Eating in the absence of hunger: Stability over time and associations with eating behaviours and body composition in children

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.

Psychometric properties of the Turkish version of the eating in the absence of hunger in children and adolescents (EAH-C)

BACKGROUND AND PURPOSE

Eating in the absence of hunger is a risk factor for excessive energy intake and predisposes children to overweight/obesity. The purpose of this study was to test the validity and reliability of the "Eating in the Absence of Hunger Questionnaire for Children and Adolescents (EAH-C)" in Türkiye.

METHODS

This study was conducted in a total of six schools, with children 8-18 years old between September and December 2022. Factor analysis, item-total score analysis and Cronbach's alpha coefficient were used for the validity and reliability.

RESULTS

The calculated KMO statistic was >0.60, and the Bartlett's test statistic was <0.05. The three subscales accounted for 65.22% of the total variance. Factor loads ranged from 0.41 to 0.84. The value obtained by dividing χ2 by the number of degrees of freedom was <5; the RMSEA was <0.10; the RMR was <0.08; and the TLI, GFI, AGFI, and CFI were >0.90. Cronbach's alpha coefficient was 0.91 for the total scale.

CONCLUSIONS

Our study has confirmed that the Turkish-language version of the EAH-C is a valid and reliable tool.

PRACTICE IMPLICATIONS

In the effort of prevention of childhood obesity, identifying eating behaviors in the absence of hunger in children and adolescents will benefit policymakers to develop intervention and prevention programs, in addition to providing guidance to pediatric nurses, all healthcare professionals, researchers, children, and parents.

Aberrant functional connectivity between reward and inhibitory control networks in pre-adolescent binge eating disorder

BACKGROUND

Behavioral features of binge eating disorder (BED) suggest abnormalities in reward and inhibitory control. Studies of adult populations suggest functional abnormalities in reward and inhibitory control networks. Despite behavioral markers often developing in children, the neurobiology of pediatric BED remains unstudied.

METHODS

58 pre-adolescent children (aged 9-10-years) with BED (mBMI = 25.05; s.d. = 5.40) and 66 age, BMI and developmentally matched control children (mBMI = 25.78; s.d. = 0.33) were extracted from the 3.0 baseline (Year 0) release of the Adolescent Brain Cognitive Development (ABCD) Study. We investigated group differences in resting-state functional MRI functional connectivity (FC) within and between reward and inhibitory control networks. A seed-based approach was employed to assess nodes in the reward [orbitofrontal cortex (OFC), nucleus accumbens, amygdala] and inhibitory control [dorsolateral prefrontal cortex, anterior cingulate cortex (ACC)] networks via hypothesis-driven seed-to-seed analyses, and secondary seed-to-voxel analyses.

RESULTS

Findings revealed reduced FC between the dlPFC and amygdala, and between the ACC and OFC in pre-adolescent children with BED, relative to controls. These findings indicating aberrant connectivity between nodes of inhibitory control and reward networks were corroborated by the whole-brain FC analyses.

CONCLUSIONS

Early-onset BED may be characterized by diffuse abnormalities in the functional synergy between reward and cognitive control networks, without perturbations within reward and inhibitory control networks, respectively. The decreased capacity to regulate a reward-driven pursuit of hedonic foods, which is characteristic of BED, may in part, rest on this dysconnectivity between reward and inhibitory control networks.

Discordance between assessments of food cue responsiveness: Implications for assessment in youth with overweight/obesity

Food cue responsiveness (FCR), broadly defined as behavioral, cognitive, emotional and/or physiological responses to external appetitive cues outside of physiological need, contributes to overeating and obesity among youth and adults. A variety of measures purportedly assess this construct, ranging from youth- or parent-report surveys to objective eating tasks. However, little research has assessed their convergence. It is especially important to evaluate this in children with overweight/obesity (OW/OB), as reliable and valid assessments of FCR are essential to better understand the role of this critical mechanism in behavioral interventions. The present study examined the relationship between five measures of FCR in a sample of 111 children with OW/OB (mean age = 10.6, mean BMI percentile = 96.4; 70% female; 68% white; 23% Latinx). Assessments included: objectively measured eating in the absence of hunger (EAH), parasympathetic activity when exposed to food, parent reported food responsiveness subscale from the Child Eating Behavior Questionnaire (CEBQ-FR), child self-reported Power of Food total score (C-PFS), and child self-reported Food Cravings Questionnaire total score (FCQ-T). Statistically significant spearman correlations were found between EAH and CEBQ-FR (ρ = 0.19, p < 0.05) and parasympathetic reactivity to food cues with both C-PFS (ρ = -0.32, p = 0.002) and FCQ-T (ρ = -0.34, p < 0.001). No other associations were statistically significant. These relationships remained significant in subsequent linear regression models controlling for child age and gender. The lack of concordance between measures assessing highly conceptually related constructs is of concern. Future studies should seek to elucidate a clear operationalization of FCR, examine the associations between FCR assessments in children and adolescents with a range of weight statuses, and evaluate how to best revise these measures to accurately reflect the latent construct being assessed.

