Child meal microstructure and eating behaviors: A systematic review

PACE: a Novel Eating Behavior Phenotype to Assess Risk for Obesity in Middle Childhood

BACKGROUND

Behavioral phenotypes that predict future weight gain are needed to identify children susceptible to obesity.

OBJECTIVES

This prospective study developed an eating behavior risk score to predict change in adiposity over 1 y in children.

METHODS

Data from 6 baseline visits (Time 1, T1) and a 1-y follow-up visit (Time 2, T2) were collected from 76, 7- to 8-y-old healthy children recruited from Central Pennsylvania. At T1, children had body mass index (BMI) percentiles <90 and were classified with either high (n = 33; maternal BMI ≥30 kg/m2) or low (n = 43; maternal BMI ≤25 kg/m2) familial risk for obesity. Appetitive traits and eating behaviors were assessed at T1. Adiposity was measured at T1 and T2 using dual-energy x-ray absorptiometry, with a main outcome of fat mass index (FMI; total body fat mass divided by height in meters squared). Hierarchical linear regressions determined which eating measures improved prediction of T2 FMI after adjustment for covariates in the baseline model (T1 FMI, sex, income, familial risk, and Tanner stage).

RESULTS

Four eating measures-Portion susceptibility, Appetitive traits, loss of control eating, and eating rate-were combined into a standardized summary score called PACE. PACE improved the baseline model to predict 80% variance in T2 FMI. PACE was positively associated with the increase in FMI in children from T1 to T2, independent of familial risk (r = 0.58, P < 0.001). Although PACE was higher in girls than boys (P < 0.05), it did not differ by familial risk, income, or education.

CONCLUSIONS

PACE represents a cumulative eating behavior risk score that predicts adiposity gain over 1 y in middle childhood. If PACE similarly predicts adiposity gain in a cohort with greater racial and socioeconomic diversity, it will inform the development of interventions to prevent obesity. This trial was registered at clinicaltrials.gov as NCT03341247.

Switching between foods is reliably associated with intake across eating events in children

Emerging evidence suggests switching between foods during an eating event is positively associated with intake. However, it is unclear whether switching is a stable behavior that predicts consumption across multiple eating events. The current study explored whether switching is consistent within children and reliably associated with intake across varied eating events. We analyzed data from 88 (45 F), 7-8-year-old children without obesity participating in a 7-visit prospective cohort study (ClinicalTrials.gov NCT03341247). Amount consumed and energy intake were measured at 4 separate meals of foods that varied by portion sizes served. Meals included macaroni and cheese, chicken nuggets, broccoli, and grapes (all 0.7-2.5 kcal/g). Children's intake was also assessed during 2 eating in the absence of hunger (EAH) paradigms separated by ≥ 1 year. The EAH paradigm included 9 sweet and savory snack foods (all 1.9-5.7 kcal/g). All eating events were video-recorded and switching was assessed by counting the number of times a child shifted between different food items. Results demonstrated that switching was reliably associated with intake at both the meals and the EAH paradigms (ps < 0.01). Specifically, at meals each additional switch was associated with 11.7 ± 1.3 kcal (7.7 ± 0.8 g) more consumed, and during EAH each additional switch was associated with 8.1 ± 2.1 kcal (2.1 ± 0.5 g) more consumed. Switching behavior was also moderately consistent across meals (ICC = 0.70) and EAH paradigms (ICC = 0.50). However, switching at meals was not related to switching at EAH paradigms. This study demonstrates the consistency of switching behavior and its reliable association with intake across eating events, highlighting its potential to contribute to chronic overconsumption and childhood obesity.

Development and validation of the baby eating behaviour coding system (BEBECS) to assess eating behaviour during complementary feeding

Eating behaviour in children is a matter of study for which diverse tools have been designed. Coding systems for videotaped meals allow the extraction of detailed in vivo information; however, there is no tool available for infants following a Baby-Led Weaning (BLW) method. This study aimed to create and validate a new tool to assess eating behaviour in infants during weaning, applicable regardless of the complementary feeding method. The Baby Eating Behaviour Coding System (BEBECS) was developed comprising time variables, behaviours, feeder-led actions, and other meal-related variables. Sixty videos of infants aged 6-18 months following spoon-feeding (SF) or BLW methods were coded by two trained coders. These scores were analysed together with intake and maternal ratings of liking and calmness. Additionally, combined analysis and internal comparison assessed the possible differences in BEBECS variables between SF and BLW. Inter-rater and test-retest reliability had good to excellent agreement: Cohen's Kappa >0.75, Lin's CCC >0.70, and Intraclass Correlation Coefficient >0.75, for almost all variables. Infants' liking and intake of the offered food correlated positively with meal duration and total count of mouth approaches but negatively with having leftovers and time between mouth approaches. Infants' calmness and tiredness were negatively correlated. More food than initially offered was available during the meal in BLW but not in SF. There was a tendency towards more autonomous behaviour in BLW infants regarding changes observed in the time the food was in the mouth at each stage (6, 12, and 18 months). In conclusion, BEBECS has the potential to be a valid tool for application in the research of infant eating behaviour during weaning by trained coders.

