Appetitive traits and food intake patterns in early life

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

PURPOSE OF REVIEW

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

RECENT FINDING

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

Stability of child appetitive traits and association with diet quality at 5 years and 9-11 years old: Findings from the ROLO longitudinal birth cohort study

BACKGROUND

We explored change in child appetitive traits from 5 to 9-11 years old and examined associations between appetitive traits at both timepoints and child diet quality.

METHODS

This is secondary analyses of the ROLO longitudinal birth cohort study, including mother-child dyads from the 5 and 9-11-year old follow-up. The Children's Eating Behaviour Questionnaire measured child appetitive traits, with 167 children having matched data for both timepoints. The Healthy Eating Index (HEI) measured diet quality. Linear mixed models and multiple linear regression were completed.

RESULTS

Mean (SD) score for 'Emotional Overeating' (1.63 (0.51) vs. 1.99 (0.57), p = <0.001) and 'Enjoyment of Food' (3.79 (0.72) vs. 3.98 (0.66), p = <0.001) increased from 5 to 9-11 years. Mean score for 'Desire to Drink' (2.63 (0.94) vs. 2.45 (0.85), p = 0.01), 'Satiety Responsiveness (3.07 (0.66) vs. 2.71 (0.66), p = <0.001), 'Slowness Eating' (3.02 (0.77) vs. 2.64 (0.78), p = <0.001), and 'Food Fussiness' (3.00 (1.04) vs. 2.81 (0.96), p = 0.001) decreased. At 5-years-old, 'Food Responsiveness' and 'Enjoyment of Food' were positively associated with HEI and 'Desire to Drink', 'Satiety Responsiveness' and 'Food Fussiness' were negatively associated with HEI. At 9-11-years, 'Enjoyment of Food' was positively and 'Desire to Drink' and 'Food 'Fussiness' were negatively associated with HEI.

CONCLUSIONS

Food approach appetitive traits increased over time, whereas food avoidant appetitive traits tended to decrease. At both time points 'Food Fussiness' and 'Desire to Drink" were inversely associated with HEI. Further research on how appetitive traits track over childhood and how this relates to dietary quality and weight is warranted.

Variety of High and Very Low-Energy Density Foods among Preschool-Aged Children and Associations with Food Intake, Diet Quality, and Weight Status

BACKGROUND

Energy density (ED) and the variety of foods are 2 factors that may have a combined effect on preschool-aged children's ability to regulate food intake. However, little is known about the variety of foods consumed within different ED categories by children in the United States.

OBJECTIVE

Therefore, we explored the variety of high ED (HED, 4-9 kcal/g) and very low ED (VLED, <0.6 kcal/g) foods consumed by a nationally representative sample of children aged 2-5 y in the United States and the relationship between variety with food intake, diet quality, and weight status.

METHODS

ED, variety, and diet quality were assessed using two 24-h dietary recalls collected as part of the National Health And Nutrition Examination Survey 2011-2018 cycles (n = 1682). We assessed associations between HED and VLED varieties with energy intake, volume of food, diet quality, and weight status using multivariable linear and logistic regressions.

RESULTS

The HED variety was positively associated with energy intake (P < 0.0001). The VLED variety was positively associated with the volume of food (P < 0.0001) and diet quality (P < 0.0001). VLED was negatively associated with the odds of having obesity in minimally adjusted models [odds ratio (OR): 0.62; 95% confidence interval (CI): 0.31, 0.87]; however, the relationship was not significant in fully adjusted models. Patterns of variety intake were differently associated with energy, volume, and diet quality. Children consuming the high VLED variety and the low HED variety had lower odds of obesity [OR: 0.43; 95% CI: 0.21, 0.90]; however, this pattern was rare (10%).

CONCLUSIONS

These findings suggest that the variety of HED foods is associated with higher average energy intake per day, and the variety of VLED foods is associated with a higher volume of food consumed per day and diet quality in a nationally representative sample of preschool-aged children.

An epigenome-wide association study of child appetitive traits and DNA methylation

The etiology of childhood appetitive traits is poorly understood. Early-life epigenetic processes may be involved in the developmental programming of appetite regulation in childhood. One such process is DNA methylation (DNAm), whereby a methyl group is added to a specific part of DNA, where a cytosine base is next to a guanine base, a CpG site. We meta-analyzed epigenome-wide association studies (EWASs) of cord blood DNAm and early-childhood appetitive traits. Data were from two independent cohorts: the Generation R Study (n = 1,086, Rotterdam, the Netherlands) and the Healthy Start study (n = 236, Colorado, USA). DNAm at autosomal methylation sites in cord blood was measured using the Illumina Infinium HumanMethylation450 BeadChip. Parents reported on their child's food responsiveness, emotional undereating, satiety responsiveness and food fussiness using the Children's Eating Behaviour Questionnaire at age 4-5 years. Multiple regression models were used to examine the association of DNAm (predictor) at the individual site- and regional-level (using DMRff) with each appetitive trait (outcome), adjusting for covariates. Bonferroni-correction was applied to adjust for multiple testing. There were no associations of DNAm and any appetitive trait when examining individual CpG-sites. However, when examining multiple CpGs jointly in so-called differentially methylated regions, we identified 45 associations of DNAm with food responsiveness, 7 associations of DNAm with emotional undereating, 13 associations of DNAm with satiety responsiveness, and 9 associations of DNAm with food fussiness. This study shows that DNAm in the newborn may partially explain variation in appetitive traits expressed in early childhood and provides preliminary support for early programming of child appetitive traits through DNAm. Investigating differential DNAm associated with appetitive traits could be an important first step in identifying biological pathways underlying the development of these behaviors.

Complementary Feeding and Child Appetitive Traits in a Sample of Hispanic Mother-Child Dyads

BACKGROUND

Complementary feeding practices may contribute to toddler eating practices that affect weight outcomes. Studies are needed to understand the relationship between complementary feeding practices and toddler dietary self-regulation.

OBJECTIVE

This study tests the hypothesis that earlier complementary food introduction predicts toddler food responsiveness and emotional overeating (ie, tendency to overeat in response to food cues and emotions, respectively), and considers whether introduction of certain foods better predict toddler dietary self-regulation.

DESIGN

This study is a secondary analysis of data from a parent longitudinal birth cohort study on early growth/development among Hispanic mother-infant dyads.

PARTICIPANTS/SETTING

The analytic sample included 174 mother-child dyads recruited from maternity clinics affiliated with the University of Southern California in Los Angeles County. Recruitment and data collection were ongoing from July 2016 to April 2020. At 1-, 6-, 12-, and 24-months postpartum, mothers reported exclusive breastfeeding duration and age of complementary food introduction via questionnaire.

MAIN OUTCOME MEASURES

Child food responsiveness and emotional overeating scores calculated from the Child Eating Behavior Questionnaire at 12 and 24 months of age.

STATISTICAL ANALYSES PERFORMED

Separate linear mixed models with repeated measures were used to examine associations between age of complementary food introduction as a predictor of child food responsiveness or emotional overeating, controlling for infant sex, birth body mass index z score, duration of exclusive breastfeeding, and mother's body mass index.

