Abstract: Objective: To assess the relative prognostic value of 11 variables including, omega-3, perceived stress, cortisol and sleep duration, in predicting adolescent depression.

Design, Setting and Participants: A cross-sectional study of 444 healthy adolescents aged 16-18 years, from 10 schools within the Northern Sydney and Central Coast regions of New South Wales, Australia. Participants provided blood and saliva samples and completed questionnaires. Statistical classification methods were used to model the relationships between the predictors and depression.

Main Outcome Measures: relative predictive value of each variable in correctly classifying depression.

Results: 6% of boys and 9% of girls were categorised as experiencing severe to extremely severe depression. 4% of boys and 10% of girls were categorised as experiencing severe to extremely severe stress. The mean AM:PM cortisol for boys, 22±101, was higher than that of girls, 11±10. The average omega-3 index for boys, 10.5±3.7, was also higher than that of girls, 7.7±2.6. The average sleep duration of 7.8±1.1 hrs showed no gender differences.

The best classification model identified perceived stress as the most significant predictor of depression followed by BMI and omega-3 index. Cortisol ratio was a significant discriminator for boys but not girls. When stress was excluded, shorter sleep duration became a significant discriminator in both boys and girls with waist to hip ratio providing further discrimination in girls only.

Conclusion: The strongest predictor of depression in adolescents was perceived stress followed by higher BMI and lower omega-3 levels. These findings provide a rational basis for establishing program priorities for the prevention and treatment of adolescent depression.

Keywords: Child, depression, adolescent, omega-3, sleep, BMI, cortisol.

Abstract: Early childhood settings (ECS) offer a unique opportunity to intervene to improve children’s nutrition. This paper reviews the literature on early childhood setting interventions that aim to improve children’s dietary intake. Environmental and individual determinants of children’s dietary intakes were also investigated. Prospective intervention studies targeting centres, staff, parents/caregivers or children, were reviewed. Methodological quality was assessed. Twenty six studies (14 weak, 12 moderate quality) were included. Interventions were delivered primarily via training workshops and/or written materials. Study findings favoured intervention effectiveness in 23 studies. Improvements were seen in children’s intake for 8 out of 11 studies assessing dietary intake outcomes. Small increases in fruit and vegetable consumption were observed in five studies. Most studies measuring parental or centre food provision observed post-intervention improvements across a number of food groups, including fruit, vegetables, whole grains and sweetened beverages. Significant improvements in child, parent and/or staff knowledge, attitudes or behaviours were observed consistently across studies. For those studies that included a comparison group, these improvements were observed only in the intervention group. ECS interventions can achieve changes in children’s dietary intake and associated socio- environmental- determinants, although the quality of current research limits confidence in study findings. Future intervention development needs to carefully consider the behavioural targets, modifiable determinants and utilise age-appropriate and effective behaviour change theory, in addition to inclusion of dietary intake outcomes.

Keywords: Early childhood settings, child care, preschool, nutrition, diet, review.