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Firman N, Wilk M, Marszalek M, Griffiths L, Harper G, Dezateux C. Is obesity more likely among children sharing a household with an older child with obesity? Cross-sectional study of linked National Child Measurement Programme data and electronic health records. BMJ Paediatr Open 2024; 8:e002533. [PMID: 38599801 PMCID: PMC11015308 DOI: 10.1136/bmjpo-2024-002533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND/OBJECTIVES We identified household members from electronic health records linked to National Child Measurement Programme (NCMP) data to estimate the likelihood of obesity among children living with an older child with obesity. METHODS We included 126 829 NCMP participants in four London boroughs and assigned households from encrypted Unique Property Reference Numbers for 115 466 (91.0%). We categorised the ethnic-adjusted body mass index of the youngest and oldest household children (underweight/healthy weight <91st, ≥91st overweight <98th, obesity ≥98th centile) and estimated adjusted ORs and 95% CIs of obesity in the youngest child by the oldest child's weight status, adjusting for number of household children (2, 3 or ≥4), youngest child's sex, ethnicity and school year of NCMP participation. RESULTS We identified 19 702 households shared by two or more NCMP participants (% male; median age, range (years)-youngest children: 51.2%; 5.2, 4.1-11.8; oldest children: 50.6%; 10.6, 4.1-11.8). One-third of youngest children with obesity shared a household with another child with obesity (33.2%; 95% CI: 31.2, 35.2), compared with 9.2% (8.8, 9.7) of youngest children with a healthy weight. Youngest children living with an older child considered overweight (OR: 2.33; 95% CI: 2.06, 2.64) or obese (4.59; 4.10, 5.14) were more likely to be living with obesity. CONCLUSIONS Identifying children sharing households by linking primary care and school records provides novel insights into the shared weight status of children sharing a household. Qualitative research is needed to understand how food practices vary by household characteristics to increase understanding of how the home environment influences childhood obesity.
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Affiliation(s)
- Nicola Firman
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Marta Wilk
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Milena Marszalek
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Lucy Griffiths
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Gill Harper
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Carol Dezateux
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Mosli RH. Sibship Composition and BMI Z-Score Among Saudi Preschoolers: A Cross-Sectional Study. Cureus 2024; 16:e56485. [PMID: 38638783 PMCID: PMC11026033 DOI: 10.7759/cureus.56485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/20/2024] Open
Abstract
Background and objective The association between sibship composition and child body mass index (BMI) has not been investigated in any Arab/Middle Eastern populations. In light of this, this study aimed to examine the association of the number of siblings, number of older siblings, and number of younger siblings with child BMI z-score (BMIz) among preschoolers in the Kingdom of Saudi Arabia (KSA). Methods A total of 209 mothers and their children were recruited from preschools in Jeddah, KSA. Mothers reported their responses to the study questionnaire via telephone. Child anthropometry was objectively measured; BMIz was calculated based on age- and sex-specific World Health Organization (WHO) growth standards and reference data. We used hierarchical multiple linear regression to examine the association between sibship composition variables and child BMIz, independent of the effect of potential confounders, and to evaluate changes in model fit. Results The number of siblings was negatively associated with child BMIz [b = -0.18, 95% confidence interval (CI) = -0.35, -0.06, p<0.01, adjusted R2 = 0.16]. There was a negative association between the number of older siblings and child BMIz (b = -0.23, 95% CI = -0.38, -0.11, p<0.01, adjusted R2 = 0.21) as well as between the number of older sisters and child BMIz (b = -0.18, 95% CI = -0.52, -0.09, p<0.01, adjusted R2 = 0.19). However, there were no significant associations between the number of older brothers or the number of younger siblings and child BMIz. Conclusions Based on our findings, sibship composition was found to be associated with BMIz among a sample of preschoolers in KSA. More research is needed to further establish this association and to understand the underlying mechanism of the association of the greater number of older siblings and older sisters with lower BMIz.
