Biological and Psychosocial Processes in the Development of Children's Appetitive Traits: Insights from Developmental Theory and Research

Infant and young child feeding practices as mediators in the relationship between early temperament and children's eating behaviors: A longitudinal study during COVID-19 pandemic

Simultaneously investigating the influence of multiple early temperament dimensions on children's eating behaviors through infant and young child feeding practices may be essential for developing optimal intervention strategies. This longitudinal study gathered data at two assessment points: Time 1, evaluation of infant and young child feeding practices and children's temperament when they were between 6 and 12 months, and Time 2, assessment of children's eating behaviors at age 2. This study included sociodemographic characteristics, the Child Eating Behavior Questionnaire for Toddlers (CEBQ-T), the short form of Children Behavior Questionnaire (Revised IBQ-RSF), and the Infant Feeding Style Questionnaire (IFSQ) in eastern China. Structural equation modeling (SEM) was utilized to examine the pathways from three dimensions of early temperament to five types of children's eating behaviors mediated by three styles of infant and young child feeding practices. A total of 972 children, children's mean age was 14.58 ± 5.11 months, 464 (47.74%) being girls, while the mothers' mean age was 30.23 ± 3.56 years. Effortful control exhibited significant effects on food responsiveness and satiety responsiveness mediated by responsive feeding. Additionally, effortful control influenced enjoyment of food and satiety responsiveness mediated by restrictive feeding. Surgency had a significant effect on food responsiveness mediated by indulgent feeding. Negative affectivity impacted satiety responsiveness, enjoyment of food, and food responsiveness mediated by responsive feeding. This longitudinal study delineates the pathways from early temperament to eating behaviors mediated by infant and young child feeding practices among children aged 6-23 months. These findings highlight the need to prioritize intervention programs aimed at nurturing early temperament through appropriate infant and young child feeding practices to promote healthy eating behaviors for upper- and middle-income countries (UMICs) with similar contexts.

Individual characteristics and environmental factors influencing preschoolers' emotional eating

Emotional eating, which refers to eating in response to emotional states, is prevalent in early childhood. Executive function (EF) and sleep problems are related to preschoolers' self-regulatory abilities during the day and night and have been reported to be associated with their emotional eating. These associations can be stronger in emotionally stressful situations, such as controlling feeding practices. This study explored the role of preschoolers' EF and sleep problems as child characteristics, as well as maternal feeding practices as environmental factors influencing emotional eating during the preschool period. Participants included 363 Korean mothers with preschoolers aged 3- to 5-years old (190 boys, 173 girls). Mothers reported on their own feeding practices, and preschoolers' EF, sleep problems, and emotional eating. Results indicated that preschoolers' EF was negatively associated with emotional over- and undereating, and this association was stronger when mothers applied more pressure to eat. Maternal monitoring had a similar effect, with emotional overeating exerting a greater impact with low levels of maternal monitoring. Finally, maternal pressure to eat moderated the influence of preschoolers' sleep problems on emotional overeating, with higher pressure to eat predicting a stronger relationship between sleep problems and emotional overeating. These findings suggest that maternal feeding practices, which are relatively modifiable, should be considered an important element in intervention programs aimed at preventing emotional eating in preschool children.

Differences in parental behaviour, emotions, and cognitions between children's eating profiles

A variety of parent psychological characteristics (e.g., wellbeing) have been related to children's eating behaviour. However, parent-child feeding interactions are reciprocal and complex, including relationships between parental cognitions, emotions, as well as the influence of children's varying appetitive traits. Using a person-centred approach, children's appetitive traits can be clustered into meaningful eating profiles. To date, no research has examined whether parental behaviours, emotions, and cognitions differ depending on a child's eating profile. Hence, this study recruited parents/primary caregivers from the APPETItE project, whose child had previously been identified as having an avoidant, typical, happy, or avid eating profile. Parents/primary caregivers of children (3-6 years; N = 632) completed online questionnaires examining broader parenting behaviour (parenting styles), parental emotions (stress, wellbeing), and parental cognitions (goals, self-efficacy, time and energy for meal planning and preparation, and perceptions about children's body size). Findings showed significant differences in parent responses to the questionnaires based on children's eating profiles. Parents of children with a happy eating profile reported better psychological wellbeing and greater parenting time and energy for meal planning and preparation, as well as being less likely to report goals of avoiding mealtime stress and conflict. In contrast, parents of children with an avoidant eating profile reported poorer psychological wellbeing. Children with an avid eating profile were perceived by parents as having a higher body weight, whereas children with an avoidant eating profile were perceived as having a lower body weight. Overall, these findings demonstrate that differences in parental characteristics and perceptions exist between children's eating profiles and thus should be considered in the development of tailored interventions to support children's healthy eating.

Biopsychosocial pathways model of early childhood appetite self-regulation: Temperament as a key to modulation of interactions among systems

The widespread discrimination against individuals with obesity often stems from a simplistic perception of obesity as a mere consequence of personal choices of overeating and insufficient physical activity. This reductionist perception fails to acknowledge the complexity of the epidemic of obesity, which extends beyond diet and exercise decisions. The concept of appetite self-regulation (ASR) has been explored as a crucial element in identifying obesogenic behavioral approaches to food. Although an extensive understanding of ASR in children is essential as an early precursor and modifiable factor influencing obesity, the prevailing view of self-regulation of eating solely as a matter of cognitive and behavioral processing tends to overlook interacting systems of influences. This narrow approach attributes obesity to the lack of voluntary self-control in food consumption while neglecting to account for the biological, psychological, and social influences implicated in the developmental processes of ASR, which may further contribute to the stigmatization of obesity. The current critical analysis provides a comprehensive developmental framework that could guide future studies with testable hypotheses, outlining pathways of interactions among biopsychosocial systems, all of which contribute to the development of ASR in early childhood. Adopting developmental perspectives allows a holistic approach to investigating ASR, which accounts for intricate interactions between biological (B), psychological (P), and social (S) factors influential in the early manifestation of ASR.

Understanding bidirectional and transactional processes of child eating behaviours and parental feeding practices explaining poor health outcomes across infancy and early childhood in Australia: protocol for the Longitudinal Assessment of Children's Eating (LACE) study

INTRODUCTION

Child eating behaviours develop through interactions between the child's characteristics, psychological factors and the child's social environment and this affects the child's diet and weight. To examine the currently existing birth cohort studies examining child eating behaviours, a review was conducted. There are currently no birth cohorts that concurrently examine child eating behaviours, dietary intake, growth and parental feeding practices from birth into early childhood. Therefore, the primary objective of the Longitudinal Assessment of Children's Eating (LACE) study is to examine the bidirectional and transactional processes of child eating behaviours and parental feeding practices explaining poor dietary intake and excess weight across infancy and early childhood.

METHODS AND ANALYSIS

The LACE study will be a prospective, longitudinal parent-reported study following infants from younger than 4 months of age across nine waves of data collection: younger than 4 months, 4 months, 6 months, 9 months, 12 months, 18 months, 2 years, 3 years and 5 years. Participants will be included if they are parents of infants younger than 4 months, 18 years or older, fluent in English and living in Australia at baseline. A sample size of 1210 is proposed. Participants will be recruited online via paid social media (Facebook and Instagram) advertisements. The study will examine child eating behaviours, body mass index Z-score, dietary intake, screen time, temperament, parent feeding practices and styles, and demographics. The data will be obtained using the online survey software Qualtrics. Data analyses will be conducted using Stata.

