pQCT bone geometry and strength: population epidemiology and concordance in Australian children aged 11–12 years and their parents

ObjectivesTo describe the epidemiology and concordance of bone health in a population-based sample of Australian parent-child dyads at child age 11–12 years.DesignPopulation-based cross-sectional study (the Child Health CheckPoint) nested between waves 6 and 7 of the Longitudinal Study of Australian Children (LSAC).SettingAssessment centres in seven cities around Australia, February 2015–March 2016.Participants: of all participating CheckPoint families (n=1874), bone data were available for 1222 dyads (1271 children, 50% girls; 1250 parents, 86% mothers).Outcome measuresPeripheral quantitative CT (pQCT) of the non-dominant leg scanned at the 4% (distal) and 66% (mid-calf) tibial sites. Stratec XCT 2000 software generated estimates of bone density, geometry and polar stress-strain index.Parent-child concordance were assessed using Pearson’s correlation coefficients and multivariable linear regression models. Percentiles were determined using survey weights. Survey weights and methods accounted for LSAC’s complex sampling, stratification and clustering within postcodes.ResultsConcordances were greater for the geometric pQCT parameters (periosteal circumference 0.38, 95% CI 0.33 to 0.43; endosteal circumference 0.42, 95% CI 0.37 to 0.47; total cross-sectional area 0.37, 95% CI 0.32 to 0.42) than density (cortical density 0.25, 95% CI 0.19 to 0.30). Mother-child and father-child values were similar. Relationships attenuated only slightly on adjustment for age, sex and body mass index. Percentiles and concordance are presented for the whole sample and by sex.ConclusionsThere is strong parent-child concordance in bone geometry and, to a lesser extent, density even before the period of peak adolescent bone deposition. This geometrical concordance suggests that future intergenerational bone studies could consider using pQCT rather than the more commonly used dual X-ray absorptiometry (DXA).

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Albuminuria: population epidemiology and concordance in Australian children aged 11–12 years and their parents

BMJ Open ◽

10.1136/bmjopen-2017-020262 ◽

2019 ◽

Vol 9 (Suppl 3) ◽

pp. 75-84 ◽

Cited By ~ 1

Author(s):

Nicholas G Larkins ◽

Siah Kim ◽

John B Carlin ◽

Anneke C Grobler ◽

David P Burgner ◽

...

Keyword(s):

Pearson Correlation ◽

Correlation Coefficients ◽

Population Based ◽

Cross Sectional Study ◽

Linear Regression Models ◽

Creatinine Concentration ◽

Cross Sectional ◽

Urine Albumin ◽

Genetic Heritability ◽

Parent Child

ObjectivesTo describe the distribution of albuminuria among Australian children aged 11–12 years and their parents, and assess its intergenerational concordance within parent–child dyads.DesignPopulation-based cross-sectional study (the Child Health CheckPoint), nested within the Longitudinal Study of Australian Children.SettingAssessment centres (seven Australian cities and eight regional towns) and home visits across Australia, February 2015 to March 2016.ParticipantsOf all participating CheckPoint families (n=1874), 1557 children (46.2% girls) and 1454 parents (85.5% mothers) provided random urine samples at the visit; samples from menstruating females were excluded.Outcome measuresUrine albumin-to-creatinine ratio (ACR) and its components (urine albumin and creatinine concentration); albuminuria was defined as an ACR ≥3.4 mg/mmol. Pearson’s correlation coefficients and multivariable linear regression models assessed parent–child concordance, using log-transformed data due to skewing. Survey weights and methods were applied to account for the complex sample design.ResultsThe median ACR for children was 1.03 mg/mmol (IQR 0.65–1.97) and 1.01 mg/mmol (IQR 0.60–2.09) for adults. The median ACR was higher in girls (1.20, IQR 0.71–2.65) than boys (0.90, IQR 0.61–1.65) and in mothers (1.13, IQR 0.63–2.33) than fathers (0.66, IQR 0.41–1.05). Albuminuria was detected in 15.1% of children (girls 20.8%, boys 10.1%) and 13.5% of adults (15.1% mothers, 4.0% fathers) had albuminuria. There was a small correlation between parent and child ACR (Pearson correlation coefficient 0.06, 95% CI 0.01 to 0.12).ConclusionsAlbuminuria is common among Australian children and adults, which is of concern because it predicts risk for kidney and cardiovascular disease, and mortality. The weak concordance among intergenerational pairs for urine ACR suggests either that genetic heritability is low or that it becomes evident only at later offspring life stages.

