Breast-feeding duration and child eating characteristics in relation to later vegetable intake in 2-6-year-old children in ten studies throughout Europe

Eating Behaviours and Dietary Intake in Children and Adolescents: A Systematic Review

PURPOSE OF REVIEW

This systematic review aimed to examine existing evidence related to associations between eating behaviours and dietary intake in children and adolescents, with a focus on the Children Eating Behaviour Questionnaire (CEBQ) and the Dutch Eating Behaviour Questionnaire (DEBQ) as assessment tools.

RECENT FINDING

We conducted a systematic review following PRISMA guidelines. We included observational and interventional studies published in English, Spanish, or Portuguese, that evaluated the association between eating behaviours and food and beverage intake. Thirteen studies from nine countries met the inclusion criteria, with sample sizes ranging from 62 to 4,914 individuals aged 2 to 16 years-old. Ten studies used the CEBQ, and three used the DEBQ. Our retrieved studies showed that children and adolescents engaging in food approach behaviours tend to consume foods rich in sugar and fats. However, we observed a higher consumption of fruits and vegetables. On the other hand, children and adolescents with lower engagement to food avoidant behaviours, generally exhibited a lower overall food consumption, except for snacks, which they consumed at a higher rate. This systematic review suggests that eating behaviours play an important role in shaping dietary intake. Nevertheless, due to the heterogeneity related to eating behaviours and diet intake, it highlights the need for further research to understand these complex relationships to develop effective interventions for promoting healthy eating habits in children and adolescents.

Socioeconomic Characteristics and the Home Food Environment Are Associated With Feeding Healthful and Discretionary Foods During the First Year of Life in the Pregnancy Eating Attributes Study

BACKGROUND

Feeding of nutrient-poor foods begins in infancy and may adversely influence long-term food preferences.

OBJECTIVE

To examine associations of socioeconomic characteristics, childbearing parent eating behaviors, and home food environment with infant feeding characteristics.

DESIGN

Secondary analysis of a prospective cohort study from first trimester of pregnancy through 12 months postpartum.

PARTICIPANTS/SETTING

Participants with uncomplicated singleton pregnancies and no major chronic illness were enrolled from November 2014 through October 2016 from 2 university-based obstetrics clinics in Chapel Hill, NC. Of 458 enrolled, 321 were retained through 12 months postpartum.

MAIN OUTCOME MEASURES

Participants completed infant food frequency questionnaires indicating age at introduction and frequency of consuming multiple food groups. Exposures included childbearing parent socioeconomic characteristics, hedonic hunger, addictive-like eating, Healthy Eating Index 2015 calculated from three 24-hour diet recalls, and home food environment fruit/vegetable and obesogenic scores.

STATISTICAL ANALYSES PERFORMED

Multiple imputation using Heckman selection model; linear and logistic regressions examining associations with infant feeding characteristics.

RESULTS

Lower education and income were associated with later infant age at introduction to, and lower frequency of consuming fruits and vegetables at age 12 months. Socioeconomic characteristics were not associated with age at introduction to discretionary solid foods; however, lower education and income were associated with greater infant frequency of intake of discretionary foods and greater odds of introducing fruit juice and sweetened beverages by age 12 months. Childbearing parent Healthy Eating Index 2015, hedonic hunger, and addictive-like eating were not consistently associated with infant feeding characteristics. A more obesogenic food environment was associated with greater frequency of intake of discretionary foods, lower frequency of intake of fruit, and greater odds of fruit juice introduction by age 12 months.

CONCLUSIONS

Infant feeding characteristics may be important intervention targets for addressing socioeconomic disparities in child diet quality. Efforts to reduce routine feeding of discretionary foods across socioeconomic groups are needed; modifying the home food environment may promote healthful infant feeding.

Association between breast feeding and food consumption according to the degree of processing in Brazil: a cohort study

BACKGROUND

The benefits of breast feeding may be associated with better formation of eating habits beyond childhood. This study was designed to verify the association between breast feeding and food consumption according to the degree of processing in four Brazilian birth cohorts.

METHODS

The duration of exclusive, predominant and total breast feeding was evaluated. The analysis of the energy contribution of fresh or minimally processed foods (FMPF) and ultra-processed foods (UPF) in the diet was evaluated during childhood (13-36 months), adolescence (11-18 years) and adulthood (22, 23 and 30 years).