ETHICS AND DISSEMINATION

Ethical approval was granted by the Deakin University Human Ethics Advisory Group, Faculty of Health (HEAG-H 120_2022). The findings from this study will be disseminated via presentations at scientific conferences and published manuscripts in peer-reviewed journals. Findings will be disseminated to the general public via mainstream media and to participants of the study with a summary of the findings.

Unraveling Childhood Obesity: A Grounded Theory Approach to Psychological, Social, Parental, and Biological Factors

Childhood obesity is a major medical and public health issue of global interest, which is influenced by a diverse array of factors and carries significant medical and psychosocial implications. Despite the extensive studies that have been conducted to explore the specific issue, the impact of several factors that influence, generate, worsen, and make chronic the phenomenon needs further exploration. This study aimed to construct a grounded theory that includes and connects the psychological, social, parental, and biological factors affecting childhood obesity. Key psychological factors include mental health issues such as depression and emotional eating, while social factors encompass socioeconomic status and cultural influences. Parental factors involve parenting styles and feeding practices, and biological factors relate to genetic predispositions and prenatal conditions. These factors interact in complex ways, highlighting the multifactorial nature of childhood obesity. The study employed a qualitative grounded theory approach, using research articles to achieve a thorough understanding. Qualitative analysis of the articles was conducted using Atlas.ti 24.0 software. Twenty-five research articles were required to reach theoretical saturation. The analysis resulted in 336 codes that were grouped into seven broad categories and twenty-four different subcategories. Through the construction of the theoretical framework, it was recognized that obesity in minors is a complex and multifactorial issue and that the network of causes and influencing factors covers a broad spectrum ranging from the individual to the family, and subsequently to society at large, which interact with each other.

Sleep duration is associated with appetitive traits in school-age years - results from the Generation XXI birth cohort

Sleep may influence appetite regulation through physiological and neurocognitive pathways. However, the association between sleep and appetite in childhood has been scarcely reported, particularly using a prospective design. We aimed to test associations between sleep duration at 7 years of age (y) and appetitive traits at both 7 and 10 y. Participants are from the population-based birth cohort Generation XXI (Porto, Portugal), at 7 (n = 2437) and 10 y (n = 1938) follow-ups. Data on sleep was gathered at 7 y and, considering bedtime and get-up time, total mean sleep duration was calculated and further categorized according to the 10th and 90th percentiles. Appetitive traits were assessed at 7 and 10 y using the parent-reported Children's Eating Behaviour Questionnaire. Associations were tested through Generalized Linear Models (co-variates: child's sex; maternal age, education and pre-pregnancy body mass index at 7 y). At 10 y, associations were further adjusted for the respective appetitive trait at 7 y. Children slept a mean of 10.2 h/night, and 13% and 9% slept ≤9.5 and ≥ 11.0 h/night at 7 y, respectively. For each additional hour in sleep duration, children scored 0.078 (99%CI: -0.145; -0.011) lower on Food Responsiveness, 0.065 (99%CI: -0.129; -0.002) lower on Emotional Undereating and 0.096 (99%CI: -0.161; -0.032) lower on Food Fussiness. Lastly, children sleeping ≤9.5 h/night scored higher on Food Responsiveness (β = 0.145 99%CI: 0.020; 0.271); while those sleeping ≥11.0 h/night scored lower on Food Fussiness (β = -0.255 99%CI: -0.370; -0.079). No significant prospective associations were found. In conclusion, in 7 y children, sleep duration was cross-sectionally associated with lower scores on food approach (Food Responsiveness) and avoidant traits (Emotional Undereating and Food Fussiness). However, the magnitude of the associations was small and further studies are warranted.

Relationship between energy balance and reward system gene polymorphisms and appetitive traits in young Mexican subjects

Introduction

Appetitive traits are influenced by the interplay between genetic and environmental factors. This study aimed to explore the relationship between gene polymorphisms involved in the regulation of energy balance and food reward and appetitive traits in young Mexican subjects.

Methods

This cross-sectional study involved 118 university freshman undergraduates who completed the Adult Eating Behaviour Questionnaire for Spanish speakers (AEBQ-Esp) to assess their appetitive traits. A real-time PCR system was employed to determine gene polymorphisms involved in energy balance (LEP rs7799039, MC4R rs17782313, FTO rs9939609, GHRL rs696217), and reward system (DRD2/ANKK1 Taq1A rs1800497 and COMT rs4680).

Results

The mean age of participants was 20.14 ± 3.95 years, 71.2% were women and their mean BMI was 23.52 ± 4.05 kg/m2. COMT Met allele carriers presented a significantly higher "Emotional overeating" mean score than Val allele carriers (2.63 ± 0.70 vs. 2.23 ± 0.70, p = 0.028). The MC4R CC + CT genotype correlated positively with "Emotional overeating" (Phi = 0.308, p = 0.01). The COMT MetMet+MetVal genotype correlated with higher "Emotional overeating" (r = 0.257, p = 0.028; Phi = 0.249, p = 0.033). The protective genotype FTO TT correlated positively with "Emotional undereating" (Phi = 0.298, p = 0.012). Carriers of the risk genotype MC4R CC + CT presented a higher risk of "Emotional overeating" than TT carriers (OR = 2.4, 95% CI 1.3-4.8, p = 0.034). Carriers of the risk genotype COMT MetMet+MetVal (OR = 3.4, 95% CI 1.1-10.3, p = 0.033), were associated with a higher risk of "Emotional overeating" than ValVal carriers. The protective FTO genotype TT was associated with "Emotional undereating" (OR = 1.8, 95% CI 1.1-9.1, p = 0.014).

Discussion

The study found a relationship between the protective genotypes of FTO TT and "Emotional undereating" and risk genotypes of COMT Met/Met+Met/Val and MC4R CC + CT with "Emotional overeating." These genetic factors may increase weight gain by enhancing hedonic food consumption and reducing satiety control. Future studies should focus on replication studies in ethnically diverse young adults and life stages to explore the relationship between polymorphisms and appetitive traits and weight. This will help tailor personalized nutrigenetic strategies to counteract disordered eating patterns leading to obesity and associated co-morbidities.

Development of food literacy in children and adolescents: implications for the design of strategies to promote healthier and more sustainable diets

Food literacy has emerged as a key individual trait to promote the transformation of food systems toward healthy and sustainable diets. Childhood and adolescence are key periods for establishing the foundations of eating habits. Different food literacy competencies are acquired as children develop different cognitive abilities, skills, and experiences, contributing to the development of critical tools that allow them to navigate a complex food system. Thus, the design and implementation of programs to support the development of food literacy from early childhood can contribute to healthier and more sustainable eating habits. In this context, the aim of the present narrative review is to provide an in-depth description of how different food literacy competencies are developed in childhood and adolescence, integrating the extensive body of evidence on cognitive, social, and food-related development. Implications for the development of multisectoral strategies to target the multidimensional nature of food literacy and promote the development of the 3 types of competencies (relational, functional, and critical) are discussed.