The correlation between different operationalisations of parental restrictive feeding practices and children's eating behaviours: Systematic review and meta-analyses

Strategies used by parents to restrict children's access to highly palatable but unhealthy foods have been described collectively as restrictive feeding practices. Ironically, evidence shows these practices may foster maladaptive eating behaviours and increase children's risk of obesity. This systematic review and series of meta-analyses aim to estimate the relationships between different operationalisations of parental restrictive feeding practices and children's eating behaviours measured by either the Children's Eating Behaviour Questionnaire (Wardle et al., 2001) or eating in the absence of hunger paradigm. PsycINFO, Medline Complete, CINAHL, Scopus and Web of Science databases were searched on April 22nd 2021 for terms relating to restrictive feeding practices, children and eating behaviours. Eligible studies (n = 24) reported a correlation between restrictive feeding and children's (2-12-years) eating behaviours. Meta-analyses were conducted on different operationalisations of restrictive feeding practices and different eating behaviours where there were three or more effects to analyse. Studies that were not meta-analysed were synthesised qualitatively. All studies were quality assessed using a standard checklist. Restrictive feeding (Child Feeding Questionnaire; Birch et al., 2001), was significantly correlated with higher food responsiveness, food fussiness, emotional overeating, and lower slowness in eating. Overt restriction (Feeding Practices and Structure Questionnaire, E. Jansen et al., 2014) was significantly correlated with higher food responsiveness. The qualitative synthesis suggests overt restriction is related to maladaptive eating behaviours, but that other operationalisations of restrictive feeding, especially covert restriction, are not. Future research should examine whether covert restriction provides an alternative, non-harmful approach to restriction, by which parents can control children's diet quality without negatively impacting their eating behaviours.

Measuring adolescents' eating in the absence of hunger in the home environment using subjective and objective measures

Eating in the absence of hunger (EAH) has been identified as a behavioral phenotype for obesity. Few studies have reported on objective measures of EAH in adolescents, and fewer yet have objectively measured EAH in a naturalistic, home setting. The purpose of this paper was to examine relations between objective, adolescent-report and parent-report measures of EAH, and to examine variation by sex and race. Participants included 295 predominantly low-income and rural adolescents (mean age = 14.2 ± 0.6 years) and their parents, drawn from the Family Life Project. An EAH task was administered in the home following an ad-libitum meal and compulsory milkshake; EAH was also reported on a web-based survey (both adolescent and parent reports) and adolescents' BMIz was calculated from height and weight, measured in the home or self-reported on the web survey. A high degree of variability in EAH intake was observed (range = 8-741 kcals). Parent and adolescent reports of EAH were weakly correlated and unrelated to observed EAH consumption; only adolescent reports of EAH were related to their BMIz. Several relations varied by sex and race. Positive associations between reported and observed EAH was only observed in girls, and positive associations between observed EAH and BMI was only observed in boys and in white adolescents. Overall EAH consumption was significantly greater in boys and in white adolescents. These findings suggest that EAH can be measured in adolescents in the home. In this sample of youth experiencing rural poverty, this home-based measure appears most valid for white adolescent girls.

Factors Associated with Eating in the Absence of Hunger among Children and Adolescents: A Systematic Review

Eating in the absence of hunger (EAH) has been extensively studied over the past two decades and has been associated with excess body weight and the development of obesity. However, determinants of EAH remain uncertain. This systematic review aims to identify individual, familial, and environmental factors associated with EAH among children and adolescents. We included studies with a measure of EAH in participants aged 3-17 years old and including ≥1 factor associated with EAH. Our search identified 1494 articles. Of these, we included 81 studies: 53 cross-sectional, 19 longitudinal and nine intervention studies. In childhood (≤12 years old), EAH increases with age, it is greater in boys compared to girls, and it is positively associated with adiposity. Moreover, EAH development seems to be influenced by genetics. In adolescence, the number of studies is limited; yet, studies show that EAH slightly increases or remains stable with age, is not clearly different between sexes, and findings for overweight or obesity are less consistent across studies in adolescence. For familial factors, parental restrictive feeding practices are positively associated with EAH during childhood, mostly for girls. Studies assessing environmental factors are lacking and robust longitudinal studies spanning from early childhood to adolescence are needed.

Psychometric and cross-cultural generalizability outcomes of the Chinese version of the Kids-Palatable Eating Motives Scale (K-PEMS-C)

Overeating for non-homeostatic needs contributes to childhood obesity. However, validated measures or eating motives and cross-cultural comparisons are limited. This study aimed to validate the Kids-Palatable Eating Motives Scale (K-PEMS) and its association with body mass index z score (BMIz) in China, and further assess its generalization across Chinese and American youth. Data were from participants aged 8–18 years from Hangzhou, China ( n = 426) and Birmingham, AL, U.S ( n = 73). The K-PEMS had sound reliability and validation (Cronbach’s α = 0.920 and all factor loadings >0.50) in the Chinese sample. Multi-group nested models CFAs showed that the ∆CFI of model comparisons of measurement weights and structural covariance, variance, and means were ⩽0.01, and ∆TLI of measurement intercepts ⩽0.05. Linear regressions revealed that frequency of consuming palatable foods and drinks for Coping, Reward Enhancement, and Conformity, but not Social motives, were positively associated with BMIz. The K-PEMS had good cross-cultural generalization and could be useful in treating obesity by identifying specific motives for consuming excessive calories.

