bates Street, Room 2025H, Houston, Texas 77030-2600, U.S.A., kwatson@bcm.tmc.edu NIH-PA Author Manuscript [Tom Baranowski, PhD] Professor of Pediatrics, Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Room 2038, Houston, Texas 77030-2600, U.S.A., tbaranow@bcm.tmc.edu Not for Publication: Phone (713) 798-6762; Fax (713) 798-7098 Baylor College of Medicine, 1100 Bates Street, Room 2038, Houston, Texas 77030-2600, U.S.A., jbaranow@bcm.tmc.edu Baylor College of Medicine, 1100 Bates Street, Room 2025H, Houston, Texas 77030-2600, U.S.A., nislam@bcm.tmc.edu Baylor College of Medicine, 1100 Bates Street, Room 2025H, Houston, Texas 77030-2600, U.S.A., mariamm@bcm.tmc.edu Abstract NIH-PA Author Manuscript Food search in a computerized 24 hour recall (24hdr) for children should be easiest when the categories reflect children’s categorization of foods, in contrast to professional categories This study assessed how 8–13 year old children categorized and labeled mixed foods (e.g fried rice, lasagna), and how these were influenced by child characteristics A set of 48 cards with pictures and names of mixed foods from 14 professionally defined food groups was sorted by each child into piles of similar foods Participants (n= 146), including to13 year old 130 English speaking, and 16 Spanish speaking children, attended data collection in the summer, 2006 One way ANOVA, pairwise comparisons and Robinson matrices for identification of clusters were used Children created an average of 10.5 (± 5.5) piles with 6.0 (±4.1) cards per pile No substantial differences in Robinson clustering were detected across subcategories for each of the demographic characteristics, body mass index, or 6-n-propylthiouracil sensitivity For the majority of the piles, children provided “Taxonomic-Professional” (26.0%) labels, such as Vegetables, Sandwiches and Drinks, or “Specificfood item” (23.0%) labels, i.e the name of the food These categories may be used to facilitate mixed food search in a computerized 24hdr for children in this age group Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication As a service to our customers we are providing this early version of the manuscript The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain Beltran et al Page Keywords NIH-PA Author Manuscript Mixed foods; Food categorization; Children; Card sort; twenty four hour dietary recall; diet assessment Introduction Pediatric nutrition research benefits from accurate diet assessment tools, which are brief, easily administered, inexpensive, accurate, and suitable for broad populations (Rockett, Berkey & Colditz, 2003) A 24 hour dietary recall (24hdr) is designed to record actual intake over a specific time period, obtaining specific foods, beverages, seasonings, cooking procedures, amounts, locations, and times of food consumed (Frank, 1991) Many consider the 24hdr to be the preferred method of diet assessment (McPherson, Hoelscher, Alexander, Scanlon & Serdula, 2000), but conducting a 24hdr, can be cost-prohibitive for large studies To minimize these costs, a prototype computerized 24hdr (called the Food Intake Recording Software System or FIRSSt) for children was developed, but primarly assessed fruit and vegetable intake (Baranowski et al., 2002) A limitation of FIRSSt was how children could best find and report mixed foods, e.g lasagna, peanut butter & jelly sandwich, pizza, which include several food ingredients and often reflect ethnic cuisines NIH-PA Author Manuscript The age at which children reach a level of cognitive maturity sufficient to accurately report dietary intake is not clear (Michela & Contento, 1984) Some studies have obtained reasonable 24 hdr from year old girls (Cullen et al., 2004), while food frequencies have elicited data similar to that from adults only with children 13 years and older (Field et al., 1999) Girls may be more reliable than boys (Prochaska, Sallis & Rupp, 2001); differences might be associated with ethnic groups (Reynolds et al., 1999); and underreporting has been associated with obesity (Briefel, Sempos, McDowell, Chien & Alaimo, 1997) Knowing how children categorize and label mixed foods should identify how to group and name the food categories in a computerized 24hdr that facilitates their rapid and accurate search Since the ability to taste propylthiouracil (PROP taster status) has been related to food preferences, food consumption and obesity (Keller & Tepper, 2004), it would be important to know if the ability to perceive the bitter taste of some foods, especially vegetables, influences the way children categorize foods NIH-PA Author Manuscript This exploratory study assessed how to 13 year olds categorized and labeled mixed foods, and how these categories and labels were influenced by gender, age, BMI, ethnicity, socioeconomic status, PROP taster status, food preference and frequency of consumption of the food items Methods This research was approved by the Baylor Institutional Review Board The sample consisted of 146 to 13 year old children, recruited via telephone from the Children’s Nutrition Research Center volunteer participant database, during the summer of 2006 Attempts were made to recruit a sample of 150 children with comparable numbers in each ethnic (White, Hispanic, and African-American) and age category A special attempt was made to recruit a cohort of primarily Spanish speaking children in anticipation of a Spanish language version of FIRSSt The study recruited a total of 152 children of whom were excluded because of missing data Of the remaining 146 children (see Table 3), 89% were predominantly English speaking; 57.5% were female; 43.2% Hispanic; 56% had normal BMI; 51.4% had above > $60,000/year family income; 52.1% had a college graduate or higher education in the home; 46.6% were PROP Appetite Author manuscript; available in PMC 2009 March Beltran et al Page NIH-PA Author Manuscript medium tasters; and were approximately similarly