RESULTS

In separate models, delaying complementary food introduction by 1 month was associated with a 6% reduction in food responsiveness (P = 0.007) and a 5% reduction in emotional overeating scores (P = 0.013). Fifty-eight unique combinations of complementary foods introduced first were found, precluding analyses to examine whether specific combinations were related to eating behavior outcomes due to sample size limitations.

CONCLUSIONS

Earlier complementary feeding was associated with higher food responsiveness and emotional overeating scores among Hispanic children. Future studies in larger samples are needed to characterize patterns of complementary food introduction and their influence on child self-regulation.

Appetitive traits and food groups consumption in school-aged children: prospective associations from the Generation XXI birth cohort

PURPOSE

Appetite can influence children's dietary choices; however, this relationship in school-aged children is still unclear. We aimed to explore the prospective associations between child appetitive traits at age 7 and food consumption at 10 years of age.

METHODS

The study included 3860 children from the Generation XXI birth cohort, recruited in 2005/2006 in Porto, Portugal. The Children's Eating Behaviour Questionnaire was used to evaluate children's appetitive traits at 7 years. Food consumption was measured at 10 years through a validated Food Frequency Questionnaire. Logistic regression models were performed and adjusted for possible confounders.

RESULTS

Children with greater Enjoyment of Food at 7 years were 36% more likely to eat fruits ≥ 2 times/day and 54% more likely to eat vegetables > 2.5 times/day at 10 years compared to those with less frequent consumption. Children who ate more in response to negative emotions had higher odds of consuming energy-dense foods (OR = 1.33; 99% CI 1.13-1.58) and salty snacks (OR = 1.28; 99% CI 1.08-1.51) 3 years later. Those with less ability to adjust intake (higher Satiety Responsiveness) and more selective about foods (higher Food Fussiness) at 7 years were less likely to consume vegetables frequently, and were more likely to consume energy-dense foods and sugar-sweetened beverages.

CONCLUSIONS

Children's appetitive traits at 7 years were associated with the consumption of several food groups at 10 years of age. Eating more in response to negative emotions (Emotional Eating), with less ability to adjust intake (Satiety Responsiveness) and more food selectivity (Food Fussiness) were associated with worse dietary choices (in general, lower fruit and vegetables, and higher energy-dense foods and sugar-sweetened beverages consumption).

LEVEL OF EVIDENCE

Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

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

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

An epigenome-wide association study of child appetitive traits and DNA methylation

Childhood appetitive traits are consistently associated with obesity risk, and yet their etiology is poorly understood. Appetitive traits are complex phenotypes which are hypothesized to be influenced by both genetic and environmental factors, as well as their interactions. Early-life epigenetic processes, such as DNA methylation (DNAm), may be involved in the developmental programming of appetite regulation in childhood. In the current study, we meta-analyzed epigenome-wide association studies (EWASs) of cord blood DNAm and early-childhood appetitive traits. Data were from two independent cohorts: the Generation R Study (n=1,086, Rotterdam, the Netherlands) and the Healthy Start study (n=236, Colorado, USA). DNAm at autosomal methylation sites in cord blood was measured using the Illumina Infinium HumanMethylation450 BeadChip. Parents reported on their child's food responsiveness, emotional undereating, satiety responsiveness and food fussiness using the Children's Eating Behaviour Questionnaire at age 4-5 years. Multiple regression models were used to examine the association of DNAm (predictor) at the individual site- and regional-level (using DMRff) with each appetitive trait (outcome), adjusting for covariates. Bonferroni-correction was applied to adjust for multiple testing. There were no associations of DNAm and any appetitive trait at the individual site-level. However, at the regional level, we identified 45 associations of DNAm with food responsiveness, 7 associations of DNAm with emotional undereating, 13 associations of DNAm with satiety responsiveness, and 9 associations of DNAm with food fussiness. This study shows that DNAm in the newborn may partially explain variation in appetitive traits expressed in early childhood and provides preliminary support for early programming of child appetitive traits through DNAm. Investigating differential DNAm associated with appetitive traits could be an important first step in identifying biological pathways underlying the development of these behaviors.

Characterization of a Vigorous sucking style in early infancy and its predictive value for weight gain and eating behaviors at 12 months

This study sought to identify sucking profiles among healthy, full-term infants and assess their predictive value for future weight gain and eating behaviors. Pressure waves of infant sucking were captured during a typical feeding at age 4 months and quantified via 14 metrics. Anthropometry was measured at 4 and 12 months, and eating behaviors were measured by parent report via the Children's Eating Behavior Questionnaire-Toddler (CEBQ-T) at 12 months. Sucking profiles were created using a clustering approach on the pressure wave metrics, and utility of these profiles was assessed for predicting which infants will have weight-for-age (WFA) percentile changes from ages 4-12 months that exceed thresholds of 5, 10, and 15 percentiles, and for estimating each CEBQ-T subscale score. Among 114 infants, three sucking profiles were identified: Vigorous (51%), Capable (28%), and Leisurely (21%). Sucking profiles were found to improve estimation of change in WFA from 4 to 12 months and 12-month maternal-reported eating behaviors above infant sex, race/ethnicity, birthweight, gestational age, and pre-pregnancy body mass index alone. Infants with a Vigorous sucking profile gained significantly more weight during the study period than infants with a Leisurely profile. Infant sucking characteristics may aid in predicting which infants may be at greater risk of obesity, and therefore sucking profiles deserve more investigation.

Capacity for Regulation of Energy Intake in Infancy

Importance

The capacity for regulation of energy intake (REI) to match energy needs is thought to contribute to differences in weight gain, and preventing excess infant weight gain is a priority.

Objective

To determine capacity for REI across infancy.

Design, Setting, and Participants

For this cohort study, a convenience sample of mother-infant dyads was recruited from the community in Michigan between 2015 and 2019. Inclusion criteria were healthy, full-term infants with weight appropriate for gestational age; biological mothers who were 18 years or older, English speaking, and a legal and custodial guardian; and infant having had consumed 2 oz or more in 1 feeding from an artificial nipple at least once per week. Infants were followed in the home setting with staff support for up to 12 months.

Interventions

Mother-infant dyads participated at infant age 1, 2.5, 5, 7, 10, and 12 months. In the intervention condition, mothers offered a feeding every hour for 6 hours. In the control condition, mothers fed infants as they typically would for 6 hours. Intake was recorded and kilocalories calculated.

Main Outcomes and Measures

Capacity for REI was indexed as the difference in intake in kilocalories per kilogram of body weight (intervention minus control condition); a value of 0 indicated perfect REI. Maternal and infant characteristics were obtained by questionnaire, and anthropometry was measured. Using multiple imputation, the intercept and slope for difference in kilocalories per kilogram across the 6 age points were estimated using mixed models accounting for repeated measures within participants. Statistical analyses were conducted between September 2021 and February 2023.

Results

The sample included 175 infants (87 [49.71%] female, 88 [50.29%] male; 494 pairs of intervention and control conditions and 4630 feedings). The mean (SD) 12-month weight-for-age z score was 0.1 (0.8). Mean (SD) gestational age as 39.55 (1.05) weeks, and mean (SD) birth weight was 3.43 (0.41) kg. Mean (SD) breastfeeding duration for those who reported stopping by 12 months was 17.83 (12.03) weeks. As designed, the intervention (compared with control) condition included more feedings at shorter intervals. After collapsing the data across age points in a mixed model accounting for repeated measures within participants, the REI estimate at 1 month differed from 0. On average, infants ate 5.21 kcal/kg (95% CI, 2.89-7.54 kcal/kg) more in the frequent feeding intervention condition than in the ad lib feeding control condition. This difference did not significantly change over 12 months of infancy (REI slope = -0.01 kcal/kg per month; 95% CI, -0.02 to 0.03 kcal/kg per month).

