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

The association of early feeding practices with eating behaviors and maternal indulgent feeding behaviors among Saudi preschoolers

Evidence from previous work suggest that feeding practices during the first years of life may influence the development of eating behaviors later in childhood. Early feeding practices may also predict later maternal feeding behaviors. Mothers from an Arab/Middle Eastern background may adopt unique early feeding practices. The objective of this study was to examine the association of offering fruit juice and date syrup-milk mixture in a baby bottle during infancy with: 1) Child eating behaviors during preschool years; 2) Maternal indulgent feeding practices during preschool years. Mothers of preschoolers (n = 115) completed questions adopted from the Children's Eating Behavior Questionnaire (CEBQ), Child Feeding Questionnaire-Arabic (CFQ-A), as well as questions assessing early feeding practices and demographic characteristics. Unadjusted and adjusted logistic regression models were tested to examine the association of early feeding practices with child eating behaviors and maternal indulgent feeding behaviors. Odds ratios (ORs) and respective 95% confidence intervals (CI) were derived. Adjusting for covariates, children who were ever offered fruit juice in a baby bottle as infants were more likely to have high food responsiveness at preschool, compared to children who were not (OR = 2.93, 95% CI = 1.16, 7.42). Mothers who reported ever offering fruit juice in a baby bottle when their children were infants were more likely to adopt greater use of food as a reward when their children were at preschool (OR = 3.25, 95% CI = 1.22, 8.68). Early feeding practices are associated with child eating and maternal feeding behaviors later in childhood. Future longitudinal studies are needed to further establish these associations. Findings from this study can help inform community awareness and education programs to prevent maladaptive feeding practices and promote appropriate feeding strategies throughout childhood.

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.

Validation of the Children's Eating Behaviour Questionnaire in Poland

INTRODUCTION

Obesity is increasingly diagnosed in pre-school and early primary school children. Eating styles displayed by the youngest children may contribute to the development of overweight and obesity. Their assessment may be extremely important in diagnosing the causes of obesity, but also in planning treatment.

AIM OF THE STUDY

In view of the need to introduce a tool for assessing eating behaviours in children in Poland, the aim of the study was to develop the Polish adaptation of the Children's Eating Behaviour Questionnaire (CEBQ).

MATERIAL AND METHODS

The study group consisted of 151 mothers of children aged 3-10 years (M = 6.77, SD = 2.34), who completed the Polish version of the CEBQ. In order to assess the validity of the questionnaire, a factor analysis was conducted, using the principal components method with the Oblimin rotation and Kaiser normalization. To assess the reliability of the questionnaire, its internal consistency was checked by calculating Cronbach's alpha consistency coefficient. The external validity of the CEBQ was also checked by correlating its scales with those of the Temperament Questionnaire (EAS-C).

RESULTS

The principal components analysis extracted an eight-factor scale from the 35 items of the questionnaire in which a total of 60.57% of the common variance was explained. The validity of such an eight-factor solution was confirmed by the Kaiser method. Satisfactorily high values of Cronbach's alpha internal consistency coefficient were obtained (0.78). Positive correlations were found between emotionality and emotional undereating and overeating, between shyness and fussiness and negative correlations between activity and slowness in eating, sociability and fussiness and slowness in eating and between shyness and enjoyment of food.

CONCLUSIONS

The Polish version of the CEBQ is characterized by the acceptable validity and reliability and has a satisfactory criterion accuracy; therefore, it can be used as a psychometric tool to assess eating behaviours in Polish children.

Initial investigation of associations between feeding practices, eating behaviours, and weight status in Vietnamese children using modified questionnaires

AIMS

This cross-sectional study aims to extend the preliminary validation of the Feeding Practices and Structure Questionnaire (FPSQ) and Children's Eating Behaviour Questionnaire (CEBQ) in the Vietnamese context by examining associations between maternal feeding practices, child eating behaviours, and child weight status.

