Controlling and less controlling feeding practices are differentially associated with child food intake and appetitive behaviors assessed in a school environment

Associations between restrictive feeding practices and children's dietary intake: Systematic review and meta-analyses

BACKGROUND

Parents' attempt to limit or restrict children's intake of 'unhealthy' or discretionary foods has been widely considered as a counterproductive feeding practice associated with poorer dietary outcomes, but empirical evidence is varied.

AIM

The present systematic literature review aimed to investigate the association between parental restriction and children's dietary intake.

METHOD

Studies were identified through PsycInfo, MEDLINE, CINAHL, Web of Science, and Scopus databases on April 29th, 2022. Included were peer-reviewed, English-language articles published between 2001 and 2022, with an effect size between restriction and children's intake of foods that are 'healthy' (i.e., fruit, vegetables, other general healthy foods) or 'discretionary' (i.e., sweet or savoury energy-dense/nutrient poor foods, high-sugar foods, high-salt/fat foods, and high-energy/sugar-sweetened beverages), or overall diet quality. Risk of bias was assessed using a quality assessment checklist designed to evaluate survey studies.

RESULTS

Included studies (n = 44) were most often conducted in the USA, cross-sectional, and participants were mothers. Effect sizes (k = 59) from 21 studies were used in nine meta-analyses investigating various healthy and discretionary dietary intake variables. No meta-analytic effects were statistically significant. Qualitative synthesis of effect sizes ineligible for meta-analysis (k = 91) identified patterns of associations between restriction and increased intake of healthy foods, and decreased intake of discretionary foods.

CONCLUSIONS

Studies used a diverse selection of measures of restriction and dietary intake, limiting the ability of this review to make accurate cross-study comparisons. However, results suggest that instead of restriction being detrimental for children's dietary outcomes, it may be unrelated, or associated with more beneficial dietary outcomes. Research that utilises validated measures of restriction and dietary outcomes and a longitudinal design is needed to clarify this association.

Food intake and eating behaviour during a real-life Snack Scenario in childhood obesity-An experiment using a hidden camera

OBJECTIVE

To compare food intake and eating behaviour in children and adolescents with obesity (OBE) undergoing weight loss intervention and normal weight (NW) in a real-life Snack Scenario.

METHODS

Sixty OBE were examined before (T0) and after weight loss (T1) and compared to a single measurement comparison group of 27 NW. Participants watched a 20-min film and were encouraged to snack from a variety of foods ad libitum. Food intake was measured and eating behaviour assessed via a hidden camera and a validated questionnaire.

RESULTS

The food and energy intake did not differ between NW (155 ± 83 g, 1067 ± 732 kJ) and OBE at T0 (144 ± 106 g, 1088 ± 883 kJ) but increased in OBE at T1 (187 ± 91 g, 1544 ± 845 kJ). Latency of food intake was significantly shorter in NW (0 m:07 s ± 0 m:08 s) compared to OBE (T0: 1 m:11 s ± 2 m:57 s). After weight loss, latency decreased in OBE (0 m:26 s ± 1 m:00 s). NW touched food more often (49 ± 24) than OBE (T0: 29 ± 23), but takes from plate were similar. The questionnaire revealed differences between OBE and NW, not correlating with Snack Scenario observations.

CONCLUSION

Eating behaviours differed in NW versus OBE at T0 but food intake was similar. Therefore, behaviour while eating may be an underestimated factor in the considerations for childhood obesity.

CLINICAL TRIAL REGISTRATION

German Clinical Trials Register (DRKS) with the trial number DRKS00005122.