Conclusions and Relevance

The study's findings suggested that, on average, when offered more frequent feedings, healthy, full-term infants may overeat. The results provide support for responsive feeding as a strategy for preventing excess infant weight gain.

Examining the associations between mothers' motivation to regulate their own eating behaviors, food parenting practices and perceptions of their child's food responsiveness

Based on the Self-Determination Theory, this study examined: 1) how mothers' autonomous and controlled motivation to regulate their own eating behaviors relate to their food parenting practices, and 2) whether and how child food responsiveness (i.e., reactivity and attraction to food) interact with mothers' motivation to predict maternal food parenting practices. Participants were 296 French Canadian mothers of at least one child aged between 2 and 8 years old. Results of partial correlation analyses (controlling for demographics and controlled motivation) showed that maternal autonomous motivation to regulate their own eating behaviors was positively related to autonomy-promoting (i.e., child involvement) and structure-based (i.e., modeling, creating a healthy environment, monitoring) food parenting practices. In contrast, controlling for demographics and autonomous motivation, maternal controlled motivation was positively associated with food-related practices based on coercive control (i.e., the use of food to regulate the child's emotions, the use of food as a reward, pressure to eat, restriction for weight reasons, and restriction for health reasons). Furthermore, the child's food responsiveness was found to interact with mothers' motivation to regulate their own eating behaviors in the prediction of maternal food parenting practices such that mothers with high autonomous motivation or low controlled motivation were found to react with more structure-based (i.e., creating a healthy environment) and autonomy-based (i.e., child involvement) practices, as well as less controlling practices (i.e., the use of food to regulate the child's emotions), to a child who is highly responsive to food. In conclusion, findings suggest that guiding mothers toward developing a more autonomous and less controlled motivation to regulate their own eating behaviors might help them adopt more autonomy-promoting and structure-based and less controlling feeding practices, especially with children who are highly responsive to food.

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.

Obesity in Children

Child obesity is widely prevalent, and general pediatricians play an important role in identifying and caring for patients with obesity. Appropriate evaluation and treatment require an understanding of the complex etiology of child obesity, its intergenerational transmission, and its epidemiologic trends, including racial/ethnic and socioeconomic disparities. The American Academy of Pediatrics has published screening, evaluation, and treatment guidelines based on the best available evidence. However, gaps in evidence remain, and implementation of evidence-based recommendations can be challenging. It is important to review optimal care in both the primary care and multidisciplinary weight management settings. This allows for timely evaluation and appropriate referrals, with the pediatrician playing a key role in advocating for patients at higher risk. There is also a role for larger-scale prevention and policy measures that would not only aid pediatricians in managing obesity but greatly benefit child health on a population scale.

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.

Ecological factors and childhood eating behaviours at 5 years of age: findings from the ROLO longitudinal birth cohort study

Background

Individual differences in children eating behaviours have been linked with childhood overweight and obesity. The determinants of childhood eating behaviours are influenced by a complex combination of hereditary and ecological factors. This study examines if key ecological predictors of childhood overweight; maternal socio-economic status (SES), children’s screen time, and childcare arrangements, are associated with eating behaviours in children aged 5-years-old.

Methods

This is secondary, cross-sectional analysis of the ROLO (Randomized COntrol Trial of LOw glycemic diet in pregnancy) study, using data from the 5-year follow-up (n = 306). Weight, height, and body mass index (BMI) were obtained from mothers and children at the 5-year follow-up. Children’s BMI z-scores were calculated. SES was determined using maternal education level and neighborhood deprivation score. Information on children’s screen time and childcare arrangements were collected using lifestyle questionnaires. Children’s eating behaviours were measured using the Children’s Eating Behaviour Questionnaire (CEBQ). Multiple linear regression, adjusted for potential confounders, assessed associations between maternal SES, screen time and children’s eating behaviours. One-way ANOVA, independent sample t-tests and Spearman’s correlation examined childcare exposure and children’s eating behaviour.

Results

Mothers in the lowest SES group had higher BMI and were younger than those in the highest SES group (p =  < 0.001, p = 0.03 respectively). In adjusted analysis, the lowest SES group was associated with a 0.463-point higher mean score for ‘Desire to Drink’ (95% CI = 0.054,0.870, p = 0.027) and higher ‘Slowness to Eat’ (B = 0.388, 95% CI = 0.044,0.733, p = 0.027) when compared with the highest SES group. Screen time (hours) was associated with higher ‘Food Fussiness’ (B = 0.032, 95% CI = 0.014,0.051, p = 0.001). Those who attended childcare had higher scores for ‘Desire to Drink’(p = 0.046). No relationship was observed between longer duration (years) spent in childcare and eating behaviours.

Conclusions

In this cohort, the ecological factors examined had an influence on children’s eating behaviours aged 5-years-old. Our results illustrate the complexity of the relationship between the child’s environment, eating behaviour and children’s body composition. Being aware of the ecological factors that impact the development of eating behaviours, in the pre-school years is vital to promote optimal childhood appetitive traits, thus reducing the risk of issues with excess adiposity long-term.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03423-x.

The impact of reducing the frequency of night feeding on infant BMI

BACKGROUND

Teaching caregivers to respond to normal infant night awakenings in ways other than feeding is a common obesity prevention effort. Models can simulate caregiver feeding behavior while controlling for variables that are difficult to manipulate or measure in real life.

METHODS

We developed a virtual infant model representing an infant with an embedded metabolism and his/her daily sleep, awakenings, and feeds from their caregiver each day as the infant aged from 6 to 12 months (recommended age to introduce solids). We then simulated different night feeding interventions and their impact on infant body mass index (BMI).

RESULTS

Reducing the likelihood of feeding during normal night wakings from 79% to 50% to 10% lowered infant BMI from the 84th to the 75th to the 62nd percentile by 12 months, respectively, among caregivers who did not adaptively feed (e.g., adjust portion sizes of solid foods with infant growth). Among caregivers who adaptively feed, all scenarios resulted in relatively stable BMI percentiles, and progressively reducing feeding probability by 10% each month showed the least fluctuations.

CONCLUSIONS

Reducing night feeding has the potential to impact infant BMI, (e.g., 10% lower probability can reduce BMI by 20 percentile points) especially among caregivers who do not adaptively feed.

IMPACT

Teaching caregivers to respond to infant night waking with other soothing behaviors besides feeding has the potential to reduce infant BMI. When reducing the likelihood of feeding during night wakings from 79% to 50% to 10%, infants dropped from the 84th BMI percentile to the 75th to the 62nd by 12 months, respectively, among caregivers who do not adaptively feed. Night-feeding interventions have a greater impact when caregivers do not adaptively feed their infant based on their growth compared to caregivers who do adaptively feed. Night-feeding interventions should be one of the several tools in a multi-component intervention for childhood obesity prevention.