Investigation of metabolomic biomarkers for childhood executive function and the role of genetic and dietary factors: The GUSTO cohort

Background

Few studies have investigated molecular biomarkers of specific executive function (EF) skills in children. We aimed to characterise the prospective associations between metabolome and multiple domains of EF using a bidirectional design.

Methods

This study was conducted within a longitudinal birth cohort, the Growing Up in Singapore Towards healthy Outcomes (GUSTO). Circulating levels of 165 metabolites were quantified using a nuclear magnetic resonance based metabolomics platform (n = 457 (∼6yrs) and n = 524 (∼8yrs)). Parent-reported EF was available for 495 children (∼7yrs). Multivariate linear regression was used to assess the metabolite-EF relationships. We examined the role of body composition, dietary factors, and genetics in the metabolite-EF associations.

Findings

Higher leucine level (∼6yrs) was associated with poorer EF (∼7yrs, Initiate (P = 0.003) and Working Memory (P = 0.004)). EF (∼7yrs) was not associated with leucine (∼8yrs). Importantly, we found weak evidence for associations of dietary factors (∼5yrs) with leucine (∼6yrs) and EF (∼7yrs). Each copy of C allele in rs1260326 (a leucine-related polymorphism) was associated with higher leucine level and poorer Initiate and Working Memory (P < 0.05). Amongst those with less strongly genetically influenced leucine, inverse association between leucine and cognitive regulation were weaker among those with higher BMI.

Interpretation

The observed association between higher leucine level and poorer EF may be determined by genetics and may not be easily amenable to dietary interventions. Further research is needed for validation and to understand mechanisms.

Funding

Singapore National Research Foundation and Agency for Science, Technology and Research.

Regional gray matter abnormalities in pre-adolescent binge eating disorder: A voxel-based morphometry study

BACKGROUND

Binge eating disorder (BED) is a pernicious psychiatric disorder which is linked with an array of multisystemic organ morbidity, broad psychiatric morbidity, and obesity. Despite behavioral markers often developing in early childhood, the neurobiological markers of early-onset BED remain understudied, and developmental pathophysiology remains poorly understood.

METHODS

71 preadolescent children (aged 9-10-years) with BED and 74 age, BMI and developmentally matched control children were extracted from the 3.0 baseline (Year 0) release of the Adolescent Brain Cognitive Development (ABCD) Study. We investigated group differences in gray matter density (GMD) via voxel-based morphometry (VBM). We additionally performed region of interest analyses, assessing the association between GMD in nodes of the reward (orbitofrontal cortex; OFC) and inhibitory control (dorsolateral prefrontal cortex; dlPFC) networks, and parent-reported behavioral inhibition and approach tendencies.

RESULTS

Diffuse elevations in cortical GMD were noted in those with BED, which spanned prefrontal, parietal, and temporal regions. No areas of reduced GMD were noted in those with BED. No alterations in subcortical GMD were noted. Brain-behavioral associations suggest a distinct and negative relationship between GMD in the OFC and dlPFC, respectively, and self-reported markers of hedonic behavioral approach tendencies.

CONCLUSIONS

Early-onset BED may be characterized by diffuse morphological abnormalities in gray matter density, suggesting alterations in cortical architecture which may reflect decreased synaptic pruning and arborization, or decreased myelinated fibers and therefore inter-regional afferents.

Validation of a Classroom Version of the Eating in the Absence of Hunger Paradigm in Preschoolers

Eating in the absence of hunger (EAH), a measure of children's propensity to eat beyond satiety in the presence of highly palatable food, has been associated with childhood obesity and later binge eating behavior. The EAH task is typically conducted in a research laboratory setting, which is resource intensive and lacks ecological validity. Assessing EAH in a group classroom setting is feasible and may be a more efficient alternative, but the validity of the classroom assessment against the traditional individually-administered paradigm has not been tested. The objective of this study was to compare EAH measured in a classroom setting to the one-on-one version of the paradigm in a sample of Head Start preschoolers. Children (n = 35) from three classrooms completed both classroom and individual EAH tasks in a random, counterbalanced order. In the group condition, children sat with peers at their classroom lunch tables; in the individual condition, children met individually with a researcher in a separate area near their classroom. In both conditions, following a meal, children were provided free access to generous portions of six snack foods (~750 kcal) and a selection of toys for 7 min. Snacks were pre- and post-weighed to calculate intake. Parents completed a survey of their child's eating behaviors, and child height and weight were measured. Paired t-tests and intraclass correlation coefficients were used to compare energy intake between conditions, and correlations between EAH intake and child BMI, eating behaviors, and parent feeding practices were examined to evaluate concurrent validity. Average intake was 63.0 ± 50.4 kcal in the classroom setting and 53.7 ± 44.6 in the individual setting, with no significant difference between settings. The intraclass correlation coefficient was 0.57, indicating moderate agreement between conditions. Overall, the EAH protocol appears to perform similarly in classroom and individual settings, suggesting the classroom protocol is a valid alternative. Future studies should further examine the role of age, sex, and weight status on eating behavior measurement paradigms.