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Retinal microvasculature: population epidemiology and concordance in Australian children aged 11–12 years and their parents

BMJ Open ◽

10.1136/bmjopen-2018-022399 ◽

2019 ◽

Vol 9 (Suppl 3) ◽

pp. 44-52 ◽

Cited By ~ 7

Author(s):

Julian Dascalu ◽

Mengjiao Liu ◽

Kate Lycett ◽

Anneke C Grobler ◽

Mingguang He ◽

...

Keyword(s):

Correlation Coefficients ◽

Population Based ◽

Linear Regression Models ◽

Cross Sectional ◽

Complex Sampling ◽

Retinal Microvasculature ◽

Automated Software ◽

Retinal Photographs ◽

Retinal Arteriolar ◽

Parent Child

ObjectivesTo describe distributions and concordance of retinal microvasculature measurements in a population-based sample of Australian parent–child dyads at child age 11–12 years.DesignCross-sectional Child Health CheckPoint study, between waves 6 and 7 of the national population-based Longitudinal Study of Australian Children (LSAC).SettingAssessment centres in seven Australian cities, February 2015–March 2016.ParticipantsOf the 1874 participating families, 1288 children (51% girls) and 1264 parents (87% mothers, mean age 43.7) were analysed. Diabetic participants and non-biological pairs were excluded from concordance analyses.Outcome measuresRetinal photographs were taken by non-mydriatic fundus camera. Trained graders scored vascular calibre using semi-automated software, yielding estimates of central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) and arteriolar–venular ratio (AVR). Pearson’s correlation coefficients and multivariable linear regression models assessed parent–child concordance. Survey weights and methods accounted for LSAC’s complex sampling, stratification and clustering within postcodes.ResultsMean (SD) of CRAE and CRVE were larger in children (159.5 (11.8) and 231.1 (16.5) μm, respectively) than parents (151.5 (14.0) and 220.6 (19.0) μm), yielding similar AVR (children 0.69 (0.05), parents 0.69 (0.06)). Correlation coefficients for parent–child pairs were 0.22 (95% CI 0.16 to 0.27) for CRAE, 0.23 (95% CI 0.17 to 0.28) for CRVE and 0.18 (95% CI 0.13 to 0.24) for AVR. Mother–child and father–child values were similar (0.20 and 0.32 for CRAE, 0.22 and 0.29 for CRVE, respectively). Relationships attenuated slightly on adjustment for age, sex, blood pressure, diabetes and body mass index. Percentiles and concordance are presented for the whole sample and by sex.ConclusionsArteriolar and venular calibre were similar to previously documented measures in midlife adult and late childhood populations. Population parent–child concordance values align with moderate polygenic heritability reported in smaller studies.

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Food choices: concordance in Australian children aged 11–12 years and their parents

BMJ Open ◽

10.1136/bmjopen-2017-020898 ◽

2019 ◽

Vol 9 (Suppl 3) ◽

pp. 147-156 ◽

Cited By ~ 2

Author(s):

Prudence Vivarini ◽

Jessica A Kerr ◽

Susan A Clifford ◽

Anneke C Grobler ◽

Pauline W Jansen ◽

...

Keyword(s):

