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

Parent-child interaction, appetite self-regulation, and BMIz in Chinese preschoolers: a mediation analysis

OBJECTIVES

Research on parent-child interaction (PCI) and its impact on children's weight status is a thriving study area. However, their potential pathways have not been established. This study investigated the association between PCI and children's body-mass index z score (BMIz) examining the role of appetite self-regulation (ASR) as a mediator.

STUDY DESIGN

Mediation analysis.

METHODS

We included children from 33 kindergartens in Wuhan with parents' consent, measuring children's height and weight, and calculating BMIz. To assess the PCI quality, we utilized the Brigance Parent-Child Interactions Scale. Additionally, children's ASR was tested by satiety responsiveness (SR) and food responsiveness (FR) using the Children's Eating Behavior Questionnaire. Quantile regression was employed to examine the PCI-BMIz association, while mediation analysis was conducted to explore ASR's mediating effect on the relationship between PCI and BMIz.

RESULTS

Of 3973 children (53.88% boys) included in the analysis, the mean BMIz was 0.24 ± 1.13. The results revealed that children with poorer PCI quality have higher BMIz across all selected BMIz percentiles, except for the 5th percentile. Furthermore, these associations were significant across most percentiles, whether for boys or girls. Mediation analysis suggested that these associations were partially mediated by children's ASR (indFR = -0.026, PFR < 0.001; indSR = -0.058, PSR < 0.001), with stronger effects observed among boys.

CONCLUSION

The variation in how strongly BMIz was linked to PCI across different percentiles suggests that children with poorer PCI have higher BMIz. The link is partially mediated through children's ASR. It's important to pay attention to the PCI quality in children with higher BMIz levels, especially in boys.

Factorial validation of the children's eating behavior questionnaire and the association between the eating behaviors assessed and BMI Z score in Chinese preschoolers aged 2-5 years

OBJECTIVE

This study aimed to evaluate the validity and reliability of the Children's Eating Behavior Questionnaire (CEBQ) among Chinese preschool children aged 2-5 years. Additionally, we investigated the associations between eating behaviors assessed by the CEBQ and body mass index (BMI).

METHODS

A cross-sectional study was conducted with a sample of Chinese preschool children aged 2 to 5 years (n = 11,780). The CEBQ was employed to assess participants' eating behaviors, and factor analysis of the CEBQ was conducted; sex and age differences in eating behaviors were examined. Correlations between children's BMI z scores and eating behaviors were analyzed via linear regression analysis controlling for age; sex; ethnicity; maternal age, education level, ethnicity and BMI; paternal age, education level, ethnicity and BMI.

RESULTS

The factor analysis confirmed the eight-factor structure of the CEBQ, which explained 67.57% of the total variance. Two items were excluded owing to low factor loadings. The subscales showed satisfactory internal reliability (Cronbach's alpha range: 0.76-0.90). Significant sex and age differences were observed for several CEBQ subscales, and BMI z scores were found to be associated with various eating behavior subscales.

CONCLUSIONS

This study's findings support the validity and reliability of the CEBQ for assessing eating behaviors among Chinese preschool children, and children's eating behaviors might be affected by age and sex. Furthermore, BMI was found to be associated with specific eating behaviors. Understanding these associations can inform interventions that promote healthy eating habits in this population.

Variations of Eating Behaviors Among Vietnamese Preschool Children and Their Association With Children's Anthropometric Z-Scores: Results From Analyses of the Children's Eating Behavior Questionnaire in 10 000 Children

Eating behaviors, which are shaped during childhood, are one of the important factors influencing children's growth. This study aimed to investigate the variations in eating behaviors among Vietnamese preschool children aged 3 to 6 years using the Children Eating Behavior Questionnaire (CEBQ) and their association with anthropometric Z-scores. A cross-sectional study was conducted on 10 172 children from 36 to 72 months old, recruited from three different socioeconomic regions of Hanoi. Differentiation of eating behaviors between two sexes was observed across all age groups, but most obvious at 36 to 48 months of age. The subscales of emotional overeating (EOE), enjoyment of food (EF), and desire to drink (DD) were higher in 60- to 72-month age groups and vice versa for slowness in eating (SE) and emotional undereating (EUE) subscales. Analyses using the general linear model showed that CEBQ subscales were associated with anthropometric Z-scores in both girls and boys.

Depression and emotional eating in children and adolescents: A systematic review and meta-analysis

Major Depressive Disorder in youth is associated with obesity and adult cardiovascular disease (CVD) risk. Eating in response to emotions (emotional eating) is a potential contributing factor to this association. Although emotional eating is associated with Major Depressive Disorder in adults, findings in children and adolescents are mixed. This systematic review and meta-analysis aims to determine the association between depression and emotional eating in children and adolescents. Systematic searches were conducted in seven databases. Studies were included if the study population had a mean age of ≤18 years and assessed both depression and emotional eating using validated measures. The search generated 12,241 unique studies, of which 37 met inclusion criteria. Random-effects meta-analyses of study outcomes were performed. Thirty-seven studies (26,026 participants; mean age = 12.4 years, SD = 3.1) were included. The mean effect size was significant for both cross-sectional and longitudinal data (Hedges' g = 0.48, p < 0.0001; g = 0.37, p = 0.002, respectively), revealing a positive moderately strong association between depressive symptoms and emotional eating in youth. Among longitudinal studies, the association was stronger when depressive symptoms and emotional eating were assessed using child and adolescent self-report versus parent-report. No studies examined youth with a clinical diagnosis of depression. Meta-analyses revealed that depressive symptoms and emotional eating are positively associated in children and adolescents. However, further research in clinical samples is needed. Results raise the possibility for the importance of emotional eating in the link between depression and early CVD risk, though further examination is required to determine whether emotional eating is a potential treatment target to decrease CVD risk among adolescents with increased depression symptoms.

Relationship between children's eating behavior (1-6 years) and body mass index: a cross-sectional study in French maternal-infant protection centers within the Parisian region

BACKGROUND

Early detection of obesity-promoting dietary behavior patterns improves the identification of at-risk families and the implementation of interventions. This is accomplished through the use of the Child Eating Behavior Questionnaire (CEBQ). No study has been conducted using the CEBQ in children followed in Essonne's Maternal-Infant Protection (PMI) centers. We investigated, in a cross-sectional design, the differences in children's eating behavior with PMI follow-up according to their weight status.

METHODS

A questionnaire addressed to parents was collected in PMI centers. Multiple hierarchical regression analysis was used to investigate the predictability of the child's CEBQ on body mass index (BMI).

RESULTS

From January to April 2022, 850 children were selected, from which 500 (aged 1-6 years) were included, and of whom 10.6% were obese. There was a significant positive association between 'Food Responsiveness', 'Enjoyment of Food' and BMI. In contrast, there was a significant negative association between 'Satiety Responsiveness', 'Slowness in Eating' and BMI. Besides, 'Food approach' and 'food avoidance' behaviors were positively and negatively related to BMI z-scores, respectively.

CONCLUSION

Due to significant differences in children's eating behavior according to their weight, it is needed to raise awareness among parents about their impact on them.

Effects of New Complementary Feeding Guidelines on Eating Behaviour, Food Consumption and Growth in Colombian Children: 6-Year Follow-Up of a Randomised Controlled Trial

Complementary feeding (CF) may influence later eating behaviour and growth. Our previous Randomised Control Trial (RCT) reported that new CF guidelines (NCFGs) implemented in 6-12-month-old infants in Bogota, Colombia, had positive short-term effects on red meat, vegetable and fruit consumption. Here, we assessed the effects of the NCFGs on food consumption, eating behaviour and growth at 6 years of age. Weight and height were measured using 50 children (58.8%) from the cohort. Feeding behaviour was measured using the Child Eating Behaviour Questionnaire (CEBQ) and maternal and child food consumption was measured using a semi-quantitative food frequency questionnaire. The control group (CG) had a significantly higher weekly consumption of chocolate milk drinks (p = 0.05). The mean food responsiveness (FR) score was significantly higher in the CG (p < 0.001). Although HAZ (height for age Z-score) at 6 years of age was significantly higher in the CG (p < 0.02), there was no significant difference between groups in the change in HAZ from 6 months and 12 months to 6 years of age. BMIZ (body mass index Z-score) and % overweight (CG 18.5% versus NCFG 13%) or obese (3.7% versus 0%) were not significantly different between groups. BMIZ was positively predicted by FR (β 0.293; p = 0.014) and negatively predicted by weekly red meat consumption episodes per week at 12 months (β -0.169; p = 0.020). Although there was no direct effect of an intervention on BMIZ at 6 years of age, the results were consistent with an indirect effect via intervention effects on meat consumption at an age of 12 months and FR at 6 years of age. However, further longitudinal studies with a larger sample size are needed.