Child meal microstructure and eating behaviors: A systematic review

Observational coding of children's eating behaviors and meal microstructure (e.g., bites, chews) provides an opportunity to assess complex eating styles that may relate to individual differences in energy intake and weight status. Across studies, however, similar terms are often defined differently, which complicates the interpretation and replication of coding protocols. Therefore, this study aimed to compile methods of coding meal microstructure in children. To limit bias and ensure a comprehensive review, a systematic search was conducted in January 2021 across three databases (PubMed, PsychInfo, Web of Science) resulting in 46 studies that coded at least one meal-related behavior in healthy children (i.e., no medical/psychological disorders) who were able to self-feed (i.e., no spoon-, breast-, or bottle-feeding). While the majority of studies had good interrater reliability, the details reported about study foods and the clarity of the definitions used for behavioral coding varied considerably. In addition to reported microstructure behaviors, a non-exhaustive review of individual differences was included. While few studies reported individual differences related to age and sex, there was a larger literature related to weight status that provided evidence for an 'obesogenic' style of eating characterized by larger Bites, faster Eating and Bite Rates, and shorter Meal Durations. However, some studies may not have been optimally designed or powered to detect individual differences because they did not set out a priori to examine them. Based on this systematic review, best practices for the field are recommended and include reporting more details about foods served and coded eating behaviors to improve reproducibility. These suggestions will improve the ability to examine patterns of individual differences across studies, which may help identify novel targets for intervention.

Eating in the absence of hunger in 18-month-old children in a home setting

BACKGROUND

Eating in the absence of hunger (EAH), the susceptibility to eat despite satiety, may increase overweight. While EAH has been established in school-aged children, less is known about it during toddlerhood.

OBJECTIVES

This study assessed to what extent 18-month-old children eat in the absence of hunger, the stability of this behaviour at 24 months and the association of child eating behaviours with EAH.

METHODS

Children were presented with four palatable finger foods (total 275 kcal) after dinner. Univariate GLM's assessed the association between EAH, child satiety and eating behaviours and energy intake of dinner at 18 and 24 months (n = 206 and 103, respectively). Another GLM was run to assess the association between EAH at both time points.

RESULTS

Mean (±SD) energy intakes from dinner and finger foods were 240 kcal (±117) and 40 kcal (±37), respectively. No association was found between energy intake of dinner and finger foods. Enjoyment of food was significantly related to intake of finger foods (P = .005). EAH at 18 months predicted EAH at 24 months.

CONCLUSION

Eighteen-month-old children ate in the absence of hunger, irrespective of satiety. Thus, preceding energy intake was not compensated for. Other factors, for example, enjoyment of food seem to determine finger food intake.

Eating in the absence of hunger in children with mild sleep loss: a randomized crossover trial with learning effects

BACKGROUND

While insufficient sleep duration has emerged as a strong, independent risk factor for obesity, the mechanisms remain unclear. One possibility is greater "eating in the absence of hunger" (EAH) or energy intake beyond the point of satiety, when tired.

OBJECTIVE

The aim was to determine whether mild sleep loss increases EAH in children.

METHODS

A crossover study was undertaken in 105 healthy children (8-12 y) with normal sleep (∼8-11 h/night). After randomization, children went to bed 1 h earlier (sleep extension) or 1 h later (sleep restriction) than their usual bedtime, over 2 intervention weeks separated by a 1-wk washout. At the end of each intervention week, children underwent an EAH feeding experiment involving a preloading meal until satiation, followed by an ad libitum buffet (of highly palatable snacks) to measure EAH, with each food item weighed before and after consumption.

RESULTS

Ninety-three children completed the EAH experiment. There was no evidence of a difference in energy intake from EAH between sleep restriction and extension conditions when analyzed as a crossover design. However, a learning effect was found, with children eating significantly less (-239 kJ; 95% CI: -437, -41 kJ; P = 0.018) during the preload phase and significantly more (181 kJ; 95% CI: 38, 322 kJ; P = 0.013) in the ad libitum phase in the second week. No significant differences were seen using an underpowered parallel analysis for energy intake during the ad libitum phase when sleep deprived (106 kJ; 95% CI: -217, 431 kJ; P = 0.514).

CONCLUSIONS

Our findings suggest that measuring a difference in eating behavior in relation to sleep proved unsuitable using the EAH experiment in a crossover design in children, due to a learning effect. This trial was registered at the Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367587&isReview=true) as ACTRN12618001671257 .

Observed behavioral indicators of child satiation at mealtime: Associations with child characteristics and parent-reported child eating behaviors

The notion of promoting parents' recognition of child satiation to reduce overfeeding and overeating in children is prevalent. To do so, it is important to identify common behaviors that may indicate satiation and can be easily recognized by parents. Relatively little work has focused on identifying behaviors that may indicate child satiation as they occur during naturalistic mealtimes, which is an important context for parents to observe their children's eating behavior. Hence, the goal of the current study is to examine whether observed behavioral indicators of child satiation at mealtimes are associated with child characteristics (i.e., sex, age, and BMIz) and parent-reported child appetitive traits. We coded observed behaviors thought to indicate satiation, specifically mealtime disengagement and mealtime negativity, in a cohort of 240 families with children between 4- and 8-years old (53% boys). First, we documented the occurrence of child disengagement and negativity during naturalistic mealtimes. Second, we found that lower child BMIz and being a boy were associated with greater mealtime disengagement, but child age was not associated with mealtime disengagement. No associations were found between child characteristics and mealtime negativity. Third, we found that mealtime disengagement and mealtime negativity were associated with mother-reported satiety responsiveness on the Child Eating Behavior Questionnaire. Taken together, our findings suggest observed mealtime disengagement and mealtime negativity behaviors could be helpful indicators of child satiation in a naturalistic mealtime context.