Appetitive traits from childhood to adolescence: Analysis of their stability, derivation of trajectory profiles, and associated characteristics

This study aimed to assess the potential stability of appetitive traits from childhood to early adolescence, identify groups of individuals with distinct trajectories for these traits, and explore their association with other child and family characteristics. Participants were 5040 children from the Generation XXI cohort. Appetitive traits were assessed with the Children's Eating Behaviour Questionnaire (CEBQ) at ages seven, 10, and 13 (eight subscales). Mixed-effect models estimated individual trajectories of appetitive traits and Gaussian mixture models identified groups following different trajectories (appetitive trait trajectory profiles). Appetitive traits showed moderate-to-high stability across the three ages (intra-class correlation coefficients:0.66-0.83); most of the variance observed across time were due to persistent individual differences rather than age-related changes. Six appetitive trait trajectory profiles were identified: 'Moderate appetite' (scores close to the average) (29% of children), 'Small to moderate appetite' (lowest food approach and emotional eating) (26%), 'Increasing appetite' (increasing food approach) (15%), 'Avid appetite' (highest food approach and lowest food avoidance) (12%), 'Smallest appetite' (highest food avoidance and low food approach) (10%), and 'Small appetite but increasing' (decreasing high food avoidance and Desire to Drink) (8%). In multinomial logistic regression, these profiles were associated with different child and family characteristics. Compared to children with a 'Moderate appetite' profile, those with higher BMI, who desired a thinner body, whose mothers were younger, had lower education, higher pre-pregnancy BMI (OR = 1.07; 95%CI:1.04,1.09), smoked during pregnancy (OR = 1.51; 95%CI:1.21,1.90), and used more restrictive feeding practices (OR = 1.79; 95%CI:1.57,2.03) had increased odds of belonging to the 'Avid Appetite'. In conclusion, distinct appetitive trait trajectory profiles emerged, differentiating individuals with avid and small appetites. These findings have implications for identifying children at higher risk for obesogenic profiles.

Reframing interventions for optimal child nutrition and childhood obesity: the importance of considering psychological factors

This review aims to emphasise the impact of poor nutrition on children's health and psychological well-being, urging those involved in childhood obesity or nutrition services to broaden their intervention approach. Poor nutrition and childhood obesity affect physical and psychological health. The stress of living with obesity further impacts quality of life, well-being and self-esteem. Children living with obesity may experience adverse childhood events and stress, and young people are able to recall the impact of psychosocial issues such as experiencing stigma and discrimination. Food is often a coping mechanism for managing negative emotions, perpetuating cycles of emotional coping and unhealthy eating behaviours. UK guidelines recommend family-based, multi-component weight management interventions for children living with obesity. Interventions mainly target health behaviours and utilise behaviour change techniques attempting to directly improve diet and physical activity as behavioural outcomes. Whilst these interventions may show some improvements in psychological well-being, there is limited consideration or understanding of the underlying mechanisms of action which indirectly influence engagement and the sustainability of the behaviour change. Lack of attention and inclusion of psychosocial variables in intervention implementation may help explain the variable effectiveness reported across childhood obesity interventions. In conclusion, enhancing the effectiveness of childhood obesity interventions requires a broader approach that fully incorporates psychosocial factors. Those responsible for commissioning, designing and implementing these interventions should adopt a holistic approach that addresses psychological and emotional needs while incorporating underlying mechanisms of action. This shift in focus could result in more sustainable and comprehensive treatment for childhood obesity.

Bidirectional Associations between Parental Feeding Practices and Child Eating Behaviors in a Chinese Sample

BACKGROUND

Child eating behaviors (CEBs) and parental feeding practices (PFPs) play critical roles in childhood obesity. However, the bidirectional relationships between CEBs and PFPs remain equivocal. This longitudinal study aimed to explore their bidirectional relationships.

METHODS

A convenience sample of 870 parents with preschoolers was recruited in this longitudinal study (Shanghai, China). Three non-responsive feeding practices (NFPs), three responsive feeding practices (RFPs), five CEBs, and covariates were collected using validated questionnaires at baseline and the 6-month follow-up. Cross-lagged analyses using structural equation modeling (SEM) were performed to examine their bidirectional relationships.

RESULTS

Eight hundred and fifty-three parents completed questionnaires, with a response rate of 98%. The mean age of their children at baseline was 4.39 years (standard deviation = 0.72 years). Eighteen out of sixty longitudinal cross-lagged paths were statistically significant. Parental encouragement of healthy eating and content-restricted feeding were found to be bidirectionally associated with child food fussiness. Four parent-driven associations and one child-driven association were identified between RFPs and CEBs. For example, monitoring was negatively associated with children's unhealthy eating habits (β = -0.066, standard error (SE) = 0.025, p < 0.01). Eight child-driven associations and one parent-driven association were observed between NFPs and CEBs. For example, higher child satiety responsiveness predicted a higher pressure to eat (β = 0.057, SE = 0.029, p < 0.01) and the use of food as a reward (β = 0.083, SE = 0.031, p < 0.01).

CONCLUSIONS

There were bidirectional, parent-driven, and child-driven associations. Parents should be encouraged to adopt RFPs to shape CEBs. Increasing parents' understanding of CEBs and providing them with reasonable coping strategies would help optimize PFPs.

Sequential mediation of early temperament and eating behaviors in the pathways from feeding practices to childhood overweight and obesity

Introduction

Childhood eating behaviors and temperament may have important implication for constructing the pathways from maternal feeding practices to childhood overweight and obesity (OW/OB). Examining multiple feeding styles simultaneously to childhood OW/OB is critical through the mediators of early childhood temperament and eating behaviors.

Methods

This cross-sectional study recruited mothers mainly responsible for child care from two hospitals and two healthcare centers in eastern China. Sociodemographic characteristics, and data from the Infant Feeding Style Questionnaire (IFSQ), the short form of Children Behavior Questionnaire [Revised (IBQ-RSF)], and the Child Eating Behavior Questionnaire for toddler (CEBQ-T) were collected. Weight and recumbent length were measured to calculate the age- and sex-specific body mass index (BMI) z-scores (BMIz). The structural equation modeling (SEM) approach was used to examine direct and indirect pathways from five maternal feeding styles to childhood OW/OB through temperament and eating behaviors.

Results

A total of 486 children were recruited, 73 (15.02%) children were OW/OB; the age of the children was 14.55 (SD = 5.14) months, and the age of the mothers was 29.90 (SD = 3.63) years. The responsive feeding exerted significant direct (β = -0.098), indirect (β = -0.136) and total (β = -0.234) effects on childhood OW/OB. Restrictive feeding had significant direct (β = 0.222), indirect (β = 0.102) and total (β = 0.324) effects on childhood OW/OB. Indulgent feeding had significant direct (β = 0.220), indirect (β = 0.063), and total (β = 0.283) effects on childhood OW/OB. Pressuring feeding had significant direct (β = -0.116), indirect (β = -0.096) and total (β = -0.212) effects on childhood OW/OB.