Different Eating Habits Are Observed in Overweight and Obese Children Than in Normal-Weight Peers

BACKGROUND

Obesity is diagnosed in 13.6% of early primary school children in Poland. Its presence at this age increases the risk of obesity occurrence in adulthood. Therefore, it is important to properly shape eating behaviors at the stage of childhood and identify incorrect eating styles.

METHODS

This study aimed to investigate whether overweight and obese children differ significantly from children with normal body weights in terms of their eating styles. For the materials and methods, 43 mothers of overweight or obese children aged 3-10 years and 88 mothers of normal-weight children aged 3-10 years completed a questionnaire related to sociodemographic factors and the Children's Eating Behaviour Questionnaire.

RESULTS

The overweight and obese children, compared with normal-weight children, scored higher on the food responsiveness (p = 0.009) and emotional overeating (p = 0.013) scales and lower on the satiety responsiveness (p = 0.025) and slowness in eating scales (p < 0.0001). No significant difference was found for other subscales between the studied groups. In the group of overweight and obese children, the child's age correlated negatively with enjoyment of food, as did the mother's BMI with slowness in eating.

CONCLUSIONS

The results indicate the presence of significant differences in eating styles between normal-weight children and overweight or obese children. Identifying families at high risk of inappropriate eating behaviors and educating them appropriately can reduce the risk of children becoming overweight or obese.

The associations between attentional bias to food cues, parent-report appetitive traits, and concurrent adiposity among adolescents

OBJECTIVE

To assess whether attentional bias to food cues and appetitive traits are independently and interactively associated with adiposity in adolescents.

METHOD

Eighty-five adolescents, 14-17-years had their attentional bias to food images measured in a sated state by computing eye tracking measures of attention (first fixation duration, cumulative fixation duration) to food and control distractor images that bordered a computer game. Parents reported adolescent appetitive traits including the food approach domains of enjoyment of food, food responsiveness, emotional overeating, and the food avoidance domains of satiety responsiveness and emotional overeating through the Children's Eating Behavior Questionnaire.

RESULTS

First fixation bias to food cues was positively associated with enjoyment of food, and negatively associated with satiety responsiveness. In a series of regression models adjusted for relevant covariates, first fixation bias to food cues (β = 0.83, p = 0.007), higher food responsiveness (β = 0.74, p < 0.001), higher emotional overeating (β = 0.51, p = 0.002), and a composite appetite score (β = 1.42, p < 0.001) were each significantly associated with greater BMI z-scores. In models assessing the interactive effects between attentional bias and appetitive traits, higher first fixation bias to food cues interacted synergistically with food responsiveness and emotional overeating in relation to BMI z-score. A synergistic interaction between first fixation bias to food cues and the composite appetite score in relation to BMI z-score was also observed.

CONCLUSION

Individuals with high attentional bias to food cues and obesogenic appetitive traits may be particularly susceptible to weight gain.

Almli V. Basic taste sensitivity, eating behaviour, food propensity and BMI of preadolescent children: How are they related?

Background

Taste sensitivity has been reported to influence children's eating behaviour and contribute to their food preferences and intake. This study aimed to investigate the associations between taste sensitivity, eating behaviour, food frequency and BMI (Body Mass Index) in preadolescents.

Methods

Preadolescents' taste sensitivity was measured by detection threshold of sweetness (sucrose), sourness (citric acid), saltiness (sodium chloride), bitterness (caffeine, quinine), and umami (monosodium glutamate). In addition, the Child Eating Behaviour Questionnaire (CEBQ), the Food Propensity Questionnaire (FPQ) measuring food frequency, and the children's body weight and height were completed by the parents. A total of 69 child-parent dyads participated (preadolescents mean age =10.9 years).

Results

Taste sensitivity to caffeine bitterness was significantly associated with eating behaviour in food responsiveness, emotional overeating, and desire to drink. The preadolescents who were less sensitive to caffeine bitterness had higher food responsiveness scores. Those who were less sensitive to caffeine bitterness and to sweetness had higher emotional overeating scores. In addition, preadolescents who were less sensitive to sourness and bitterness of both caffeine and quinine demonstrated to have higher scores in desire to drink. There was no association between taste sensitivity and FPQ, but significant differences were observed across preadolescents' BMI for FPQ of dairy food items, indicating higher consumption of low-fat milk in the overweight/obese compared to the underweight/normal-weight subjects. There was no significant difference in taste sensitivity according to BMI. Preadolescents' eating behaviour differed across BMI, demonstrating a positive association between BMI and food approach, and a negative association between BMI and food avoidance.

Conclusions

This study contributes to the preliminary understanding of the relationships between taste sensitivity and eating behaviour in preadolescents. The results may be used to develop effective strategies to promote healthy eating practices by considering taste sensitivity in preadolescents.

Eating behaviour in Swiss preschool children-Validation of a German and a French version of the Children's Eating Behaviour Questionnaire (CEBQ)

Young children's eating behavior is crucial for any further development of healthy eating. Early eating behavior are often assessed through parental report. The Children's Eating Behaviour Questionnaire (CEBQ) is a widely used parental questionnaire that has been validated in families of different gender, age and cultural background. Research has shown that the 8-factor structure has some inconsistencies and sample characteristics such as age, gender, and culture can influence the results. To which extent such sample characteristics might influence results within a multi-lingual culture has not been investigated so far. Therefore, the aim of the study was to evaluate the factor structure of the CEBQ among 511 preschool children of the French and German parts of Switzerland, aged 2 to 6 years (Mean 3.85 years; SD 0.69). Confirmatory Factor Analysis showed a modified structure of the original questionnaire, with a 7-factor structure providing a reasonable fit to the data (TLI = 0.954, CFI = 0.952, RMSEA = 0.063 and SRMR = 0.067). The subscale 'Desire to drink' was removed, and a few items moved to other subscales as they loaded higher on a different subscale compared to the original model. Reliabilities based on the coefficient omega were acceptable to satisfying across the seven factors, ranging from 0.66 to 0.90. There were no significant gender or age differences, but French speaking children showed higher levels of 'Satiety responsiveness' and lower 'Enjoyment of food' than German speaking children. Yet, these effects were small. The German and French CEBQ are valid and reliable versions of the original CEBQ and can be used in a multicultural context.

Reliability and validity of a Korean version of the children's eating behavior questionnaire in anorexia context

Background

Although childhood anorexia is a common clinical disorder, there is no established tool for evaluating it. The Children's Eating Behavior Questionnaire (CEBQ) is a parent-reported measure designed to assess the eating behavior of children. We aimed to investigate the reliability and validity of the Korean version of the CEBQ (K-CEBQ) for children with anorexia.

Methods

Parents of children with anorexia aged between 2 and 9 years participated in a survey conducted twice at 1-month intervals. The general characteristics and K-CEBQ scores of the children were recorded. To assess the reliability of the K-CEBQ, the internal consistency and test-retest methods were used. Furthermore, correlation analysis was performed for each item and factor, and the discriminant validity was determined through comparison with the normal group. Optimal cut-off scores, which are based on the maximum area under the curve of the receiver operating characteristic curve, were calculated in two categories.

Results

A total of 336 participants responded to the first survey, and the responses from 171 participants from the second survey were included in the analysis. The K-CEBQ showed relatively high internal consistency reliability (Cronbach's alpha = 0.738), and the retest demonstrated sufficient temporal stability. The relationship between each item of the K-CEBQ and the factor to which the item belongs showed a high correlation. There were significant differences between the anorexia and normal groups in two categories of the K-CEBQ: 'food approach' (p = 0.0063) and 'food avoidant' (p < 0.0001). The optimal cut-off values for the 'food approach' and 'food avoidant' category scores were 39.50 and 58.50 points, respectively.

Conclusion

This study demonstrated that the K-CEBQ may be a reliable and valid tool for assessing the eating behavior of children with anorexia.

Assessing Food Preferences and Neophobias among Spanish Adolescents from Castilla-La Mancha

Food neophobia is a reaction of dislike or fear of food, which may be due to a wide variety of factors (taste, texture, exposure at an early age, genetics, or diversity in feeding practices and food consumption). The aim of this study was to assess the preferences for tastes and foods and food neophobias among Spanish adolescents and to compare the differences between boys and girls. This was a cross-sectional observational study on 11-18-year-old healthy adolescents (n = 600; 50% female) recruited in the Castilla-La Mancha region (central Spain). Information on taste preferences, food neophobias, anthropometric measurements, and sociodemographic data was recorded. The highest taste preference was found for sweet, salty, and umami. Most adolescents usually did not try new foods outside the home, nor did they like to try foods from other countries. More than half of them also acknowledged being selective eaters or were very particular about the foods they ate. There were no significant associations between taste preference and neophobias with obesity, waist-to-height ratio (WtHR), sleep, and smoking. Adolescents showed a high unwillingness to change food habits, and most of the food neophobias found in the current study were related to new, novel, or previously unknown foods. Spanish adolescents from central Spain (Castilla-La Mancha region) showed a preference for sweet, salty, and umami tastes of foods, as well as food neophobia towards foods that they do not regularly consume, mainly those with a bitter taste. Gender and body weight showed little influence, and age had a moderate influence on food neophobias. Familiarity with foods, as well as educational activities, are suggested as useful to decrease food neophobias among adolescents.