The Pediatric Obesity Encounter: Literature and Resources to Help with 4 Common Issues

PURPOSE OF REVIEW

We review here best practices and resources for pediatricians providing pediatric obesity management in 4 key areas: how to assess all of the relevant factors contributing to obesity, how to provide nutrition education, how to counsel families who eat out regularly, and what to do with patients who frequently make poor eating choices.

RECENT FINDINGS

While there are many resources indicating recommendations for the physical exam and laboratory tests, there are very few resources that give pragmatic advice on the counseling aspects of the pediatric obesity encounter. We note new nutrition research showing the importance of avoiding ultra-processed foods. Most importantly, we list several resources regarding useful questionnaires, nutrition guidance, and even further training for pediatricians. There is a need for more curation of resources in different aspects of obesity care. We hope that this review and list of resources are helpful for pediatricians and will empower families and can be expanded in the future.

Appetite self-regulation declines across childhood while general self-regulation improves: A narrative review of the origins and development of appetite self-regulation

This narrative review discusses the origins and development of appetite self-regulation (ASR) in childhood (from infancy to age 6 or 7 years). The origins, or foundations, are the biological infrastructure associated with appetite regulation and appetite self-regulation. Homeostatic regulation in infancy is examined and then evidence about developmental change in components of ASR. The main ASR-related components covered are: delay-of-gratification, caloric compensation, eating in the absence of hunger, food responsiveness/hedonics and fussy eating. The research included behavioral measures, parent-reports of appetitive traits and fMRI studies. There were two main trends in the evidence: a decline across childhood in the components of ASR associated with food approach (and therefore an increase in disinhibited eating), and wide individual differences. The decline in ASR contrasts with general self-regulation (GSR) where the evidence is of an improvement across childhood. For many children, bottom-up automatic reactive processes via food reward/hedonics or food avoidance as in fussy eating, appear not to be matched by improvements in top-down regulatory capacities. The prominence of bottom-up processes in ASR could be the main factor in possible differences in developmental paths for GSR and ASR. GSR research is situated in developmental science with its focus on developmental processes, theory and methodology. In contrast, the development of ASR at present does not have a strong developmental tradition to access and there is no unifying model of ASR and its development. We concluded (1) outside of mean-level or normative changes in the components of ASR, individual differences are prominent, and (2) there is a need to formulate models of developmental change in ASR together with appropriate measurement, research designs and data analysis strategies.

Networks of stress, affect and eating behaviour: anticipated stress coping predicts goal-congruent eating in young adults

BACKGROUND

Many people aim to eat healthily. Yet, affluent food environments encourage consumption of energy dense and nutrient-poor foods, making it difficult to accomplish individual goals such as maintaining a healthy diet and weight. Moreover, goal-congruent eating might be influenced by affects, stress and intense food cravings and might also impinge on these in turn. Directionality and interrelations of these variables are currently unclear, which impedes targeted intervention. Psychological network models offer an exploratory approach that might be helpful to identify unique associations between numerous variables as well as their directionality when based on longitudinal time-series data.

METHODS

Across 14 days, 84 diet-interested participants (age range: 18-38 years, 85.7% female, mostly recruited via universities) reported their momentary states as well as retrospective eating episodes four times a day. We used multilevel vector autoregressive network models based on ecological momentary assessment data of momentary affects, perceived stress and stress coping, hunger, food craving as well as goal-congruent eating behaviour.

RESULTS

Neither of the momentary measures of stress (experience of stress or stress coping), momentary affects or craving uniquely predicted goal-congruent eating. Yet, temporal effects indicated that higher anticipated stress coping predicted subsequent goal-congruent eating. Thus, the more confident participants were in their coping with upcoming challenges, the more they ate in line with their goals.

CONCLUSION

Most eating behaviour interventions focus on hunger and craving alongside negative and positive affect, thereby overlooking additional important variables like stress coping. Furthermore, self-regulation of eating behaviours seems to be represented by how much someone perceives a particular eating episode as matching their individual eating goal. To conclude, stress coping might be a potential novel intervention target for eating related Just-In-Time Adaptive Interventions in the context of intensive longitudinal assessment.

Manipulation of fatty acid composition in a high-fat meal does not result in differential alterations in appetite or food intake in normal weight females: A single-blind randomized crossover study

A behavioral concept that generates a path to obesity is eating in the absence of hunger (EAH). One strategy that may be effective in preventing EAH is the manipulation of dietary fatty acid (FA) composition. However, it remains unclear which FA has the greatest impact on both appetite and EAH. Therefore, the purpose of this study was to examine the effect of different dietary FA compositions (monounsaturated, MUFA; polyunsaturated, PUFA; saturated, SFA) on subjective ratings of appetite and subsequent ad libitum eating after a 3 h postprandial period. Sixteen apparently healthy normal weight females between ages 18-40 completed this randomized, single-blind, crossover study. Participants consumed a HF meal (65% energy from fat) rich in SFA, MUFA, and PUFA with an energy content corresponding to 35% of their measured resting metabolic rate on three separate occasions. Visual analog scales were collected while fasted and every 30 min for 3 h during a postprandial period to measure feelings of hunger, fullness, and desire to eat (DTE). Participants were provided an ad libitum buffet meal 3 h after the HF meal. There were no statistically significant differences for ratings of hunger, fullness, or DTE across conditions. Further, there was no significant difference in energy intake during the ad libitum lunch. We conclude that the manipulation of FA composition in a HF meal does not differentially affect appetite sensations or subsequent energy intake.

