Children's Eating Behaviour Questionnaire: associations with BMI in Portuguese children

To study problematic eating behavior and its association with early childhood caries among 36-71-month-old children using children eating behavior questionnaire

CONTEXT

Problematic eating behavior pattern prevalent in children can be a potential risk factor for Early Childhood Caries (ECC). Pediatric dentist must be vigilant to enquire about eating behavior pattern and guide parents comprehensively.

AIM

The aim of this study is to find the association between problematic ECC among 36-71-month-old children.

SETTING AND DESIGN

A cross-sectional study was conducted in 2000 children from both the sex and various socioeconomic backgrounds.

METHODS

A questionnaire was made to assess the personal information and problematic eating behavior of the child using Children's Eating Behavior Questionnaire (CEBQ) which was filled by parents. Clinical examinations were performed on the date of questionnaire collection and caries diagnosis was done in the dentition status part of "WHO oral health assessment form 2013."

STATISTICAL ANALYSIS USED

The software used for the statistical analysis was SPSS (Statistical Package for the Social Sciences) software version 16.0.

RESULTS

The prevalence of ECC in the study sample was 42.6%. Out of eight domains into which problematic eating behavior was divided, domains Emotional Overeating (EOE), Satiety Responsiveness (SR), Slowness of Eating (SE), Desire to Drink, Food Fussiness, and Emotional Under eating were significantly associated with ECC.

CONCLUSION

There is a positive correlation between problematic eating behavior and ECC; such behavior should be recognized at early stages and interrupted so that the risk of developing caries in permanent dentition could be prevented.

Psychometric properties of the Child Eating Behavior Questionnaire (CEBQ) in school age children with overweight and obesity: A proposed three-factor structure

BACKGROUND

Obesity in youth is a significant public health concern, with eating behaviors being a major contributor. The Child Eating Behavior Questionnaire (CEBQ) was developed to evaluate the appetitive characteristics of young children, across a myriad of eating domains. Despite the breadth of its use, the psychometric properties of the measure in children with overweight/obesity (OW/OB), particularly treatment seeking youth, remains largely unexplored.

METHODS

The psychometric properties of the CEBQ were examined in a sample of school age children (8-12) with OW/OB. Parent-child dyads (N = 148) completed assessments prior to beginning a family weight management program. Exploratory factor analysis (EFA) was performed utilizing polychoric correlations, and emerging subscales were assessed to ensure that the range of response scores demonstrated adequate variability. Indices of the number of factors to be retained included acceleration factor (2), optimal coordinates (4), Velicer's MAP (5) and parallel analysis (11). These indices were used in combination with clinical utility to determine the final factor structure.

RESULTS

A three-factor structure emerged. The first factor combined many food responsiveness, enjoyment of food, satiety responsiveness and slowness in eating items, with the latter two domains loading negatively. The second factor retained the food fussiness subscale, and the third factor included items from the emotional over- and under-eating subscales.

CONCLUSIONS

These results suggest that in children with OW/OB, eating behaviors may be optimally assessed using three domains: reward-based eating, emotional eating and picky eating. Future research should explore how this structure holds in non-treatment-seeking samples and across wider socio-demographic profiles.

The effect of sugar-sweetened beverages at 4 years of age on appetitive behaviours of 7-year-olds from the Generation XXI birth cohort

The consumption of energy-dense sugar-sweetened beverages (SSB) and its low satiating effects may influence the development of child eating behaviours. We aimed to investigate the association of SSB consumption at 4 years on appetitive behaviours at age 7 years. Children from the Generation XXI birth cohort were included (n 3880). SSB consumption was evaluated through a FFQ and appetitive behaviours were evaluated through the Children's Eating Behaviour Questionnaire, which includes eight subscales. Two composite factors, derived by principal component analysis (Appetite Restraint - related to Food Fussiness, Enjoyment of Food, Slowness in Eating and Satiety Responsiveness - and Appetite Disinhibition - related to Food Responsiveness, Emotional Under- and Overeating and Desire to Drink), were also investigated. The dose-response relationship between SSB consumption and appetitive behaviours was examined using multivariable linear regression (continuous eating behaviour scores) and multinomial logistic regression (tertile categories of eating behaviour scores). Child SSB consumption at 4 years was associated with higher Appetite Disinhibition and Desire to Drink and lower Food Fussiness and Slowness in Eating at 7 years. Consuming SSB ≥1 times/d (compared with a lower intake) was associated with 29 % increase in the odds of Desire to Drink (3rd v. 1st tertile). Pre-schoolers' SSB consumption was associated with higher food approach and less food avoidant behaviours later in childhood. Family characteristics, particularly maternal SSB consumption, explained part of these associations. It is essential to promote the intake of water, instead of sugary drinks, and make parents and caregivers aware of the importance of this exposure, since they have a pivotal role in shaping children's eating behaviours.

Confirmatory factor analysis of the Children's Eating Behaviour Questionnaire in a Chinese urban preschooler sample

Background

Understanding young children's eating behaviours is vital to childhood obesity prevention. However, the widely used Children's Eating Behaviour Questionnaire (CEBQ) has not been validated in Chinese young children. Thus, the present study aimed to assess the validity of the CEBQ in a Chinese urban sample of preschool children.

Methods

Participants included 389 mothers with preschool children residing in Beijing, China. Confirmatory factor analysis was conducted, and measurement invariance between child genders was evaluated.

Results

The modified 8-factor structure of the CEBQ exhibited acceptable model fit in our sample, and no measurement bias against any gender was observed. The associations between the CEBQ factors and child age showed that desire to drink, emotional overeating, and emotional undereating significantly decreased with age, but food responsiveness increased with age. The relation between child BMI and the CEBQ factors provided convergent validity for the CEBQ.

Conclusions

Our study supported the validity of the CEBQ as a measurement tool for examining preschool children's eating behaviours in a Chinese urban sample.

Factorial validation analysis of the Baby and Children's Eating Behavior Questionnaires in Samoa

Survey instruments for assessing eating behaviors in infancy and early childhood have yet to be validated among Pacific Islanders, among whom the prevalence of pediatric obesity is steadily increasing. This study aimed to evaluate Baby Eating Behavior Questionnaire (BEBQ) and Children's Eating Behavior Questionnaire (CEBQ) factor structures against data collected from mother-infant dyads in Samoa. The BEBQ was administered across two time points: approximately 2 months (mean = 2.37 [SD = 0.34]; N = 105) and 4 months postpartum (mean = 4.22 [SD = 0.44]; N = 117). The CEBQ was administered at approximately 21 months postpartum (mean = 21.45 [SD = 1.72]; N = 113). Both the original four-factor BEBQ and seven-factor CEBQ models failed to replicate in confirmatory factor analyses. BEBQ data from 2 and 4 months demonstrated acceptable fit to a nine-item, two factor model, generated by elimination of factors with low internal reliability. A series of exploratory factor analyses on CEBQ data from 21 months postpartum ultimately revealed 16-item, three-factor structure. There was little correlation between BEBQ and CEBQ scores, suggesting either that infant feeding behaviors before and after weaning are not strongly associated, or that the BEBQ and CEBQ function better in cross-sectional, rather than longitudinal analyses. Newly derived CEBQ factors raise concerns regarding whether original CEBQ items and factors were sufficiently theoretically distinct. Study results suggest that demographic and cultural differences may impact both BEBQ and CEBQ factor structure. Further qualitative research is necessary to address these issues.

Effect of community-based nutritional counseling intervention on children's eating habits

AIM

This study aimed to assess the outcome of community-based nutritional counseling interventions on eating habits of rural-dwelling children.

METHODS

A group-randomized trial design was used in this study. A total of 108 rural-dwelling children from a community in the Enugu North agricultural zone, Enugu State, who participated in the study. The children were randomly assigned to 2 groups: the treatment group (n = 54) and the no-treatment control group (n = 54). The child eating behavior questionnaire was used for data collection. Parents of the participating children within each study group completed the child eating behavior questionnaire at 3 time points. The data collected were analyzed using an independent sample t test at a probability level of .05.

RESULT

The outcome of the study showed that the children's eating habits in the treatment group improved positively following the community-based nutritional counseling intervention. The positive gain from exposure to the community-based nutritional counseling intervention program was sustained during follow-up for children in the treatment group compared with the no-treatment group.

CONCLUSION

The community-based nutrition counseling intervention carried out among children in rural communities had a positive adjustment in children's eating habits. The intervention requires the constant collaboration of professional childhood educators, caregivers, home economists, school staff, healthcare specialists, families, and the children themselves. Furthermore, there is a need for future long-term evaluations of the effects of community-based nutritional counseling interventions on children's nutrition and eating habits.