distributed across the ages of to 13 years old Written informed consent was previously mailed or brought in person when attending the research center Children were asked to five different card sorts taking about 30 each Card sort contained diverse single food items, card sort was composed of mixed food items which were analyzed for this manuscript, card sort included only fruits, card sort had vegetables and, card sort was composed of diverse grains and cereals Children were scheduled to the card sort activities for two days, unless they had an early morning appointment and had time to finish all the activities in one day Participant’s demographic data (age, gender, ethnicity, parents’ highest educational attainment and family income) were obtained by parent report On the first day, BMI was estimated by measuring height and weight Height was measured according to a standardized protocol using a stadiometer (PE-AIM-101 from Perspective Enterprises) Weight was measured using an electric scale (SECA Alpha 882 from SECA Corporation) according to standardized protocol CDC percentiles were obtained by calculating body mass index (BMI) as weight (kg)/height (m2) and referring to values on their website (Kuczmarski et al., 2000) NIH-PA Author Manuscript Sensitivity to PROP (6-n-propylthiouracil), a natural chemical substance found in brassica vegetables (e.g broccoli, Brussels sprouts) giving them a bitter taste, was measured using the impregnated tissue paper procedure (Zhao, Kirkmeyer & Tepper, 2003) Two paper disks were given to each child The first one, which was labeled with an odd number, contained NaCl (1.0 mol/l), and a second disk, labeled with an even number, contained PROP (0.280 ± 0.002 mg, with a coefficient of variation across disks of ± 2.2%) Each child was asked to rinse their mouth with bottled water, place the paper disk on the tip of their tongue and count thirty seconds After the thirty seconds, they drew a line on a log scale, which ranged from – 100, with labels as “barely taste it”, “weak”, “strong”, “very strong”, or “strongest imaginable”, demarcating the intensity of taste (Zhao, Kirkmeyer & Tepper, 2003) This cross line was later measured with a ruler and data recorded by project staff to classify the children as “non-tasters”, “medium tasters”, or “super tasters” following standardized protocol (Zhao, Kirkmeyer & Tepper, 2003) Both paper disks were administered in the same manner All research staff were trained on the protocols in all tasks Card Sorting NIH-PA Author Manuscript Each child conducted five unconstrained card sorts; and the sequence of card sort tasks was randomly assigned to minimize possible sequence and fatigue effects The food items were selected from 14 professionally identified food categories (see Table 1) that were intended to be used with adults (Subar et al., in press) Items within categories (mostly mixed dishes) were selected based upon those most commonly consumed by to 13 year old children from different ethnic groups and reflected the consensus among a group of dietitians and behavioral researchers Card sort 2, analyzed in this manuscript, was composed of a set of 48 ẳ ì ẵ cards, each containing a photograph and name of the selected food item A small set of single food items that were components or otherwise related to some of the mixed dishes were introduced to assess their clustering with the mixed foods The child was asked to sort the cards into piles of similar foods Children were permitted to make as many or as few piles as they wanted If there was a food they didn’t know, a “Don’t Know” pile was allowed; and if they weren’t sure where to place a food, a “Not Sure” pile was suggested At the end of sorting, the research staff went through the “don’t know” and “not sure” food items and asked the child to try to place the cards in one of the existing piles At the completion of sorting the child was asked to name each pile and then explain why he/she had selected that particular name In response to pilot testing, participants were instructed not to separate foods as “healthy” or “unhealthy”, nor like or don’t Appetite Author manuscript; available in PMC 2009 March Beltran et al Page like The research staff recorded the name on a sticky note and attached it to the top of each pile NIH-PA Author Manuscript Between each card sort, the child completed a food preference questionnaire administered on a PDA which included the 48 foods depicted on the cards The food preference response categories were: Never had it, Don’t like it, Like it a little, and Like it a lot (Domel et al., 1993) Additionally, they used the PDA to answer a food frequency questionnaire on how often they consumed each of the 48 food items during the previous week (Cullen, Baranowski T., Baranowski J., Hebert & Moore, 1999) The frequency of consumption response categories were: Never eaten this, Didn’t eat it in last days, Ate it 1–2 times, Ate it 3–5 times, Ate it 6– times, Ate it more than times (Cullen et al., 1999) Each child received monetary compensation, a nutrition education brochure on healthier diet and physical activity practices, and had questions answered about healthier diet and physical activity practices at the end of their participation Each food card contained a distinct bar code on the back At the end of each morning’s data collection, the name given by the child (as recorded on the sticky note labels by the research staff) for each pile was first typed into a computer data base, and food items included in the pile were scanned with a bar code reader (to minimize data entry errors) Data Processing and Analyses NIH-PA Author Manuscript Descriptive statistics (means, standard deviations, frequencies, percentages) were used to depict the samples by their anthropometric and demographic characteristics Children were separated by age into 8–10 year old and 11–13 year old categories Participants were divided into normal (BMI