Feeding under fire: Relations between parental stress hormones and controlling feeding behaviors

Under stress, parents tend to use more controlling feeding behaviors toward their children (Berge et al., 2017; Doan et al., 2022; Loth et al., 2016). However, the majority of prior work focuses on subjective reports of stress, and there is a dearth of research examining parental physiological stress and its impact on feeding behaviors. In the current study, we examined how parental physiological stress reactivity would influence their feeding behaviors under mild stress in a lab-based setting. Parents (n = 83, 50 % females) and their children (59% female, Mage = 42 months, SD = 4.48) participated. Stress was induced using the Trier Social Stress Test in the laboratory (Kirshbaum et al., 1993). Salivary samples were collected at 4 time points during the visit to index stress reactivity and later assayed for cortisol and DHEA. Parent-child interactions during the anticipatory period of the stress test were observationally coded for parent use of controlling feeding behaviors. To examine whether parent stress physiology predicts their feeding behaviors, we ran a Poisson regression using income, parent ethnicity, parent sex (mom/dad), time of day, and DHEA/cortisol ratio as predictors of controlling feeding behavior. Latinx parents used less controlling feeding behaviors, b = -0.323, p = 0.041 than non-Latinx parents. Parents with a higher DHEA/Cortisol ratio were less likely to use controlling feeding behaviors, b = -0.231, p = 0.008. To our knowledge, this is the first study to show that for both mothers and fathers, DHEA relative to cortisol has a protective role in controlling feeding practices, and lends support to the role of acute stress reactivity in predicting behavioral outcomes.

Food Behaviour and Metabolic Characteristics of Children and Adolescents with Type 1 Diabetes: Relationship to Glycaemic Control

Diet is an essential element of treating and managing type 1 diabetes (T1D). However, limited research has examined food behaviour in children and adolescents with T1D and their relationship to glycaemic control. This study evaluated food behaviour, metabolic characteristics and their impact on the glycaemic control of children and adolescents with T1D. Two hundred and fifty-eight participants with T1D (6-15 years, duration of diabetes >1 year) were recruited. Demographic, anthropometric and clinical data were collected. Questionnaires on food neophobia and food preferences were administered. The Child Food Questionnaire (CFQ) also assessed parental feeding practices. An analysis of food behaviour showed that food neophobia was inversely associated with the liking of vegetables, fruits, fish, sweets and carbohydrates. Moreover, by analysing parental feeding practices, an inverse association of "Pressure to eat", "Monitoring" and "Restriction" with liking for vegetables and carbohydrates emerged. Considering glycaemic control, increased food neophobia and the parent practices "Restriction", "Pressure to eat" and "Concern about weight" were found in participants with glycated haemoglobin (HbA1c) values >8.5%. Finally, higher body mass index (BMI) and total cholesterol values were observed in subjects with HbA1c values >8.5%. These findings contribute to a better understanding of eating behaviour, metabolic status and their complex relationship with glycaemic control.

Parental child-feeding practices at 4 years of age are associated with dietary patterns of 7-year-olds

BACKGROUND

Parental child-feeding practices have been associated with child body mass index (BMI) and specific food group consumption; however, their role in the development of dietary patterns is less understood. We aim to study the association between parental child-feeding practices at 4 years old and dietary patterns at 7 years that explain BMI z-scores at age 10.

METHODS

Participants were children from the Generation XXI birth cohort (n = 3272). Three patterns of feeding practices at 4 years were previously identified: 'Perceived monitoring', 'Restriction' and 'Pressure to eat'. At 7 years, two dietary patterns were derived: 'Energy-dense foods', higher consumption of energy-dense foods and drinks and processed meats and lower consumption of vegetable soup (significantly associated with BMI z-scores at 10 years) and 'Fish-based', higher in fishery intake and lower in energy-dense food intake. Associations were estimated by linear regression models, adjusted for potential confounders (mother's age, education and pre-pregnancy BMI).