Sodium Intake ◽

Health Assessment ◽

Correlation Coefficients ◽

Daily Basis ◽

Population Based ◽

Snack Food ◽

Linear Regression Models ◽

Cross Sectional ◽

Cumulative Impact ◽

Parent Child

ObjectivesSnack foods—typically high in salt, sugar, fat and/or energy—are likely important to the obesity epidemic. In the context of a population-based health assessment involving parent–child dyads at child age 11–12 years, we report cross-generational concordance in intake at a controlled snack food observation.DesignCross-sectional study (Child Health CheckPoint), nested within the Longitudinal Study of Australian Children.SettingAssessment centres in seven Australian cities, February 2015–March 2016.ParticipantsOf all participating CheckPoint families (n=1874), 1299 children (50.3% girls) and 1274 parents (85.9% mothers) with snack data were included. Survey weights and methods were applied to account for the clustered multistage sample design.Outcome measuresPartway through the 3.5-hour assessment, parents and children attended Food Stop separately for a timed 15 min ‘snack break’. One of four standardised box size/content combinations was randomly provided to all participants on any given day. Total food mass, energy, nutrients and sodium consumed was measured to the nearest 1 g. Pearson’s correlation coefficients and adjusted multivariable linear regression models assessed parent–child concordance in each variable.ResultsChildren consumed less grams (151 g [SD 80] vs 165 g [SD 79]) but more energy (1393 kJ [SD 537] vs 1290 kJ [SD 658]) than parents. Parent–child concordance coefficients were small, ranging from 0.07 for sodium intake to 0.17 for carbohydrate intake. Compared with children with parents’ energy intake on the 10th centile, children whose parents were on the 90th centile ate on average 227 kJ more. If extrapolated to one similar unsupervised snack on a daily basis, this equates to an additional 83 050 kJ per year, which could have a cumulative impact on additional body fat.ConclusionsAlthough modest at an individual level, this measured parent-child concordance in unsupervised daily snack situations could account for substantial annual population differences in energy, fat and sodium intake for children aged 11–12 years.Trial registration numberISRCTN12538380.

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Physical activity and sedentary activity: population epidemiology and concordance in Australian children aged 11–12 years and their parents

BMJ Open ◽

10.1136/bmjopen-2018-023194 ◽

2019 ◽

Vol 9 (Suppl 3) ◽

pp. 136-146 ◽

Cited By ~ 12

Author(s):

François Fraysse ◽

Anneke C Grobler ◽

Josh Muller ◽

Melissa Wake ◽

Timothy Olds

Keyword(s):

Physical Activity ◽

Vigorous Physical Activity ◽

Correlation Coefficients ◽

Population Based ◽

Cross Sectional Study ◽

Activity Data ◽

Cross Sectional ◽

Study Child ◽

Objectively Measured ◽

Parent Child

ObjectivesTo describe the epidemiology and parent–child concordance of objectively measured physical activity in a population-based sample of Australian parent–child dyads.DesignCross-sectional study (Child Health CheckPoint) nested within the Longitudinal Study of Australian Children.SettingAssessment centres in seven Australian cities and eight regional towns or home visits; February 2015–March 2016.ParticipantsOf all CheckPoint families (n=1874), 1261 children (50% girls) and 1358 parent (88% mothers) provided objectively measured activity data, comprising 1077 parent–child dyads.Outcome measuresActivity behaviour was assessed by GENEActiv accelerometer. Duration of moderate-to-vigorous physical activity (MVPA) and vigorous physical activity and sedentary behaviour (SB) were derived using Cobra custom software, along with MVPA/SB fragmentation and mean daily activity. Pearson’s correlation coefficients and linear regression estimated parent–child concordance. Survey weights and methods accounted for the complex sample design and clustering.ResultsAlthough parents had average lower accelerometry counts than children (mean [SD] 209 [46] vs 284 [71] g.min), 93% of parents met MVPA daily duration guidelines on published cutpoints (mean [SD] 125 [63] min/day MVPA), compared with only 15% of children (mean 32 [27] min). Parents showed less daily SB duration (parents: 540 [101], children: 681 [69] minutes) and less fragmented accumulation of MVPA (parents: α=1.85, children: α=2.00). Parent–child correlation coefficients were 0.16 (95% CI 0.11 to 0.22) for MVPA duration, 0.10 (95% CI 0.04 to 0.16) for MVPA fragmentation, 0.16 (95% CI 0.11 to 0.22) for SB duration and 0.18 (95% CI 0.12 to 0.23) for SB fragmentation.ConclusionsStandardised cutpoints are needed for objective activity measures to inform activity guidelines across the lifecourse. This may reflect large amounts of time in non-shared environments (school and work).

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Starchy Vegetables and Metabolic Syndrome in Costa Rica

Nutrients ◽

10.3390/nu13051639 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1639

Author(s):

Zhongyao Li ◽

Dongqing Wang ◽

Edward A. Ruiz-Narváez ◽

Karen E. Peterson ◽

Hannia Campos ◽

...