Cultural adaptation and validation of the Children's Eating Behaviour Questionnaire in Ethiopia

Eating behaviours have been associated both with being underweight or overweight and poor growth. The Children's Eating Behaviour Questionnaire (CEBQ) is a widely used measure of child eating behaviours. The instrument is, however, mostly validated in high-income countries, with a scarcity of evidence among developing countries such as Ethiopia. The present study aims to assess the cultural adaptability and validity of the CEBQ to be used in Ethiopia. We conducted a school-based cross-sectional study among 542 caregivers of children aged 3–6 years in selected preschools. Tests of factorial validity, convergent validity and reliability were performed. The Confirmatory Factor Analysis model indicated that eight subscales provided the best fit (root-mean-square error of approximation = 0⋅05 (90 % CI 0⋅045, 0⋅055); Comparative Fit Index = 0⋅92 and Tucker–Lewis Index = 0⋅90) after seven items from the original CEBQ were removed. Convergent validity with child's weight status was found for emotional overeating, food fussiness, satiety responsiveness and slowness in eating subscales. Reliability, measured using Cronbach's α, provided values between 0⋅50 and 0⋅79. The eight-factor structure of the CEBQ showed adequate content validity and provided factorial, discriminant and convergent validity among preschool children. Further replication of the study among low-income countries is essential to improve the literature on children's eating behaviours.

Learning to overeat in infancy: Concurrent and prospective relationships between maternal BMI, feeding practices and child eating response among Hispanic mothers and children

BACKGROUND

Parents play a key role in shaping children's eating behaviours and self-regulation. There is limited data on how maternal weight influences feeding practices in the first year of life.

OBJECTIVE

To examine the relationships between maternal BMI, feeding practices and infant eating behaviours related to self-regulation.

METHODS

Participants were 160 mother-infant dyads. A longitudinal design was used to examine concurrent and prospective associations between maternal 6-month postpartum BMI, mothers' feeding practices at 6 months (Infant Feeding Practices Questionnaire) and children's eating behaviours at 6 months (Baby Eating Behaviour Questionnaire) and 12 months (Child Eating Behaviour Questionnaire).

RESULTS

Higher maternal BMI was associated positively with mothers' use of restrictive feeding practices (β = 0.036, p = 0.033), and inversely with responsivity to infant satiety cues (Spearman partial r = -0.249, p = 0.002) at 6 months. Mother's restrictive feeding practices were associated with infant food responsiveness (β = 0.157, p = 0.009) and emotional overeating (β = 0.118, p = 0.005) at 12 months. Maternal use of responsive feeding practices was associated with lower infant food responsiveness at 6 months (Spearman partial r = -0.173, p = 0.031) and lower emotional overeating at 12 months (Spearman partial r = -0.183, p = 0.022).

CONCLUSIONS

Our findings add to studies suggesting that feeding practices can provide mechanistic pathways in the intergenerational transmission of obesity. Postpartum family-system approaches focusing on maternal health while integrating infant feeding guidance may confer benefits in improving maternal-child health.

Infant and Early Child Appetite Traits and Child Weight and Obesity Risk in Low-Income Hispanic Families

BACKGROUND

Child appetite traits (ATs) are associated with later child weight and obesity risk. Less research has focused on ATs in low-income Hispanic children or included longitudinal associations with infant weight.

OBJECTIVE

To determine stability of ATs during infancy and childhood and their relationship with subsequent weight and obesity risk at age 3 years among low-income Hispanic children.

DESIGN

A secondary longitudinal analysis of data from the Starting Early Program randomized controlled obesity prevention trial.

PARTICIPANTS/SETTING

Three hundred twenty-two low-income, Hispanic mother-child pairs enrolled between 2012 and 2014 in a public hospital in New York City.

MAIN OUTCOME MEASURES

ATs, including Slowness in Eating, Satiety Responsiveness, Food Responsiveness, and Enjoyment of Food were assessed using the Baby and Child Eating Behavior Questionnaires at ages 3 months, 2 years, and 3 years. Main outcome measures were child standardized weight-for-age z score (WFAz) and obesity risk (WFA≥95th percentile) at age 3 years.

STATISTICAL ANALYSES PERFORMED

AT stability was assessed using correlations and multilevel modeling. Linear and logistic regression analyses examined associations between ATs and child WFAz and obesity risk at age 3 years.

RESULTS

There was limited stability for all ATs measured over time. During infancy, Slowness in Eating was associated with lower 3-year WFAz (B = -0.18, 95% CI -0.33 to -0.04; P = 0.01). At age 2 years, Slowness in Eating and Satiety Responsiveness were associated with lower WFAz (B = -0.29, 95% CI -0.47 to -0.12; P < 0.01; B = -0.36, 95% CI -0.55 to -0.17; P < 0.01) and obesity risk (adjusted odds ratio 0.49, 95% CI 0.28 to 0.85; adjusted odds ratio 0.61, 95% CI 0.38 to 0.99) at 3 years. Increased Slowness in Eating and Satiety Responsiveness over time were associated with lower 3-year WFAz (B = -0.74, 95% CI -1.18 to -0.2 [Slowness in Eating]; B = -1.19, 95% CI -1.87 to -0.52 [Satiety Responsiveness], both P values = 0.001). Higher Enjoyment of Food over time was associated with higher 3-year WFAz (B = 0.62, 95% CI 0.24 to 1.01; P = 0.002).

CONCLUSIONS

Infants with lower Slowness in Eating and Satiety Responsiveness may have higher levels of obesity risk and need more tailored approaches to nutrition counseling and obesity prevention.

The association between childhood adiposity and appetite assessed using the Child Eating Behavior Questionnaire and Baby Eating Behavior Questionnaire: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to quantify associations between Child Eating Behavior Questionnaire (CEBQ) and Baby Eating Behavior Questionnaire (BEBQ) appetitive traits (food approach: Food Responsiveness [FR], Enjoyment of Food [EF], Emotional Overeating [EOE], and Desire to Drink [DD]; food avoidant: Satiety Responsiveness [SR], Slowness in Eating [SE], Emotional Undereating [EUE], Food Fussiness [FF]) and measures of child adiposity. Searches of six databases up to February 2019 identified 72 studies (CEBQ, n = 67; BEBQ, n = 5), and 27 met the meta-analysis criteria. For cross-sectional studies reporting unadjusted correlations with body mass index z-scores (BMIz) (n = 19), all traits were associated with BMIz in expected directions (positive: FR, EF, EOE, and DD; negative: SR, SE, EUE, and FF). Pooled estimates ranged from r = 0.22 (FR) to r = -0.21 (SR). For cross-sectional studies reporting regression coefficients (n = 10), three traits (FR, EF, and EOE) associated positively, and three traits (SR, SE, and EUE) negatively, with BMIz (β = -0.31 [SR] to β = 0.22 [FR]). Eleven studies reported prospective relationships from appetite to adiposity measures for six scales (positive: FR, EF, EOE, and DD; negative: SR and SE). Five studies reported relationships from adiposity measures to appetite for five traits (positive: FR, EF, and EOE; negative: SR). All BEBQ traits were consistently cross-sectionally associated with adiposity measures. Overall, CEBQ/BEBQ-assessed appetitive traits show consistent cross-sectional relationships with measures of child adiposity.

Gender effect on eating habits of Nigerian school children

It is important to investigate children's eating habits based on different eating behaviors such as satiety responsiveness (SR), slowness in eating (SE), food fussiness (FF), food responsiveness (FR), enjoyment of food (EF), desire to drink (DD), emotional under-eating (EUE), and emotional over-eating (EOE). The main objective of this research was to investigate whether gender affects the eating habits of Nigerian school children.A cross-sectional survey was conducted between March and June 2019. A total of 120 parents of school children participated in the study. The Child Eating Behavior Questionnaire (CEBQ) was used to collect data. The CEBQ is composed of 35 items and eight subscales.Based on the analysis of parents' reports, DD was higher in boys than girls, t (118) = 7.086, P < .001; EOE was higher in boys than girls, t (118) = 5.184, P < .001; EF was higher in boys than girls, t (118) = 2.183, P < .001; FF was higher in boys than girls, t (118) = 9.441, P < .001; and SR was higher in boys than girls, t (118) = 7.323, P < .001. However, EUE was lower in boys than girls, t (118) = -4.339, P < .001; FR was lower in boys than girls, t(118) = -3.112, P < .001; SE was lower in boys than girls, t(118) = -3.832, P < .001; thus, gender had a significant influence on eating habits of the school children.Gender significantly affects the eating habits of Nigerian school children. Thus, gender is an important factor to be considered when aiming to improve the eating habits of Nigerian school children.

Parents accurately perceive problematic eating behaviors but overestimate physical activity levels in preschool children

PURPOSE

The aim of this study is to examine the associations between parents' perceptions of their child's physical activity and eating behaviors to actual physical activity, body mass index percentage (BMI%), and body fat percentage (BF%). A secondary aim is to examine additional parental determinants to child's physical activity.