Lifestyle-Related Determinants of Obesity Among Omani Children

Objectives

This study aimed to examine the relationship between body mass index (BMI) z-scores and lifestyle-related factors including nutrition, physical activity, screen time and time spent sleeping in 6-10-year-old Omani children.

Methods

This cross-sectional study included mother-child dyads that were recruited from five provinces in Oman. Children's BMI measurements and questionnaires on nutrition intake, physical activity, screen time and time spent sleeping and a single-day dietary recall were collected.

Results

A total of 197 dyads were included in this study. The children's mean age was 7.7 ± 1.6 years and 53% were female. In this study, 17.4% of the children were classified as overweight or obese. No significant relationship was found between the children's BMI z-scores and nutrition intake, moderate-to-vigorous physical activity time or screen time (P ≥0.05). Increased time spent sleeping at night was positively associated with childhood obesity (P <0.05).

Conclusion

The relationship between obesity and caloric intake, physical activity and screen time among children younger than 10 years seems to be moderated by certain factors that need to be investigated. Qualitative studies and questionnaires that are culturally sensitive are therefore needed.

Combined Impact of a Faster Self-Reported Eating Rate and Higher Dietary Energy Intake Rate on Energy Intake and Adiposity

Eating more quickly and consuming foods with a higher energy-intake-rate (EIR: kcal/min) is associated with greater energy intake and adiposity. However, it remains unclear whether individuals who eat more quickly are more likely to consume foods with higher EIR. We investigated the overlap between self-reported eating rate (SRER) and the consumption of higher EIR foods, and their combined impact on daily energy intake and adiposity in a population-based Asian cohort (n = 7011; 21-75y). Food consumption was assessed using a validated Food Frequency Questionnaire. Moderated regression with simple slope analysis was conducted to evaluate whether SRER modified the association between dietary EIR and total dietary energy intakes. Faster eaters consumed a significantly higher proportion of energy from higher EIR foods among overweight individuals, but not among normal-weight individuals. Associations between dietary EIR and total energy intake were stronger among medium (β = 15.04, 95%CI: 13.00-17.08) and fast (β = 15.69, 95%CI: 12.61-18.78) eaters, compared with slower eaters (β = 9.89, 95%CI: 5.11-14.67; p-interaction = 0.032). Higher dietary EIR also tended to be more strongly associated with BMI in fast eaters (β = 0.025, 95%CI: 0.011-0.038) than in slow eaters (β = 0.017, 95%CI: -0.007-0.040). These findings suggest that the combination of eating more quickly and selecting a greater proportion of energy from higher EIR foods (i.e., softly textured, energy dense), promoted higher dietary energy intakes and adiposity.

Eating in the Absence of Hunger and Obesity Among Adolescents in Santiago, Chile

In reports among mostly, US, white, preschool and young school-age children eating in the absence of hunger (EAH) has been positively related to adiposity, with some support for a sex-specific relationship. There is considerable interest in EAH and obesity in populations at risk for obesity-like populations of countries that have undergone rapid development. We assessed adolescents (n = 679) after an overnight fast with anthropometry and an EAH paradigm beginning with an ad lib pre-load meal. Participants reported satisfaction and perceived ability to eat more food, and then proceeded to a room with freely available snacks where they were permitted to eat ad lib for 20 min. Adolescents were 16.8 years old, 52% male, and 14% with obesity. Median preload meal kcal consumption was 602 (IQR 474-746). Additional calories were consumed at the EAH snack by 47.6%. Among those who ate snack, 155 additional calories were consumed (IQR 78-283). Adolescents with obesity had 0.61 (95% CI 0.37-0.99) reduced odds of eating at the EAH snack adolescents without obesity. Adolescents with obesity were also less likely to eat above the median total calories compared to adolescents without obesity (OR = 0.59, 95% CI 0.36-0.96). A sex by obesity interaction term was not significant in any model. Obesity was related to eating behavior in our sample of Chilean adolescents, however not in the direction we hypothesized. Adolescents with obesity were less likely to eat additional calories in the EAH paradigm and ate fewer total calories compared to adolescents without obesity.

The Mediating Effect of Self-Regulation in the Association Between Poverty and Child Weight: A Systematic Review

Deficits in self-regulation (SR) have been proposed as a potential contributor to child overweight/obesity, a public health concern that disproportionately affects children living in poverty. Although poverty is known to influence SR, SR has not been considered as a potential mechanism in the association between poverty and child obesity. The aim of the current paper was to systematically review the current literature to determine whether SR is a viable mechanism in the relationship between child exposure to poverty and later risk of overweight/obesity. We systematically review and summarize literature in three related areas with the aim of generating a developmentally informed model that accounts for the consistent association between poverty and child weight, specifically how: (1) poverty relates to child weight, (2) poverty relates to child SR, and (3) SR is associated with weight. To quantify the strength of associations for each pathway, effect sizes were collected and aggregated. Findings from the studies included suggest small but potentially meaningful associations between poverty and child SR and between SR and child weight. The conceptualization and measurement of SR, however, varied across literature studies and made it difficult to determine whether SR can feasibly connect poverty to child obesity. Although SR may be a promising potential target for obesity intervention for low-income children, additional research on how SR affects risk of obesity is crucial, especially based on the lack of success of the limited number of SR-promoting interventions for improving children's weight outcomes.