Discussion

There was a direct effect of feeding practices on childhood OW/OB; feeding practices indirectly predicted childhood OW/OB through temperament and eating behaviors in children aged 6-23 months. This study could help governments agencies, policymakers, and healthcare workers to establish optimal intervention programs targeting feeding practices through childhood eating behaviors and temperament to prevent childhood OW/OB.

Low Self-Esteem and Life Satisfaction as a Significant Risk Factor for Eating Disorders among Adolescents

Background: Eating disorders are a problem that is becoming more and more common among younger and younger age groups. Many studies examine the risk factors for EDs, however, the treatment of these diseases is very complicated and requires dietary, psychological and medical intervention. Methods: 233 primary and secondary school students aged 12 to 19 were surveyed using the EAT-26 (Eating Attitudes Test-26) questionnaire, the self-esteem Scale SES and the Cantril scale for life satisfaction. Results: Women, when compared to men, showed lower self-esteem, satisfaction with their appearance, body weight and their lives and at the same time a higher risk of eating disorders in all three areas. Low life satisfaction is often correlated with weight loss greater than 10 kg. Low self-esteem correlated positively with significant weight loss (>10 kg) and more frequent uncontrollable binge eating and exercising (more than 60 min a day) to influence appearance. People with low self-esteem were more likely to be treated for EDs. Subjects dissatisfied with their lives binged, feeling that they could not stop. Conclusion: The younger the person, the more likely they are to develop eating disorders. This is closely correlated with low self-esteem and negative life satisfaction. Men were more likely to be satisfied with their weight, appearance, and life, and were less likely to show ED symptoms.

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.

Children's eating behaviours and related constructs: conceptual and theoretical foundations and their implications

BACKGROUND

There is a substantial body of research on children's eating behaviours (e.g., food responsiveness and fussiness) and related constructs (e.g., eating in the absence of hunger, appetite self-regulation). This research provides a foundation for understanding children's dietary intakes and healthy eating behaviours, as well as efforts at intervention, whether in relation to food avoidance, overeating and/or trajectories to excess weight gain. The success of these efforts and their associated outcomes is dependent on the theoretical foundation and conceptual clarity of the behaviours and constructs. This, in turn contributes to the coherence and precision of the definitions and measurement of these behaviours and constructs. Limited clarity in these areas ultimately creates uncertainty around the interpretation of findings from research studies and intervention programs. At present there does not appear to be an overarching theoretical framework of children's eating behaviours and associated constructs, or for separate domains of children's eating behaviours/constructs. The main purpose of the present review was to examine the possible theoretical foundations of some of the main current questionnaire and behavioural measures of children's eating behaviours and related constructs.

METHODS

We reviewed the literature on the most prominent measures of children's eating behaviours for use with children aged ~ 0-12 years. We focused on the explanations and justifications for the original design of the measures and whether these included theoretical perspectives, as well as current theoretical interpretations (and difficulties) of the behaviours and constructs.

RESULTS

We found that the most commonly used measures had their foundations in relatively applied or practical concerns rather than theoretical perspectives.

CONCLUSIONS

We concluded, consistent with Lumeng & Fisher (1), that although existing measures have served the field well, to advance the field as a science, and better contribute to knowledge development, increased attention should be directed to the conceptual and theoretical foundations of children's eating behaviours and related constructs. Suggestions for future directions are outlined.

Relationships between parental responsive feeding and infant appetitive traits: The moderating role of infant temperament

Introduction

Between the ages of 6 and 12 months is a crucial stage for children to develop appetitive self-regulation. Evidence suggests that a combination of parental responsive feeding and infant temperament (surgency, effortful control, negative affect) shapes infant appetitive traits (food approach, food avoidance). There is a need for research to explore these relationships, in order to provide guidance for the design of an effective intervention to improve appetitive traits. The objective of the current study was to explore the moderating role of infant temperament in the relationship between parental responsive feeding and infant appetitive traits.

Methods

A total of 616 questionnaires, measuring parental responsive feeding, infant appetitive traits, and infant temperament, were collected from parents with infants aged 6-12 months.

Results

Results revealed that responsive feeding was associated with both food approach and food avoidance. Furthermore, only lower levels of surgency significantly moderated the relationship between responsive feeding and food approach, while responsive feeding was associated with food avoidance irrespective of infant temperament.

Discussion

These findings suggest that a strategy embedding responsive feeding interventions should be adopted to reduce infant food avoidance and low-surgent infant food approach, and interventions that are tailored toward food approach for infants with effortful control, negative affect, or higher levels of surgency should be further sought.

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.

Bidirectional associations between parental feeding practices, infant appetitive traits and infant BMIz: a longitudinal cohort study

BACKGROUND

Little is known about the pathways linking parent feeding practices with appetitive traits and BMIz throughout infancy. This study examined bidirectional associations between parental feeding practices, infant appetitive traits, and infant BMIz.

METHODS

Parents (n = 380) of infants aged less than 6 months at baseline reported their feeding practices (using the Feeding Practices and Structure Questionnaire (FPSQ) for infants and toddlers), infant appetitive traits (using the Baby Eating Behaviour Questionnaire) and infant BMIz (parent-reported) at three timepoints (< 6 months, ~ 9 months, ~ 12 months) up to 12 months of age. Cross-lagged models examined bidirectional associations between parent feeding practices, infant appetitive traits and infant BMIz.

RESULTS

There was strong continuity across the three timepoints for maternal feeding practices, infant appetitive traits, and infant BMIz. Infant food avoidance was prospectively associated with higher parental persuasive feeding. Infant BMIz was prospectively associated with higher parent-led feeding. Parent use of food to calm was prospectively associated with lower infant BMIz, and infant BMIz was prospectively associated with higher infant food approach. Feeding on demand was prospectively associated with lower infant food approach.

CONCLUSION

This study highlights the complex associations between parental feeding practices, infant appetitive traits and infant BMIz. The study demonstrated that both child and parent effects are important, suggesting a need for tailored programs beginning in infancy to promote and support infant appetitive traits and parent feeding practices that support healthy development.

Child ADHD and autistic traits, eating behaviours and weight: A population-based study

BACKGROUND

Children with Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) have an increased obesity risk. Although these conditions commonly co-occur, shared factors relating to obesity risk are unknown.

OBJECTIVES

To examine the shared and unique associations of ADHD and autistic traits with eating behaviours and BMI.

METHODS

Children (N = 4134) from the population-based Generation R Study were categorized into subgroups based on parent-reported ADHD and autistic traits scores at 6 years: ADHD_High , ASD_High , ADHD+ASD_High and REF (reference group: ADHD+ASD_Low ). Multiple linear regressions examined the associations between subgroups and eating behaviours (at 10 years) and BMIz (at 14 years), relative to REF. Mediation analyses tested the indirect effect of subgroup and BMIz through eating behaviours.

RESULTS

ADHD + ASD_High children expressed both food approach (increased food responsiveness and emotional overeating) and avoidant eating behaviours (increased emotional undereating, satiety responsiveness/ slowness in eating and picky eating, and decreased enjoyment in food). ASD_High children were more food avoidant, while ADHD_High children had more food approach behaviours and greater BMIz. ADHD_High and BMIz were indirectly associated with food responsiveness and emotional overeating.

CONCLUSIONS

ADHD and autistic trait phenotypes show distinct associations with potential obesity risk factors, and further research is needed to improve targeted early intervention.