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Affiliation(s)
- Rana H Mosli
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, SAU
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Yoshinaga M, Takahashi H, Ito Y, Aoki M, Miyazaki A, Kubo T, Shinomiya M, Horigome H, Tokuda M, Lin L, Ogata H, Nagashima M. Developmental trajectories at a high risk for childhood overweight/obesity. Pediatr Int 2023; 65:e15425. [PMID: 36416571 DOI: 10.1111/ped.15425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 08/24/2022] [Accepted: 10/12/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The associations between developmental patterns (trajectories) in children and maternal factors have been widely investigated, but paternal effects on these trajectories are unclear. This study aimed to determine child and parental factors involved in developmental trajectories at high risk for causing adverse cardiovascular (CV) profiles in children. METHODS We analyzed longitudinal anthropometric data from birth to the present and CV profiles of 1,832 healthy volunteers (51% girls) aged 3-15 years who participated in a nationwide study between July 2012 and January 2014. Six trajectory latent class growth models were developed using body mass index z- scores. Predictors for being in developmental trajectories at high risk for causing adverse CV profiles were determined by multivariate regression analysis. RESULTS The mean±standard deviation number of anthropometric data points was 12±3 for both boys and girls. Among the six trajectories, the infantile onset and continual increase groups had significantly worse levels of many CV profiles than those in the remaining groups. Paternal overweight/obesity was an independent predictor for boys being in the infantile onset group and for girls being in the continual increase group. Additionally, maternal pre-pregnancy overweight/obesity in boys and maternal excessive gestational weight gain in girls were independent predictors for being in the infantile onset group. Having no sibling in boys and an older maternal age were independent predictors for being in the continual increase group. CONCLUSIONS Interventions to prevent childhood obesity should include strategies that focus on fathers and mothers as well as those that focus on children with certain types of familial background.
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Affiliation(s)
- Masao Yoshinaga
- Department of Pediatrics, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan.,Orange Medical and Welfare Center for Severe Motor and Intellectual Disabilities, Kirishima, Japan
| | | | - Yoshiya Ito
- Clinical Medicine Area, Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
| | - Machiko Aoki
- Department of Pediatrics, Aoki Internal Medicine and Cardiovascular and Pediatrics Clinic, Fukuoka, Japan
| | - Ayumi Miyazaki
- Department of Pediatrics, Japan Community Health Care Organization Takaoka Fushiki Hospital, Takaoka, Japan
| | - Toshihide Kubo
- Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Masaki Shinomiya
- Department of Internal Medicine, Nishifuna Naika, Funabashi, Japan
| | - Hitoshi Horigome
- Department of Child Health, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | | | - Lisheng Lin
- Department of Child Health, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Hiromitsu Ogata
- Epidemiology and Biostatistics, Kagawa Nutrition University, Sakado, Japan
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Mosli RH, Kutbi HA. The Association between Sibship Composition and Child Eating Behaviors. Behav Med 2022; 49:130-136. [PMID: 35156545 DOI: 10.1080/08964289.2021.1997892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
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.
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Affiliation(s)
- Rana H Mosli
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hebah A Kutbi
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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Ruggiero CF, McHale SM, Paul IM, Savage JS. Learned Experience and Resource Dilution: Conceptualizing Sibling Influences on Parents' Feeding Practices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115739. [PMID: 34071852 PMCID: PMC8199493 DOI: 10.3390/ijerph18115739] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 11/16/2022]
Abstract
Studies from diverse cultures report mixed results in the relationship between birth order and risk for obesity. Explanations may thus lie in the postnatal period when growth is shaped by the family environment, including parental feeding practices, which may be affected by siblings. Consistent with a family systems perspective, we describe two processes that may explain birth order effects on parental feeding practices and child outcomes: learned experience and resource dilution. Parents learn from experience when earlier-born children influence their parents’ knowledge, expectations, and behavior toward later-born siblings through their behaviors and characteristics—which can have both positive and negative implications. Resource dilution is a process whereby the birth of each child limits the time, attention and other resources parents have to devote to any one of their children. The goal of this review is to provide a theoretical basis for examining potential sibling influences on parental responsive feeding toward developing recommendations for future research and practice aimed at preventing obesity throughout family systems.
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Affiliation(s)
- Cara F. Ruggiero
- The Center for Childhood Obesity Research, Penn State University, University Park, State College, PA 16802, USA;
- Department of Nutritional Sciences, Penn State University, University Park, State College, PA 16802, USA
- Correspondence:
| | - Susan M. McHale
- Department of Human Development and Family Studies, Penn State University, University Park, State College, PA 16802, USA;
| | - Ian M. Paul
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA;
| | - Jennifer S. Savage
- The Center for Childhood Obesity Research, Penn State University, University Park, State College, PA 16802, USA;
- Department of Nutritional Sciences, Penn State University, University Park, State College, PA 16802, USA
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Kracht CL, Sisson SB, Guseman EH, Hubbs-Tait L, Arnold SH, Graef J, Knehans A. Family Eating Behavior and Child Eating Patterns Differences Between Children With and Without Siblings. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:1188-1193. [PMID: 31706459 DOI: 10.1016/j.jneb.2019.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 08/01/2019] [Accepted: 08/11/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To examine the differences in family eating behaviors and child eating patterns in children with siblings (nonsingletons) and without siblings (singletons). METHODS Cross-sectional analysis of mother-child dyads of 5-7-year-old children, (nonsingletons with a 2-to-4-year-old sibling) was conducted. Anthropometrics were measured. Mothers completed questionnaires and a child dietary log. Healthy Eating Index 2010 (HEI) score was calculated. Linear regression models adjusting for child age, child sex, maternal body mass index, and hours-away-from-home were conducted, with a revised P < .021. RESULTS Sixty-eight mother-child dyads (27 singletons, 41 nonsingletons) participated. Singletons exhibited less healthy family eating behaviors (β = -4.98, SE = 1.88, P = .003), and lower total HEI scores than did nonsingletons (average: β = -8.91, SE =2.40, P = .001). On average, singletons had lower scores in 3 HEI components compared with nonsingletons (P < .021 for all). CONCLUSION In this sample, singleton children exhibited less healthy eating behaviors. Additional investigation into parent-level differences is warranted.