Eating behaviors moderate the associations between risk factors in the first 1000 days and adiposity outcomes at 6 years of age

BACKGROUND

Several risk factors in the first 1000 d are linked with increased obesity risk in later childhood. The role of potentially modifiable eating behaviors in this association is unclear.

OBJECTIVES

This study examined whether the association between cumulated risk factors in the first 1000 d and adiposity at 6 y is moderated by eating behaviors.

METHODS

Participants were 302 children from the GUSTO (Growing Up in Singapore Towards healthy Outcomes) cohort. Risk factors included maternal prepregnancy and paternal overweight, excessive gestational weight gain, raised fasting plasma glucose during pregnancy, short breastfeeding duration, and early introduction of solid foods. Composite risk scores reflecting the prevalence and the importance of the risk factors present were computed. Adiposity outcomes were child BMI and sum of skinfolds (SSF), and candidate eating behavior moderators were portion size, eating rate, and energy intake during lunch and in an eating in the absence of hunger task.

RESULTS

Higher composite risk score predicted higher BMI z scores (B = 0.08; 95% CI: 0.04, 0.13) and larger SSF (0.70 mm; 0.23, 1.18 mm), and was associated with larger self-served food portions (5.03 kcal; 0.47, 9.60 kcal), faster eating rates (0.40 g/min; 0.21, 0.59 g/min), and larger lunch intakes (7.05 kcal; 3.37, 10.74 kcal). Importantly, the association between composite risk score and adiposity was moderated by eating behaviors. The composite risk score was unrelated to SSF in children who selected smaller food portions, ate slower, and consumed less energy, but was positively associated with SSF among children who selected larger food portions, ate faster, and consumed more energy (eating behavior × risk score interactions: P < 0.05).

CONCLUSIONS

The association between risk factors in the first 1000 d and adiposity at 6 y varies by eating behaviors, highlighting modifiable behavioral targets for interventions.This trial was registered at clinicaltrials.gov as NCT01174875.

Is breastfeeding associated with later child eating behaviours?

Individual differences in children's eating behaviours emerge early. We examined the relationship between breastfeeding exposure and subsequent eating behaviours among children from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. Children (n = 970) were grouped according to their breastfeeding exposure: high (full breastfeeding ≥ 4 months with continued breastfeeding ≥ 6 months), low (any breastfeeding < 3 months or no breastfeeding) and intermediate (between low and high breastfeeding categories). Aspects of eating behaviour from ages 15 months to 6 years were captured using a combination of maternal reports (Child Eating Behaviour Questionnaire; Infant Feeding Questionnaire; Preschooler Feeding Questionnaire) and laboratory-based measures of meal size, oral processing behaviours (e.g. average eating speed and bite size) and tendency to eat in the absence of hunger. Most children had low (44%) or intermediate (44%) breastfeeding exposure; only 12% had high exposure. After adjusting for confounders, multivariable linear regression analyses indicated the high (but not intermediate) breastfeeding group was associated with significantly lower reported food fussiness at 3 years compared to low breastfeeding group (-0.38 [-0.70, -0.06]), with similar but non-significant trends observed at 6 years (-0.27 [-0.66, 0.11]). At 3 years, mothers in the high breastfeeding group also reported the least difficulty in child feeding compared to low breastfeeding group (-0.22 [-0.43, -0.01]). However, high breastfeeding was not associated with any other maternal-reports of child feeding or eating behaviours, and no significant associations were observed between breastfeeding exposure and any of the laboratory measures of eating behaviour at any of the time points. These results do not strongly support the view that increased breastfeeding exposure alone has lasting and consistent associations with eating behaviours in early childhood.

Modified eating in the absence of hunger test is associated with appetitive traits in infants

BACKGROUND

Appetite traits and feeding practices have been linked to children's weight status. For example, eating in response to food cues (high food responsiveness (FR)), and poor regulation of intake (low satiety responsiveness (SR)), increase risk for obesity. Appetitive traits of infants, and feeding practices, are typically measured by parent-report. The purpose of this study was to use a modified eating in the absence of hunger (EAH) paradigm, measuring infants' intake 30 min after a typical meal, to test whether infant acceptance of a second meal is associated with parent-reported appetitive traits or feeding practices.

METHODS

Healthy infants aged 3-5 months (N = 54) were fed a typical meal and then offered a second meal by bottle 30 min later. Appetitive traits and feeding practices were assessed with surveys. Analyses of covariance were used to assess whether appetitive traits differed by acceptance of the second meal after adjusting for covariates.

RESULTS

Fifty-nine percent of infants accepted the second meal and these infants had greater parent-reported FR (M = 3.06 ± 0.58 vs M = 2.43 ± 0.80, p < 0.01) and lower SR (M = 1.87 ± 0.62 vs M = 2.67 ± 0.87, p = 0.01), compared to infants who rejected it. Group differences remained after adjusting for infant age, feeding mode, weight-for-length, and maternal body mass index. No other appetitive traits or feeding practices differed by group.