RESULTS

Those who were predominantly breastfed for less than 4 months had a higher UPF consumption (β 3.14, 95% CI 0.82 to 5.47) and a lower FMPF consumption (β -3.47, 95% CI -5.91 to -1.02) at age 22 years in the 1993 cohort. Exclusive breast feeding (EBF) for less than 6 months was associated with increased UPF consumption (β 1.75, 95% CI 0.25 to 3.24) and reduced FMPF consumption (β -1.49, 95% CI -2.93 to -0.04) at age 11 years in the 2004 cohort. In this same cohort, total breast feeding for less than 12 months was associated with increased UPF consumption (β 1.12, 95% CI 0.24 to 2.19) and decreased FMPF consumption (β -1.13, 95% CI -2 .07 to -0.19). Children who did not receive EBF for 6 months showed an increase in the energy contribution of UPF (β 2.36, 95% CI 0.53 to 4.18) and a decrease in FMPF (β -2.33, 95% CI -4 .19 to -0.48) in the diet at 13-36 months in the 2010 cohort. In this cohort, children who were breastfed for less than 12 months in total had higher UPF consumption (β 2.16, 95% CI 0.81 to 3.51) and lower FMPF consumption (β -1.79, 95% CI -3.09 to -0.48).

CONCLUSION

Exposure to breast feeding is associated with lower UPF consumption and higher FMPF consumption in childhood, adolescence and adulthood.

Association between breast-feeding exposure and duration with offspring's dietary patterns over 1 year of age: a systematic review of observational studies

Some evidence suggests that breast-feeding may modify food preferences in the later years of life. The present study aimed to provide a systematic review of observational studies investigating the association between exposure to breast milk and its duration with data-driven or hypothesis-driven (or diet quality scores) dietary patterns over 1 year of age. The databases of PubMed, Scopus and Web of Science were searched for observational studies published from January 2010 until July 2021, which led to the identification of twenty-two eligible articles. There was considerable heterogeneity between studies in terms of assessment of exposure and outcome. Of the eleven studies that assessed data-driven dietary patterns, ten reported a significant association for at least one identified dietary pattern. Overall, being breast-fed and a longer duration of any/exclusive breast-feeding were associated with higher scores on healthy dietary patterns characterised mainly by high loadings of fruits, vegetables and whole grains. In comparison, a negative association was found for unhealthy dietary patterns rich in foods with high content of added sugar, salt and saturated fats. In terms of diet quality scores, nine out of eleven studies reported a significant positive association between the duration of any breast-feeding and adherence to recommended healthy diets or dietary guidelines. In conclusion, the evidence from this review was generally in support of the hypothesis indicating breast-feeding is associated with healthy dietary patterns at later ages. However, due to the methodological limitations in the available studies, further research is warranted to elucidate solid evidence on this topic.

Food Trying and Liking Related to Grade Level and Meal Participation

School-based child nutrition programs provide students with meals and snacks that align with guidelines for a healthy eating pattern. However, participation is not universal, and research on the determinants of food selection is needed to improve school nutrition practices and policies. The purpose of this study was to examine the relationships between grade level (i.e., grade school, middle school, or high school) as well as meal participation category (i.e., only breakfast, only lunch, or both) and food trying and liking in a large urban school district. Outcomes were measured using an online survey completed by students from 2nd through 12th grade (n = 21,540). Breakfast and lunch item liking scores were higher among the grade school and middle school students than among the high school students. Breakfast and lunch liking scores were also higher among those who participated in both breakfast and lunch as opposed to those who only participated in one meal. Food item liking scores were positively correlated with the percentage of students who had tried the particular foods (r = 0.52, p < 0.001), and the number of foods tried was dependent on both grade level and meal participation category (F(4, 21,531) = 10.994, p < 0.001). In this survey of students, both grade level and meal participation category were found to be related to the liking of foods, while foods that were tried more often tended to be liked more. Future studies should consider grade level and meal participation when exploring student preferences. School nutrition programs should also consider these factors when assessing satisfaction.

Associations between feeding practices in infancy and fruit and vegetable consumption in childhood

A diet rich in fruits and vegetables may reduce the risk of chronic diseases. However, in many countries, the majority of children do not eat the recommended quantities of fruits and vegetables. The present study aimed to understand associations between feeding practices in infancy (breast-feeding and first complementary food) and fruit and vegetable consumption in childhood (frequency and variety). Data were from the national, observational, cross-sectional Mothers and their Children’s Health study conducted in 2016/2017, a sub-study of the national Australian Longitudinal Study on Women’s Health. Mothers completed a written survey on feeding practices in infancy (breast-feeding duration, use of formula, first complementary food) and children’s fruit and vegetable frequency (number of times eaten) and variety (number of different types eaten) in the past 24 h, using the Children’s Dietary Questionnaire. Children (n 4981, mean 7·36 (sd 2·90) years) ate vegetables 2·10 (sd 1·11) times and fruits 2·35 (sd 1·14) times and ate 3·21 (sd 1·35) different vegetables and 2·40 (sd 1·18) different fruits, on average. Compared with breast-feeding for <6 months, breast-feeding for ≥6 months was associated with higher vegetable variety. Compared with cereal as the first complementary food, fruits or vegetables were associated with higher vegetable frequency and variety, and higher fruit frequency. Overall, infancy is a window of opportunity for dietary intervention. Guidance to parents should encourage the use of fruits and vegetables at the beginning of complementary feeding.