RESULTS

Girls whose parents used more Restriction, Perceived monitoring and Pressure to eat at 4 years were less likely to follow the 'Energy-dense foods' dietary pattern at 7 years (β̂ = -0.082; 95% confidence intervals [CI]: -0.134; -0.029; β̂ = -0.093; 95% CI: -0.146; -0.039; β̂ = -0.079; 95% CI: -0.135; -0.04, respectively). In both sexes, children whose parents used more Restriction and Perceived monitoring at 4 years were more likely to follow the 'Fish-based' dietary pattern at 7 years (girls: β̂ = 0.143; 95% CI: 0.077; 0.210; β̂ = 0.079; 95% CI: 0.011; 0.148; boys: β̂ = 0.157; 95% CI: 0.090; 0.224; β̂ = 0.104; 95% CI: 0.041; 0.168).

CONCLUSIONS

Children whose parents used more Restriction and Perceived monitoring at preschool age were more likely to follow healthier dietary patterns at age 7.

Parental feeding practices as a response to child appetitive traits in toddlerhood and early childhood: a discordant twin analysis of the Gemini cohort

BACKGROUND

Parental feeding practices (PFPs) have been implicated in the development of children's eating behaviours. However, evidence suggests that feeding practices may also develop in response to their child's weight or emerging appetitive traits. We used the twin design to test the hypothesis that parents develop their feeding practices partly in response to their child's appetite.

METHODS

Data were from Gemini, a population-based cohort of 2402 British families with twins born in 2007. Psychometric measures of PFPs and appetite were completed by parents when their twins were 16-months and 5-years. Within-family analyses including all twins with available data in the sample (n = 1010-1858 pairs), examined if within-pair differences in PFPs were associated with differences in appetitive traits, controlling for differences in birth weight-SDS, early feeding method and child sex. In a subsample of twin pairs who were considerably discordant for appetitive traits by ≥ 1SD (n = 122-544 pairs), the direction and magnitude of within-pair differences in feeding practices was explored.

RESULTS

Within-family variation in parental feeding practices in toddlerhood and early childhood was low (discordance ranged from 0.1 to 6% of the sample), except for pressure to eat (toddlerhood: 19%; early childhood: 32%). Within-pair differences in all appetitive traits were associated with differential use of 'pressure to eat' at both 16-months and 5-years. In the subsample of twins most discordant for appetitive traits, parents used more pressure with the twin expressing lower food responsiveness, lower emotional overeating, lower food enjoyment, higher satiety responsiveness, slower speed of eating, higher emotional undereating and greater fussiness in toddlerhood and early childhood (p-values < 0.001). Effect sizes were small to large at 16-months (η²=0.02-0.09) and 5-years (η²=0.05-0.21).

CONCLUSION

Parents rarely varied their feeding practices between twins in toddlerhood and early childhood, except for pressure. Parents exerted greater pressure on their twin who expressed a poorer appetite compared to their co-twin, suggesting that parents develop a pressuring feeding style when their child expresses a poorer appetite or lower interest in, and enthusiasm for, eating. These findings could be used to guide interventions seeking to support parents in feeding their children in a way that nurtures the development of healthy eating behaviours.

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.

Parental Feeding Practices and Children's Eating Behaviours: An Overview of Their Complex Relationship

Several studies have found an association between eating behaviours and weight status and obesity risk in childhood. Children's eating behaviours arise from a combination of genetic and environmental factors. Parents appear to play a central role in their development as the main responsible for shaping children's feeding environment and eating experiences. The purpose of this paper is to review the literature on parental influences on eating behaviours across childhood, mainly focusing on parental feeding practices. The associations between parental feeding practices and children's eating behaviours have been extensively studied. However, most of the findings come from cross-sectional studies, so the possibility of reverse causality cannot be ruled out (i.e., children's behaviours influencing parents). Most recently, a few longitudinal studies with a cross-lagged design have shown that the relationship between children's eating behaviours and parental feeding practices seems to be bidirectional, where it is not straightforward whether parental feeding practices are a predictor or a consequence of children's eating behaviours. Children's eating behaviours influence parents to adopt certain feeding practices, but these practices also influence children's behaviours over time. Parental feeding practices may have the potential to shape children's eating behaviours and should be targeted to promote the development of non-obesogenic traits. However, parent-child interactions are complex and therefore both parent and child characteristics and the family dynamics should be considered.