Keyword(s):

Metabolic Syndrome ◽

Regression Models ◽

Fasting Blood Glucose ◽

Population Based ◽

Cross Sectional Study ◽

Costa Rican ◽

Least Square ◽

Inverse Association ◽

Linear Regression Models ◽

Cross Sectional

Only a few studies primarily examined the associations between starchy vegetables (other than potatoes) and metabolic syndrome (MetS). We aimed to evaluate the association between starchy vegetables consumption and MetS in a population-based sample of Costa Rican adults. We hypothesized that a higher overall intake of starchy vegetables would not be associated with higher MetS prevalence. In this cross-sectional study, log-binomial regression models were used to estimate prevalence ratios (PRs) of MetS across quintiles of total, unhealthy, healthy starchy vegetables, and individual starchy vegetables (potatoes, purple sweet potatoes, etc.), among 1881 Costa Rican adults. Least square means and 95% confidence intervals (CIs) from linear regression models were estimated for each MetS component by categories of starchy vegetable variables. Higher intakes of starchy vegetables were associated with a higher prevalence of MetS in crude models, but no significant trends were observed after adjusting for confounders. A significant inverse association was observed between total starchy and healthy starchy vegetables consumption and fasting blood glucose. In this population, starchy vegetables might be part of a healthy dietary pattern.

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Lung function: population epidemiology and concordance in Australian children aged 11–12 years and their parents

BMJ Open ◽

10.1136/bmjopen-2018-023486 ◽

2019 ◽

Vol 9 (Suppl 3) ◽

pp. 53-62 ◽

Cited By ~ 4

Author(s):

Liam Welsh ◽

Gayan Kathriachchige ◽

Tahmeed Raheem ◽

Anneke C Grobler ◽

Melissa Wake ◽

...

Keyword(s):

Lung Function ◽

Population Sample ◽

Correlation Coefficients ◽

Cross Sectional Study ◽

Forced Expiratory Volume ◽

International Standards ◽

Linear Regression Models ◽

Cross Sectional ◽

Parents And Children ◽

Z Scores

ObjectivesTo describe the epidemiology of lung function in Australian children aged 11–12 years and their parents, and explore the degree of intergenerational concordance.DesignCross-sectional study (the Child Health CheckPoint) nested in the Longitudinal Study of Australian Children (LSAC).SettingAssessment centres in seven Australian cities and eight regional towns, February 2015 to March 2016. Families unable to attend a clinic appointment were offered a home visit during the same period.Participants1874 families (53% of all eligible) participated in the study. Lung function data were available for 1759 children aged 11–12 years and 1774 parents (1668 biological pairs).Outcome measuresParticipants completed spirometry with measures including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and mid expiratory flow (MEF), converted to z-scores using Global Lung Initiative equations. Parent–child concordance was assessed using Pearson’s correlation coefficients and multivariable linear regression models. Survey weights and methods accounted for LSAC’s complex sampling, stratification and clustering within postcodes.ResultsAll lung function measures followed approximately normal distributions. Mean (SD) for FEV1, FVC and MEF z-scores in children were 0.33 (1.07), 0.83 (1.14) and −0.48 (1.09), respectively. Mean (SD) in parents were 0.28 (1.10), 0.85 (1.15) and −0.45 (1.10), respectively. Parent FEV1, FVC and MEF were associated with child lung function with significant positive correlation coefficients (0.22, 95% CI 0.17 to 0.26; 0.24, 95% CI 0.20 to 0.29; and 0.24, 95% CI 0.20 to 0.29, respectively).ConclusionsMean lung volumes were larger but with smaller airway size than international standards for both parents and children in this population sample. Modest associations between parent and child lung function highlight the potential for better identification of ‘at risk’ populations. Therefore, these findings may aid the development of health policy that aims to prevent the onset or limit the progression of lung disease.