METHODS

Participants were preschool children (N = 114, 59 females, M_age= 4.06) from three University-sponsored centers and parents (N = 114, 107 mothers). Parents self-reported physical activity, perceptions of child's physical activity, and completed "The Child Eating Behavior Questionnaire". Children physical activity was collected with accelerometers.

RESULTS

Whereas 97% of the 68 parents with children meeting physical activity guidelines accurately identified their child as active, 93% of the 14 parents with children not meeting physical activity guidelines inaccurately identified their child as active (X²(1, N = 82) = 0.58, p = 0.446)). Regarding eating behaviors, child BMI% was moderately correlated with parent's perceptions of their child's Emotional Overeating (r(74) = 0.416, p < 0.001) and Food Responsiveness (r(74) = 0.543, p < 0.001). Parent's engagement in vigorous physical activity demonstrated a positive relationship to child's physical activity (r(78) = 0.297, p = 0.008).

CONCLUSION

Parents of inactive children have inaccurate perceptions of their child's physical activity. The association between children's BMI% and eating behaviors indicates parents can accurately perceive problematic eating behaviors. Parents, who accurately perceive their child's behaviors, may be in a better position to identify deficiency and seek early intervention. Additionally, parent's physical activity may have implications to children's physical activity.

LEVEL OF EVIDENCE

Level V: Descriptive cross-sectional study.

Children's eating behaviour traits and dental caries

OBJECTIVES

This cross-sectional study aimed to assess eating behavior traits in children with or without dental caries.

METHODS

A sample of 580 children aged 8 years enrolled in 20 public schools in the city of Pelotas, Brazil were included. Parents/caregivers provided sociodemographic information and answered the Children's Eating Behavior Questionnaire (CEBQ) to assess eating behavior traits. This instrument possesses the subscales: food responsiveness, enjoyment of food, satiety responsiveness, slowness in eating, food fussiness, emotional overeating, emotional undereating, and desire to drink. To assess the presence of decayed, missing or filled teeth (DMFT/dmft), the World Health Organization (WHO) criteria were adopted. WHO criteria were used to evaluate presence of overweight and obesity. Analysis of variance (ANOVA) was used to compare the mean score in each CEBQ subscale according to the different exposure variables. Linear regression was used to assess the association between dental caries and CEBQ subscales means.

RESULTS

Approximately half of the children were male (51.03 percent) and 66.73 percent had low/middle socioeconomic status. The mean DMFT/dmft was 2.41, ranging from 0 to 13, and 63 percent of the children showed DMFT/dmft > 0. After adjustments for potential confounders, children with dental caries showed higher scores on the subscales desire to drink (P = 0.03), and satiety responsiveness (P = 0.04).

CONCLUSION

The present study showed that some aspects of eating behaviors differ in children with or without caries. Such knowledge adds to the understanding of the multifactorial etiology of caries and may help in the development of nutritional interventions to promote healthy eating behaviors, with benefits for oral health.

Knowledge and food practices questionnaire: construction and validation

OBJECTIVES

To develop and validate an instrument about nutritional knowledge and feeding practices to be used in children aged 7-11 years, based on the latest Brazilian Food Guide.

METHODS

Review on the subject; instrument creation; content validity with two groups of judges: first, nutritionists and, after adjustments, a multidisciplinary group (content validity index [CVI]); FACE validity; reproducibility analysis (intraclass correlation coefficient [ICC], level of agreement, and kappa [k]); internal consistency analysis (Cronbach's alpha[α]) and construct validity (Kaiser-Meyer-Olkin and exploratory factorial analysis). The sample was calculated, considering at least ten subjects for each question of the questionnaire.

RESULTS

There was a final sample of 453 children (53.6% girls), with a mean age of 9.45 years (SD = 1.44). The content validity showed a CVI ≥ 0.80 for relevance in 62.3% of the items for nutritionists' group and 100% of the items for the multidisciplinary group, clarity (49.4%, 91.8%), and pertinence (58.8%, 98.4%), respectively. The test-retest showed a level of agreement of 84.3% and k = 0.740 for the Knowledge dimension and ICC = 0.754 for the Food Practices dimension. The internal consistency showed α = 0.589 for the Knowledge dimension and α = 0.618 for the Food Practices dimension. For the construct validity, Kaiser-Meyer-Olkin was 0.724 and exploratory factorial analysis showed a variance of 47.01 with varimax rotation and defined five factors for the Practices Dimension.

CONCLUSION

The Food Knowledge and Practices Questionnaire (Questionário de Conhecimento e Práticas Alimentares [QCPA]) instrument showed validity and reliability to assess nutritional knowledge and food practices in children aged 7-11 years.

Reliability and Validity Study of the Children's Eating Behavior Questionnaire in Chinese School-Age Children

Children's Eating Behavior Questionnaire (CEBQ) was widely used in western countries to measure children's eating behavior and played an important role in the research on the risk of childhood obesity, but it is rarely used in China yet. This study aimed to examine the Chinese version of CEBQ's reliability and validity in a pilot study, then applied it to bigger population. Data was collected with CEBQ in two districts of Shanghai, respectively. Using stratified cluster sampling method, a total of 2,520 children were included in the study. The questionnaires were filled out by children's parents. It was proved that the Cronbach's coefficient α of the questionnaire was greater than 0.7, indicating that the questionnaire had good internal consistency. Aside from the subscales 'Emotional undereating' and 'Food fussiness', the Pearson's correlation coefficients of the other subscales were all greater than 0.5. It showed that test-retest reliability of CEBQ was acceptable. We found that boys and girls had different eating behavior characteristics. And there was a graded association between eating behavior and nutritional status of school-age children. It suggested that appetitive traits of school-age children could be used as indicators of susceptibility to weight gain. In conclusion, the Chinese version of CEBQ was of good reliability and validity, so it is considered as a reliable tool that can be applied to Chinese school-age children's eating behavior and related studies.

Children's Eating Behavior Questionnaire Correlated with Body Compositions of Thai Children and Adolescents with Obesity: A Pilot Study

Introduction

Obesity is a major threat to public health. Eating behavior and dietary intake of especially high energy-dense food with low nutrients contribute to the current epidemic of childhood obesity. However, the relationship between eating behavior and body composition has yet to be examined in Thai children and adolescents with obesity. We assessed the association between children's eating behaviors and their body composition in prerandomized patients who participated in the randomized trial titled "Impact of Dietary Fiber as Prebiotics on Intestinal Microbiota in Obese Thai Children".

Methods

During the prerandomization process, a cross-sectional study was conducted. We recruited children and adolescents aged 7 to 15 years from Bangkok, Thailand. Eating behaviors were assessed by the Children's Eating Behavior Questionnaire (CEBQ), which is a parent or self-reported research instrument conducted by face-to-face interviews. Body mass index (BMI), BMI-for-age Z-score, waist and hip circumferences, and body compositions were assessed. Pearson's correlation coefficients were used to assess associations between the study variables.

Results

Ninety-seven Thai children and adolescents with obesity participated in the study; 59 (61%) were male. Median [IQR] of age and BMI z-score were 10.5 [9.0, 12.2] years and 3.0 [2.6, 3.7], respectively. Subscale for Enjoyment of Food had the highest score. There were no associations between eating behaviors and BMI z-score. However, Emotional Overeating was associated with fat-free mass index (correlation coefficient = 0.24, p=0.02) and girls with obesity had lower scores in "Slowness in Eating" compared to boys [mean 2.1 versus 1.8, 95% CI: (-0.06, -0.01), p=0.04].

Conclusion

Among Thai children and adolescents with obesity, the difference in multidimensional eating behavior might be affected by fat-free mass. Additional study with a larger sample size needed to explore underlying mechanisms and findings can be used to develop future behavior modification program.

Eating Behaviors in Relation to Child Weight Status and Maternal Education

Background: The eating behavior of children is important to maintain a healthy weight. This current study explored the differences in children’s eating behaviors and their relation to weight status and maternal education level, using the child eating behavior questionnaire (CEBQ). Methods: The study recruited 169 participants aged between six and ten years. Multinomial logistic regression was conducted to examine the association between the CEBQ factors and children’s body weight status. The association between the CEBQ scores and maternal educational levels was examined using a one-way analysis of variance (ANOVA). Results: The multinomial logistic regression findings indicate that children in the obese group exhibited a significant increase in food responsiveness, enjoyment of food, emotional overeating, and a decrease in satiety responsiveness compared to normal weight children. The one-way ANOVA showed a significant difference in subscales under the food approach (food responsiveness, desire to drink, emotional overeating) and food avoidance (satiety responsiveness) based upon the child’s weight status. The three subscales under the food approach category were significantly dependent upon the maternal education but did not have a significant association with food avoidance. Conclusions: The results suggest that the increase in food responsiveness and emotional overeating in obese children is influenced by maternal education.