Analysis of Association between Breastfeeding and Vegetable or Fruit Intake in Later Childhood in a Population-Based Observational Study

Vegetable and fruit consumption in childhood remains below recommendations in many countries. As the intake of fruit and/or vegetables during childhood in a few studies was associated with breastfeeding, it may be suggested as a serious interfering factor while analyzing the association between breastfeeding and its long-term health effects. Thus, it may be important for creation and implementation of effective public health programs. The aim of this study was to evaluate the association between breastfeeding and consumption of fruit or vegetables in later childhood. The study was conducted within the Project “ABC of Healthy Eating—ABC of Kids and Parents” among a representative sample of 703 pairs of mothers and children aged 7–12 years in Poland. A systematic purposive-quota selection according to gender, age, place of residence, and region of Poland was applied. The study was conducted by interviewers in the respondents’ homes in 2017. Logistic regression analysis was conducted, and models adjusted for children’s age, BMI centile and gender, maternal education, employment status, and economic situation, as well as for EU–28 average Gross Domestic Product (GDP) region. Almost 86% of children were ever breastfed. Vegetables for breakfast, second breakfast, dinner, supper, and between meals were consumed by 23.9%, 18.6%, 47.4%, 26.7%, and 4.0% of children, whereas fruit was consumed by 13.9%, 46.1%, 7.7%, 12.9%, and 59.7% of children, respectively. Breastfeeding for a period of 4–6 months increased the chance of vegetable consumption for breakfast in the whole group (aOR 3.80, 95% CI 1.90–7.59, p ≤ 0.001) and particularly in girls (aOR 4.60, 95% CI 1.43–14.75, p ≤ 0.01) when compared to boys (aOR 3.17, 95% CI 1.32–7.63, p ≤ 0.01). Longer duration of breastfeeding (over 12 months) increased the chance of vegetable consumption for dinner in the total group (aOR 2.36, 95% CI 1.30–4.26, p ≤ 0.01) and particularly in girls (aOR 3.04, 95% CI 1.24–7.46, p ≤ 0.01) when compared to boys (aOR 2.20, 95% CI 1.01–4.95, p ≤ 0.05). We showed a positive association between breastfeeding and vegetable consumption for breakfast and dinner among children aged 7–12 years. These associations were gender-specific (stronger among girls) and were not diminished by socio-demographic factors.

Maternal diet during lactation and breast-feeding practices have synergistic association with child diet at 6 years

OBJECTIVE

Children breast-fed during infancy consume more fruits and vegetables than formula-fed children. This pattern is likely due, in part, to infant learning from flavours of the mother's diet transmitted through breast milk, but more research is needed to understand associations between early flavour exposures and later dietary patterns. We examined whether breast-feeding and maternal fruit and vegetable consumption during nursing were synergistically associated with higher child fruit and vegetable consumption.

DESIGN

Prospective cohort study of breast-feeding duration, maternal diet postpartum and child diet. Complete breast-feeding and maternal diet data were available for 1396 mother-child dyads; multiple imputation was used for missing data in other variables. In separate multivariable logistic regression models, we estimated the adjusted odds of high child fruit or vegetable consumption at 12 months or 6 years as a function of breast-feeding duration, maternal fruit or vegetable consumption during nursing, and their interaction.

SETTING

The Infant Feeding Practices Study II and Year 6 Follow-Up.

PARTICIPANTS

Mother-child dyads followed from birth to 6 years during 2005-2012 in the USA.

RESULTS

Longer breast-feeding duration was associated with high child fruit and vegetable consumption at 12 months. At 6 years, the interaction between breast-feeding duration and maternal vegetable consumption was associated with high child vegetable consumption.

CONCLUSIONS

Higher maternal vegetable consumption and longer breast-feeding duration were synergistically associated with high child vegetable consumption at 6 years, independent of sociodemographic characteristics and fruit and vegetable availability. Exposures to vegetable flavours through breast milk may promote later child vegetable consumption.