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Affiliation(s)
- Chelsea L Kracht
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Susan B Sisson
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
| | - Emily Hill Guseman
- Diabetes Institute and Department of Family Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH
| | - Laura Hubbs-Tait
- Department of Human Development and Family Science, College of Human Sciences, Oklahoma State University, Stillwater, OK
| | - Sandra H Arnold
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jennifer Graef
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Allen Knehans
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Difference in Objectively Measured Physical Activity and Obesity in Children With and Without Siblings. Pediatr Exerc Sci 2019; 31:348-355. [PMID: 30646816 DOI: 10.1123/pes.2018-0184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/21/2018] [Accepted: 11/23/2018] [Indexed: 11/18/2022]
Abstract
UNLABELLED Background/Context: Children without siblings (singletons) have higher rates of obesity than do children with siblings (nonsingletons). Higher moderate to vigorous physical activity (PA) and less sedentary behavior (SB) are associated with lower childhood obesity. PURPOSE To examine the difference in PA and SB between singleton and nonsingleton children. METHODS Mothers of children ages 5.0-7.9 years old who were singletons or nonsingletons with a sibling between the ages of 2.0 and 4.9 years old were recruited. Height, weight, and waist circumference of the 5.0- to 7.9-year-old children were measured, and age and sex percentiles were calculated. Accelerometry measured SB and PA, including light PA, moderate to vigorous PA, and counts per minute. RESULTS Fifty-six mother-child dyads (23 singletons and 33 nonsingletons) with an average child age of 5.7 (0.7) years participated. More singletons were classified as overweight or obese than were nonsingletons (49% vs 17%, P = .04). In adjusted linear models, singletons had less light PA per day (β = -38.1, SE = 19.2, P = .001) and more SB (β = 38.0, SE = 16.5, P = .02) than did nonsingletons, with no difference in moderate to vigorous PA or counts per minute. CONCLUSION In this sample, singletons had higher obesity and lower light PA than did nonsingleton children. Investigation into differences in singleton/nonsingleton families, including family health behaviors, may help assess sibling influence in early behavior development.
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East P, Delker E, Blanco E, Burrows R, Lozoff B, Gahagan S. Home and Family Environment Related to Development of Obesity: A 21-Year Longitudinal Study. Child Obes 2019; 15:156-166. [PMID: 30676769 PMCID: PMC6442262 DOI: 10.1089/chi.2018.0222] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Early-life conditions are important for the development of obesity. We hypothesized that home and family characteristics reflective of less supportive environments during childhood will be associated with higher adult BMI and faster BMI growth between ages 5 and 21 years. We also examined the timing and acceleration of BMI increase by adult weight status (normal weight, overweight, obese, and extremely obese) to discern how BMI increase differs across group and across time. METHODS BMI was assessed in 1000 Chilean youth (52% female) at ages 5, 10, 15, and 21 years. Latent growth curve analysis modeled BMI trajectories from 5 to 21 years. Observer and maternal ratings assessed children's home and family environments and parenting at 1 and 10 years. RESULTS The four weight groups differed in acceleration of BMI increase starting at age 5, with bigger children getting bigger faster. Higher 21-year BMI related to family stress, father absence, maternal depression, frequent child confinement (in playpen), an unclean home environment at 1 year, and low provision for active stimulation and few stimulating experiences at 10 years. Accelerated BMI increase related to lower learning stimulation in the home at 1 year and less parental warmth and acceptance at child age 10. CONCLUSIONS Home and family characteristics that reflect an absence of support for children's development were associated with overweight/obesity in young adulthood and accelerated BMI growth. Findings identify several home and family characteristics that can serve as preventive or intervention targets.