Associations of parents' use of food as reward with children's eating behaviour and BMI in a population-based cohort

BACKGROUND

Parents' use of food as reward has been linked to children's dietary intake, but the association with children's eating behaviour and overweight risk is less clear.

OBJECTIVES

To examine the temporal association of using food as reward with eating behaviour, body mass index (BMI) and weight status of children.

METHODS

Participants were 3642 children of the population-based Generation R Study in the Netherlands (8.3% overweight/obese). Repeated assessments were collected at child ages 4 and 9 years, including measured anthropometrics and parent reports on feeding practises and eating behaviour.

RESULTS

Linear regressions and cross-lagged models indicated that parents' use of food as reward at child age 4 years predicted Emotional Overeating and Picky Eating at age 9 years. Reversely, higher Emotional Overeating and Food Responsiveness scores were associated with more use of food as reward over time. Using food as reward was not associated with children's satiety response, BMI or overweight risk.

CONCLUSIONS

A vicious cycle may appear in which children who display food approach behaviour are rewarded with food by their parents, which in turn might contribute to the development of unhealthy eating habits (emotional eating, fussiness). These findings warrant further research, to facilitate evidence-based recommendations for parents.

Influence of parental education levels on eating habits of pupils in Nigerian primary schools

This study investigated the eating habits of pupils in Nigerian primary schools based on the respective education levels of their parents.Data were obtained using the Child Eating Behavior Questionnaire (CEBQ). Participants included a total of 144 pupils who were purposively selected from 6 primary schools. Based on responses, a cross-sectional analytic study design was implemented to investigate how parental education levels (PELs) influenced the eating habits of their children. Data assessment was performed using a one-way between-group analysis of variance at the .05 probability level.PELs significantly affected the eating habits of participants, respectively. Specifically, low PEL was associated with more satiety responsiveness to food (F [2, 141] = 14.251, P < .001), higher responsiveness to food (F [2, 141] = 36.943, P = <.001) greater food enjoyment (F [2, 141] = 93.322, P < .001), greater drinking desires (F [2, 141] = 23.677, P < .001), and the tendency for emotional over-eating (F [2, 141] = 13.428, P < .001), while high PEL was associated with slower eating (F [2, 141] = 11.665, P < .001), fussier responses to food (F [2, 141] = 14.865, P < .001), and a higher tendency for emotional under-eating (F [2, 141] = 5.137, P < .01).This study examined PELs in relation to the respective eating habits of their children, who were attending Nigerian primary schools. Data showed that children with parents who had high, middle, and low education levels tended to exhibit progressively worse eating habits, in descending order.

Effect of Family-Based REDUCE Intervention Program on Children Eating Behavior and Dietary Intake: Randomized Controlled Field Trial

The objective of this study was to evaluate the effect of a family-based intervention program (REDUCE) on children’s eating behaviors and dietary intake. A two-arm randomized controlled field trial was conducted among parents and children of 7 to 10 years old who were either overweight or obese. The intervention was conducted via face-to-face sessions and social media. The child eating behaviors were assessed using the child eating behaviors questionnaire (CEBQ), while their dietary consumption of vegetables and unhealthy snacks was assessed using a parental report of three days unweighted food. The generalized linear mixed modelling adjusted for covariates was used to estimate the intervention effects with alpha of 0.05. A total of 122 parents (91% response rate) completed this study. At the six-month post-training, there were statistically significant mean differences in the enjoyment of food (F(6481) = 4.653, p < 0.001), fruit and vegetable intake (F(6480) = 4.165, p < 0.001) and unhealthy snack intake (F(6480) = 5.062, p < 0.001) between the intervention and wait-list groups; however, it was not clinically meaningful. This study added to the body of knowledge of family-based intervention that utilized social media and assessed the effect in children’s eating behavior using the CEBQ and children’s dietary intake.

Show or tell: Children's learning about food from action vs verbal testimony

BACKGROUND

Childhood obesity continues to be a critical health concern in the United States. Nonetheless, interventions that focus on delivering verbal lessons about food and health to children in preschool classrooms have had only modest effects.

OBJECTIVES

The present study examines the relative effectiveness of showing vs telling children about food to promote healthy eating, with a focus on unfamiliar foods and vegetables.

METHODS

Three- to six-year-old children (n = 71) were tested in a laboratory study in which they watched videos of two people eating apple-broccoli puree. One person took five bites of the food; the other said they liked the food.

RESULTS

Children did not differentiate between the food they saw someone eat and the food they heard someone talk about. Children's food intake was negatively associated with parent reports of children's eating behavior on the Food Fussiness subscale of the Child Eating Behavior Questionnaire. We found similar patterns in an analogous toy task. In an unfamiliar object task, children selected the action demonstration as the right way to use the object.

CONCLUSIONS

We find no evidence that action vs verbal testimony is more persuasive in guiding children's food choices, but action testimony may be persuasive in other domains. The associations between children's food intake and pickiness provide growing evidence of alignment between parent assessments of their children's typical eating behavior and children's food choices in laboratory studies.

Impact of problematic eating behaviour and parental feeding styles on early childhood caries

BACKGROUND

Eating behaviour in childhood has been implicated in development of early childhood caries. Parenting feeding styles can also contribute to development of various eating behaviours.

AIM

To evaluate relationship between children's eating behaviour and parental feeding styles with ECC in preschool children.

DESIGN

A case-control study was conducted in 440 children who were selected and divided into 2 groups: Group A-children with ECC and Group B-children without ECC. Dental caries was recorded using dmft index. The parents of children in both groups were requested to complete the Children's Eating Behaviour Questionnaire (CEBQ) and Parental Feeding Style Questionnaire (PFQ).

RESULTS

There was positive association of food avoidance subscales of CEBQ (Satiety Responsiveness, Food Fussiness, Slowness in Eating, and Emotional Undereating) along with certain food-approaching subscales (Desire to Drink and Emotional Overeating) with dental caries status. It was also seen that parental feeding patterns such as Encouragement and Instrumental feeding contributed to decrease in dental caries of the child when compared to Control and Emotional feeding.

CONCLUSION

Certain eating and feeding behaviours can possibly be associated with development of ECC, such behaviours can be successfully identified using CEBQ and PFQ.

Appetitive traits as targets for weight loss: The role of food cue responsiveness and satiety responsiveness

Individuals with overweight or obesity (OW/OB) are at increased risk for significant physical and psychological comorbidities. The current treatment for OW/OB is behavioral weight loss, which provides psychoeducation on nutrition and physical activity, as well as behavior therapy skills. However, behavioral weight loss is not effective for the majority of the individuals who participate. Research suggests that overeating, or eating past nutritional needs, is one of the leading causes of weight gain. Accumulating evidence suggests that appetitive traits, such as food cue responsiveness and satiety responsiveness, are associated with overeating and weight in youth and adults. The following review presents the current literature on the relationship between food cue responsiveness, satiety responsiveness, overeating, and OW/OB. Research suggests that higher food cue responsiveness and lower satiety responsiveness are associated with overeating and OW/OB cross-sectionally and longitudinally. Emerging data suggest that food cue responsiveness and satiety responsiveness may exist along the same continuum and can be targeted to manage overeating and reduce weight. We have developed a treatment model targeting food cue responsiveness and satiety responsiveness to reduce overeating and weight and have preliminary feasibility, acceptability, and efficacy data, with testing currently being conducted in larger trials. Through programs targeting appetitive traits we hope to develop an alternative weight loss model to assist individuals with a propensity to overeat.

Caregiver Influences on Eating Behaviors in Young Children: A Scientific Statement From the American Heart Association

A substantial body of research suggests that efforts to prevent pediatric obesity may benefit from targeting not just what a child eats, but how they eat. Specifically, child obesity prevention should include a component that addresses reasons why children have differing abilities to start and stop eating in response to internal cues of hunger and satiety, a construct known as eating self‐regulation. This review summarizes current knowledge regarding how caregivers can be an important influence on children's eating self‐regulation during early childhood. First, we discuss the evidence supporting an association between caregiver feeding and child eating self‐regulation. Second, we discuss what implications the current evidence has for actions caregivers may be able to take to support children's eating self‐regulation. Finally, we consider the broader social, economic, and cultural context around the feeding environment relationship and how this intersects with the implementation of any actions. As far as we are aware, this is the first American Heart Association (AHA) scientific statement to focus on a psychobehavioral approach to reducing obesity risk in young children. It is anticipated that the timely information provided in this review can be used not only by caregivers within the immediate and extended family but also by a broad range of community‐based care providers.

A cultural adaptation and validation of a child eating behaviour measure in a low- and middle-income country

OBJECTIVE

The Child Eating Behaviour Questionnaire (CEBQ), a widely used instrument that has been validated mostly in high-income countries, has limitations in its factorial validity when used among different cultures. This study examines whether the CEBQ instrument is culturally appropriate and valid to be used in a low- and middle-income country (LMIC) in a setting where child undernutrition remains prevalent.