Taste and smell alterations affect nutritional status in children under chemotherapy

AIM

This study aimed to evaluate the incidence of self-reported taste and smell alterations (TSA) in cancer paediatric patients and evaluate the impact of TSA on nutritional status in this population. We also developed and validated a composite score to detect TSA in children undergoing chemotherapy.

METHODS

Paediatric patients who were undergoing chemotherapy in a paediatric oncology unit were included. TSA were assessed from the Gustonco questionnaire from which a composite score was developed and internally validated, eating behaviour was assessed using Child Eating Behaviour Questionnaire, and major weight loss was defined from nutritional status. All data were calculated at 1, 3 and 6 months after chemotherapy start. Associations between nutritional status and scores were studied by using logistic models.

RESULTS

Among 49 patients included, TSA occurred in 71.7% of patients at 1 month after chemotherapy start and persisted at 3 and 6 months. TSA led to altered appetite since 1 month after chemotherapy start. The occurrence of a major weight loss at 6 months seemed to be associated with a high Gustonco score.

CONCLUSION

Taste and smell alterations often occurred in paediatric cancer patients after chemotherapy start and seemed to be associated with impaired nutrition at 6 months after chemotherapy.

Associations of appetitive traits with growth velocities from infancy to childhood

Several studies have reported associations between appetitive traits and weight gain during infancy or childhood, but none have directly compared these associations across both age periods. Here, we tested the associations between appetitive traits and growth velocities from birth to childhood. Appetitive trait data were collected using the Children's Eating Behaviour Questionnaire (CEBQ) in 149 children from the Cambridge Baby Growth Study at age 9-17 years. These participants also provided anthropometric measurements during infancy (birth, 3, 12, 18, and 24 months) and childhood (5 to 11 years). Standardized growth velocities (in weight, length/height, BMI, and body fat percentage) for 0-3 months, 3-24 months, and 24 months to childhood were estimated using individual linear-spline models. Associations between each of the eight CEBQ traits and each growth velocity were tested in separate multilevel linear regression models, adjusted for sex, age at CEBQ completion, and the corresponding birth measurement (weight, length, BMI, or body fat percentage). The three food-approach traits (food responsiveness, enjoyment of food and emotional overeating) were positively associated with infancy and childhood growth velocities in weight, BMI, and body fat percentage. By contrast, only one of the food-avoidant traits, satiety responsiveness, was negatively associated with all growth velocities. Significant associations were mostly of similar magnitude across all age periods. These findings reveal a broadly consistent relationship between appetitive traits with gains in weight and adiposity throughout infancy and childhood. Future interventions and strategies to prevent obesity may benefit from measuring appetitive traits in infants and children and targeting these as part of their programs.

Complementary Feeding and Child Appetitive Traits in a Sample of Hispanic Mother-Child Dyads

BACKGROUND

Complementary feeding practices may contribute to toddler eating practices that affect weight outcomes. Studies are needed to understand the relationship between complementary feeding practices and toddler dietary self-regulation.

OBJECTIVE

This study tests the hypothesis that earlier complementary food introduction predicts toddler food responsiveness and emotional overeating (ie, tendency to overeat in response to food cues and emotions, respectively), and considers whether introduction of certain foods better predict toddler dietary self-regulation.

DESIGN

This study is a secondary analysis of data from a parent longitudinal birth cohort study on early growth/development among Hispanic mother-infant dyads.

PARTICIPANTS/SETTING

The analytic sample included 174 mother-child dyads recruited from maternity clinics affiliated with the University of Southern California in Los Angeles County. Recruitment and data collection were ongoing from July 2016 to April 2020. At 1-, 6-, 12-, and 24-months postpartum, mothers reported exclusive breastfeeding duration and age of complementary food introduction via questionnaire.

MAIN OUTCOME MEASURES

Child food responsiveness and emotional overeating scores calculated from the Child Eating Behavior Questionnaire at 12 and 24 months of age.

STATISTICAL ANALYSES PERFORMED

Separate linear mixed models with repeated measures were used to examine associations between age of complementary food introduction as a predictor of child food responsiveness or emotional overeating, controlling for infant sex, birth body mass index z score, duration of exclusive breastfeeding, and mother's body mass index.

RESULTS

In separate models, delaying complementary food introduction by 1 month was associated with a 6% reduction in food responsiveness (P = 0.007) and a 5% reduction in emotional overeating scores (P = 0.013). Fifty-eight unique combinations of complementary foods introduced first were found, precluding analyses to examine whether specific combinations were related to eating behavior outcomes due to sample size limitations.

CONCLUSIONS

Earlier complementary feeding was associated with higher food responsiveness and emotional overeating scores among Hispanic children. Future studies in larger samples are needed to characterize patterns of complementary food introduction and their influence on child self-regulation.

Patterns of Eating Behavior among 13-Year-Old Adolescents and Associated Factors: Findings from the Generation XXI Birth Cohort

Eating behavior adopted during adolescence may persist into adulthood. The aims of this study were to identify eating behavior patterns among Portuguese adolescents and to explore whether groups differ in terms of early life and family characteristics, severity of depressive symptoms, and body mass index (BMI) z-score. Participants were 3601 13-year-olds enrolled in the birth cohort Generation XXI. Eating behavior was assessed using the self-reported Adult Eating Behavior Questionnaire (AEBQ), validated in this sample. The severity of depressive symptoms was measured through the Beck Depression Inventory (BDI-II), and data on sociodemographic and anthropometrics were collected at birth and 13-years-old. Latent class analysis was conducted, and associations were estimated using multinomial logistic regression models. Five patterns of individuals were identified: "Picky eating", "Disinterest towards food", "Food neophilia", "Emotional eating", and "Food attractiveness". The adolescents' sex, maternal education, BMI z-score, and severity of depressive symptoms were significantly associated with the identified patterns. In particular, adolescents with a higher BMI z-score were more likely in "Food neophilia" while individuals with more severe depressive symptoms were in the "Picky eating", "Emotional eating", and "Food attractiveness" patterns. These findings suggest a starting point for the development and planning of targeted public health interventions.

Eating Behaviours of Polish and Portuguese Adults-Cross-Sectional Surveys

Eating behaviours affect energy intake through the types and amounts of foods chosen and decisions about the beginning and ending of the eating process. This study aims to determine and compare the eating behaviours of Polish and Portuguese adults and, in addition, to establish the correlations between daily behaviours, food-approaches and food-avoidance behaviours, and BMI in both populations. The study was conducted between January 2023 and March 2023. Participants from Poland and Portugal responded to the AEBQ questionnaire and questions on eating habits and body-image self-perception. The research tool was a website-based survey questionnaire with single-choice questions. No significant differences related to BMI levels were found between the Polish and Portuguese adults in terms of their eating behaviours. Both groups were characterised by the increased intensity of their food-approach behaviours, which was directly correlated with increases in BMI. Greater snacking intensity and binge drinking were associated with higher BMI. The study revealed an increased prevalence of binge drinking in the Polish sample. The study also confirmed a higher frequency of food-approach behaviours in overweight and/or obese individuals and uncontrolled calorie intake in participants imposing dietary restrictions for weight loss. Nutrition education is needed to improve eating habits and food choices, as well as to prevent overweight and obesity in adults.

Measurement is the foundation of research and theory on children's eating behaviours: Current issues and directions for progress

Eating behaviours affect food intakes and are involved in the aetiology of obesity. There has been impetus to translate findings about children's eating behaviour into intervention and policy programs. However, measurement limitations have hindered our capacity to understand and influence children's eating behaviours. In the present paper we provide an overview of some of the key methodological and measurement issues facing the field of children's eating behaviours and highlight implications for research and health promotion. Drawing on insight from parallel issues that occur in the measurement of early social and emotional development, we examine two overlapping themes in children's (aged 0-∼12 years) eating behaviours (Somaraki et al., 2021) measurement issues related to validity and reliability, and (Steinsbekk & Wichstrøm, 2015) associated methodological challenges, such as contextual influences and the importance of designing studies that use multiple informants and multiple methods. We then suggest insights and strategies aimed at advancing approaches to measurement of children's eating behaviours. To progress our understanding of children's eating behaviours, we conclude that a range of psychometrically sound, fit-for-purpose measurement instruments and procedures are needed for use in multi-trait, multi-method, multi-informant studies in a range of populations and contexts.