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.

Predicting preschool children's emotional eating: The role of parents' emotional eating, feeding practices and child temperament

Emotional eating (EE; defined as overeating irrespective of satiety and in response to emotional states) develops within childhood, persists into adulthood, and is linked with obesity. The origins of EE remain unclear, but parental behaviours (e.g., controlling feeding practices and modelling) and child characteristics (e.g., temperament) are often implicated. To date, the interaction between these influences has not been well investigated. This study explores whether the relationship between parent and child EE is shaped by parental feeding practices, and if the magnitude of this relationship varies as a function of child temperament. Mothers (N = 244) of 3-5-year-olds completed questionnaires about their EE, feeding practices, their children's EE and temperament. Results showed that parental use of food to regulate children's emotions fully mediated the relationship between parent and child EE, and using food as a reward and restricting food for health reasons partially mediated this relationship. Analyses demonstrated that the mediated relationship between parent and child EE via use of food as a reward and restriction of food for health reasons varied as a function of child negative affect, where high child negative affect moderated these mediations. These findings suggest child EE may result from interrelationships between greater parent EE, use of food as a reward, restriction of food for health reasons and negative affective temperaments, but that greater use of food for emotion regulation may predict greater child EE irrespective of child temperament.

Infant Food Responsiveness in the Context of Temperament and Mothers' Use of Food to Soothe

Parents' use of food to soothe an infants' non-hunger related distress may impair an infants' development of appetite self-regulation. Parents tend to use food to soothe if their infant has more ‘difficult' temperamental tendencies. However, the role of infant appetite in this association is unclear. This study investigates the moderating effect of infant food responsiveness on cross-sectional and prospective associations between infant temperament and mothers' use of food to soothe. Mothers (n = 200) from low-income households reported their infants' temperament (i.e., surgency, negative affect and regulation) and food responsiveness at age 4 months, and their use of food to soothe at age 4 and 6 months. Temperament × food responsiveness interactions on mothers' use of food to soothe were examined using general linear models, adjusting for covariates. Cross-sectional associations showed that mothers used more food to soothe at 4 months for infants who were lower in negative affect and higher in food responsiveness (negative affect × food responsiveness interaction: p = 0.03). Prospective associations showed that mothers used more food to soothe at 6 months for infants who were lower in regulation and higher in food responsiveness (infant regulation × food responsiveness interaction: p = 0.009). Other interactions were not significant. Infant food responsiveness was consistently associated with mothers' use of food to soothe, independent of some temperamental dimensions. The findings highlight the salience of infant food responsiveness, both independent of and in association with temperament, on mothers' use of food to soothe.

Infant Appetitive Phenotypes: A Group-Based Multi-Trajectory Analysis

Background: Examining appetitive traits with person-centered analytical approaches can advance the understanding of appetitive phenotype trajectories across infancy, their origins, and influences upon them. The objective of the present study was to empirically describe appetitive phenotype trajectories in infancy and examine the associations with infant and parent factors.

Materials and Methods: In this longitudinal cohort study of Australian infants, parents completed three online surveys ~3 months apart, beginning when the infant was <6 months. Appetitive traits were assessed with the Baby Eating Behavior Questionnaire (BEBQ) and parent feeding practices with the Feeding Practices and Structure Questionnaire (FPSQ) infant and toddler version. Parent demographics and cognitions were also collected. Infant weight and length were transcribed from health records and converted to a BMI z-score. Group-based trajectory modeling identified appetitive phenotype trajectories using the BEBQ. Multilevel modeling examined change in feeding practices and child BMI z-score over time by appetitive phenotype trajectories.

Results: At time 1, 380 participants completed the survey (mean infant age 98 days), 178 at time 2 (mean infant age 198 days), and 154 at time 3 (mean infant age 303 days). Three multi-trajectory appetitive phenotype groups were identified and labeled as (Phenotype 1) food avoidant trending toward low food approach (21.32% of infants), (Phenotype 2) persistently balanced (50.53% of infants), and (Phenotype 3) high and continuing food approach (28.16% of infants). Formula feeding was more common in Phenotype 1 (p = 0.016). Parents of infants in Phenotype 1 were more likely to rate them as being more difficult than average, compared to infants with phenotypes 2 or 3. Phenotype 2 had the greatest increase in persuasive feeding over time [0.30; 95% CI (0.12, −0.47)].

Conclusions: Distinct multi-trajectory appetitive phenotype groups emerge early in infancy. These trajectories appear to have origins in both infant and parent characteristics as well as parent behaviors and cognitions. The infant multi-trajectory appetitive phenotype groups suggest that for some infants, difficulties in self-regulating appetite emerge early in life. Investigation of infant multi-trajectory appetitive phenotype groups that utilize a range of measures, examine relationships to key covariates and outcomes, and extend from infancy into childhood are needed.

Associations between feeding practices and child dietary quality, and the moderating effect of child eating behaviours on these associations

BACKGROUND

Parents' feeding practices are associated with children's food intake. Little is known about how children's eating behaviours (fussiness, enjoyment of food, food responsiveness, satiety responsiveness) moderate these associations. This study examines the relationships between feeding practices and pre-school children's dietary quality and whether children's eating behaviours moderate these relationships.

METHODS

In 2018, 1349 Australian mothers of children aged 2-5 years completed an online survey including validated measures of feeding practices (n = 9), child eating behaviours (n = 4) and dietary quality. Thirteen items from a food frequency questionnaire were summed as a measure of dietary quality. Linear regression assessed associations between feeding practices and dietary quality, including interactions between feeding practices and child eating behaviours.

RESULTS

The feeding practices positively associated with dietary quality were structured meal timing, monitoring, covert restriction, modelling healthy eating and structured meal setting (B coefficients: 0.63 to 2.70). The feeding practices inversely associated with dietary quality were overt restriction, persuasive feeding, reward for eating and reward for behaviour (B coefficients: -0.88 to -1.85). Child eating behaviours moderated associations between three feeding practices and dietary quality.

CONCLUSIONS

This exploratory study showed that some associations between feeding practices and child dietary quality were moderated by children's eating behaviours. The potential for tailoring nutrition promotion strategies for parents of children with differing eating behaviours should be further investigated.

Temperament and eating self-regulation in young children with or at risk for obesity: An exploratory report

BACKGROUND

Few studies have examined the relationship between temperament and eating self-regulation in early childhood, despite emerging evidence for associations with pediatric obesity.

METHOD

The aim of this exploratory report was to examine the associations between three eating behaviors and three facets of temperament among 4- to 8-year-olds with or at risk for obesity.

RESULTS

Among 28 participants in a family intervention to reduce eating speed, we found at baseline that slower child eating speed was associated with less surgency (r = -.39, p = .04) and higher food responsiveness was associated with higher negative affect (r = .40, p = .03).

CONCLUSIONS

These findings support the potential yield of integrating temperament with eating self-regulation assessments in studies of early obesity risk. A better understanding is needed regarding ways in which parents differentially feed in response to child temperament.