DESIGN

The study employed a qualitative process to validate the content of items relative to the culture and setting, which was followed by a survey to test the psychometric properties of the instrument. Tests of factorial validity, convergent validity and reliability were performed.

SETTING

Three different socio-economic settings of Yogyakarta, Indonesia.

PARTICIPANTS

The participants of this study were mothers of children aged 25-60 months. In-depth interviews were conducted with twenty-four mothers and the questionnaire validation process involved 238 mothers in the survey.

RESULTS

A Confirmatory Factor Analysis model with eight subscales provided the best fit (root-mean-square error of approximation = 0·048 (90 % CI 0·040, 0·057); Comparative Fit Index = 0·95 and Tucker Lewis Index = 0·95) after three new items and eight items from the original CEBQ were removed. Convergent validity with child's weight was found for two subscales, slowness in eating and satiety responsiveness. Reliability measured using Cronbach's alpha provided values between 0·62 and 0·78.

CONCLUSION

The original eight-factor structure of the CEBQ showed adequate content validity and provided factorial, discriminant and convergent validity with mothers of preschool children living in a LMIC where child nutrition remains a significant public health issue.

Associations of appetitive behaviors in 7-year-old children with their cardiometabolic health at 10 years of age

BACKGROUND AND AIMS

Atherosclerosis begins early in life, thus optimal cardiovascular health needs to be promoted early. We investigated whether appetitive behaviors among 7 year olds are associated with their cardiometabolic health years later.

METHODS AND RESULTS

A sample of 2951 children from a Portuguese birth cohort was analyzed. The Children's Eating Behavior Questionnaire assessed eating behaviors, and a measure of cardiometabolic risk (higher risk group: those in the upper quartile of triglycerides, homeostatic model assessment-insulin resistance, waist circumference and systolic blood pressure and in the lower quartile of high-density lipoprotein cholesterol z-scores) was created. Linear and logistic regressions were run. Children with more food avoidant behaviors had lower cardiometabolic risk (Satiety Responsiveness - boys: OR = 0.39, 95% CI 0.16; 0.93, girls: OR=0.37, 95% CI 0.17; 0.82 and Slowness in eating - boys: OR = 0.49, 95% CI 0.25; 0.95, girls: OR = 0.49, 95% CI 0.27; 0.91). Food approach behaviors (Food responsiveness (CEBQ-FR), Enjoyment of food (CEBQ-EF) and Emotional overeating (CEBQ-EOE)) increased cardiometabolic risks (e.g. CEBQ-FR: boys: OR = 2.50, 95% CI 1.45; 4.32, girls: OR = 2.33, 95% CI 1.46; 3.71). CEBQ-EF had stronger effects in boys, while CEBQ-EOE was positively associated with cardiometabolic risk among girls. When adjusting for BMIz at 7y, associations did not remain significant. Appetitive behaviors were also associated with isolated cardiometabolic parameters; the strongest association being with waist circumference.

CONCLUSIONS

Appetitive behaviors at 7-years are associated with cardiometabolic risk at age 10. While 'food avoidant' behaviors protect against cardiometabolic risk and 'food approach' behaviors increase cardiometabolic risk, these associations are largely dependent of child's adiposity.

Associations between dietary patterns, eating behaviours, and body composition and adiposity in 3-year-old children of mothers with obesity

BACKGROUND

The relationships between eating habits, behaviours, and the development of obesity in preschool children is not well established.

OBJECTIVE

As children of mothers with obesity are themselves at risk of obesity, we examined these relationships in a cohort of 482 three-year-old children of mothers with obesity from the UK Pregnancy Better Eating and Activity Trial (UPBEAT).

METHOD

Dietary patterns were derived using factor analysis of an 85-item food frequency questionnaire (FFQ). Eating behaviours were assessed using the Children's Eating Behaviour Questionnaire (CEBQ). Measures of body composition included age-specific BMI cut-offs, WHO z scores, sum of skinfolds, waist and arm circumferences, and body fat percentage. Using adjusted regression analysis, we examined associations between dietary patterns, eating behaviours, and measures of body composition.

RESULTS

Three distinct dietary patterns were defined: "healthy/prudent," "African/Caribbean," and "processed/snacking." The "processed/snacking" pattern was associated with greater odds of obesity; OR 1.53 (95% CI, 1.07-2.19). The "African/Caribbean" and the "healthy/prudent" patterns were associated with a lower arm circumference (β = -0.23 cm [-0.45 to -0.01]) and sum of skinfolds (β = -1.36 cm [-2.88 to -0.37]), respectively. Lower enjoyment of food and food responsiveness, and greater slowness in eating and satiety, were associated with lower arm and waist circumferences, WHO z scores, and obesity (all P < .05).

CONCLUSION

In children of mothers with obesity, those who had higher scores on a "processed/snacking" dietary pattern had greater odds of obesity. In contrast, slowness in eating was associated with lower measures of body composition. These novel findings highlight modifiable behaviours in high-risk preschool children which could contribute to public health strategies for prevention of childhood obesity.

Bidirectional relationships between appetitive behaviours and body mass index in childhood: a cross-lagged analysis in the Generation XXI birth cohort

PURPOSE

Appetitive behaviours have been associated with body mass index (BMI). However, existing data were largely derived from cross-sectional studies and cannot provide insight into the direction of associations. We aimed to explore the bidirectionality of these associations in school-age children.

METHODS

Participants are from the Generation XXI birth cohort, assessed at both 7 and 10 years of age (n = 4264; twins excluded). The Children's Eating Behaviour Questionnaire (CEBQ) was used to measure appetitive behaviours (8 subscales). Anthropometrics were measured and WHO BMI z-score was calculated. Cross-lagged analyses were performed to compare the magnitude and direction of the associations (behaviours at 7 years to BMI z-score at 10 years and the reverse) (covariates: child's sex, physical exercise, maternal age and education; plus BMI z-score at age 7 or, in the reverse direction, the subscale score).

RESULTS

In cross-lagged analyses, appetitive behaviours at 10 years of age (apart from emotional undereating) were shown to be reactive to the child BMI z-score at 7 years of age. Only slowness in eating was significantly related to subsequent BMI. However, the strongest association was from the child BMI z-score to the behaviour (β_standardized = - 0.028 compared with β_standardized = - 0.103, likelihood ratio test p < 0.001).

CONCLUSIONS

BMI at age 7 was related to appetitive behaviours at 10 years of age, rather than the reverse. This suggests that children with a higher BMI in middle childhood are at increased risk of developing an avid appetite over time.

Associations between appetitive traits, dietary patterns and weight status of children attending the School Kids Intervention Program

BACKGROUND

The nexus between appetitive traits, dietary patterns and weight status has predominantly been studied in a mixed sample (healthy weight, overweight and obese sample).

AIM

This cross-sectional study examined associations between overweight/obese children's appetitive traits, dietary patterns and weight status.

METHODS

We studied children (N = 58, body mass index z-score: 2.25±0.46), 4-12 years attending the School Kids Intervention Program. Children's appetitive traits and dietary patterns were measured with the Child Eating Behaviour Questionnaire and Children's Dietary Questionnaire, respectively. Children's height and weight were used to compute body mass index z-score; waist circumference was also measured and waist-to-height ratio was calculated.

RESULTS

After controlling for children's age and gender, hierarchical linear regression analyses showed that lower scores for slowness in eating were associated with higher body mass index z-scores in children (β = -0.31, p = 0.01). Higher scores for emotional overeating were associated with higher waist-to-height ratio in children (β = 0.48, p = 0.01). Higher scores for fussiness were correlated with lower scores for fruits and vegetables (β = -0.59, p < 0.001) and higher scores for non-core foods (β = 0.26, p = 0.04).

CONCLUSION

Results observed in the current sample of overweight and obese children are consistent with previous studies examining healthy-weight children. Slowness in eating may foster an obesity 'protective' effect, whereas emotional overeating may promote susceptibility to weight gain. Fussy eating may impair diet quality by lower consumption of vegetables and fruits and higher intake of non-core foods. This evidence will support dietitians to consider children's appetitive traits when providing dietary consultation to support obesity management among overweight/obese children.

Short-Term Effects of an Obesity Prevention Program Among Low-Income Hispanic Families With Preschoolers

OBJECTIVE

To assess the short-term effects of an obesity prevention program promoting eating self-regulation and healthy food preferences in low-income Hispanic children.

DESIGN

Randomized controlled trial with pretest, posttest, and 6- and 12-month assessments.

SETTING AND PARTICIPANTS

Head Start and similar early learning institutions in Houston, TX, and Pasco, WA. A total of 255 families with preschoolers randomized into prevention (n = 136) and control (n = 119) groups.