METHODS

Modified versions of the FPSQ and CEBQ were used to measure maternal feeding practices and child eating behaviours, respectively, in a sample of Vietnamese mothers of children within the age range of two to five years (n = 100). Children's weight-for-height z-scores (WHZs) were calculated using weight and height measurements obtained by clinicians. Pearson's correlation coefficients were used to examine bivariate associations between maternal feeding practices, child eating behaviours, and child WHZs. Significant variables were then entered into a multivariable regression model.

RESULTS

Child WHZs were associated with maternal persuasive feeding, and child slowness in eating, enjoyment of food/food responsiveness, and emotional undereating, but in multivariable regression analysis, only persuasive feeding (β = -0.44, p = 0.027) and slowness in eating (β = -0.39, p = 0.036) contributed significantly to the model.

CONCLUSIONS

The findings provide some evidence of construct validity for the modified questionnaires. Potential implications of dietary-related behaviours on weight status in preschool-aged children in Viet Nam are evident. However, further validation and analysis in larger datasets must be undertaken in order to examine these associations with increased certainty.

The Association between Sibship Composition and Child Eating Behaviors

Development of eating habits and patterns during childhood can have life-long effects on weight and health status. Family structure, functioning, and interactions during mealtimes may influence the development of eating behaviors among children. The objective of this study was to examine the association between sibship composition and child eating behaviors among preschoolers in Saudi Arabia. One hundred and fifteen mothers were recruited through various preschools around the city of Jeddah, Saudi Arabia. A previously validated Arabic version of the Children's Eating Behavior Questionnaire (CEBQ) was completed over the telephone along with questions assessing sibship composition and demographic characteristics. Spearman correlations and adjusted linear regression models were examined to assess the association between sibship composition and child eating behaviors. Adjusting for covariates, number of older siblings was positively associated with emotional over eating, food responsiveness, and the desire to drink. Number of older sisters was positively associated with the desire to drink but negatively associated with food fussiness. Having a greater number of older (rather than younger) siblings may be associated with food-approach eating behaviors. Having a greater number of older sisters may be associated with less food fussiness. Focusing on older siblings in encouraging healthy eating habits and appropriate food choices may be beneficial in promoting adaptive eating behaviors and prevention of excessive energy intake and weight gain. Future longitudinal and mixed-methods research studies with larger sample sizes are needed in order to better understand the underlying mechanisms for the associations between sibship composition and child eating behaviors.

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 the use of the Children's Eating Behaviour Questionnaire (CEBQ) and Feeding Practices and Structure Questionnaire (FPSQ) in Vietnamese mothers

OBJECTIVE

This preliminary pilot study aims to explore the use of the Feeding Practices and Structure Questionnaire (FPSQ) and Children's Eating Behaviour Question (CEBQ) in a sample of Vietnamese mothers.

SUBJECTS/METHODS

Cross-sectional data from the FPSQ and CEBQ were collected from a convenience sample of mothers (n = 102) who attended the Ho Chi Minh City Nutrition Centre in Viet Nam. Mothers had at least one child aged 2-5 years. The reliability of the questionnaire subscales was tested using Cronbach's alpha coefficients. Face validity was assessed using dialogue from a translation-back-translation procedure undertaken by an expert committee, and cognitive interviews conducted in a subsample of mothers (n = 6). Based on these findings, exploratory factor analyses (EFAs) were performed to assess the underlying structures of both questionnaires in this sample.

RESULTS

Cronbach's alpha coefficients for the original questionnaires ranged from 0.23 to 0.92. Limitations in translation and comprehension of items surfaced, warranting modifications of the questionnaires, which were subsequently examined using EFA. EFA of the FPSQ and CEBQ revealed a six-factor structure with 23 items, and a six-factor structure with 27 items, respectively, which were interpretable solutions for this sample. Cronbach's alpha coefficients were >0.70 for all subscales in the revised questionnaires.

CONCLUSIONS

Modified versions of the FPSQ and CEBQ are proposed for use in Viet Nam. However, prior to their use, further reliability and validity testing must be undertaken in larger samples, including assessment of test-retest reliability and construct validity, as well as confirmatory factor analysis to verify the proposed factor structures.

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

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