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Urban and rural dietary patterns are associated with anthropometric and biochemical indicators of nutritional status of adolescent Mozambican girls

Public Health Nutrition ◽

10.1017/s1368980017003676 ◽

2017 ◽

Vol 21 (6) ◽

pp. 1057-1064 ◽

Cited By ~ 1

Author(s):

Helena H Hauta-alus ◽

Liisa Korkalo ◽

Riitta Freese ◽

Carina Ismael ◽

Marja Mutanen

Keyword(s):

Nutritional Status ◽

Dietary Patterns ◽

Principal Component ◽

Population Based ◽

Cross Sectional Study ◽

Serum Folate ◽

Linear Regression Models ◽

Cross Sectional ◽

Biochemical Indicators ◽

Resource Setting

AbstractObjectiveThe objective of the present study was to explore whether dietary patterns (DP) are associated with nutritional status indicators among adolescent Mozambican girls.Design/Setting/SubjectsIn this population-based cross-sectional study we used the FFQ data of 547 girls aged 14–19 years from Central Mozambique to derive dietary patterns by means of principal component analysis. We used two-level linear regression models to examine the associations between the DP and anthropometric and biochemical indicators of nutritional status.ResultsWe identified three DP: ‘Urban bread and fats’, ‘Rural meat and vegetables’ and ‘Rural cassava and coconut’. The ‘Urban bread and fats’ DP was positively associated with BMI-for-age Z-score (BMIZ), mid-upper arm circumference (MUAC), triceps skinfold (P for all<0·001) and blood Hb (P=0·025). A negative association was observed between the ‘Urban bread and fats’ DP and serum folate (P<0·001). The ‘Rural meat and vegetables’ DP and the ‘Rural cassava and coconut’ DP were associated negatively with BMIZ, MUAC and triceps skinfold (P for all<0·05), but the ‘Rural meat and vegetables’ DP was associated positively with serum ferritin (P=0·007).ConclusionsUrban and rural DP were associated with nutritional status indicators. In a low-resource setting, urban diets may promote body fat storage and blood Hb concentrations but compromise serum folate concentration. It is important to continue valuing the traditional, rural foods that are high in folate.

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Carotid artery intima–media thickness, distensibility and elasticity: population epidemiology and concordance in Australian children aged 11–12 years old and their parents

BMJ Open ◽

10.1136/bmjopen-2017-020264 ◽

2019 ◽

Vol 9 (Suppl 3) ◽

pp. 23-33 ◽

Cited By ~ 5

Author(s):

Richard S Liu ◽

Sophie Dunn ◽

Anneke C Grobler ◽

Katherine Lange ◽

Denise Becker ◽

...

Keyword(s):

Carotid Artery ◽

Correlation Coefficients ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Repeated Measurements ◽

Linear Regression Models ◽

Cross Sectional ◽

Carotid Imt ◽

Media Thickness ◽

Parent Child

ObjectivesTo describe a well-established marker of cardiovascular risk, carotid intima–media thickness (IMT) and related measures (artery distensibility and elasticity) in children aged 11–12 years old and mid-life adults, and examine associations within parent–child dyads.DesignCross-sectional study (Child Health CheckPoint), nested within a prospective cohort study, the Longitudinal Study of Australian Children (LSAC).SettingAssessment centres in seven Australian major cities and eight selected regional towns, February 2015 to March 2016.ParticipantsOf all participating CheckPoint families (n=1874), 1489 children (50.0% girls) and 1476 parents (86.8% mothers) with carotid IMT data were included. Survey weights and methods were applied to account for LSAC’s complex sample design and clustering within postcodes and strata.Outcome measuresUltrasound of the right carotid artery was performed using standardised protocols. Primary outcomes were mean and maximum far-wall carotid IMT, quantified using semiautomated edge detection software. Secondary outcomes were carotid artery distensibility and elasticity. Pearson’s correlation coefficients and multivariable linear regression models were used to assess parent–child concordance. Random effects modelling on a subset of ultrasounds (with repeated measurements) was used to assess reliability of the child carotid IMT measure.ResultsThe average mean and maximum child carotid IMT were 0.50 mm (SD 0.06) and 0.58 mm (SD 0.05), respectively. In adults, average mean and maximum carotid IMT were 0.57 mm (SD 0.07) and 0.66 mm (SD 0.10), respectively. Mother–child correlations for mean and maximum carotid IMT were 0.12 (95% CI 0.05 to 0.23) and 0.10 (95% CI 0.03 to 0.21), respectively. For carotid artery distensibility and elasticity, mother–child correlations were 0.19 (95% CI 0.10 to 0.25) and 0.11 (95% CI 0.02 to 0.18), respectively. There was no strong evidence of father–child correlation in any measure.ConclusionsWe provide Australian values for carotid vascular measures and report a modest mother–child concordance. Both genetic and environmental exposures are likely to contribute to carotid IMT.