The Relationship between Eating and Screen Viewing Behavior with Nutritional Status of Adolescents in Medan City

Adolescents are vulnerable to experiencing malnutrition issues, both overnutrition and undernutrition. This study’s objective was to determine the relationship between eating and screen viewing behaviour and with nutritional status of adolescents. This study used a cross-sectional design with 145 adolescents chosen through the purposive sampling method. The samples were divided into three categories: early adolescents, middle adolescents, and late adolescents, and data on eating behaviour were obtained by using Adult Eating Behavior Questionnaire (AEBQ). The screen viewing behavior variable had two categories: low screen time and high screen time. Adolescent body mass index z-scores measured nutritional status. This study was conducted from June to August 2022. Results showed 5.5% underweight participants, 18.6% subject overweight participants, and 22.8% obese participants of the total participants. Spearman’s tests showed that there was a significant relationship between eating behaviour and nutritional status (p<0.05) only on two subscales of appetite traits (emotional overeating and food responsiveness) in early adolescents. Likewise, in late adolescents, there was a significant relationship between eating behaviour and nutritional status (p<0.05) only with emotional undereating. There was no significant relationship between screen viewing behaviour and nutritional status in all categories of adolescents. The highest prevalence of obesity was found in early adolescents, and it influenced the adolescent’s eating behavior such as emotional overeating. While in late adolescents, malnutrition cases were more or less common due to emotional undereating.

Associations of preschoolers' dietary patterns with eating behaviors and parental feeding practices at a 12-month follow-up of obesity treatment

Although dietary patterns are key to the management of childhood obesity, they are rarely assessed and thus poorly understood. This study examines preschoolers' dietary patterns and correlates 12 months after the start of obesity treatment (n = 99, mean age 5.2 years, 52% girls). A food frequency questionnaire (FFQ), the Child Eating Behavior Questionnaire (CEBQ), Child Feeding Questionnaire (CFQ) and Lifestyle Behavior Checklist (LBC) were answered by parents to assess children's food intake, eating behaviors, parental feeding practices, and obesity-related behaviors, respectively. Principal component analysis identified dietary patterns based on FFQ data. Through multiple linear regressions we examined correlations between a healthy (HD) and a less healthy (LHD) dietary pattern and mean scores of the CEBQ, CFQ, LBC scales as well as BMI z-scores. The reported intake of items in the LHD decreased after treatment while no differences were found for the HD. Children's eating behaviors, in particular food fussiness, showed consistent associations with diet (b = -0.39, 95% CI -0.63, -0.14 for HD and b = 0.41, 95% CI 0.15, 0.66 for LHD). Feeding practices and obesity-related behaviours were weakly associated with the dietary patterns (HD and Monitoring: b = 0.36, 95% CI 0.09, 0.62; LHD and Screen time b = 0.08, 95% CI 0.01, 0.15). Among the measured variables, eating behaviors had the largest impact on children's dietary patterns. The LHD was associated with a higher BMI z-score but no associations were found between changes in LHD intake and changes in BMI z-scores. Our findings suggest that decreasing food fussiness in children with obesity is key to positive dietary changes. Assessment of children's eating behaviors can help tailor dietary advice and provide support for families of children with obesity.

How do young children eat after an obesity intervention? Validation of the Child Eating Behaviour Questionnaire using the Rasch Model in diverse samples from Australia and Sweden

Child eating behaviours have consistently been linked to child weight status. Yet, changes in child eating behaviours during early obesity treatment are rarely evaluated. Psychometric evaluation of the Child Eating Behaviour Questionnaire (CEBQ) is common, but results are sample-dependent and included items may not capture the full range of the underlying traits. Rasch analysis can overcome these disadvantages. The aim of this paper was to assess child eating behaviours measured by the CEBQ after a 12-month obesity intervention applying the Rasch model for the validation of the CEBQ. The Rasch-based fit statistics were applied in children from two samples, Australian and Swedish (n = 1724). Changes in eating behaviours amongst children aged 4-6 years were examined in the More and Less RCT for obesity treatment (n = 177), which compared a parenting programme (with and without boosters) against standard treatment. Parents completed the CEBQ at four time points over 12-months. Linear mixed models were applied to estimate treatment effects on the CEBQ, refined according to Rasch, over time. We found that the validity of CEBQ was confirmed after removing 4 items (item fit statistics outside range 0.5-1.5). When the refined CEBQ was used in the assessment of the RCT, there were no differences in parental reports of changes in children's eating behaviours between the parenting programme and standard treatment (group-by-time interactions p > 0.05). However, in the total sample food approach behaviours decreased while fussy eating behaviours increased (p < 0.05). In conclusion, the refined CEBQ proved to be a valid tool for examining parent-reported child eating behaviours. Early obesity treatment may decrease eating behaviours associated with higher child weight. Future research should address the associations between changes in child weight status and eating behaviours.

Associations between Food Preferences, Food Approach, and Food Avoidance in a Polish Adolescents' COVID-19 Experience (PLACE-19) Study Population

Food preferences are among the strongest predictors of the food choices of adolescents. These are associated with appetitive traits (food approach and avoidance) to some extent. However, no research has been conducted so far analyzing the association between food preferences and appetitive traits of adolescents. The aim of this study was to evaluate the associations between food preferences and appetitive traits in adolescents (aged 15-20 years) within the Polish Adolescents' COVID-19 Experience (PLACE-19) Study population. The PLACE-19 Study was carried out in a population-based sample of 2448 secondary school students sampled across the country (random quota sampling). Food preferences (including the preference for vegetables, fruit, meat/fish, dairy, snacks, and starches) of the adolescents were assessed using the validated Food Preference Questionnaire (FPQ) while their appetitive traits (hunger, food responsiveness, emotional overeating, enjoyment of food, satiety responsiveness, emotional undereating, food fussiness, slowness in eating) were assessed using the validated Adult Eating Behavior Questionnaire (AEBQ). The k-means clustering was performed to identify the homogenous clusters of respondents based on their preferences, and linear regression was performed to determine the relationship between food preferences and appetitive traits with a model adjusted for sex and age. Based on their preferences, three homogenous clusters of respondents were defined: low-preferring respondents (low preference for all food categories), respondents preferring snacking foods (low preference for all food categories, except for fruit and snacks), and high-preferring respondents (high preference for all food categories). The low-preferring respondents showed the lowest values for all appetitive traits (p = 0.0008), as well as the lowest total score (p = 0.0001), except for food fussiness, for which they showed the highest value (p = 0.0008). All preference scores were positively associated with traits such as hunger, food responsiveness, enjoyment of food, and emotional under-eating, while negatively associated with food fussiness (all p < 0.05). The largest amount of variance was observed for preference for dairy (14.6%; R² = 0.146, p = 0.008) and snacks with respect to enjoyment of food (16.2%; R² = 0.162, p = 0.008), for vegetable with respect to food fussiness (22%; R² = 0.220, p = 0.008), and for meat/fish with respect to enjoyment of food (19.9%; R² = 0.199, p = 0.008) and food fussiness combined (19.1%; R² = 0.191, p = 0.008). These results support the association of food preferences with both food approach traits and food avoidance traits.