Self-regulatory processes in early childhood as predictors of Hispanic children's BMI z-scores during the elementary school years: Differences by acculturation and gender

Over the last decade, longitudinal research has shown that children's general, top-down self-regulation during early childhood is negatively associated with children's weight status in elementary school. The samples in these previous studies have been primarily White, and no study to date has examined this issue in a sample of Hispanic children from low-income families-a population at high risk for childhood obesity. The present study followed 130 Hispanic children over a time period of three to just under five years, examining the degree to which multiple measures of general, top-down self-regulation, along with a measure of appetite regulation (eating in the absence of hunger), predicted children's BMI z-scores in the early elementary school years. Results showed that children's ability to delay gratification in the preschool years was negatively associated with later BMI z-scores and that children's eating in the absence of hunger was positively associated. In separate models by gender, these relationships were significant only for girls. Moreover, analyses run separately for children of mothers low or high on acculturation showed that the relationship between delay of gratification and later BMI z-scores was significant only for children whose mothers were low on acculturation. Possible socialization and environmental factors contributing to these findings are considered.

The association between problematic Internet use, eating disorder behaviors, and well-being among Palestinian university students

Objectives

The current study aimed to test the correlation between problematic Internet use, eating disorder behaviors, and well-being among Palestinian university students.

Methods

To examine the relationship between the study variables, a correlational study was conducted. The geographical representation of the study sample showed that 48.1% of participants were from urban populations, 48.1% were from rural villages, and 3.8% were from internally displaced people’s camps.

Results

Pearson’s correlation coefficient was used to test the relationship between problematic Internet use, eating disorder behaviors, and well-being. Results showed that problematic Internet use was negatively correlated to well-being (r = − .32, p < .01), and positively correlated to eating disorder behaviors (r = .39, p < .01). The regression analysis found that problematic Internet use contributes statistically and significantly towards explaining variance in eating disorder behaviors (B = .46, SE = .08, β = .32). Moreover, well-being contributed in a way that was statistically significant towards explaining variance in eating disorders behaviors (B = − .39, SE = .09, β = − .25).

Conclusion

The results of our study support previous studies that indicated that problematic Internet use was significantly and positively correlated with eating disorder behaviors, while it was significantly and negatively correlated to well-being among Palestinian university students. Further studies testing this relationship will be crucial in developing interventions to both reduce problematic Internet use and eating disorder behaviors and increase well-being among university students.

Groups of mothers based on feeding practices and their associations with dietary quality of pre-school children: A latent profile analysis

Parents' feeding practices are associated with children's food intake. However, little is known about the patterns of feeding practices used by groups of mothers or how these groupings of practices influence children's dietary intake. Therefore, the aims of this study are to classify and describe groups of mothers according to their patterns of feeding practices and to examine the associations between the groups of maternal feeding practices and pre-school children's dietary quality. In 2018, 1349 mothers based in Australia of children aged 2-5 years completed an online survey including validated measures of nine feeding practices and dietary quality, measured using thirteen summed dietary items. Latent profile analysis was used to identify distinct groups of mothers who shared similar feeding practices. Linear regression models were fitted to examine associations between the feeding practice profiles and child dietary quality. A three-profile model was chosen based on interpretation, profile size and statistical model fit criteria. Profile 1 had lower mean scores of structure-related feeding practices than the other profiles; profile 2 had mean scores reflecting slightly higher use of most structure-related feeding practices and lower mean scores of some non-responsive feeding practices; profile 3 had higher mean scores of non-responsive feeding practices than the other profiles. Profile 1 (-2.95, CI: 3.97; -1.92) and profile 3 (-2.81, CI: 3.49; -2.13) had lower mean child dietary quality scores compared with profile 2. Profile 2, which reflected the most engagement in structure-related feeding practices combined with least non-responsive feeding practices, was associated with higher child diet quality, compared with the other two profiles. The identification of these unique profiles could help to tailor future interventions to consider patterns of feeding practices used by groups of mothers.

The Families Improving Health Together (FIT) Program: Initial evaluation of retention and research in a multispecialty clinic for children with obesity

BACKGROUND

Obesity affects ∼17% of US children, with parallel increases in multiple comorbidities, especially among African-, Asian-, Hispanic-, and Native-Americans. Barriers to patient retention in pediatric obesity programs include lack of centralized care, and frequent subspecialty MD visits which conflict with patient school attendance and parental work attendance as well as with support service utilization. Lack of integration of multispecialty clinical care with interdisciplinary research is a major barrier to fuller exploration of the treatment, prevention, and understanding of obesity in childhood.

OBJECTIVE

To test the hypothesis, a novel multispecialty/interdisciplinary clinical and research infrastructure with strong emphasis on a primary obesity care physician for children with early-onset (<9 years) obesity (Families Improving health Together [FIT]) could promote lower patient attrition (primary goal) and foster productive research in pediatric obesity (secondary goal).

RESULTS

Data support the hypotheses. Over 15 months, FIT reported a >90% participant retention (p < 0.001 vs. expected rate based on other studies of similar programs). Though 90% of children had at least one adiposity-related comorbidity and 70% had at least two, there was no need for additional subspecialist visits with cardiologists, endocrinologists, gastroenterologists, or molecular geneticists. Three abstracts were presented at national meetings, and two manuscripts were published all with junior faculty as primary authors.

CONCLUSION

This pilot study suggests that an integrated multispecialty/interdisciplinary approach to children with obesity improves patient retention and can be integrated successfully with research.

Parental Perception of Weight and Feeding Practices in SchoolChildren: A Cross-Sectional Study

Childhood obesity has become a public health problem. Parents play an important role in the transmission of feeding habits and the detection of their child's weight status. The aim was to analyse the prevalence of overweight/obesity and to determine the relationship between children's weight status, different feeding practices and weight misperception. A cross-sectional study was conducted in randomly selected schools. The children's weight status was measured, and a questionnaire was used to identify the feeding practices applied by parents and their perception of their children's weight. The sample comprised 127 children aged 4 and 5 years and 189 aged 10 and 11. Differences were observed between parental feeding practices and weight status, monitoring being the most used practice. Parents use less pressure to eat and more restriction if their children have overweight or obesity. Misperception of weight was 39.6%, being higher in overweight children, who were perceived as normal weight in 53.19%. Children classified as obese were perceived as overweight in 88.23%. The use of inappropriate eating practices shows a need for health education in parents according to weight status. In addition, the parents' perception should be improved to increase early detection of overweight and start actions or seek professional help.

Appetite self-regulation declines across childhood while general self-regulation improves: A narrative review of the origins and development of appetite self-regulation

This narrative review discusses the origins and development of appetite self-regulation (ASR) in childhood (from infancy to age 6 or 7 years). The origins, or foundations, are the biological infrastructure associated with appetite regulation and appetite self-regulation. Homeostatic regulation in infancy is examined and then evidence about developmental change in components of ASR. The main ASR-related components covered are: delay-of-gratification, caloric compensation, eating in the absence of hunger, food responsiveness/hedonics and fussy eating. The research included behavioral measures, parent-reports of appetitive traits and fMRI studies. There were two main trends in the evidence: a decline across childhood in the components of ASR associated with food approach (and therefore an increase in disinhibited eating), and wide individual differences. The decline in ASR contrasts with general self-regulation (GSR) where the evidence is of an improvement across childhood. For many children, bottom-up automatic reactive processes via food reward/hedonics or food avoidance as in fussy eating, appear not to be matched by improvements in top-down regulatory capacities. The prominence of bottom-up processes in ASR could be the main factor in possible differences in developmental paths for GSR and ASR. GSR research is situated in developmental science with its focus on developmental processes, theory and methodology. In contrast, the development of ASR at present does not have a strong developmental tradition to access and there is no unifying model of ASR and its development. We concluded (1) outside of mean-level or normative changes in the components of ASR, individual differences are prominent, and (2) there is a need to formulate models of developmental change in ASR together with appropriate measurement, research designs and data analysis strategies.