INTERVENTION

Multicomponent family-based prevention program. Fourteen waves lasted 7 weeks each with 8-10 mother-child dyads in each group.

MAIN OUTCOME MEASURES

Parent assessments included feeding practices, styles, and knowledge. Child assessments included child eating self-regulation, willingness to try new foods, and parent report of child fruit and vegetable preferences. Parent and child heights and weights were measured.

ANALYSIS

Multilevel analyses were employed to consider the nested nature of the data: time points within families within waves.

RESULTS

The program had predicted effects on parental feeding practices, styles, and knowledge in the pre- to post-comparisons. Effects on child eating behavior were minimal; only the number of different vegetables tried showed significant pre-post differences.

CONCLUSIONS AND IMPLICATIONS

Short-term effects of this prevention program highlight the importance of family-focused feeding approaches to combating child overweight and obesity.

Fetal size and eating behaviour in childhood: a prospective cohort study

BACKGROUND

Although studies showed that an adverse intrauterine environment increases the obesity risk in adulthood, little is known about consequences of fetal growth and birth size for eating behaviour. We examined whether fetal and birth size are associated with childhood eating behaviour.

METHODS

Participants were 4350 mother-child dyads of the prospective cohort study Generation R. We assessed the relation between fetal and birth size measurements with child eating behaviour at age 4 years by maternal report on the Child Eating Behaviour Questionnaire. Child body mass index (BMI) was measured at age 2 years.

RESULTS

Per one standard deviation (SD) larger birthweight, children scored lower on Satiety Responsiveness [-0.29 points; 95% confidence interval (CI): -0.39; -0.18], higher on Food Responsiveness (0.28 points; 95% CI: 0.17; 0.39) and on Enjoyment of Food (0.21 points; 95% CI: 0.12; 0.31) at age 4 years. Similar associations were found in late pregnancy. Per one SD increase in fetal growth from late pregnancy to birth, children scored lower on Satiety Responsiveness (-0.15 points; 95% CI: -0.26; -0.04). Children within the 10% highest birthweight scored higher on food approach and lower on food avoidant scales, whereas associations in children within the 10% lowest birthweights were absent. Although child BMI partly mediated the association, direct effects of birthweight on appetitive traits remained.

CONCLUSIONS

This study indicates that fetal size, especially being large in utero, is associated with obesity-inducing eating behaviour. Our findings point to intrauterine influences on appetite and satiety, and contribute to understanding the complex aetiology of obesity.

Obesity risk in Hispanic children: Bidirectional associations between child eating behavior and child weight status over time

Individual differences in eating behaviors have been associated with obesity among young children. Food responsiveness tends to be positively associated with childhood obesity, satiety responsiveness tends to show a negative association, and the results for emotional overeating are mixed. Previous studies in this area, however, have generally employed cross-sectional designs. The purpose of the present study was to examine, in a sample of Hispanic children from families with low-income levels, the degree to which individual differences in child eating behaviors in the preschool years predicted changes in child weight into the early elementary school years. Parent/child dyads (n = 113) were seen on three separate occasions starting when the children were 4-years-old and ending when they were 8-years-old. Separate cross-lag panel analyses were conducted for food responsiveness, satiety responsiveness, and emotional overeating in examining the relationships between child eating behavior and child weight status over time. Consistent with previous cross-sectional studies, at all three time points, food responsiveness was positively associated with concurrent child weight status and satiety responsiveness showed a negative relationship. No concurrent relationship with child weight status was found for emotional overeating until the third time point when children were eight-years-old. Only two cross-lag associations between child eating behavior and child weight status were significant: emotional overeating and child weight status showed a bidirectional relationship between the second and third time points. Future longitudinal studies should examine these relationships in other populations.

Nutritional status and eating behavior of children: A study among primary school children in a rural area of West Bengal

Background:

Dietary preferences and childhood eating behavior has marked influence on nutritional status of children. The objective of the study was to find out eating behavior of primary school children in a rural area of West Bengal using Child Eating Behavior Questionnaire and to determine association of body mass index (BMI) with eating behavior.

Methodology:

It was an institution-based observational study with cross-sectional design done from May to August, 2018. The study was done among 142 children studying at four primary schools at Singur, in the rural field practice area of our institute. The four schools were selected randomly using list of primary schools in the area. Eating behavior of children was assessed using Child Eating Behavior Questionnaire (CEBQ). BMI of the children was assessed using WHO Z scores tables for children. Data analysis was done using SPSS Version 16 and binary logistic regression was done to find out association of BMI with eating behavior of study participants.

Results:

The proportion of under-nutrition and overnutrition was 22.0% and 16.0%, respectively. Food fussiness was significantly associated with thinness [BMI below (−2SD)]. Enjoyment of food, satiety response was significantly associated with overnutrition [BMI above (+1 SD)]. Food avoidance subscale was significantly associated with thinness [OR: 2.5, CI: 1.11, 5.63] and this subscale was protective for overweight [OR: 0.22, CI: 0.07, 0.69].

Conclusion:

This study showed association of BMI with child eating behavior. Therefore, awareness among parents should be created to change problematic eating of their children which would further help them to achieve normal BMI.

The sex-specific association between autistic traits and eating behavior in childhood: An exploratory study in the general population

Children with Autism Spectrum Disorder (ASD) often exhibit problematic eating behaviors, an observation mostly based on male dominated, clinical ASD study samples. It is, however, important to evaluate both children with an ASD diagnosis and children with subclinical autistic traits as both often experience difficulties. Moreover, considering the suggestion of a possible girl-specific ASD phenotype, there is a need to determine whether autistic traits are related with problematic eating behaviors in girls as well. This study explores the sex-specific association between autism (both autistic traits and diagnosed ASD) and eating behavior in middle childhood in Generation R, a prospective population-based cohort from fetal life onwards. We collected parental reports of autistic traits at six years (Social Responsiveness Scale) and of eating behavior at ten years (Children's Eating Behaviour Questionnaire). In this cohort of 3559 children, autistic traits at six years were associated with more Picky Eating, Emotional Eating and Food Responsiveness in later childhood (e.g. adjusted B for Picky Eating = 0.07; 95% CI: 0.03, 0.11). Stratified analyses showed that in girls, autistic traits were associated with more Emotional Overeating and Emotional Undereating (e.g. adjusted B for Emotional Undereating = 0.12; 95% CI: 0.04, 0.20), while no associations were found for boys. Results comparing children with and without an ASD diagnosis in the cohort largely confirm these associations (e.g. in girls, adjusted B for Emotional Undereating = 0.72; 95% CI: 0.01, 1.42). Our results point to a sex-specific association between autism and eating behavior in middle childhood. Also, our study is the first study to show that autistic traits are associated with emotionally based eating problems in girls and possibly represent part of a girl-specific ASD phenotype.

Factors Impacting on Eating in Pediatric Intestinal-Transplant Recipients: A Mixed-Methods Study

BACKGROUND

No empirical data are found examining why eating may be difficult for some children and not others following intestinal transplant. This study aimed to describe the eating behaviors and nutrition intake of intestinal-transplant-recipient children and examine factors that may impact on their eating.

METHODS

Caregivers of all (n = 34) intestinal-transplant recipients <18 years of age in the United Kingdom were invited to participate in this mixed-methods study comprising questionnaires, a 3-day food diary and interviews. Questionnaires included the Children's Eating Behaviour Questionnaire and demographic/nutrition-related items. Analysis was by descriptive statistics using SPSS. Semistructured telephone interviews explored caregiver perceptions of their child's eating. Analysis was thematic.

RESULTS

Nine caregivers were recruited and completed the questionnaire and food diary. Eight of these were interviewed. Home tube feeding was required by 77% (n = 7) of children post transplant, 56% (n = 5) were "food avoidant", and median energy intake was 93% (range, 61%-137%) of requirements. The findings revealed complex, interrelated positive and negative medical, caregiver, and child-related influences on eating. Learning to eat at the recommended age and having positive and significant pretransplant eating experiences appeared protective, whereas receiving nothing by mouth and having aversive experiences were barriers.

CONCLUSION

This study provides the first empirical evidence of factors that may influence eating after intestinal transplant in children. The findings suggest promoting eating pretransplant, when the negative physical consequences can be managed, may be protective, and there may be eating-difficulty predictors that could be used to facilitate targeted interventions.

Confirmation of the Factor Structure and Reliability of the 'Adult Eating Behavior Questionnaire' in an Adolescent Sample

Introduction

Appetitive traits, including Food Responsiveness, Enjoyment of Food, Satiety Responsiveness, Emotional Over- and Under-Eating, Food Fussiness and Slowness in Eating, have been captured across childhood using the Children’s Eating Behavior Questionnaire (CEBQ). The Adult Eating Behavior Questionnaire (AEBQ) has explored these traits in adults, but not adolescents. This study aimed to test the factor structure and reliability of the AEBQ in a sample of UK adolescents, and explore demographic differences.