Childhood overeating is associated with adverse cardiometabolic and inflammatory profiles in adolescence

Childhood eating behaviour contributes to the rise of obesity and related noncommunicable disease worldwide. However, we lack a deep understanding of biochemical alterations that can arise from aberrant eating behaviour. In this study, we prospectively associate longitudinal trajectories of childhood overeating, undereating, and fussy eating with metabolic markers at age 16 years to explore adolescent metabolic alterations related to specific eating patterns in the first 10 years of life. Data are from the Avon Longitudinal Study of Parents and Children (n = 3104). We measure 158 metabolic markers with a high-throughput (1H) NMR metabolomics platform. Increasing childhood overeating is prospectively associated with an adverse cardiometabolic profile (i.e., hyperlipidemia, hypercholesterolemia, hyperlipoproteinemia) in adolescence; whereas undereating and fussy eating are associated with lower concentrations of the amino acids glutamine and valine, suggesting a potential lack of micronutrients. Here, we show associations between early behavioural indicators of eating and metabolic markers.

Learning to overeat in infancy: Concurrent and prospective relationships between maternal BMI, feeding practices and child eating response among Hispanic mothers and children

BACKGROUND

Parents play a key role in shaping children's eating behaviours and self-regulation. There is limited data on how maternal weight influences feeding practices in the first year of life.

OBJECTIVE

To examine the relationships between maternal BMI, feeding practices and infant eating behaviours related to self-regulation.

METHODS

Participants were 160 mother-infant dyads. A longitudinal design was used to examine concurrent and prospective associations between maternal 6-month postpartum BMI, mothers' feeding practices at 6 months (Infant Feeding Practices Questionnaire) and children's eating behaviours at 6 months (Baby Eating Behaviour Questionnaire) and 12 months (Child Eating Behaviour Questionnaire).

RESULTS

Higher maternal BMI was associated positively with mothers' use of restrictive feeding practices (β = 0.036, p = 0.033), and inversely with responsivity to infant satiety cues (Spearman partial r = -0.249, p = 0.002) at 6 months. Mother's restrictive feeding practices were associated with infant food responsiveness (β = 0.157, p = 0.009) and emotional overeating (β = 0.118, p = 0.005) at 12 months. Maternal use of responsive feeding practices was associated with lower infant food responsiveness at 6 months (Spearman partial r = -0.173, p = 0.031) and lower emotional overeating at 12 months (Spearman partial r = -0.183, p = 0.022).

CONCLUSIONS

Our findings add to studies suggesting that feeding practices can provide mechanistic pathways in the intergenerational transmission of obesity. Postpartum family-system approaches focusing on maternal health while integrating infant feeding guidance may confer benefits in improving maternal-child health.

Infant and Early Child Appetite Traits and Child Weight and Obesity Risk in Low-Income Hispanic Families

BACKGROUND

Child appetite traits (ATs) are associated with later child weight and obesity risk. Less research has focused on ATs in low-income Hispanic children or included longitudinal associations with infant weight.

OBJECTIVE

To determine stability of ATs during infancy and childhood and their relationship with subsequent weight and obesity risk at age 3 years among low-income Hispanic children.

DESIGN

A secondary longitudinal analysis of data from the Starting Early Program randomized controlled obesity prevention trial.

PARTICIPANTS/SETTING

Three hundred twenty-two low-income, Hispanic mother-child pairs enrolled between 2012 and 2014 in a public hospital in New York City.

MAIN OUTCOME MEASURES

ATs, including Slowness in Eating, Satiety Responsiveness, Food Responsiveness, and Enjoyment of Food were assessed using the Baby and Child Eating Behavior Questionnaires at ages 3 months, 2 years, and 3 years. Main outcome measures were child standardized weight-for-age z score (WFAz) and obesity risk (WFA≥95th percentile) at age 3 years.

STATISTICAL ANALYSES PERFORMED

AT stability was assessed using correlations and multilevel modeling. Linear and logistic regression analyses examined associations between ATs and child WFAz and obesity risk at age 3 years.

RESULTS

There was limited stability for all ATs measured over time. During infancy, Slowness in Eating was associated with lower 3-year WFAz (B = -0.18, 95% CI -0.33 to -0.04; P = 0.01). At age 2 years, Slowness in Eating and Satiety Responsiveness were associated with lower WFAz (B = -0.29, 95% CI -0.47 to -0.12; P < 0.01; B = -0.36, 95% CI -0.55 to -0.17; P < 0.01) and obesity risk (adjusted odds ratio 0.49, 95% CI 0.28 to 0.85; adjusted odds ratio 0.61, 95% CI 0.38 to 0.99) at 3 years. Increased Slowness in Eating and Satiety Responsiveness over time were associated with lower 3-year WFAz (B = -0.74, 95% CI -1.18 to -0.2 [Slowness in Eating]; B = -1.19, 95% CI -1.87 to -0.52 [Satiety Responsiveness], both P values = 0.001). Higher Enjoyment of Food over time was associated with higher 3-year WFAz (B = 0.62, 95% CI 0.24 to 1.01; P = 0.002).

CONCLUSIONS

Infants with lower Slowness in Eating and Satiety Responsiveness may have higher levels of obesity risk and need more tailored approaches to nutrition counseling and obesity prevention.

INSIGHT responsive parenting intervention effects on child appetite and maternal feeding practices through age 3 years

Expert guidance encourages interventions promoting structure-based practices to establish predictable eating environments in order to foster children's self-regulatory skills. However, few studies have examined whether and how child characteristics may moderate effects of interventions on maternal feeding practices. This analysis aimed to examine the effect of the INSIGHT Responsive Parenting (RP) intervention delivered largely during infancy, on child appetitive traits at 2.5 years and maternal feeding practices at 3 years. Primiparous mother-newborn dyads were randomized to a RP intervention designed for obesity prevention or a safety control intervention. Mothers completed the Child Eating Behavior Questionnaire at 2.5 years and the Structure and Control in Parent Feeding Questionnaire at 3 years. T-tests assessed study group differences on child appetitive traits at 2.5 years and maternal feeding practices at age 3. ANCOVA models assessed the effect of study group on parent feeding practices and tested appetitive traits as a moderator. Two hundred thirty-two mother-child dyads completed the trial. Mothers were predominantly white, non-Hispanic, college educated, and married. RP group mothers used more consistent meal routines, and less pressure, food to soothe, and food as reward compared to controls. Child satiety responsiveness moderated the RP intervention effect on maternal use of limiting exposure to unhealthy foods such that the RP intervention was most effective for children at higher levels of satiety responsiveness. Food responsiveness moderated RP intervention effects on maternal use of pressure, such that at lower levels of food responsiveness, control group mothers used more pressure than RP mothers. The INSIGHT RP intervention demonstrated sustained effects on maternal feeding practices through age 3 years, with some intervention effects showing moderation by child appetitive traits.