CONCLUSIONS

Results expand research in older children by showing that infant response to a modified EAH protocol is associated with parent-reported FR and SR. Future research with this protocol in infants should investigate the consistency of this behavior across time and examine whether response to this protocol predicts subsequent growth.

Baby's first bites: a randomized controlled trial to assess the effects of vegetable-exposure and sensitive feeding on vegetable acceptance, eating behavior and weight gain in infants and toddlers

BACKGROUND

The start of complementary feeding in infancy plays an essential role in promoting healthy eating habits. Evidence shows that it is important what infants are offered during this first introduction of solid foods: e.g. starting exclusively with vegetables is more successful for vegetable acceptance than starting with fruits. How infants are introduced to solid foods also matters: if parents are sensitive and responsive to infant cues during feeding, this may promote self-regulation of energy intake and a healthy weight. However, the effectiveness of the what and the how of complementary feeding has never been experimentally tested in the same study. In the current project the what and how (and their combination) are tested in one study to determine their relative importance for fostering vegetable acceptance and self-regulation of energy intake in infants.

METHODS

A four-arm randomized controlled trial (Baby's First Bites (BFB)) was designed for 240 first-time Dutch mothers and their infants, 60 per arm. In this trial, we compare the effectiveness of (a) a vegetable-exposure intervention focusing on the what in complementary feeding; (b) a sensitive feeding intervention focusing on the how in complementary feeding, (c) a combined intervention focusing on the what and how in complementary feeding; (d) an attention-control group. All mothers participate in five sessions spread over the first year of eating solid foods (child age 4-16 months). Primary outcomes are vegetable consumption, vegetable liking and self-regulation of energy intake. Secondary outcomes are child eating behaviors, child anthropometrics and maternal feeding behavior. Outcomes are assessed before, during and directly after the interventions (child age 18 months), and when children are 24 and 36 months old.

DISCUSSION

The outcomes are expected to assess the impact of the interventions and provide new insights into the mechanisms underlying the development of vegetable acceptance, self-regulation and healthy eating patterns in infants and toddlers, as well as the prevention of overweight. The results may be used to improve current dietary advice given to parents of their young children on complementary feeding.

TRIAL REGISTRATION

The trial was retrospectively registered during inclusion of participants at the Netherlands National Trial Register (identifier NTR6572 ) and at ClinicalTrials.gov ( NCT03348176 ). Protocol issue date: 1 April 2018; version number 1.

Eating in the absence of hunger in young children is related to brain reward network hyperactivity and reduced functional connectivity in executive control networks

BACKGROUND

Recent work has implicated disinhibited eating behaviours (DEB) as a potential pathway toward obesity development in children. However, the underlying neurobiology of disinhibited eating behaviours in young, healthy weight children, prior to obesity development, remains unknown.

OBJECTIVES

This study tested the relationship between DEB and intrinsic neuronal activity and connectivity in young children without obesity.

METHODS

Brain networks implicated in overeating including reward, salience and executive control networks, and the default mode network were investigated. DEB was measured by the eating in the absence of hunger (EAH) paradigm with postlunch kilocalories consumed from highly palatable foods (EAH kcal) used as the predictor. Intrinsic neuronal activity within and connectivity between specified networks were measured via resting-state functional magnetic resonance imaging. Eighteen typically developing children (mean age = 5.8 years) were included.

RESULTS

EAH kcal was positively associated with activity of the nucleus accumbens, a major reward network hub (P < 0.05, corrected). EAH kcal was negatively associated with intrinsic prefrontal cortex connectivity to the striatum (P < 0.01, corrected).

CONCLUSIONS

These results suggest that neural aspects of DEB are detectable in young children without obesity, providing a potential tool to better understand the development of obesity in this population.

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.

Longitudinal associations between eating and drinking engagement during mealtime and eating in the absence of hunger in low income toddlers

To develop effective obesity-related interventions during early life, it is important to identify predictors of eating in the absence of hunger during toddlerhood. Hence, this study examined longitudinal associations between child eating and drinking engagement at 27 months of age and child eating in the absence of hunger (EAH) at 33 months of age (N = 91 children; 57.1% boys). At 27 months of age, we coded child eating and drinking engagement during a videotaped naturalistic lunch meal at home. We also obtained mothers' reports of their child's food responsiveness (FR), satiety responsiveness (SR), and desire to drink (DD) using the Child Eating Behavior Questionnaire (CEBQ). Children participated in a standard EAH protocol at 27 and 33 months of age where they were presented with palatable foods and the amount of food eaten was assessed (calculated as total kilocalories consumed). Correlational analyses showed that EAH at 27 months of age was positively related to EAH at 33 months of age and that neither mother-reported child FR or SR were associated with child eating engagement. Mother-reported child DD was associated with child drinking engagement. To predict EAH at 33 months, a regression analysis was conducted in which EAH at 27 months, mother-reported and observed child eating and drinking engagement at 27 months were entered as predictors, controlling for child demographics (i.e., age, sex, race/ethnicity and weight-for-length z-score (WLZ). Findings were that children who were observed to engage in more drinking at 27 months of age consumed more energy (measured as kcal) in the EAH at 33 months of age. Implications for understanding eating, and drinking, behaviors in toddlerhood are discussed.