Child Weight Status: The Role of Feeding Styles and Highly Motivated Eating in Children

Although parental feeding plays an important role in child eating and weight status, high food motivation among children may also be a factor shaping how feeding impacts child weight. This study explored whether individual differences in preschool children’s food motivation interacted with mothers’ feeding styles in predicting subsequent child weight status. Participants included 129 Hispanic Head Start mother/child dyads. Data were collected at ages 4–5 years (Time 1) and 7–9 (Time 3). Staff measured heights/weights and observed children in an eating in the absence of hunger task. Mothers reported on feeding styles/practices and children’s eating behaviors. A principal components analysis derived a measure of highly motivated eating in children. Multiple regressions predicted Time 3 child BMI z-scores. Time 3 BMI z-scores were positively predicted by authoritative and indulgent feeding styles and negatively predicted by monitoring. Since feeding style interacted with highly motivated eating, separate regressions were run for high and low food motivation in children. Unexpectedly, results showed that authoritative feeding positively predicted Time 3 child BMI z-scores only for children showing low levels of food motivation. Characterizing differential parental feeding and child eating phenotypes may assist in tailoring childhood obesity prevention programs for the target populations.

Eating Behavior and Obesity in a Sample of Spanish Schoolchildren

From the point of view of prevention, it is convenient to explore the association between eating behavior and the obese phenotype during school and adolescent age. The aim of the present study was to identify eating behavior patterns associated with nutritional status in Spanish schoolchildren. A cross-sectional study of 283 boys and girls (aged 6 to 16 years) was carried out. The sample was evaluated anthropometrically by Body Mass Index (BMI), waist-to-height ratio (WHtR) and body fat percentage (%BF). Eating behavior was analyzed using the CEBQ "Children's Eating Behavior Questionnaire". The subscales of the CEBQ were significantly associated with BMI, WHtR and %BF. Pro-intake subscales (enjoyment of food, food responsiveness, emotional overeating, desire for drinks) were positively related to excess weight by BMI (β = 0.812 to 0.869; p = 0.002 to <0.001), abdominal obesity (β = 0.543-0.640; p = 0.02 to <0.009) and high adiposity (β = 0.508 to 0.595; p = 0.037 to 0.01). Anti-intake subscales (satiety responsiveness, slowness in eating, food fussiness) were negatively related to BMI (β = -0.661 to -0.719; p = 0.009 to 0.006) and % BF (β = -0.17 to -0.46; p = 0.042 to p = 0.016).

Associations of parental feeding practices with children's eating behaviors and food preferences: a Chinese cross-sectional study

BACKGROUND

Childhood inadequate eating behaviors contribute to the epidemic of obesity. Previous research suggests that parental feeding practices are partially associated with development of eating behaviors among children, but the results are inconsistent. The present study was to investigate whether parental feeding practices were associated with eating behaviors and food preferences among Chinese children.

METHODS

A cross-sectional study was conducted to collect data from 242 children (ages 7-12) in six-primary schools in Shanghai, China. A series of questionnaires including parental feeding practices and children's eating behaviors have been validated, and were completed by one of parent who has responded for child's daily diet and living. In addition, researchers instructed children to complete the questionnaire of food preference. After adjustment for children's age, sex and BMI status, as well as parental education and family income, the linear regression analysis was used to evaluate relationships of parental feeding practices with children's eating behaviors and food preferences.

RESULTS

Parents with boys had higher level of control overeating practice than those with girls. Mothers who responded to child's daily diet and living and completed feeding practices questionnaire used a greater level of emotional feeding practices than fathers. Boys had higher levels of food responsiveness, emotional overeating, enjoyment of food and desire to drink than girls. Boys had different preferences for meat, processed meat products, fast foods, dairy foods, eggs, and snacks and starchy staples & beans from girls. In addition, scores of instrumental feeding practice and preference for meat significantly differed among children with different weight status. Furthermore, parental emotional feeding practice was positively associated with children's emotional undereating (β 0.54, 95% CI 0.16 to 0.92). There were also positive associations of parental encouragement to eat with children's preference for the processed meat (β 0.43, 95% CI 0.08 to 0.77). Moreover, instrumental feeding practice was negatively associated with children's fish liking (β -0.47, 95% CI -0.94 to -0.01).

CONCLUSION

The current findings support associations of emotional feeding practice with some children's emotional undereating, as well as parental encouragement to eat and instrumental feeding practice related to preference for processed meat and fish, respectively. Further studies should continue to ascertain these associations using longitudinal designs, and to evaluate efficacy of parental feeding practices impacting developments of healthy eating behaviors and preferences for healthy foods among children by interventional studies.

Food as a key disgust elicitor in infancy and childhood: Previous research and opportunities for future study

Disliked foods may have important value in the study of the development of disgust. The current review draws from literature across disciplines, including theories of disgust and studies of the development of eating behavior and food preferences, to highlight food as an important category of disgust responses across a wide age range, including children as young as 3 years old and adults. Children's disgust responses to certain types of food are considered to be both innate and culturally constrained behaviors, and their perceptions of other people's food choices indicate potential links between foods and cultural groups. We end by discussing several ongoing and future research areas, including connections between disgust responses and food rejection in infancy and children's food rejection behaviors across cultures.

Appetitive traits and body mass index in Chinese adolescents: An 18-month longitudinal study with latent growth curve analyses

A longitudinal approach with Latent Growth Curve Modeling (LGCM) was adopted to explore the trajectories of appetitive traits corresponding to BMI in Chinese adolescents. Within a large sample of adolescents (N = 2566, 45.9% boys) aged from 11 to 17 years (M = 13.80, SD = 1.56) at the baseline survey, our results indicated that appetitive traits of emotional overeating, food fussiness, and hunger increased significantly over time while enjoyment of food decreased over time. Slowness in eating and satiety responsiveness significantly increased in girls, while emotional undereating significantly decreased in boys. Moreover, the growth parameters of emotional undereating and satiety responsiveness were significantly and negatively related to BMI in girls. Our findings evidence that certain appetitive traits could change over time in adolescence and these changes relate to weight status. Gender differences are suggested in the design of future intervention and treatment of overweight/obesity in Chinese adolescents.

Subclinical binge eating symptoms in early adolescence and its preceding and concurrent factors: a population-based study

OBJECTIVE

Binge eating, loss of control eating and overeating often develop during late childhood or early adolescence. Understanding the presentation of binge eating as early as symptoms manifest and its preceding and concurrent factors is essential to hamper the development of eating disorders. This study examined the prevalence, concurrent and preceding factors (e.g. compensatory behaviors, emotional and behavioral problems) of subclinical binge eating symptoms in early adolescence.

METHODS

Data from the population-based Generation R Study were used (n = 3595). At 10 years and 14 years, preceding and concurrent factors including eating behaviors, body dissatisfaction, emotional and behavioral problems and body composition were assessed. At 14 years, 3595 adolescents self-reported on binge eating symptoms in the past 3 months and were categorized into four groups: no symptoms (n = 3143, 87.4%), overeating only (n = 121, 3.4%), loss of control (LOC) eating only (n = 252, 7.0%) or binge eating (i.e. both, n = 79, 2.2%).

RESULTS

In total, 452 (12.6%) young adolescents reported subclinical binge eating symptoms. Those who reported LOC eating and binge eating showed most compensatory behaviors (e.g. hide or throw away food, skipping meals). Concurrent emotional and behavioral problems, body dissatisfaction, more emotional-, restrained- and uncontrolled eating, and a higher BMI were associated with subclinical binge eating symptoms. Preceding self-reported emotional and behavioral problems, body dissatisfaction, more restrained eating and higher BMI (both fat mass and fat-free mass) at 10 years were associated with LOC eating and binge eating, but not with overeating.

DISCUSSION

Among young adolescents, subclinical binge eating symptoms were common. Considering the high prevalence of LOC eating, and the overlapping preceding and concurrent factors of LOC eating and binge eating compared to overeating, LOC eating seems to be a key symptom of binge eating in early adolescence.