Combined effects of weight change trajectories and eating behaviors on childhood adiposity status: A birth cohort study

Previous studies have suggested that infant rapid weight change can be associated with an increased weight later in life. However, the weight change trajectory in early life over time and which childhood lifestyle behaviors may modify the risk of rapid weight change have not been characterized. Using our ongoing birth cohort study, we have addressed these issues. Nine follow-up time points (birth, 3, 6, 9, 12, 18, 24, 36, and 48 months) were used to calculate the change between two adjacent weight-for-age z-scores (WAZ-change), and then WAZ-change trajectories were defined via group-based trajectory modeling. The solitary, independent and combined effects of WAZ-change trajectories and each lifestyle factor (eating behaviors, physical activity, media exposure time and total sleep duration) on childhood adiposity measures at age 4 years were determined using multivariate regression analysis. Overall, 84 (38%) children had a steady growth trajectory from birth to 4 years, while the other 137 (62%) children had an early infancy rapid growth trajectory, particularly in the first three months. Compared to children with steady growth, children with early infancy rapid growth had a significantly higher body mass index, waist circumference, and subcutaneous fat. Moreover, weight change trajectory and three eating behaviors (i.e. food responsiveness, satiety responsiveness and food fussiness), not only had independent effects, but also combined (synergistic) effects on the majority of adiposity measures. Our results extend the current literature and provide a potentially valuable model to aid clinicians and health professionals in designing early-life interventions targeting specific populations, specific ages and specific lifestyle behaviors to prevent childhood overweight/obesity.

Validity of the Adult Eating Behavior Questionnaire for adolescents treated in a weight management clinic

BACKGROUND

The Child and Adult Eating Behavior Questionnaires (CEBQ, AEBQ) are established measures of eating behaviors. However, no similar measure is available for adolescents. Prior research has validated the AEBQ in adult samples, and one study has explored using the measure with adolescents. However, no studies to date have examined the validity of the AEBQ in adolescent clinical populations. Furthermore, no studies have examined associations between the AEBQ and indicators of health status in adolescents.

METHODS

A total of 280 adolescents (12-17 years old, 60% female) seen in a pediatric weight management clinic completed the AEBQ at intake. Confirmatory factor analysis (CFA) was conducted with AEBQ items to evaluate the model fit of one-, two-, seven-, and eight-factor structures. Intercorrelations between scale scores from AEBQ Food Approach and Food Avoidance domains were calculated. Associations of AEBQ scales with body mass index (BMI) and binge-eating behaviors were examined using Spearman Rho correlations and independent t-tests.

RESULTS

CFAs revealed that the best fitting model was a seven-factor structure excluding the Hunger scale, although overall model fit was only marginally acceptable (X² = 980.94, CFI = 0.925, TLI = 0.915, RMSEA = 0.074). Intercorrelation analyses indicated that all Food Approach scales were significantly associated with one another (r = 0.243-0.654); Food Avoidance scales were inconsistently correlated (r = 0.034-0.439). No AEBQ scales were correlated with BMI (r = -0.101-0.082). Stronger links were found with binge eating; higher frequency binge-related behaviors were associated with higher Food Approach scores.

CONCLUSIONS

The seven-factor structure of AEBQ demonstrates a marginally acceptable fit for treatment-seeking adolescents with obesity. The Food Approach scales demonstrated more convergent validity than the Food Avoidance scales. The Food Approach scales also exhibited some clinical utility for identifying patients with increased risk for binge eating, which is a common target for behavioral intervention. Implications for maximizing the AEBQ's potential for assessing eating behaviors in adolescents with obesity are discussed.

The Role of the Environment in Overweight and Eating Behavior Variability: Insights from a Multivariate Twin Study

Research has emphasized the genetic basis of individual differences in body mass index (BMI); however, genetic factors cannot explain the rapid rise of obesity. Eating behaviors have been stipulated to be the behavioral expression of genetic risk in an obesogenic environment. In this study, we decompose variation and covariation between three key eating behaviors and BMI in a sample of 698 participants, consisting of 167 monozygotic, 150 dizygotic complete same-sex female twins and 64 incomplete pairs from a population-based twin registry in the southeast of Spain, The Murcia Twin Registry. Phenotypes were emotional eating, uncontrolled eating and cognitive restraint, measured by the Three Factor Eating Questionnaire and objectively measured BMI. Variation in eating behaviors was driven by nonshared environmental factors (range: 56%-65%), whereas shared environmental and genetic factors were secondary. All three eating behaviors were correlated with BMI (r = .19-.25). Nonshared environmental factors explained the covariations (Emotional eating-Uncontrolled eating: rE = .54, 95% CI [.43, .64]; BMI-Cognitive restraint: rE = .15, 95% CI [.01, .28]). In contrast to BMI, individual differences in eating behaviors are mostly explained by nonshared environmental factors, which also accounted for the phenotypic correlation between eating behaviors and BMI. Due to the sample size, analyses were underpowered to detect contributions of additive genetic or shared environmental factors to variation and covariation of the phenotypes. Although more research is granted, these results support that eating behaviors could be viable intervention targets to help individuals maintain a healthy weight.

The genomics of childhood eating behaviours

Eating behaviors may be expressions of genetic risk for obesity and are potential antecedents of later eating disorders. However, childhood eating behaviors are heterogeneous and transient. Here we show associations between polygenic scores for body mass index (BMI-PGS) and anorexia nervosa (AN-PGS) with eating behavior trajectories during the first ten years of life using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), N=7,825. Results indicated that one standard deviation (SD) increase in the BMI-PGS was associated with a 30-37% increased risk for early- and mid-childhood overeating. In contrast, one SD increase in BMI-PGS was associated with a 20% decrease in risk of persistent high levels of undereating and a 15% decrease in risk of persistent fussy eating. There was no evidence for a significant association between AN-PGS and eating behavior trajectories. Our results support the notion that child eating behavior share common genetic variants associated with BMI.

Appetitive Traits in a Population-Based Study of Polish Adolescents within the PLACE-19 Study: Validation of the Adult Eating Behavior Questionnaire

Appetitive traits of food approach or food avoidance are commonly measured using the Adult Eating Behavior Questionnaire (AEBQ). However, there is no Polish version of the AEBQ validated for adolescents, and to the best of our knowledge, no study completed with the Polish version of the AEBQ has been published thus far. The present study aimed to validate the AEBQ in a population-based sample of Polish secondary school students and to assess differences in appetitive traits between boys and girls within the Polish Adolescents' COVID-19 Experience (PLACE-19) Study. The PLACE-19 Study was conducted in a group of 2448 adolescents recruited in May 2020 through the random quota sampling of secondary schools. The AEBQ was used to assess food approach subscales (Food Responsiveness, Emotional Over-Eating, and Enjoyment of Food) and food avoidance subscales (Satiety Responsiveness, Emotional Under-Eating, Food Fussiness, and Slowness in Eating). To validate the questionnaire, the standardized factor loadings within confirmatory factor analysis (CFA) with weighted least squares (WLS) were analyzed, and invariance was verified. The CFA presented good model fit, with χ² = 4826.105 (degrees of freedom (df) = 384), root mean square error of approximation (RMSEA) = 0.069 (90% confidence interval (CI): 0.067, 0.070), comparative fit index (CFI) = 0.90, and standardized root mean square residual (SRMR) = 0.08. The results revealed that, compared to the configural invariance model, the metric invariance model did not result in significantly decreased model fit, with ΔCFI = -0.002 and ΔRMSEA = -0.001, which were lower than the recommended cutoffs of 0.010 and 0.015, respectively. The scalar invariance model also did not result in significantly decreased fit of the model over the metric invariance model, with ΔCFI = -0.005 and ΔRMSEA = 0.000. Girls reported higher levels of Food Responsiveness (p < 0.0001), Emotional Over-Eating (p < 0.0001), Satiety Responsiveness (p < 0.0001), Emotional Under-Eating (p < 0.0001), and Slowness in Eating than boys (p < 0.0001), and the total AEBQ scores of girls were also higher (p < 0.0001). Positive inter-correlations were observed between all food approach subscales, as well as between Emotional Under-Eating and all food approach subscales for girls, boys, and the total sample; positive inter-correlations were also observed between the majority of food avoidance subscales. The present study confirmed the validity of the AEBQ in the studied population, and supported the associations between appetitive traits assessed using the AEBQ; it also indicated higher scores of both food approach and food avoidance subscales in girls than in boys in a population-based sample of Polish secondary school students.