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Affiliation(s)
- Patricia East
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
| | - Erin Delker
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
- Joint Doctoral Program in Public Health, San Diego State University/University of California, San Diego, La Jolla, CA
| | - Estela Blanco
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
- Doctoral Program in Public Health, University of Chile, Santiago, Chile
| | - Raquel Burrows
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Betsy Lozoff
- Center of Human Growth and Development, University of Michigan, Ann Arbor, MI
| | - Sheila Gahagan
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
- Center of Human Growth and Development, University of Michigan, Ann Arbor, MI
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Griauzde DH, Lumeng JC, Shah PE, Kaciroti N. Lower Body Mass Index Z-Score Trajectory During Early Childhood After the Birth of a Younger Sibling. Acad Pediatr 2019; 19:51-57. [PMID: 29920332 DOI: 10.1016/j.acap.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 06/06/2018] [Accepted: 06/09/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The objectives of this study were to examine differences in body mass index z-score (BMIZ) trajectory during early childhood among children with a younger sibling compared with those without and to test potential mediators. METHODS This longitudinal cohort study included 6050 participants of the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B). Focal children's weight, height, sibship status, screen time, active play time, family dinner frequency, and diet quality were assessed at 9 months, 24 months, preschool, and kindergarten when available. A piecewise linear regression model was used to examine the association between sibling birth and focal child's subsequent BMIZ trajectory to kindergarten. Mediation by screen time, active play time, family dinner frequency, and diet quality was tested. RESULTS BMIZ trajectory was lower among children who had a new sibling join the family before kindergarten compared to children who did not have a new sibling join the family by kindergarten. The association was strongest when new sibship occurred when the focal child was 48 to 66 months (b = -0.026, P = .044). The association was not mediated by screen time, active play time, family dinner frequency, or diet quality. CONCLUSION Among a nationally representative cohort of US children, new sibship before kindergarten was associated with a lower BMIZ trajectory. Several common obesogenic risk factors did not explain the association.
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Affiliation(s)
- Dina H Griauzde
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System; Department of Internal Medicine.
| | - Julie C Lumeng
- Center for Human Growth and Development, University of Michigan, Ann Arbor, Mich.; Department of Pediatrics and Communicable Diseases (JC Lumeng and PE Shah), Medical School, University of Michigan, Center for Human Growth and Development , University of Michigan; Department of Nutritional Sciences (JC Lumeng)
| | - Prachi E Shah
- Center for Human Growth and Development, University of Michigan, Ann Arbor, Mich.; Department of Pediatrics and Communicable Diseases (JC Lumeng and PE Shah), Medical School, University of Michigan, Center for Human Growth and Development , University of Michigan
| | - Niko Kaciroti
- Center for Human Growth and Development, University of Michigan, Ann Arbor, Mich.; Department of Biostatistics , School of Public Health, University of Michigan, Ann Arbor, Mich
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Kracht CL, Swyden KJ, Weedn AE, Salvatore AL, Terry RA, Sisson SB. A Structural Equation Modelling Approach to Understanding Influences of Maternal and Family Characteristics on Feeding Practices in Young Children. Curr Dev Nutr 2018; 2:nzy061. [PMID: 30283915 PMCID: PMC6163107 DOI: 10.1093/cdn/nzy061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/11/2018] [Accepted: 07/09/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The family environment is influential for a child's healthy development through parent and sibling influences on feeding practices. Multiple-child households may protect against unhealthy feeding practices, but additional children contribute to higher maternal stress. Households of married parents may decrease maternal stress by sharing parental demands. OBJECTIVE We aimed to evaluate the collective influence of maternal stress, marital status, and number of children on feeding practices. METHODS Mothers of 2- to 5-y-old children (n = 278) were recruited mainly on a university campus and completed an online survey to examine associations between maternal stress (Depression, Anxiety, Stress Scale), number of children, marital status, and feeding practices (restriction and pressure to eat; Child Feeding Questionnaire). Relationships were examined through the use of multivariate regression and structural equation modelling. RESULTS A mainly married (85%) and Caucasian (73%) sample participated, with most mothers reporting multiple children [2 children (45%) or ≥3 children (24%)]. Marital status was not associated with either feeding practice, i.e., restriction and pressure to eat (P < 0.05). In adjusted models, maternal stress (β = 0.04, SE = 0.01, P = 0.003) and number of children (β = 0.24, SE = 0.08, P = 0.003) in the household individually contributed to higher feeding restriction; their interaction resulted in lower feeding restriction (β = -0.01, SE = 0.05, P = 0.005). In stratified models, maternal stress was associated with restriction in single-child households (β = -0.03, SE = 0.009, P = 0.002), but not multiple-child households (β = -0.004, SE = 0.005, P = 0.40). CONCLUSIONS Number of children had no effect on feeding practices individually, but may contribute to a less restrictive feeding environment. Additional investigation into creating less stressful and more positive feeding environments for all mothers can lead to healthier mothers and families.
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Affiliation(s)
- Chelsea L Kracht
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Katheryn J Swyden
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Ashley E Weedn
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Alicia L Salvatore
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Robert A Terry
- Department of Psychology, University of Oklahoma, Norman, OK
| | - Susan B Sisson
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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