Development and Psychometric Characteristics of an Instrument to Assess Parental Feeding Practices to Promote Young Children's Eating Self-Regulation: Results with a Portuguese Sample

A parental child-centered feeding approach is likely to keep children’s biological mechanisms activated while eating, protecting them in an obesogenic context. However, few feeding practice measures assess parents’ behaviors to guide and prompt children to identify and respond appropriately to their signs of hunger and satiety. We aimed to develop and study the reliability, validity, and measurement invariance of a new scale to assess parental feeding practices to promote children’s self-regulation of food intake. To pursue this aim, we conducted two descriptive, cross-sectional, online studies in Portugal in an online format; a total of 536 parents of 2- to 6-year-old children completed the evaluation protocol. Factorial analysis findings support the theoretical organization proposed for the scale. The confirmatory factorial analysis supported a first-order factor structure with two subscales, Prompting for eating self-regulation and Teaching about eating consequences, with eight items in total. Both scales presented good internal consistency and adequate temporal stability, with a significant, positive, and moderate relationship. The results showed metric invariance for the child’s sex. Both types of practices were positively correlated with the child’s enjoyment of food. Prompting for eating self-regulation showed negative associations with parents’ emotional lack of control, children’s satiety responsiveness, slowness in eating, and fussiness. Preliminary studies confirmed both the validity and reliability of the instrument and the adequacy of adopting a self-regulatory approach when assessing child-centered feeding practices. Combining this instrument with others that assess coercive practices can be beneficial to capture ineffective parents’ behaviors on children’s eating self-regulation.

The relationship of parenting style and eating behavior in preschool children

BACKGROUND

Eating behavior represents individual appetitive traits which are related to the individual's regulation of food intake. Eating behavior develops at an early age. There is some evidence that parenting styles might impact on the child's eating behavior. The aim of this study was to investigate the relationship of different dimensions of positive and negative parenting styles with the child's eating behavior at a critical age period of the child's early development.

METHODS

Parents of 511 preschool children (aged 2-6 years) completed the Children Eating Behavior Questionnaire and the Alabama Parenting Questionnaire.

RESULTS

Analyses revealed that different dimensions of negative parenting styles were associated with eating behavior of the child. In details, inconsistent parenting showed a consistent association with eating behavior of a child (i.e. higher emotional eating, higher food responsiveness, higher food fussiness, higher satiety responsiveness and more enjoyment of food), whereas corporal punishment was associated with more emotional overeating and more food responsiveness but less satiety responsiveness. Further, powerful implementation was related to higher food responsiveness and less enjoyment of food and low monitoring was associated with higher emotional overeating and more slowness in eating. There was no such consistent association of positive parenting and eating behavior.

CONCLUSIONS

More negative parenting styles were associated with eating behavior which is more often related to potential weight problems in a long term, whereas positive parenting did not show such a consistent relationship with eating behavior. Negative parenting should be in the focus of prevention and treatment of eating behavior problems in young children.

TRIAL REGISTRATION

ISRCTN41045021 (06/05/2014).

Disinhibited Eating and Executive Functioning in Children and Adolescents: A Systematic Review and Meta-Analysis

A growing body of research suggests disinhibited eating and weaker executive function (EF) are two risk factors for pediatric obesity. Emerging brain imaging and behavioral findings support the notion that EF skills impact eating regulation. However, a major gap in the current literature is a synthesis of the association between various EF skills and disinhibited eating patterns across child development. To address this gap, a systematic review and meta-analysis was conducted to examine the effect of EF skills on disinhibited eating behaviors among youth ages 3-18 years old. PubMed and PsychINFO databases were utilized and data from 15 studies with a total sample of 4909 youth were included. A random effects meta-analysis revealed a small negative effect of overall EF skills on disinhibited eating behavior, r = -0.14, p < 0.01. Analysis of individual EF skills found working memory had an overall medium negative effect on disinhibited eating behavior, r = -0.25, p < 0.05. Taken together, findings from this meta-analysis support an inverse relationship between EF abilities and disinhibited eating patterns in children and adolescents, such that poorer EF abilities are associated with higher levels of disinhibited eating. Given the effect on eating behavior, future research is needed to assess whether EF difficulties may be a barrier to effective weight management in youth. Specifically, research is needed to examine whether EF skills may be a key target to consider for effective obesity prevention and treatment in children and adolescents.

Can children report on their own picky eating? Similarities and differences with parent report

Picky eating in childhood is associated with children's dietary outcomes and parental feeding experiences. The Child Eating Behavior Questionnaire (CEBQ) is a frequently-used parent-report survey that measures children's eating behaviors, including picky eating. Limited work has adapted the CEBQ into a child-friendly format to measure children's ability to report directly on their own picky eating behavior. We sought to extend previous research by adapting the Food Fussiness subscale of the CEBQ into a child self-report format and measuring parent-child resemblance in scores, with children as young as 3 years. Our final sample included 3- to 10-year-old children (n = 95) and their parents, who were assessed at a local children's museum. The internal consistency of parent-report on the CEBQ FF was α = 0.9 and child-report was α = 0.7, with parent scores predicting child scores when controlling for child age and child gender. The largest difference between parent and child scores on child picky eating (with parents reporting higher scores) was for 3- to 4-year-old children. Children are able to report on their own picky eating and with age their reports converge with those of their parents, highlighting the potential benefit of collecting picky eating scores from multiple informants (parent and child). We suggest future directions for the validation and extension of this measure.

Factorial Model of Obese Adolescents: The Role of Body Image Concerns and Selective Depersonalization-A Pilot Study

BACKGROUND

The relationship binding body weight to psychological well-being is unclear. The present study aims at identifying the contribution, and specificity, of some dimensions (i.e., eating-related symptoms, body image disorders, eating habits, personality traits, and emotional difficulties) characterizing the psychological profile of obese adolescents (749 participants, 325 females; 58.3% normal-weight, 29.9% overweight, and 11.7% obese; mean age = 16.05, SD = 0.82).

METHODS

By introducing the scores obtained by standardized self-report tools into a generalized linear model, a factorial reduction design was used to detect the best fitting discriminant functions and the principal components explaining the higher proportion of the variance.

RESULTS

We found two discriminant functions correctly classifying 87.1% of normal-weight, 57.2% of overweight, and 68.2% of obese adolescents. Furthermore, two independent factors, explaining 69.68% of the total variance, emerged.

CONCLUSIONS

The first factor, "Body Image Concerns", included the drive for thinness, body dissatisfaction, and interpersonal distrust. The second factor, "Selective Depersonalization", included a trend toward depersonalization and dissatisfaction with the torso. The neurophysiological implications of our findings will be discussed.

Associations of diet quality, food consumption, eating frequency and eating behaviour with dental caries experience in Finnish children: a 2-year longitudinal study

We examined cross-sectional and longitudinal associations of dietary factors with caries experience in a population sample of 487 children aged 6-9 years at baseline examinations of the Physical Activity and Nutrition in Children (PANIC) Study. Altogether, 406 of these children attended 2-year follow-up examinations. Food consumption and eating frequency were assessed using 4-day food records, diet quality using the Baltic Sea Diet Score (BSDS) and eating behaviour using the Children's Eating Behavior Questionnaire. Caries experience was examined clinically. The cross-sectional associations of dietary factors with caries experience at baseline were analysed using linear regression and the longitudinal associations of dietary factors with a change in caries experience over follow-up using generalised mixed-effects regression adjusted for other risk factors. A higher consumption of high-fibre grain products (standardised regression coefficient β = -0·16, P = 0·003) and milk (β = -0·11, P = 0·025) and higher BSDS (β = -0·15, P = 0·007) were associated with lower caries experience, whereas a higher consumption of potatoes (β = 0·11, P = 0·048) and emotional overeating (β = 0·12, P = 0·025) were associated with higher caries experience. Higher snacking frequency (fixed coefficient β = 0·07, P = 0·033), desire to drink (β = 0·10, P = 0·046), slowness in eating (β = 0·12, P = 0·027) and food fussiness (β = 0·12, P = 0·018) were associated with higher caries experience, whereas enjoyment of food (β = -0·12, P = 0·034) and higher BSDS (β = -0·02, P = 0·051) were associated with lower caries experience.

Relationships between retrospective parental feeding practices and Chinese university students' current appetitive traits, weight status, and satisfaction with food-related life

Accumulating evidence suggests that parental feeding practices during childhood are related to adults' eating behaviors and weight status, but research exploring these relationships is largely conducted in Western contexts. However, China, a country that holds the largest world population, has distinct patterns of eating habits and food culture from Western countries. Therefore, the present study aimed to examine relationships between retrospective parental feeding practices (e.g., concern, monitoring, pressure to eat, and restriction) and current body mass index (BMI) and satisfaction with food-related life in a sample of 476 Chinese university students (195 men; Mage = 19.78 years, SD = 1.23). We also examined whether appetitive traits mediated these associations. Retrospective parental feeding practices were significantly related with participants' current BMI (concern: r = 0.26, p < .001; pressure to eat: r = -0.15, p < .001) and satisfaction with food-related life (concern: r = 0.15, p < .001; monitoring: r = 0.12, p = .009; pressure to eat: r = 0.13, p = .006; restriction: r = 0.16, p < .001). Relationships were partially mediated by young adults' current appetitive traits (e.g., enjoyment of food, emotional overeating, satiety responsiveness, slowness in eating). These findings suggest that retrospective parental feeding practices are important correlates of young adults' current weight status and satisfaction with food-related life, and that appetitive traits partially explain these relationships in the Chinese context.