Appetitive traits as targets for weight loss: The role of food cue responsiveness and satiety responsiveness

Individuals with overweight or obesity (OW/OB) are at increased risk for significant physical and psychological comorbidities. The current treatment for OW/OB is behavioral weight loss, which provides psychoeducation on nutrition and physical activity, as well as behavior therapy skills. However, behavioral weight loss is not effective for the majority of the individuals who participate. Research suggests that overeating, or eating past nutritional needs, is one of the leading causes of weight gain. Accumulating evidence suggests that appetitive traits, such as food cue responsiveness and satiety responsiveness, are associated with overeating and weight in youth and adults. The following review presents the current literature on the relationship between food cue responsiveness, satiety responsiveness, overeating, and OW/OB. Research suggests that higher food cue responsiveness and lower satiety responsiveness are associated with overeating and OW/OB cross-sectionally and longitudinally. Emerging data suggest that food cue responsiveness and satiety responsiveness may exist along the same continuum and can be targeted to manage overeating and reduce weight. We have developed a treatment model targeting food cue responsiveness and satiety responsiveness to reduce overeating and weight and have preliminary feasibility, acceptability, and efficacy data, with testing currently being conducted in larger trials. Through programs targeting appetitive traits we hope to develop an alternative weight loss model to assist individuals with a propensity to overeat.

Eating behavior trajectories in the first 10 years of life and their relationship with BMI

Background

Child eating behaviors are highly heterogeneous and their longitudinal impact on childhood weight is unclear. The objective of this study was to characterize eating behaviors during the first ten years of life and evaluate associations with BMI at age 11 years.

Method

Data were parental reports of eating behaviors from 15 months to age 10 years (n=12,048) and standardized body mass index (zBMI) at age 11 years (n=4884) from the Avon Longitudinal Study of Parents and Children. Latent class growth analysis was used to derive latent classes of over-, under-, and fussy eating. Linear regression models for zBMI at 11 years on each set of classes were fitted to assess associations with eating behavior trajectories.

Results

We identified four classes of overeating; “low stable” (70%), “low transient” (15%), “late increasing” (11%), and “early increasing” (6%). The “early increasing” class was associated with higher zBMI (boys: β=0.83, 95%CI:0.65, 1.02; girls: β=1.1; 0.92, 1.28) compared to “low stable”. Six classes were found for undereating; “low stable” (25%), “low transient” (37%), “low decreasing” (21%), “high transient” (11%), “high decreasing” (4%), and “high stable” (2%). The latter was associated with lower zBMI (boys: β=-0.79; -1.15, -0.42; girls: β=-0.76; -1.06, -0.45). Six classes were found for fussy eating; “low stable” (23%), “low transient” (15%), “low increasing” (28%), “high decreasing” (14%), “low increasing” (13%), “high stable” (8%). The “high stable”class was associated with lower zBMI(boys: β =-0.49; -0.68 -0.30; girls: β =-0.35;-0.52, -0.18).

Conclusions

Early increasing overeating during childhoodis associated with higher zBMI at age 11. High persistent levels of undereating and fussy eating are associated with lower zBMI. Longitudinal trajectories of eating behaviors may help identify children potentially at risk of adverse weight outcomes.

Bidirectional relationships between appetitive behaviours and body mass index in childhood: a cross-lagged analysis in the Generation XXI birth cohort

PURPOSE

Appetitive behaviours have been associated with body mass index (BMI). However, existing data were largely derived from cross-sectional studies and cannot provide insight into the direction of associations. We aimed to explore the bidirectionality of these associations in school-age children.

METHODS

Participants are from the Generation XXI birth cohort, assessed at both 7 and 10 years of age (n = 4264; twins excluded). The Children's Eating Behaviour Questionnaire (CEBQ) was used to measure appetitive behaviours (8 subscales). Anthropometrics were measured and WHO BMI z-score was calculated. Cross-lagged analyses were performed to compare the magnitude and direction of the associations (behaviours at 7 years to BMI z-score at 10 years and the reverse) (covariates: child's sex, physical exercise, maternal age and education; plus BMI z-score at age 7 or, in the reverse direction, the subscale score).

RESULTS

In cross-lagged analyses, appetitive behaviours at 10 years of age (apart from emotional undereating) were shown to be reactive to the child BMI z-score at 7 years of age. Only slowness in eating was significantly related to subsequent BMI. However, the strongest association was from the child BMI z-score to the behaviour (β_standardized = - 0.028 compared with β_standardized = - 0.103, likelihood ratio test p < 0.001).

CONCLUSIONS

BMI at age 7 was related to appetitive behaviours at 10 years of age, rather than the reverse. This suggests that children with a higher BMI in middle childhood are at increased risk of developing an avid appetite over time.

Eating Style and the Frequency, Size and Timing of Eating Occasions: A cross-sectional analysis using 7-day weighed dietary records

The tendencies to overeat in response to negative emotions (emotional eating) and environmental cues (external eating) have both been associated with BMI. However, it is unclear how they are expressed at the eating architecture level, for example, respecting frequency, timing and size of eating occasions, which could comprise 'downstream' specific behavioural intervention targets. In our analyses of the UK National Diet and Nutrition Survey 2000-2001, a 1-unit higher emotional eating score was associated with meals containing approximately 15 (3, 26) fewer kcals per occasion, consuming 1.4 (0.5, 2.3) more snacks per week and snacking over a 35- (16, 53) minute longer period a day. A 1-unit higher external eating score was associated with snacking over a 24- (1, 46) minute shorter period a day. Associations were independent of BMI and other potential confounders. The distinct pattern of eating architecture associated with emotional eating, suggests specific approaches to intervention, such as the number, timing and caloric content of snacks, could be considered further in experimental studies for their potential to prevent weight gain in people with a higher emotional eating tendency. Longitudinal studies and better measurement are also needed to strengthen causal inference in terms of the downstream effects of eating styles.

Confirmation of the Factor Structure and Reliability of the 'Adult Eating Behavior Questionnaire' in an Adolescent Sample

Introduction

Appetitive traits, including Food Responsiveness, Enjoyment of Food, Satiety Responsiveness, Emotional Over- and Under-Eating, Food Fussiness and Slowness in Eating, have been captured across childhood using the Children’s Eating Behavior Questionnaire (CEBQ). The Adult Eating Behavior Questionnaire (AEBQ) has explored these traits in adults, but not adolescents. This study aimed to test the factor structure and reliability of the AEBQ in a sample of UK adolescents, and explore demographic differences.