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

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

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

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

Profiles of Behavioral Self-Regulation and Appetitive Traits in Preschool Children: Associations With BMI and Food Parenting Practices

Appetitive traits that contribute to appetite self-regulation have been shown to relate to non-food-related regulation in general domains of child development. Latent profile analysis (LPA) was used to identify typologies of preschool children's behavioral self-regulation (BSR) and appetitive traits related to appetite self-regulation (ASR), and we examined their relation with children's BMIz and food parenting practices. Participants included 720 children and their parents (90% mothers), drawn from the baseline assessment of a childhood obesity preventive intervention. BSR measures included teacher reports of children's inhibitory control, impulsivity and attentional focusing, as well as an observed measure of inhibitory control. ASR was assessed using parents' reports of children's appetitive traits related to food avoidance (e.g., satiety responsiveness, slowness in eating) and food approach (e.g., enjoyment of food, food responsiveness). Children's body mass index z-score (BMIz) was calculated from measured height and weight. Parents' BMI and food parenting practices were also measured. Four profiles were identified that characterized children with dysregulated behavior, higher food approach and lower food avoidance (16%), dysregulated behavior but lower food approach and higher food avoidance (33%), regulated behavior but highest food approach and lowest food avoidance (16%), and highly-regulated behavior, lowest food approach and highest food avoidance (35%). Children's BMIz was highest in the profile consisting of children with dysregulated behavior, higher food approach and lower food avoidance. BMI was similar in the profile with children with regulated behavior but highest food approach and lowest food avoidance; children in this profile also had parents who reported the highest levels of controlling food parenting practices, and the lowest levels of parental modeling of healthy eating. Compared to all other profiles, children in the profile characterized by highly-regulated behavior, lowest food approach and highest food avoidance had the lowest BMIz and had parents who reported food parenting practices characterized by the highest levels of child control in feeding and the lowest levels of pressure to eat. These findings provide evidence of differing patterns of relations between self-regulation across behavioral and eating domains, and children's obesity risk may vary based on these different patterns.

An exploration of eating behaviours and caregiver mealtime actions of children with Tourette syndrome

Food avoidant behaviours are common concerns amongst individuals with Tourette syndrome, with high levels of food selectivity reported in children and food neophobia and avoidant restrictive eating behaviours in adults. However, less is known about food approach behaviours. The current study aimed to explore differences in food approach and food avoidant eating behaviours in children with Tourette syndrome (TS) and their relationship to caregiver mealtime actions. Thirty-seven caregivers of children with Tourette syndrome were compared with children with Autism Spectrum Disorders, children with Attention-Deficit/Hyperactivity Disorder and a control group. Caregivers completed the Child Eating Behaviour Questionnaire and Parent Mealtime Action Scale-Revised. Caregiver-reported findings revealed that children with Tourette syndrome exhibited more food approach behaviours, specifically greater food responsiveness, emotional overeating and desire to drink, compared to controls. Children from the three neurodiverse groups had similar levels of emotional overeating and food selectivity, which were all significantly higher than the control group. Positive persuasion was uniquely identified as a mealtime strategy adopted by caregivers of children with Tourette syndrome. The results suggest that children with Tourette syndrome are at more risk of showing a broader array of food difficulties than previously reported, including food avoidant and approach behaviours. It is encouraged that clinicians monitor eating behaviour in appointments with children with Tourette syndrome.