Validation of ketogenic diet adherence questionnaire: Keto-check

Background The ketogenic diet is a therapeutic option to control drug-resistant epileptic seizures and has difficult compliance standards due to adverse effects, psychosocial factors, or dietary restriction.

Objective To create and validate a ketogenic diet compliance questionnaire.

Methods Methodological study, convergent care. The instrument was analyzed (construct validation) by five judges during two cycles of the Delphi technique. The judges assessed the relevance and clarity by using the Likert scale with three levels and made suggestions. The validation of the instrument was calculated using the agreement rate and content validity index (CVI). The application by two nutritionists made it possible to test reproducibility using the Kappa coefficient. When comparing the classification with a template developed by the health professionals who cared for the patients in question, the Pearson correlation and Fisher exact tests were used. For the reliability test, self-applied data were collected and evaluated using Cronbach Alpha coefficient.

Results The questionnaire initially created with 11 multiple choice questions on a Likert scale was reduced to 10 questions with an agreement rate and the CVI classified as excellent after two rounds with judges. In the application of the tool, a kappa of 0.6087 was obtained, a Pearson that showed no significant difference between evaluators and a Cronbach α of 0.6483, with substantial consistency.

Conclusions This work resulted in the creation of an unprecedented and reliable questionnaire on adherence to the national ketogenic diet. Further studies should be performed to extrapolate the use of this questionnaire in different populations.

Characteristics of eating behavior profiles among preschoolers with low-income backgrounds: a person-centered analysis

BACKGROUND

Individual differences in eating behaviors among young children are well-established, but the extent to which behaviors aggregate within individuals to form distinct eating behavior profiles remains unknown. Our objectives were to identify eating behavior profiles among preschool-aged children and evaluate associations with temperament and weight.

METHODS

A secondary, cross-sectional analysis of baseline data from 2 cohort studies was conducted involving 1004 children aged 3-4 years and their parents with low-income backgrounds. Children's eating behaviors and temperament were assessed by parental report. Body mass index z-scores and weight status were calculated using measured heights and weights. Latent profile analysis (LPA) was used to generate profiles and bivariate analyses were used to evaluate associations with temperament and weight status.

RESULTS

LPA revealed the presence of 3 eating behavior profiles among children. Children with High Food Approach profiles (21.2%) had lower temperamental inhibitory control and the highest percent of children with obesity relative to the other profiles. Children with High Food Avoidant profiles (35.6%) had lower temperamental impulsivity and lower BMI z-scores relative to the other profiles, whereas children with Moderate Eating profiles (intermediary levels of all behaviors; 43.2%) had higher temperamental inhibitory control and lower anger/frustration, than other profiles.

CONCLUSIONS

Young children's eating behaviors appear to aggregate within individuals to form empirically distinct profiles reflecting food approach, food avoidance, and moderate approaches to eating that are differentiated by aspects of temperament and weight. Future work should seek to understand the extent to which health promotion and obesity prevention approaches should be tailored to take into account children's fundamental dispositions towards eating.

Sleep duration and eating behaviours are associated with body composition in 5-year-old children: findings from the ROLO longitudinal birth cohort study

Inadequate sleep and poor eating behaviours are associated with higher risk of childhood overweight and obesity. Less is known about the influence sleep has on eating behaviours and consequently body composition. Furthermore, whether associations differ in boys and girls has not been investigated extensively. We investigate associations between sleep, eating behaviours and body composition in cross-sectional analysis of 5-year-old children. Weight, height, BMI, mid upper arm circumference (MUAC), abdominal circumference (AC) and skinfold measurements were obtained. Maternal reported information on child's eating behaviour and sleep habits were collected using validated questionnaires. Multiple linear regression examined associations between sleep, eating behaviours and body composition. Sleep duration was negatively associated with BMI, with 1-h greater sleep duration associated with 0·24 kg/m² (B = 0·24, CI -0·42, -0·03, P = 0·026) lower BMI and 0·21 cm lower (B = -0·21, CI -0·41, -0·02, P = 0·035) MUAC. When stratified by sex, girls showed stronger inverse associations between sleep duration (h) and BMI (kg/m²) (B = -0·32; CI -0·60, -0·04, P = 0·024), MUAC (cm) (B = -0·29; CI -0·58, 0·000, P = 0·05) and AC (cm) (B = -1·10; CI -1·85, -0·21, P = 0·014) than boys. Positive associations for 'Enjoys Food' and 'Food Responsiveness' with BMI, MUAC and AC were observed in girls only. Inverse associations between sleep duration and 'Emotional Undereating' and 'Food Fussiness' were observed in both sexes, although stronger in boys. Sleep duration did not mediate the relationship between eating behaviours and BMI. Further exploration is required to understand how sleep impacts eating behaviours and consequently body composition and how sex influences this relationship.

Reliability and Validation of the Child Eating Behavior Questionnaire in 3- to 6-Year-Old Spanish Children

Introduction

Eating behavior is often established during the first years of life. Therefore, it is important to make a research on it to understand the relationships that children have with food and how this can contribute to prevent the development of childhood obesity. An appropriate assessment of eating behavior can be achieved using the “Child Eating Behavior Questionnaire” (CEBQ). This questionnaire has been validated in several populations and languages, but it has never been translated, adapted, and validated for Spanish children.

Aim

To evaluate the reliability and internal consistency of the CEBQ questionnaire, culturally adapted and translated into Spanish (Spain), in Spanish families with children aged 3 to 6 years, as well as its association with children’s body mass index (BMI) to test its construct validity.

Materials and Methods

Children between 3 and 6 years old were recruited from the ongoing MELI-POP randomized controlled clinical trial, as well as from public schools located in middle class neighborhoods of Zaragoza, Spain, to complete the sample. Sociodemographic characteristics and anthropometric measures were obtained according to standardized methods. The 35-item CEBQ questionnaire was completed twice with a time difference of 3 weeks between each response. Statistical analyses included the evaluation of internal consistency and reliability of the questionnaire, a confirmatory factor analysis, and the association between the different CEBQ scales and the children’s BMI.

Results

A total of 197 children completed variables; 97 of them were boys (49.2%) and 100 girls (50.8%). Mean age of the total sample was 4.7 ± 0.9 years. There was a high test-re-test reliability of the questionnaire with values close to 1, with an average of 0.66 and a good internal consistency (Cronbach alpha with values above 0.7), so that a high reliability is established between the items in each scale. A gradual positive association was found between the score of different “pro-intake” scales of the CEBQ: “Food Responsiveness,” “Emotional Overeating,” and “Enjoyment of food” and the children’s BMI; at the opposite, negative associations were observed between BMI and the score of anti-intake scales “Satiety Responsiveness,” “Slowness in Eating,” and “Emotional Undereating.”

Conclusion

The Spanish version of the CEBQ is a useful tool to assess the eating behavior of Spanish children because the high reliability and internal validity. There is a significant association between eating behavior and BMI in Spanish children.

Food-Approach Eating Behaviors and Brain Morphology: The Generation R Study

Food-approach eating behaviors are associated with an increased risk of developing overweight/obesity and binge-eating disorder, while obesity and binge-eating disorder have also been linked with altered brain morphology in adults. To understand these associations, we examined the association of food-approach eating behaviors during childhood with adolescents' brain morphology. The sample included 1,781 adolescents with assessments of eating behaviors at ages 4 and 10 years and brain imaging data at 13 years from a large, population-based cohort. Food approach eating behaviors (enjoyment of food, emotional overeating, and food responsiveness) were assessed using the Child Eating Behavior Questionnaire. Additionally, we assessed binge eating symptoms using two items from the Development and Well-Being Assessment at 13 years of age. Adolescents participated in an MRI procedure and measures of brain morphology, including cerebral white, cerebral gray and subcortical gray matter volumes, were extracted from T1-weighted images processed using FreeSurfer. Enjoyment of food and food responsiveness at the age of 4 and 10 years were positively associated with cerebral white matter and subcortical gray matter volumes at age 13 years (e.g., enjoyment of food at 4 years and cerebral white matter: β = 2.73, 95% CI 0.51, 4.91). Enjoyment of food and food responsiveness at 4 years of age, but not at 10 years, were associated with a larger cerebral gray matter volume at 13 years of age (e.g., enjoyment of food at 4 years: β = 0.24, 95% CI 0.03, 0.45). No statistically significant associations were found for emotional overeating at both ages and brain measurements at 13 years of age. post-hoc analyses showed no associations of food-approach eating behaviors with amygdala or hippocampus. Lastly, we did not observe significant associations of binge-eating symptoms with global brain measurements and a priori-defined regions of interest, including the right frontal operculum, insular and orbitofrontal cortex. Our findings support an association between food-approach eating behaviors, especially enjoyment of food and food responsiveness, and brain morphology in adolescence. Our findings add important knowledge to previous studies that were mostly conducted in adults, by suggesting that the eating behavior-brain link may be visible earlier in life. Further research is needed to determine causality.