Materials and Methods

Confirmatory factor analysis (CFA) tested an 8-factor and a 7-factor AEBQ, based on valid, completed AEBQ responses (n = 913) from adolescents aged 11–18 recruited from four London secondary schools. Test–retest reliability was analyzed in a subsample (n = 106) 2-weeks later, and 492 participants completed the Dutch Eating Behavior Questionnaire (DEBQ) to assess convergent validity. Demographic differences were explored using a multiple indicator multiple cause (MIMIC) model.

Results

The CFA revealed an adequate model fit for a 7-factor structure without Hunger [RMSEA = 0.038 (90% CI:0.035,0.041); CFI = 0.926, TLI = 0.916; and χ²(df = 595) = 8502.69, p < 0.001]. These seven subscales showed acceptable internal consistency (Cronbach’s α > 0.70). The ICC for the test–retest was above 0.70. Comparisons with the DEBQ supported the convergent validity of the AEBQ. Older age was associated with greater Food Responsiveness and Enjoyment of Food (all p-values < 0.005). Females reported higher levels of Emotional Over-Eating, Satiety Responsiveness, and Slowness in Eating than males (all p-values ≤ 0.003).

Conclusion

This study supports the use of the 7-factor AEBQ as a reliable measure of appetitive traits in adolescents.

Children’s Eating Behaviour Questionnaire: association with BMI in children aged 3–10 years from Bosnia and Herzegovina

Objective:

To evaluate differences in children’s eating behaviour in relation to their weight status.

Design:

Prospective, cross-sectional study. Anthropometric measures were taken and age- and sex-adjusted BMI percentiles and Z-scores were calculated according to the Centers for Disease Control and Prevention recommendations to assess weight status. Parents completed a questionnaire which included demographic data and the Children’s Eating Behaviour Questionnaire (CEBQ) to assess eating behaviour.

Setting:

Tuzla Canton, Bosnia and Herzegovina (September 2016–September 2017).

Participants:

Male and female children aged 3–10 years and one of their parents.

Results:

The study sample comprised 2500 children; 6·8 % of them were underweight and 14·4 % were overweight, while there were 14·8 % obese children and 64·0 % had normal weight. The factor analysis of CEBQ revealed an eight-factor solution. Significant differences in CEBQ subscale scores were found within BMI categories for all CEBQ subscales except Food Fussiness. On the other hand, child BMI Z-scores showed a linear increase with the ‘food approach’ subscales of the CEBQ, except the Desire to Drink subscale which was excluded from analysis, and a decrease with ‘food avoidant’ subscales.

Conclusions:

The present study suggests that the CEBQ is valuable for identifying specific eating styles that are associated with weight status and can be seen as important and modifiable determinants implicated in the development and maintenance of overweight/obesity as well as underweight.

Appetitive characteristics in children with cystic fibrosis: Questionnaire validation and associations with nutritional status

BACKGROUND

Appetitive characteristics are an important factor in the nutritional status of children with cystic fibrosis (CF). We administered a brief parent-report eating behavior questionnaire, validated in healthy children, to determine the relationship between appetitive characteristics and body weight in children with CF.

METHODS

Parents of children attending the Johns Hopkins Pediatric CF Clinic completed the Child Eating Behavior Questionnaire (CEBQ) at a routine clinic visit. Responses were correlated with anthropometric and other clinical data.

RESULTS

Parents of 64 children with CF aged 7.74 ± 3.17 years (mean ± SD) completed the CEBQ. The CEBQ subscales demonstrated good internal consistency (Cronbach's α = 0.76-0.94). Higher scores on food avoidance subscales (Slowness in Eating) were associated with lower body mass index (BMI) z-scores, and higher scores on food approach subscales (Food Responsiveness, Enjoyment of Food, Emotional Overeating) with higher BMI z-scores. Children with feeding aids (i.e. gastric tube or appetite-stimulating medications) demonstrated greater food avoidance (Slowness in Eating) and lesser food approach (Enjoyment of Food) when compared to those without feeding aids. Children with pancreatic insufficiency also demonstrated greater food avoidance (Slowness in Eating).

CONCLUSIONS

The CEBQ can be used in a clinical setting to identify children with CF with appetitive characteristics associated with difficulty gaining weight. These children could potentially benefit from earlier interventions to aid in weight gain. Characterization of appetite using the CEBQ could aid investigation of the biological etiology of low appetite, and optimization of clinical and parental approaches to achieving a healthy nutritional status.

Pediatric Eating Behaviors as the Intersection of Biology and Parenting: Lessons from the Birds and the Bees

PURPOSE OF REVIEW

Current feeding advice to prevent pediatric obesity focuses on caregiver feeding behaviors. This review integrates newer data showing that child appetitive traits also have a genetic component.

RECENT FINDINGS

Caregiver feeding behaviors robustly correlate with child eating behaviors; however, there is also a strong heritable component. The satiety cascade delineates the biological drive underlying hunger, satiation, and satiety. Innate individual differences exist for the components of the satiety cascade, which may explain the heritability of child eating behaviors. However, given the correlation of caregiver feeding behaviors with child eating behaviors, any etiological model should include both genetic/biological components and environmental. Integrating the biological etiology of child eating behaviors into the current environmental model has implications for tailoring feeding advice which needs to move from a "one size fits all" approach to one that is tailored to individual differences in children's biological drives to appetite.

Assessment of Problematic Eating Behaviour and Dental Caries in Children

Background/Aim: Eating behaviour in children has wide range from anorexia, to selective eating, fussy eater, neophobic/pouching of food & slow eating. Eating behaviour in childhood has been implicated in the development of dental caries and further affecting the body mass index of the child. The aim was to assess the Problematic Eating Behaviour (PEB) and its association with dental caries status of the child.

Material and Methods: Parents of 150 children between 3-8 years of age were divided into 2 groups, Group A (3-5 years) and Group B (6-8 years). The parents completed the Children’s Eating Behaviour Questionnaire (CEBQ) & the child’s dental caries status was recorded. The collected data was subjected to statistical analysis using unpaired t test & Pearson’s correlation coefficient test.

Results: The results showed that the dental caries status was significantly higher in younger age group (3-5 years) than older age group (6-8 years). Further evaluating the PEB using CEBQ, there was no significant relation found between PEB and dental caries in younger age group of children (3-5 years), but in the older age group (6-8 years) the Factor 4 Desire to Drink (p=0,274) and Factor 5 Satiety Responsiveness (p=0,291) were significantly associated to the dental caries.

Conclusions: Eating behaviour can contribute to the development of caries and this has been successfully studied with the use of CEBQ in the present study.

Toddlers' impulsivity, inhibitory control, and maternal eating-related supervision in relation to toddler body mass index: Direct and interactive effects

Previous studies have noted that child temperament characteristics, such as aspects of self-regulation, as well as parental feeding practices contribute to children's body mass index (BMI), and have implications for identifying children who may be at risk of being overweight or obese. While studies have considered children's temperament or maternal feeding practices separately, few have considered these correlates of children's BMI jointly or in interaction in relation to children's BMI. The current study included 179 mother-child dyads participating in a longitudinal study. Information on children's impulsivity and inhibitory control was collected when children were 24 months of age. Children's tendency to emotionally overeat, maternal supervision of children's eating, and toddler and maternal BMI were assessed when children reached 30 months of age. Higher toddler impulsivity and emotional overeating, as well as maternal BMI were positively associated with toddler BMI. Inhibitory control and maternal supervision of toddler eating were not directly associated with toddler BMI. However, the main effect of toddler impulsivity was qualified by a significant interaction with maternal supervision of toddler eating. For children high in impulsivity, there was a significant negative association between maternal eating supervision and toddler BMI. For children low in impulsivity, there was a trend level (p = .059) positive relation between maternal eating supervision and toddler BMI. These findings suggest that increased maternal supervision of children's eating may be beneficial for helping children maintain a healthy BMI when they exhibit high impulsivity.