Parental feeding practices and ultra-processed food consumption in preschool children

ABSTRACT: Objective: To investigate the association between parental feeding practices and the consumption of ultra-processed foods in preschool children. Methods: Cross-sectional study with 140 parents (father and mother) and their children (2-6 year-old). Parental feeding practices were assessed using the Comprehensive Feeding Practices Questionnaire. Children’s body weight and height were measured, and body mass index z-score per age was calculated. Parental anthropometric measurements (body weight and height) were obtained by self-report, and body mass index was calculated. The consumption of ultra-processed foods was assessed through the Child Food Frequency Questionnaire and the daily intake score was calculated. Multivariable linear regression analyses were performed to investigate the association between parental feeding practices and the consumption of ultra-processed foods. Results: Children’s ultra-processed food consumption was negatively associated with the “Monitoring” parental feeding practices. On the other hand, “Emotion Regulation” and “Health restriction” parental feeding practices were positively associated with the ultra-processed food consumption score. Conclusion: Ultra-processed food consumption was associated to the “Monitoring”, “Emotion regulation” and “Health restriction” parental feeding practices in preschool children. These results support the importance of using successful parental feeding practices to promote healthy eating in preschoolers.

Association between Parents' Perceptions of Preschool Children's Weight, Feeding Practices and Children's Dietary Patterns: A Cross-Sectional Study in China

Parental perception of children's weight may influence parents' feeding practices, and in turn, child dietary intake and weight status; however, there is limited evidence generated for preschoolers. The aim of this cross-sectional study was to investigate associations between Chinese parents' perceptions of child weight, feeding practices and preschoolers' dietary patterns. Participants (1616 parent-child pairs) were recruited from six kindergartens in Hunan, China. Parents' misperception, concern, and dissatisfaction on child weight were collected through a self-administered caregiver questionnaire. Parental feeding practices and children's dietary intake were, respectively, assessed using the Child Feeding Questionnaire and a Food Frequency Questionnaire. Linear regression models were applied to analyze associations between parental weight perceptions, feeding practices, and preschooler's dietary patterns. Associations between parents' weight perceptions and dietary patterns were significant only among underweight children. Regardless of child weight status, parental weight underestimation and preference for a heavier child were positively associated with pressure-to-eat. Parental weight concern was positively associated with restriction in normal weight child, but this was not found in other weight groups. In conclusion, Parents' misperception, concern, and dissatisfaction about child weight are associated with parents' feeding practices and may influence preschoolers' dietary quality, but the relationships vary by children's actual weight status.

Promoting vegetable intake in preschool children: Independent and combined effects of portion size and flavor enhancement

This study investigated the independent and combined effects on preschool children's vegetable intake of serving a larger portion of vegetables and enhancing their flavor. In a crossover design, lunch was served in childcare centers once a week for four weeks to 67 children aged 3-5 y (26 boys, 41 girls). The meal consisted of two familiar vegetables (broccoli and corn) served with fish sticks, rice, ketchup, applesauce, and milk. Across the four meals, we varied the portion of vegetables (60 or 120 g total weight, served as equal weights of broccoli and corn) and served them either plain or enhanced (6.6% light butter and 0.5% salt by weight). All meals were consumed ad libitum and were weighed to determine intake. Doubling the portion of vegetables led to greater consumption of both broccoli and corn (both p < 0.0001) and increased meal vegetable intake by 68% (mean ± SEM 21 ± 3 g). Enhancing vegetables with butter and salt, however, did not influence their intake (p = 0.13), nor did flavor enhancement modify the effect of portion size on intake (p = 0.10). Intake of other meal components did not change when the vegetable portion was doubled (p = 0.57); thus, for the entire meal, the increase in vegetable consumption led to a 5% increase in energy intake (13 ± 5 kcal; p = 0.02). Ratings indicated that children had similar liking for the plain and enhanced versions of each vegetable (both p > 0.31). All versions of vegetables were well-liked, as indicated by ≥ 76% of the children rating them as "yummy" or "just okay". Serving a larger portion of vegetables at a meal was an effective strategy to promote vegetable intake in children, but when well-liked vegetables were served, adding butter and salt was not necessary to increase consumption.