Poorer inhibitory control was related to greater food intake across meals varying in portion size: A randomized crossover trial

Individuals eat more food when larger portions are served, and this portion size effect could be influenced by inhibitory control (the ability to suppress an automatic response). Inhibitory control may also relate to obesogenic meal behaviors such as eating faster, taking larger bites, and frequent switching between meal components (such as bites of food and sips of water). In a randomized crossover design, 44 adults ate lunch four times in the laboratory. Lunch consisted of a pasta dish that was varied in portion size (400, 500, 600, or 700 g) along with 700 g of water. Meals were video-recorded to assess meal duration and bite and sip counts, which were used to determine mean eating rate (g/min), mean bite size (g/bite), and number of switches between bites and sips. Participants completed a food-specific stop-signal task, which was used to calculate Stop-Signal Reaction Time (SSRT). Across participants, SSRT values ranged from 143 to 306 msec, where greater SSRT indicates poorer inhibitory control. As expected, serving larger portions increased meal intake (p < 0.0001); compared to the smallest portion, intake of the largest increased by 121 ± 17 g (mean ± SEM). SSRT did not moderate the portion size effect (p = 0.34), but individuals with poorer inhibitory control ate more across all meals: 24 ± 11 g for each one SD unit increase in SSRT (p = 0.035). SSRT was not related to eating rate or bite size (both p > 0.13), but poorer inhibitory control predicted greater switching between bites and sips, such that 1.5 ± 0.7 more switches were made during meals for each one SD unit increase in SSRT (p = 0.03). These findings indicate that inhibitory control can contribute to overconsumption across meals varying in portion size, potentially in part by promoting switching behavior.

Observational Methods in Studies of Infant and Young Child Feeding Practices in Low- and Middle-Income Countries: A Twenty-Year Retrospective Review

This narrative review describes the observational approaches used to study infant and young child feeding (IYCF) practices in low- and middle-income countries (LMICs) published between 2001 and 2021. Articles were included in this narrative review if they were (1) original peer-reviewed articles published in English in PubMed and Web of Science; (2) published between 1 January 2001, and 31 December 2021; (3) conducted in an LMIC; and (4) employed observations and focused on IYCF practices among children aged 6-59 months. The studies (n = 51) revealed a wide-ranging application of direct meal and full-day observations, as well as indirect spot checks, to study IYCF. The findings revealed that meal observations were typically conducted during a midday meal using precise recording approaches such as video and aimed to understand child-caregiver interactions or specialized nutritious food (SNF) usage. Conversely, full-day observations lasted between 6 and 12 h and often used a field notes-based recording approach. Behaviors occurring outside of mealtime, such as snacking or interhousehold food sharing, were also a primary focus. Finally, spot checks were conducted to indirectly assess SNF compliance during both announced and unannounced visits. This review highlights the adaptability of observations across contexts and their versatility when used as a primary data collection tool to help monitor and evaluate nutrition programs.

Inter-individual differences in children's short-term energy compensation: a systematic review and meta-analysis

BACKGROUND

The ability to regulate energy intake is often assessed using a preloading paradigm to measure short-term energy compensation. In children, large variability exists with this paradigm both within- and across- studies and is poorly understood.

OBJECTIVES

This systematic review and meta-analysis aimed to better understand factors contributing to variability in children's energy compensation. We tested 1) whether children demonstrated "good" energy compensation, defined as adjusting meal intake commensurate with preload intake and 2) differences in children's energy compensation by child age, sex, and weight status (assessed both continuously and categorically).

METHODS

Standard guidelines for systematic review were followed to search PubMed, PsychInfo, and Web of Science. Data on study design (preload form, preload-to-meal interval, preload energy difference, study setting) and participant characteristics (sex, age, weight status) were extracted from 29 experiments meeting inclusion criteria, and 13 were included in meta-analyses. COMPx (energy compensation index), a linear transformation comparing food intake following a high- vs. low-energy preload, was the outcome. Hedge's g was calculated, and random intercept-only models tested associations between COMPx and sex, age, and weight status.

RESULTS

The systematic review revealed mixed results regarding children's energy compensation and the role of inter-individual differences. Meta-analytic models revealed that children undercompensated (overate) for preload energy (β = -0.38; P = 0.008). Sex (β = 0.11; P = 0.76), age (β = 0.03; P = 0.75), and weight (assessed continuously; β = -0.07, P = 0.37) were not related to compensation. Children with overweight/obesity (assessed categorically) undercompensated more than children with healthy weight (β = 0.18; P = 0.04).

CONCLUSIONS

The systematic review highlighted wide variability across studies, while the meta-analysis demonstrated differences in COMPx by child weight status but not by age or sex. Standardizing protocols across studies is recommended, along with designing adequately powered studies aiming to test inter-individual differences a priori. Alternative approaches to the use of COMPx are recommended to allow better characterization of children's energy compensation ability. This study was registered at PROSPERO as CRD42020197748.