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Cognitive reserve as a moderator of the negative association between mood and cognition: evidence from a population-representative cohort

Psychological Medicine ◽

10.1017/s003329171700126x ◽

2017 ◽

Vol 48 (1) ◽

pp. 61-71 ◽

Cited By ~ 15

Author(s):

C. Opdebeeck ◽

F. E. Matthews ◽

Y-T. Wu ◽

R. T. Woods ◽

C. Brayne ◽

...

Keyword(s):

Cognitive Function ◽

Cognitive Reserve ◽

Large Population ◽

Population Based ◽

Cross Sectional Study ◽

Negative Association ◽

Linear Regression Models ◽

Cross Sectional ◽

The Individual ◽

Mood And Cognition

BackgroundCognitive reserve (CR) has been associated with better cognitive function and lower risk of depression in older people, yet it remains unclear whether CR moderates the association between mood and cognition. This study aimed to investigate whether a comprehensive indicator of CR, including education, occupation and engagement in cognitive and social activities, acts as a moderator of this association.MethodsThis was a cross-sectional study utilising baseline data from the Cognitive Function and Ageing Study II (CFAS II), a large population-based cohort of people aged 65+ in England. Complete data on the measures of CR, mood and cognition were available for 6565 dementia-free individuals. Linear regression models were used to investigate the potential modifying effect of CR on the association between cognition and mood with adjustment for age, sex and missing data.ResultsLevels of CR did moderate the negative association between mood and cognition; the difference in cognition between those with and without a clinical level mood disorder was significantly smaller in the middle (−2.28; 95% confidence interval (CI) −3.65 to −0.90) and higher (−1.30; 95% CI −2.46 to −0.15) CR groups compared with the lower CR group (−4.01; 95% CI −5.53 to −2.49). The individual components of CR did not significantly moderate the negative association between mood and cognition.ConclusionThese results demonstrate that CR, indexed by a composite score based on multiple indicators, can moderate the negative association between lowered mood and cognition, emphasising the importance of continuing to build CR across the lifespan in order to maintain cognitive health.

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Parent-child resemblance in body mass index and obesity status and its correlates in China

Public Health Nutrition ◽

10.1017/s1368980020005108 ◽

2021 ◽

pp. 1-34

Author(s):

Lu Ma ◽

Yixin Ding ◽

Xiaozhong Wen ◽

Liwang Gao ◽

Li Zhao ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Weight Status ◽

Pearson Correlation ◽

Correlation Coefficients ◽

Weighted Kappa ◽

Cross Sectional Study ◽

School Age Children ◽

Cross Sectional ◽

Parent Child

Abstract Objectives: Examine mother-son, mother-daughter, father-son, and father-daughter resemblance in weight status, and potential modifying effects of socio-demographic and childcare characteristics. Design: Cross-sectional study. Setting: School. Participants: 1,973 school-age children and their parents from five mega-cities across China in 2017. Results: Pearson correlation coefficients (r) for body mass index (BMI) of father-son, father-daughter, mother-son, and mother-daughter pairs were 0·16, 0·24, 0·26, and 0·24, respectively, while their weighted kappa coefficients (k) were 0·09, 0·14, 0·04, and 0·15, respectively. Children aged 6–9 years (r ranged from 0·30 to 0·35) had larger BMI correlation with their parents than their counterparts aged 10–14 years or 15–17 years (r ranged from 0·15 to 0·24). Children residing at home (r ranged from 0·17 to 0·27) had greater BMI correlations with their parents than children residing at school/other places. BMI correlation coefficients were significant if children were mainly cared for by their mothers (r ranged from 0·17 to 0·29) but non-significant if they were mainly cared for by others. Only children who ate the same meal as their parents “most times” (r ranged from 0·17 to 0·27) or had dinner with their parents “at most times” (r ranged from 0·21 to 0·27) had significant BMI correlation with their parents. Similarly, children who had dinner with their parents “most times” but not “sometimes,” had significant BMI correlation coefficients. Conclusions: Parent-child resemblance in weight status was modest, and varied by child age, gender, primary caregiver, whether having similar food or dinner with parents in China.

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