Parental feeding practices and child eating behavior in different socioeconomic neighborhoods and their association with childhood weight. The STEPS study

Child obesity risk, child eating behavior and parental feeding practices show a graded association with individual level socioeconomic status. However, their associations with neighborhood socioeconomic disadvantage are largely unknown. In this study (n = 682), we investigated how parental feeding practices and child eating behaviors were associated with body mass index and risk of overweight at preschool age in affluent and disadvantaged neighborhoods. We found that high food approach tendency in disadvantaged neighborhoods predicted higher body mass index and increased the risk of overweight at the age of 6 years compared with affluent neighborhoods. Our results suggest that children's eating habits may have stronger impact on overweight risk in disadvantaged than in affluent neighborhoods.

Examining the validity and consistency of the Adult Eating Behaviour Questionnaire-Español (AEBQ-Esp) and its relationship to BMI in a Mexican population

PURPOSE

Appetitive traits in adults and their associations with weight can be measured using the Adult Eating Behaviour Questionnaire (AEBQ). The aim of this study was to confirm the factor structure of the Spanish AEBQ (AEBQ-Esp) in a Mexican sample and explore associations between the eight traits with body mass index (BMI).

METHOD

A sample of 1023 adults, mean age of 36.8 ± 12.8 years, was recruited from Guadalajara, Mexico. Researchers weighed and measured participants, and they completed the AEBQ-Esp either online or in paper format and reported sociodemographic data. To test two alternative factor structures (eight factors including Hunger; seven factors excluding Hunger), confirmatory factor analysis (CFA) was used. Internal reliability was assessed using Cronbach's alpha; test-retest reliability was assessed using intra-class correlation coefficients. Multivariate linear regressions were used to test for associations between the AEBQ subscales and BMI, adjusted for age, sex, format of AEBQ responses, education, marital and employment status.

RESULTS

A seven-factor structure was the best model fit using CFA, excluding the Hunger subscale but similar to the original AEBQ. Internal reliability was good for all subscales (Cronbach's α = 0.70-0.86), and the intra-class correlation coefficient (0.70-0.91) reflected good test-retest reliability. In the fully adjusted models, Satiety Responsiveness [β = - 0.61; (- 1.01, - 0.21)] and Slowness in Eating [β = - 0.70; (- 1.01, - 0.39)] were negatively associated with BMI, and Emotional Over-Eating [β = 0.94; (0.62, 1.27)] was positively associated with BMI.

CONCLUSIONS

The AEBQ-Esp (excluding Hunger) appears to be a valid and reliable psychometric questionnaire for measuring appetitive traits in a Mexican Spanish-speaking population. Some traits appear to be associated with BMI in adulthood and warrant further exploration.

LEVEL OF EVIDENCE

Level III evidence obtained from well-designed cohort or case-control analytic studies. Although this was just an observational study, it was well designed and provided new evidence.

Analysis of association between eating behaviours and childhood obesity among pre-school children: A cross-sectional study

BACKGROUND

Childhood obesity is a worldwide critical health concern. We aimed to clarify whether eating behaviours increased the risk of childhood obesity.

METHODS

We recruited 2,049 pre-school children aged 3-6 years between 1 December 2021 and 31 January 2022 in Taizhou, China. Children's weight status was classified according to the International Obesity Task Force criteria, and their eating behaviours were evaluated using the Children's Eating Behaviour Questionnaire. Correlation analyses, linear regressions, and one-way ANCOVA. were performed to analyse the association between children's eating behaviours and weight status.

RESULTS

In 'Food Avoidant' subscales, the scores of satiety responsiveness (P < 0.001) and slowness in eating (P = 0.001) were negatively associated with body mass index z score among pre-school children of both sexes. In 'Food Approach' subscales, the score of enjoyment of food was positively associated with body mass index z score in both boys (P = 0.007) and girls (P = 0.035), but the association of scores of food responsiveness with body mass index z score was found only in girls (P = 0.001).

CONCLUSION

Our results supported that pre-school children with low scores in 'Food Avoidant' subscales and high scores in 'Food Approach' scales were more likely to become obese.

Associations of preschoolers' dietary patterns with eating behaviors and parental feeding practices at a 12-month follow-up of obesity treatment

Although dietary patterns are key to the management of childhood obesity, they are rarely assessed and thus poorly understood. This study examines preschoolers' dietary patterns and correlates 12 months after the start of obesity treatment (n = 99, mean age 5.2 years, 52% girls). A food frequency questionnaire (FFQ), the Child Eating Behavior Questionnaire (CEBQ), Child Feeding Questionnaire (CFQ) and Lifestyle Behavior Checklist (LBC) were answered by parents to assess children's food intake, eating behaviors, parental feeding practices, and obesity-related behaviors, respectively. Principal component analysis identified dietary patterns based on FFQ data. Through multiple linear regressions we examined correlations between a healthy (HD) and a less healthy (LHD) dietary pattern and mean scores of the CEBQ, CFQ, LBC scales as well as BMI z-scores. The reported intake of items in the LHD decreased after treatment while no differences were found for the HD. Children's eating behaviors, in particular food fussiness, showed consistent associations with diet (b = -0.39, 95% CI -0.63, -0.14 for HD and b = 0.41, 95% CI 0.15, 0.66 for LHD). Feeding practices and obesity-related behaviours were weakly associated with the dietary patterns (HD and Monitoring: b = 0.36, 95% CI 0.09, 0.62; LHD and Screen time b = 0.08, 95% CI 0.01, 0.15). Among the measured variables, eating behaviors had the largest impact on children's dietary patterns. The LHD was associated with a higher BMI z-score but no associations were found between changes in LHD intake and changes in BMI z-scores. Our findings suggest that decreasing food fussiness in children with obesity is key to positive dietary changes. Assessment of children's eating behaviors can help tailor dietary advice and provide support for families of children with obesity.

Measuring short-term eating behaviour and desire to eat: Validation of the child eating behaviour questionnaire and a computerized 'desire to eat' computerized questionnaire

The Child Eating Behaviour Questionnaire (CEBQ) is designed to measure 'usual' eating behaviour, with no time period attached, thus may not be suitable for assessing the effectiveness of short-term experimental studies. The aim of this study was to validate i) the CEBQ adapted to measure 'past week' rather than 'usual' eating behaviour, and ii) a computerized questionnaire assessing desire to eat core and non-core foods, against an objective measure of eating behaviour and food intake (eating in the absence of hunger (EAH) experiment). Children (n = 103) aged 8-12 years completed the desire to eat questionnaire followed by the EAH experiment while primary caregivers completed the adapted CEBQ. Results from the CEBQ showed that children with greater 'satiety responsiveness' (1-point higher) consumed less energy (-342 kJ; 95% CI -574, -110) whereas those with greater 'enjoyment of food' scale consumed more energy (380 kJ; 95% CI 124, 636) during the ad-libitum phase of the EAH experiment. Higher scores for slowness in eating (-705 kJ; 95% CI -1157, -254), emotional undereating (-590 kJ; 95% CI -1074, -106) and food fussiness (-629 kJ; 95% CI -1103, -155) were associated with lower total energy intake. Children who expressed greater desire to eat non-core foods consumed more energy in total (275 kJ; 95% CI 87, 463). Overall, this adapted CEBQ appears valid for measuring several short-term eating behaviours in children. The desire to eat questionnaire may be useful for identifying short-term susceptibility to overeating, however further investigation into how ratings of desire relate to the intake of highly palatable, energy dense foods is warranted.

How do young children eat after an obesity intervention? Validation of the Child Eating Behaviour Questionnaire using the Rasch Model in diverse samples from Australia and Sweden

Child eating behaviours have consistently been linked to child weight status. Yet, changes in child eating behaviours during early obesity treatment are rarely evaluated. Psychometric evaluation of the Child Eating Behaviour Questionnaire (CEBQ) is common, but results are sample-dependent and included items may not capture the full range of the underlying traits. Rasch analysis can overcome these disadvantages. The aim of this paper was to assess child eating behaviours measured by the CEBQ after a 12-month obesity intervention applying the Rasch model for the validation of the CEBQ. The Rasch-based fit statistics were applied in children from two samples, Australian and Swedish (n = 1724). Changes in eating behaviours amongst children aged 4-6 years were examined in the More and Less RCT for obesity treatment (n = 177), which compared a parenting programme (with and without boosters) against standard treatment. Parents completed the CEBQ at four time points over 12-months. Linear mixed models were applied to estimate treatment effects on the CEBQ, refined according to Rasch, over time. We found that the validity of CEBQ was confirmed after removing 4 items (item fit statistics outside range 0.5-1.5). When the refined CEBQ was used in the assessment of the RCT, there were no differences in parental reports of changes in children's eating behaviours between the parenting programme and standard treatment (group-by-time interactions p > 0.05). However, in the total sample food approach behaviours decreased while fussy eating behaviours increased (p < 0.05). In conclusion, the refined CEBQ proved to be a valid tool for examining parent-reported child eating behaviours. Early obesity treatment may decrease eating behaviours associated with higher child weight. Future research should address the associations between changes in child weight status and eating behaviours.