The relationship between maternal dietary patterns during pregnancy in women with gestational diabetes mellitus and infant appetitive feeding behaviour at 6 months

Early dietary exposure may influence infant appetitive feeding behaviour, and therefore their later health. Maternal diabetes in pregnancy is associated with an increased risk of obesity in the offspring. We, therefore, examined third-trimester dietary patterns of women with gestational diabetes, their offspring's appetitive feeding behaviour at 6 months of age, and relationships between these. We used data from a prospective cohort of women with gestational diabetes and assessed maternal dietary patterns at 36 weeks' gestation using principal component analysis; infant appetitive feeding behaviour at 6 months of age using the Baby Eating Behaviour Questionnaire; and relationships between these using general linear modelling and chi-square tests. In 325 mother-infant dyads, we identified three distinct maternal dietary patterns: 'Junk,' 'Mixed,' and 'Health-conscious.' The maternal 'Health-conscious' pattern was inversely associated with 'enjoyment of food' in their sons (β - 0.24, 95% CI - 0.36 to - 0.11, p = 0.0003), but not daughters (β - 0.02, 95% CI - 0.12 to 0.08, p = 0.70), and was positively associated with 'slowness in eating,' (β 0.13, 95% CI 0.02 to 0.24, p = 0.01). Third-trimester dietary patterns in women with gestational diabetes may have sex-specific effects on infant appetitive feeding behaviour at 6 months of age.

Rationale, design and study protocol of the 'Strong Families Start at Home' feasibility trial to improve the diet quality of low-income, ethnically diverse children by helping parents improve their feeding and food preparation practices

There is an urgent need to create effective interventions that help parents establish a healthy diet among their children early in life, especially among low-income and ethnically and racially diverse families. U.S. children eat too few fruits, vegetables and whole grains, and too many energy dense foods, dietary behaviors associated with increased morbidity from chronic diseases. Parents play a key role in shaping children's diets. Best practices suggest that parents should involve children in food preparation, and offer, encourage and model eating a variety of healthy foods. In addition, while parents help to shape food preferences, not all children respond in the same way. Certain child appetitive traits, such as satiety responsiveness (sensitivity to internal satiety signals), food responsiveness (sensitivity to external food cues), and food fussiness may help explain some of these differences. Prior interventions to improve the diet of preschool children have not used a holistic approach that targets the home food environment, by focusing on food quality, food preparation, and positive feeding practices while also acknowledging a child's appetitive traits. This manuscript describes the rationale and design for a 6-month pilot randomized controlled trial, Strong Families Start at Home, that randomizes parents and their 2-to 5-year old children to either a home-based environmental dietary intervention or an attention-control group. The primary aim of the study is to explore the feasibility and acceptability of the intervention and evaluation and to determine the intervention's preliminary efficacy on child diet quality, feeding practices, and availability of healthy foods in the home.

"Food" and "non-food" self-regulation in childhood: a review and reciprocal analysis

BACKGROUND

In developmental science, there is an extensive literature on non-food related self-regulation in childhood, where several domains relating to emotions, actions and cognitions have been identified. There is now growing attention to food related self-regulation in childhood, especially difficulties with ASR, and the consequences for weight gain and adiposity. The aim of this narrative review was to conduct a reciprocal analysis of self-regulation in the food and non-food domains in childhood (referred to as appetite self-regulation (ASR) and general self-regulation (GSR) respectively). The focus was on commonalities and differences in key concepts and underpinning processes.

METHODS

Databases and major journals were searched using terms such as self-regulation, appetite self-regulation, or self-regulation of energy intake, together with associated constructs (e.g., Executive Function, Effortful Control, delay-of-gratification). This was followed by backward and forward snowballing.

RESULTS AND DISCUSSION

The scholarship on GSR in childhood has had a focus on the role of the cognitively-oriented Executive Function (EF), the temperamentally-based Effortful Control (EC) and the recursive interplay between bottom-up (reactive, emotion driven, approach or avoidance) and top-down (cognitive, conscious decision-making) processes. "Hot" and "cool/cold" EF and self-regulation situations have been distinguished. There were some parallels between GSR and ASR in these areas, but uncertainty about the contribution of EF and EC to ASR in young children. Possible differences between the contribution to ASR-related outcomes of delay-of-gratification in food and non-food tasks were apparent. Unique elements of ASR were identified; associated with psychological, biological and neurological responses to food and bottom-up processes. A diverse number of situations or elements connected to ASR exist: for example, energy balance homeostasis, caloric compensation, hunger regulation, satiation, satiety, energy density of food, eating in the absence of hunger, emotional eating, etc. CONCLUSIONS: Self-regulation in food and non-food domains are amenable to a reciprocal analysis. We argue that self-regulation of appetite should be added as a domain under the umbrella of self-regulation in childhood along with the other non-food related domains. This could lead to a broader understanding of self-regulation in childhood, and generate novel lines of enquiry.

A longitudinal study of eating behaviours in childhood and later eating disorder behaviours and diagnoses

BACKGROUND

Eating behaviours in childhood are considered as risk factors for eating disorder behaviours and diagnoses in adolescence. However, few longitudinal studies have examined this association.

AIMS

We investigated associations between childhood eating behaviours during the first ten years of life and eating disorder behaviours (binge eating, purging, fasting and excessive exercise) and diagnoses (anorexia nervosa, binge eating disorder, purging disorder and bulimia nervosa) at 16 years.

METHOD

Data on 4760 participants from the Avon Longitudinal Study of Parents and Children were included. Longitudinal trajectories of parent-rated childhood eating behaviours (8 time points, 1.3-9 years) were derived by latent class growth analyses. Eating disorder diagnoses were derived from self-reported, parent-reported and objectively measured anthropometric data at age 16 years. We estimated associations between childhood eating behaviours and eating disorder behaviours and diagnoses, using multivariable logistic regression models.

RESULTS

Childhood overeating was associated with increased risk of adolescent binge eating (risk difference, 7%; 95% CI 2 to 12) and binge eating disorder (risk difference, 1%; 95% CI 0.2 to 3). Persistent undereating was associated with higher anorexia nervosa risk in adolescent girls only (risk difference, 6%; 95% CI, 0 to 12). Persistent fussy eating was associated with greater anorexia nervosa risk (risk difference, 2%; 95% CI 0 to 4).

CONCLUSIONS

Our results suggest continuities of eating behaviours into eating disorders from early life to adolescence. It remains to be determined whether childhood eating behaviours are an early manifestation of a specific phenotype or whether the mechanisms underlying this continuity are more complex. Findings have the potential to inform preventative strategies for eating disorders.