Switching between foods: A potential behavioral phenotype of hedonic hunger and increased obesity risk in children

CONTEXT

Reward-based eating is a trait that increases risk for eating in the absence of hunger (EAH) and obesity. Eating behaviors such as switching more frequently between different foods may increase intake during EAH by delaying the onset of sensory-specific satiation (SSS); however, this question has not been empirically tested.

OBJECTIVES

1) Test whether switching between foods mediates the relationship between reward-based eating and EAH intake. 2) Test whether switching between foods during EAH moderates the relationship between reward-based eating and weight status.

METHODS

Data were analyzed from a study assessing decision-making in children (n = 63 children; 9.4 ± 1.4 years, 77.0 ± 22.4 BMI%tile). Reward-based eating was quantified using the Children's Eating Behaviour Questionnaire. EAH was assessed as the amount of palatable food consumed following ad libitum consumption of a standard meal. Videos of eating behavior were coded for eating time, number of different foods consumed, and food switches. Ordinary least squares regressions were conducted to test hypotheses.

RESULTS

Switching was positively associated with EAH intake for both kcal (p < 0.01) and grams (p < 0.01) such that each additional switch was associated with an increased intake of 17.0 kcal or 3.5 gs. Switching mediated the relationship between reward-based eating and EAH (p < 0.01) such that more frequent switching fully accounted for the positive association between reward-based eating and EAH (ps < 0.01). While reward-based eating was also positively associated with weight status (p < 0.01), this association was moderated by food switching (p < 0.01) such that the relationship was stronger for children who switch more frequently (p < 0.01).

CONCLUSIONS

Frequent switching between foods was positively associated with EAH intake and mediated the relationship between reward-based eating and EAH. Moreover, reward-based eating was more strongly related to weight status in children who switched more frequently. Thus, food switching may contribute to overconsumption and be an important behavioral indicator of increased obesity risk in children. Studies across multiple meals and contexts will help determine if switching is a reliable behavioral phenotype.

Factors associated with eating rate: a systematic review and narrative synthesis informed by socio-ecological model

Accumulating evidence shows associations between rapid eating and overweight. Modifying eating rate might be a potential weight management strategy without imposing additional dietary restrictions. A comprehensive understanding of factors associated with eating speed will help with designing effective interventions. The aim of this review was to synthesise the current state of knowledge on the factors associated with eating rate. The socio-ecological model (SEM) was utilised to scaffold the identified factors. A comprehensive literature search of eleven databases was conducted to identify factors associated with eating rate. The 104 studies that met the inclusion criteria were heterogeneous in design and methods of eating rate measurement. We identified thirty-nine factors that were independently linked to eating speed and mapped them onto the individual, social and environmental levels of the SEM. The majority of the reported factors pertained to the individual characteristics (n = 20) including demographics, cognitive/psychological factors and habitual food oral processing behaviours. Social factors (n = 11) included eating companions, social and cultural norms, and family structure. Environmental factors (n = 8) included food texture and presentation, methods of consumption or background sounds. Measures of body weight, food form and characteristics, food oral processing behaviours and gender, age and ethnicity were the most researched and consistent factors associated with eating rate. A number of other novel and underresearched factors emerged, but these require replication and further research. We highlight directions for further research in this space and potential evidence-based candidates for interventions targeting eating rate.

Validation of computational models to characterize cumulative intake curves from video-coded meals

Introduction

Observational coding of eating behaviors (e.g., bites, eating rate) captures behavioral characteristics but is limited in its ability to capture dynamic patterns (e.g., temporal changes) across a meal. While the Universal Eating Monitor captures dynamic patterns of eating through cumulative intake curves, it is not commonly used in children due to strict behavioral protocols. Therefore, the objective of this study was to test the ability of computational models to characterize cumulative intake curves from video-coded meals without the use of continuous meal weight measurement.

Methods

Cumulative intake curves were estimated using Kisslieff's Quadratic model and Thomas's logistic ordinary differential equation (LODE) model. To test if cumulative intake curves could be characterized from video-coded meals, three different types of data were simulated: (1) Constant Bite: simplified cumulative intake data; (2) Variable Bite: continuously measured meal weight data; and (3) Bite Measurement Error: video-coded meals that require the use of average bite size rather than measured bite size.

Results

Performance did not differ by condition, which was assessed by examining model parameter recovery, goodness of fit, and prediction error. Therefore, the additional error incurred by using average bite size as one would with video-coded meals did not impact the ability to accurately estimate cumulative intake curves. While the Quadratic and LODE models were comparable in their ability to characterize cumulative intake curves, the LODE model parameters were more distinct than the Quadradic model. Greater distinctness suggests the LODE model may be more sensitive to individual differences in cumulative intake curves.

Discussion

Characterizing cumulative intake curves from video-coded meals expands our ability to capture dynamic patterns of eating behaviors in populations that are less amenable to strict protocols such as children and individuals with disordered eating. This will improve our ability to identify patterns of eating behavior associated with overconsumption and provide new opportunities for treatment.