Preliminary Exploration of Obesity-Related Eating Behaviour Patterns in a Sample of Saudi Preschoolers Aged 2-6 Years through the Children's Eating Behaviour Questionnaire

BACKGROUND

The Children's Eating Behaviour Questionnaire (CEBQ) is used with parents to determine the characteristics of eating behaviour of their children and, consequently, children's propensity to become obese. It has been successfully used mainly in Western countries, but not in Saudi Arabia. In this pilot study, we explored the use of the Saudi version of the CEBQ for preschool children aged 2-6 years in Saudi Arabia, and assessed the associations between eating behaviours and children's age, gender and relative weight and parental weight.

METHODS

Parents of 200 Saudi preschool children in Riyadh completed the Saudi version of the CEBQ. Factor analyses on all CEBQ items were performed and differences between genders and age groups were examined. Correlations between children's BMI z-scores and eating behaviours were analysed using linear regression.

RESULTS

The factor analysis revealed an eight-factor solution similar to the theoretical factor structure, with good internal reliability and acceptable correlations between subscales. Boys scored higher than girls on food responsiveness; no difference between age groups was found. Positive associations between BMI z-scores and 'food approach' subscales, food responsiveness, enjoyment of food and emotional overeating were found, while 'food avoidant' subscales, satiety responsiveness and slowness in eating had inverse relationships with BMI z-scores. Maternal BMI had a positive association with BMI z-scores and food responsiveness.

CONCLUSION

The CEBQ is a valid psychometric tool that can be reliably used to assess eating behaviour characteristics in Saudi preschool children.

Longitudinal bidirectional relationship between children's appetite and diet quality: A prospective cohort study

This study explored the relationship between eating behaviours and diet quality, from 7 to 10y. The sample included 3879 children evaluated, from the Portuguese birth cohort Generation XXI, with complete information on Food Frequency Questionnaire (FFQ) and the Children Eating Behaviour Questionnaire (CEBQ). A healthy eating index (HEI) (range: 9-31) was developed to evaluate the child's diet quality. The eight CEBQ's eating behaviours were included in the analysis. Generalised linear models were used to estimate the associations. Adjusted structural equation modelling was performed to study the direction of the associations. Eating behaviours measured at age 7y tracked to age 10y. A bidirectional inverse association between the food fussiness trait and diet quality was found, with a similar magnitude (p < 0.001), thus a higher score on food fussiness predicted a lower quality of the diet. A higher HEI score at 7y was associated with lower satiety responsiveness at 10y (β_standardized = -0.039), and a higher HEI score at age 10y was associated with higher enjoyment of food at 7y (β_standardized = 0.046). Eating behaviours were linked to diet quality in children with high enjoyment of food and low food fussiness at age 7y linked to a high-quality diet at 10y. In addition, children with high-quality diets at 7y were more likely to have lower food fussiness and satiety responsiveness at 10y. Given the stability of eating behaviours and the bidirectional nature of effects between eating behaviours and dietary quality in the long term, tailored interventions may be needed to encourage the acquisition of healthy eating behaviours and habits in early life.

[Association between eating behavior pattern and caries in a population of children aged 3 to 9 years in the province of Alicante]

INTRODUCTION

dental caries is the most common contagious infectious disease of childhood. Much has been studied about the effect of a healthy diet on oral health, but little attention has been paid to the importance of eating patterns.

OBJECTIVES

to establish the relationship between dental caries and eating behavior pattern using the Child Eating Behavior Questionnaire (CEBQ) in a sample of children.

MATERIALS AND METHODS

a cross-sectional and descriptive study was carried out by selecting any boy or girl between 3 and 9 years who attended a dental clinic in the province of Alicante (Spain). An oral examination was performed to diagnose caries in children whose parents signed an informed consent. These parents/caregivers were also given the CEBQ to fill out.

RESULTS

a total of 276 children with a mean age of 86.5 months were examined. A higher average score was observed in the "food-avoidant" dimension in: "demand for food" and in the "response to satiety". A statistically significant difference was obtained in the mean values of the variables "slow eating" (p = 0.016) and "response to satiety" (p = 0.001) of the groups with and without caries. That is, the time a person spends eating influences the development of caries. Likewise, the ability of a person to be satisfied is also related to caries.

CONCLUSIONS

The eating behavior pattern of children is a risk factor associated with infant caries.

Appetitive behaviors and body composition in school-age years: Bi-directional analyses in a population-based birth cohort

Cross-sectional studies have consistently associated appetitive behaviors with child body mass index. However, few prospective studies have investigated the association between appetite and other measures of body composition and its directionality. We aimed to investigate the bi-directional relationship between appetitive behaviors and body composition in school-aged children. Data from 3668 children of the Generation XXI birth cohort were analyzed. Appetitive behaviors were assessed at 7 and 10 years through the Children's Eating Behavior Questionnaire. Higher fat mass and fat-free mass were measured through tetrapolar bioelectric impedance and waist-to-weight and waist-to-height ratios were calculated. Fat and fat-free mass indexes, waist-to-weight and waist-to-height age- and sex-specific z-scores were then calculated. Cross-lagged analyses were performed (body composition at 7 to appetitive behaviors at 10 and the reverse) to measure the magnitude and direction of associations. Fat mass and waist-to-height ratio at 7y predicted greater food approach behaviors at 10y (Enjoyment of Food, Food Responsiveness, Desire to Drink and Emotional Overeating), but not waist-to-weight, which seems to be consequence of child's avid appetite (e.g. Enjoyment of Food at 7y: β_standardized = 0.085, 95%CI = 0.041; 0.128, p < 0.001). Child scores on food avoidant behaviors, such as Satiety Responsiveness (β_standardized = -0.073, 95%CI = -0.110;-0.034, p < 0.001) and Slowness in Eating (β_standardized = -0.080, 95% CI = -0.120;-0.041, p < 0.001) at 7y predicted lower fat-free mass at 10. Appetitive behaviors may not solely predict weight status, but the path of association between body composition and later appetitive behavior may also be true, especially for food approaching behaviors and adipose tissue. Interventions aiming to prevent excess weight should focus on appetitive behaviors. Moreover, in children with higher adiposity, other pathways also seem to regulate appetite and need to be considered in interventions.

Caregivers' feeding behaviour, children's eating behaviour and weight status among children of preschool age in China

BACKGROUND

Childhood overweight and obesity have become significant public health challenges worldwide. The present study aimed to investigate whether caregivers' feeding behaviour and children's eating behaviour were associated with the weight status of preschool children in China.

METHODS

A cross-sectional questionnaire was administered to 912 caregivers of preschool children from April to July 2016. Caregivers' feeding behaviours were assessed by the Chinese Preschooler's Caregiver Feeding Behaviour Scale. Children's eating behaviours were evaluated using the Chinese Preschooler's Eating Behaviour Questionnaire. After controlling for demographic characteristics, multiple linear regression and logistic regression analyses were performed to evaluate the relationship between caregivers' feeding behaviour, children's eating behaviour and children's body mass index (BMI).

RESULTS

The results showed that weight concerns on the part of caregivers (β = 0.53) and food responsiveness on the part of children (β = 0.93) were positively correlated with children's BMI, whereas caregivers' responsibility for feeding (β = -0.68) and children's external eating (β = -0.53) were negatively correlated with BMI. Among caregiver feeding behaviours, weight concerns [odds ratio (OR) =4.54, p < 0.001] and behaviour-restricted feeding (OR =0.29, p < 0.001) were positively correlated with children's BMI. A child's food responsiveness (OR =4.04, p < 0.001) was also positively correlated with his/her BMI, whereas the child's satiety responsiveness (OR =0.42, p < 0.001) and emotional eating habits (OR =0.56, p < 0.001) were negatively correlated with overweight/obesity status.

CONCLUSIONS

Our study demonstrated that children's eating behaviour and caregivers' feeding behaviour were associated with weight status among preschool children in China. Behaviour interventions on caregivers and their children may prevent or reduce weight problems in preschool children.