The Influence of Taste Liking on the Consumption of Nutrient Rich and Nutrient Poor Foods

Repeated consumption of high-energy nutrient poor foods can lead to undesirable health outcomes such as obesity. Taste plays an important role in food choice, and a better understanding of the links between the taste of foods, individual taste preferences, food choices, and intakes will aid in our understanding of why some people might select and consume unhealthy foods. The present review focuses on three main questions: (1) do nutrient poor and nutrient rich foods significantly differ in taste profile? (2) are humans predisposed toward developing a liking or preference for certain taste profiles? (3) how are individual variations in liking of the basic taste qualities related to long term food intake and adverse health outcomes such as obesity? Results indicated that nutrient poor foods were likely to be sweet, salty and fatty mouthfeel, while the taste profiles of nutrient rich foods were diverse. Although humans are born with a universal liking for sweet and aversion for bitter taste, large individual differences exist in liking of all the basic taste qualities. These individual differences partly explain differences in short term intakes of foods varying in taste profiles. However they fail to sufficiently explain long term food choices and negative health outcomes such as obesity. Future studies should focus on how the full sensory profile of food which includes taste, smell and texture interacts with individual characteristics (e.g., taste or health motivations, taste preferences) to affect consumption of nutrient rich and nutrient poor foods.

Development and Validation of a New Questionnaire Assessing Feeding Styles in Toddlers: Toddler Feeding Style Questionnaire (TFSQ)

PURPOSE

To develop and validate a new questionnaire assessing feeding styles in toddlers, the Toddler Feeding Style Questionnaire (TFSQ).

DESIGN AND METHODS

An instrumental design was used in this study. A convenience sample of 546 Spanish mothers of a toddler (12-24 months-old) completed the TFSQ and a web-based survey to obtain data on feeding styles, sociodemographic and anthropometric characteristics, weaning and attachment style. Items were developed and classified into two content domains: responsiveness and demandingness. For the construct validity analysis, the sample was randomly divided into two halves used to the exploratory and confirmatory factor analysis, respectively. Validation hypotheses about the differences in the TFSQ scores were suggested.

RESULTS

The factorial analysis revealed a responsiveness scale and a demandingness scale. The McDonald's Omega and Cronbach's alpha values coincided in both scales, being 0.84 and 0.75, respectively. A high responsiveness and demandingness feeding styles degree of agreement showed a statistically significant association with the correspondent scale (p < .01). The 33.3% of children who are overweight or obese have mothers who classify themselves as neglectful. Both scales were related to the mothers' attachment styles, toddler's age and the time of weaning at 6 and 12 months.

CONCLUSIONS

The TFSQ provides a valid and reliable Responsiveness and Demandingness scale to evaluate feeding styles in toddlers.

PRACTICE IMPLICATIONS

Parental feeding styles influence future eating behavior and children's weight. There is a lack of validated instruments used to evaluate feeding styles in toddlerhood based on the two theoretical dimensions of responsiveness and demandingness.

A biopsychosocial approach to processes and pathways in the development of overweight and obesity in childhood: Insights from developmental theory and research

Childhood obesity has reached alarming proportions in many countries. There is consensus that both biological (especially genetic) and environmental (including psychosocial) factors contribute to weight gain and obesity in childhood. Research has identified extensive risk or predictive factors for childhood obesity from both of these domains. There is less consensus about the developmental processes or pathways showing how these risk factors lead to overweigh/obesity (OW/OB) in childhood. We outline a biopsychosocial process model of the development of OW/OB in childhood. The model and associated scholarship from developmental theory and research guide an analysis of research on OW/OB in childhood. The model incorporates biological factors such as genetic predispositions or susceptibility genes, temperament, and homeostatic and allostatic processes with the psychosocial and behavioral factors of parenting, parental feeding practices, child appetitive traits, food liking, food intakes, and energy expenditure. There is an emphasis on bidirectional and transactional processes linking child biology and behavior with psychosocial processes and environment. Insights from developmental theory and research include implications for conceptualization, measurement, research design, and possible multiple pathways to OW/OB. Understanding the developmental processes and pathways involved in childhood OW/OB should contribute to more targeted prevention and intervention strategies in childhood.

A Biopsychosocial Model of Sex Differences in Children's Eating Behaviors

The prevalence of obesity and eating disorders varies by sex, but the extent to which sex influences eating behaviors, especially in childhood, has received less attention. The purpose of this paper is to critically discuss the literature on sex differences in eating behavior in children and present new findings supporting the role of sex in child appetitive traits and neural responses to food cues. In children, the literature shows sex differences in food acceptance, food intake, appetitive traits, eating-related compensation, and eating speed. New analyses demonstrate that sex interacts with child weight status to differentially influence appetitive traits. Further, results from neuroimaging suggest that obesity in female children is positively related to neural reactivity to higher-energy-dense food cues in regions involved with contextual processing and object recognition, while the opposite was found in males. In addition to differences in how the brain processes information about food, other factors that may contribute to sex differences include parental feeding practices, societal emphasis on dieting, and peer influences. Future studies are needed to confirm these findings, as they may have implications for the development of effective intervention programs to improve dietary behaviors and prevent obesity.

Child temperament predicts the adiposity rebound. A 9-year prospective sibling control study

METHODS

We repeatedly examined 25889 siblings within the Norwegian Mother and Child Cohort Study, following them from the mothers' pregnancy through child age 8 years. Information on the children's height and weight was collected by means of health registries and maternal reports. Information on the siblings' temperament was collected by questionnaires completed when they were 1.5, 3, and 5 years old. We examined the associations of temperament at different child ages with the timing of the adiposity rebound among siblings and controls by means of growth curve and multilevel analyses.

RESULTS

Within siblings, high scores on the approach trait of sociability predicted an earlier adiposity rebound and high scores on the avoidance trait of shyness predicted a later adiposity rebound with timing differences ranging between 6 and 16 weeks. Surprisingly, negative emotionality did not predict the adiposity rebound. The associations between temperament and the adiposity rebound increased with increasing child age. The results within controls-comparing siblings with the population, broadly paralleled those within siblings.

CONCLUSIONS

The findings encourage the notion that child temperament functions as an early marker for the adiposity rebound. Future studies may advance our knowledge by including measures of child personality along the taxonomy of the adult Five Personality Factors.

Associations of children's Big Five personality with eating behaviors

Objective

Our aim is to examine the associations of the Big Five personality factors with eating behaviors in children using a cross-sectional study in 1543 randomly Norwegian 7–12 year olds.

Results

Mothers rated the hierarchical personality inventory for children, and the child eating behaviour questionnaire to describe her child. Personality and eating behaviors were substantially associated in bivariate correlations and multivariate analyses of variance. The strongest predictors of eating behaviors were neuroticism, followed by agreeableness and conscientiousness. Neuroticism correlated the highest with slow eating, emotional undereating, food responsiveness, and emotional overeating, and showed minor associations with satiety responsiveness, and fussiness. Neuroticism was not associated with enjoyment of food. Agreeableness was associated with low fussiness, low emotional undereating, low food responsiveness and low emotional overeating, conscientiousness was associated with low satiety responsiveness, and food responsiveness, and extraversion and imagination were associated with high enjoyment of food.