Relationships among Child Eating Behaviors and Household Food Insecurity in Youth with Obesity

Background: Food insecurity may trigger eating behaviors that contribute to pediatric obesity. The aim of this study is to identify eating behaviors among a pediatric population with obesity and household food insecurity. Methods: A cross-sectional study analyzed Child Eating Behavior Questionnaire (CEBQ) and household food insecurity screener responses, and BMI measurements from pediatric participants with obesity (BMI ≥95th percentile) from a weight management clinic between 2013 and 2017. Multivariate linear regression was performed to evaluate associations between CEBQ eating domains [Food Responsiveness, Emotional Overeating, Enjoyment of Food, Desire to Drink (DD), Satiety Responsiveness, Slowness in Eating, Emotional Undereating (EUE), and Food Fussiness] and household food insecurity, adjusting for age, sex, race/ethnicity, SNAP participation, and BMI percentile. A sub-group analysis was performed on participants from food insecure (FI) households to evaluate the associations between SNAP participation and eating domains. Results: Eight hundred twenty-two participants were included in the final analysis. Participants from FI households had significantly higher BMI percentiles even after adjustment for age, sex, race/ethnicity, and SNAP status (p = 0.000). Household food insecurity was associated with increased DD beverages (p = 0.000). Among participants from FI households, SNAP participation was significantly positively associated with the EUE (p = 0.009). Conclusions: Youth from FI households have higher BMIs even among a population with obesity. DD is positively associated with household food insecurity and may contribute to obesity in this population. Results suggest that providers treating pediatric patients with obesity should consider regularly screening for household food insecurity and associated eating behaviors as part of their medical management of obesity.

Growth and body composition in children who are picky eaters: a longitudinal view

BACKGROUND/OBJECTIVES

Picky eating may be associated with higher risk of being underweight and poor growth over time or conversely, being overweight. Our aim was to investigate if children identified as picky eaters showed differences in height, weight and body composition from their non-picky peers.

SUBJECTS/METHODS

Picky eaters were identified in the Avon Longitudinal Study of Parents and Children cohort at 3 years of age. Height and weight were measured on seven occasions (age 7-17 years). Body composition was measured on five occasions by dual-energy x-ray absorptiometry (age 9-17 years). Participants were classified as thin/normal/overweight or obese at each age point using body mass index (BMI) classifications. Data were analysed with adjusted multiple regression analysis and mixed-design repeated measures ANOVA.

RESULTS

There was a main effect of being a picky child on height and weight (and on BMI and lean mass index (LMI) in boys) (lower in the picky children, all p ≤ 0.044), but not on percentage body fat or fat mass index (and not on BMI and LMI in girls) (all p > 0.2). The mean heights, weights and BMIs of picky eaters were consistently above the 50th centiles of reference growth charts. More than two-thirds of picky eaters were not thin at any age point. However, being a picky eater was predictive of being thin at a few age points.

CONCLUSIONS

The growth trajectories of children who were picky eaters were reassuring. The prevalence of thinness amongst some picky eaters is notable, suggesting that some children may need specific early identification, intervention and growth surveillance.

Validation of the Children's Eating Behavior Questionnaire in 5 and 6 Year-Old Children: The GUSTO Cohort Study

Revised subscales of the Children’s Eating Behavior Questionnaire (CEBQ) have been proposed to be more appropriate for assessing appetitive traits in Singaporean 3 year-olds, but the CEBQ has not yet been validated in older children in this population. The current study aimed to validate the CEBQ at ages 5 (n = 653) and 6 (n = 449) in the ethnically diverse GUSTO cohort. Confirmatory factor analysis (CFA) examined whether the established eight-factor model of the CEBQ was supported in this sample. Overall, the CFA showed a poor model fit at both ages 5 and 6. At both ages 5 and 6, an exploratory factor analysis revealed a six-factor structure: food fussiness, enjoyment of food, slowness in eating, emotional undereating, emotional overeating and desire to drink. Cronbach’s alpha estimates ranged from 0.70 to 0.85 for all subscales. Criterion validity was tested by correlating subscales with the weight status of 6 years of age. At age 5 and 6, lower scores of slowness of eating while higher scores of enjoyment of food was associated with child overweight. At age 6, higher scores of desire to drink was also associated child overweight. In conclusion, a revised six factor-structure of the CEBQ at ages 5 and 6 were more appropriate for examining appetitive traits in this sample.

Diet at Age 10 and 13 Years in Children Identified as Picky Eaters at Age 3 Years and in Children Who Are Persistent Picky Eaters in A Longitudinal Birth Cohort Study

Picky eating has been associated with lower intakes of some nutrients and foods during preschool ages but there is little known about the longer-term diet. The aim of this study was to characterise the diets of children aged 10 and 13 years who had been identified as: (1) picky eaters at age 3 years (cross-sectional); and (2) picky eaters at 2-5.5 years old (longitudinal). Picky eating behaviour (PE) was identified in the Avon Longitudinal Study of Parents and Children (ALSPAC) from parental/caregiver questionnaires. Dietary intake was assessed at age 3.5 years and repeated at 10 and 13 years. For cross-sectional PE compared with non-PE there were differences at age 10 years that were similar to those at 3.5 years: lower intakes of protein (-5%) and fibre (-7%) and of meat (-15%), fruit (-10%) and vegetables (-33%). At 13 years, differences in vegetable (-23%), fruit (-14%) and meat (-8%) intakes were evident. For longitudinal (persistent) PE, differences were more pronounced at each age. More effective strategies to help parents to widen the food choices of their children at early ages need to be developed, focusing particularly on vegetable and fruit intakes.

A Biopsychosocial Model of Sex Differences in Children's Eating Behaviors

The prevalence of obesity and eating disorders varies by sex, but the extent to which sex influences eating behaviors, especially in childhood, has received less attention. The purpose of this paper is to critically discuss the literature on sex differences in eating behavior in children and present new findings supporting the role of sex in child appetitive traits and neural responses to food cues. In children, the literature shows sex differences in food acceptance, food intake, appetitive traits, eating-related compensation, and eating speed. New analyses demonstrate that sex interacts with child weight status to differentially influence appetitive traits. Further, results from neuroimaging suggest that obesity in female children is positively related to neural reactivity to higher-energy-dense food cues in regions involved with contextual processing and object recognition, while the opposite was found in males. In addition to differences in how the brain processes information about food, other factors that may contribute to sex differences include parental feeding practices, societal emphasis on dieting, and peer influences. Future studies are needed to confirm these findings, as they may have implications for the development of effective intervention programs to improve dietary behaviors and prevent obesity.

Development and validation of a tool to assess appetite of children in low income settings

Reliable and validated tools for measuring appetite of children in South Asia are not available. This study aimed to develop and validate a tool for assessing appetite level of under-five children. Based on literature review and findings from focus group discussions (FGDs), an initial 27-item interview-based tool, the "Early Childhood Appetite and Satiety Tool (ECAST)" was developed in Bangladesh. Fourteen FGDs were carried out in rural and urban settings and constructs for inclusion were derived from the themes and coding of FGDs and appetite assessment tools used in Western contexts. For structural validation, the ECAST-27-was administered on 150 mothers/primary caregivers of children aged 6-59 months, living in urban and rural areas. To validate the association with other variables, the ECAST was administered on mothers of children aged 12-24 months in the community (N = 50), and two groups of wasted, hospitalized children (Weight-for-length, Z score <-2SD) [group1: twenty acutely ill children aged 6-59 months; group 2: twenty children in nutritional rehabilitation aged 18-24 months]. Reliability of ECAST was estimated using Cronbach's alpha and Pearson's correlation coefficient. Kaiser-Meyer-Olkin = 0.73 and the Bartlett's test of sphericity, χ²(253) = 755.791, p < 0.001 indicated that the raw data were suitable. Given the convergence of the Scree plot, Kaiser's criterion and dropping of cross loading items, a 16-item ECAST was produced with three sub scales: Appetite cue; Food responsiveness and Emotion and preference, which were internally valid and had good test-retest reliability (Cronbach's alpha 0.6 and test-retest reliability 0.797). Total ECAST scores of wasted children with good appetite were significantly higher from those with poor appetite (p = 0.004 and 0.001 for two wasted groups respectively). Results suggest that ECAST may provide a useful measure to assess the appetite level of under-five children.

Emotional Eating, Health Behaviours, and Obesity in Children: A 12-Country Cross-Sectional Study

Eating in response to negative emotions (emotional eating, EE) may predispose an individual to obesity. Yet, it is not well known how EE in children is associated with body mass index (BMI) and health behaviours (i.e., diet, physical activity, sleep, and TV-viewing). In the present study, we examined these associations in a cross-sectional sample of 5426 (54% girls) 9–11-year-old children from 12 countries and five continents. EE, food consumption, and TV-viewing were measured using self-administered questionnaires, and physical activity and nocturnal sleep duration were measured with accelerometers. BMI was calculated using measured weights and heights. EE factor scores were computed using confirmatory factor analysis, and dietary patterns were identified using principal components analysis. The associations of EE with health behaviours and BMI z-scores were analyzed using multilevel models including age, gender, and household income as covariates. EE was positively and consistently (across 12 study sites) associated with an unhealthy dietary pattern (β = 0.29, SE = 0.02, p < 0.0001), suggesting that the association is not restricted to Western countries. Positive associations between EE and physical activity and TV viewing were not consistent across sites. Results tended to be similar in boys and girls. EE was unrelated to BMI in this sample, but prospective studies are needed to determine whether higher EE in children predicts the development of undesirable dietary patterns and obesity over time.