Materials and Methods

Confirmatory factor analysis (CFA) tested an 8-factor and a 7-factor AEBQ, based on valid, completed AEBQ responses (n = 913) from adolescents aged 11–18 recruited from four London secondary schools. Test–retest reliability was analyzed in a subsample (n = 106) 2-weeks later, and 492 participants completed the Dutch Eating Behavior Questionnaire (DEBQ) to assess convergent validity. Demographic differences were explored using a multiple indicator multiple cause (MIMIC) model.

Results

The CFA revealed an adequate model fit for a 7-factor structure without Hunger [RMSEA = 0.038 (90% CI:0.035,0.041); CFI = 0.926, TLI = 0.916; and χ²(df = 595) = 8502.69, p < 0.001]. These seven subscales showed acceptable internal consistency (Cronbach’s α > 0.70). The ICC for the test–retest was above 0.70. Comparisons with the DEBQ supported the convergent validity of the AEBQ. Older age was associated with greater Food Responsiveness and Enjoyment of Food (all p-values < 0.005). Females reported higher levels of Emotional Over-Eating, Satiety Responsiveness, and Slowness in Eating than males (all p-values ≤ 0.003).

Conclusion

This study supports the use of the 7-factor AEBQ as a reliable measure of appetitive traits in adolescents.

Feeding circuit development and early-life influences on future feeding behaviour

A wide range of maternal exposures - undernutrition, obesity, diabetes, stress and infection - are associated with an increased risk of metabolic disease in offspring. Developmental influences can cause persistent structural changes in hypothalamic circuits regulating food intake in the service of energy balance. The physiological relevance of these alterations has been called into question because maternal impacts on daily caloric intake do not persist to adulthood. Recent behavioural and epidemiological studies in humans provide evidence that the relative contribution of appetitive traits related to satiety, reward and the emotional aspects of food intake regulation changes across the lifespan. This Opinion article outlines a neurodevelopmental framework to explore the possibility that crosstalk between developing circuits regulating different modalities of food intake shapes future behavioural responses to environmental challenges.

Association between eating frequency and eating behaviours related to appetite from 4 to 7 years of age: Findings from the population-based birth cohort generation XXI

The examination of specific characteristics of eating habits in childhood and its influence on eating behaviours is needed to better understand the establishment of appetite-related eating behaviours. This study aimed to assess the association between eating frequency (EF) (main meals vs. snacks) at 4 and 7y and problematic eating behaviours and appetite-related eating behaviours at 7y. The analysis included 1359 children from the birth cohort Generation XXI who provided 3-day food diaries, at both ages, and complete information on the Child Eating Behaviour Questionnaire, at 7y. Problematic eating behaviours were assessed using parental perception of child's poor eating (including not eating enough, eating too slow or overeating) at both ages. A time-of-day approach was used to distinguish main meals from snacks. A cross-lagged analysis was performed to check the direction of the association between EF and parental concerns regarding problematic eating behaviours. Associations between EF and appetite-related eating behaviours were evaluated through linear regression models. Between 4 and 7y a moderate tracking of EF was described as well as a strong tracking of parental concerns. We found a bidirectional relationship between EF and parental concerns. Prospectively, a higher frequency of snacks at 4y was independently associated with higher scores in 'Desire to Drink' at 7y (β = 0.051, 95%CI:0.009; 0.093). At 7y, a higher EF had a positive association with 'Satiety Responsiveness' but an inverse association with 'Enjoyment of Food'. A higher number of main meals had a positive association with 'Enjoyment of Food' and 'Food Responsiveness'. In conclusion, children who had more eating occasions seem to have more food-avoidance behaviours, traits that might protect these children from gaining excessive weight.

Longitudinal associations between eating and drinking engagement during mealtime and eating in the absence of hunger in low income toddlers

To develop effective obesity-related interventions during early life, it is important to identify predictors of eating in the absence of hunger during toddlerhood. Hence, this study examined longitudinal associations between child eating and drinking engagement at 27 months of age and child eating in the absence of hunger (EAH) at 33 months of age (N = 91 children; 57.1% boys). At 27 months of age, we coded child eating and drinking engagement during a videotaped naturalistic lunch meal at home. We also obtained mothers' reports of their child's food responsiveness (FR), satiety responsiveness (SR), and desire to drink (DD) using the Child Eating Behavior Questionnaire (CEBQ). Children participated in a standard EAH protocol at 27 and 33 months of age where they were presented with palatable foods and the amount of food eaten was assessed (calculated as total kilocalories consumed). Correlational analyses showed that EAH at 27 months of age was positively related to EAH at 33 months of age and that neither mother-reported child FR or SR were associated with child eating engagement. Mother-reported child DD was associated with child drinking engagement. To predict EAH at 33 months, a regression analysis was conducted in which EAH at 27 months, mother-reported and observed child eating and drinking engagement at 27 months were entered as predictors, controlling for child demographics (i.e., age, sex, race/ethnicity and weight-for-length z-score (WLZ). Findings were that children who were observed to engage in more drinking at 27 months of age consumed more energy (measured as kcal) in the EAH at 33 months of age. Implications for understanding eating, and drinking, behaviors in toddlerhood are discussed.

Perceived child eating behaviours and maternal migrant background

The Child Eating Behaviour Questionnaire (CEBQ) is a well-established instrument in the study of obesity-related eating behaviours among children. However, research using the CEBQ in multicultural samples is limited. This study aims to identify and examine differences in child eating behaviours as reported by Swedish-born and non-Swedish-born mothers living in Sweden. Mothers (n = 1310, 74 countries of origin, mean age 36.5 years, 63.6% with higher education, 29.2% with overweight or obesity) of children aged 3-8 years (mean age 4.8 years, 18.1% with overweight or obesity) completed the CEBQ. Responses were analysed using CEBQ subscales Food Responsiveness, Emotional Overeating, Enjoyment of Food, and Desire to Drink, clustering into Food Approach, and subscales Satiety Responsiveness, Slowness in Eating, Emotional Undereating, and Food Fussiness, clustering into Food Avoidance. Data were compared across seven regional groups, divided by maternal place of birth: (1) Sweden (n = 941), (2) Nordic and Western Europe (n = 68), (3) Eastern and Southern Europe (n = 97), (4) the Middle East and North Africa (n = 110), (5) East, South and Southeast Asia (n = 52), (6) Sub-Saharan Africa (n = 16), and (7) Central and South America (n = 26). Crude, partly and fully adjusted linear regression models controlled for child's age, gender and weight status, and mother's education, weight status and concern about child weight. The moderation effect of maternal concern about child weight was examined through interaction analyses. Results showed that while Food Approach and Food Avoidance behaviours were associated with maternal migrant background, associations for Food Fussiness were limited. Notably, mothers born in the Middle East and North Africa reported higher frequencies of both Food Approach (except for Enjoyment of Food) and Food Avoidance. The study highlights the importance of examining how regionally-specific maternal migrant background affects mothers' perceptions of child eating behaviours.

Appetitive traits associated with higher and lower body mass index: evaluating the validity of the adult eating behaviour questionnaire in an Australian sample

BACKGROUND

The aims of this study were to evaluate the factor structure of the newly developed Adult Eating Behaviour Questionnaire (AEBQ) (Hunot et al., Appetite 105:356-63, 2016) in an Australian sample, and examine associations between the four food approach and four food avoidance appetitive traits with body mass index (BMI).

METHODS

Participants (N = 998) recruited between May and October 2016 via a university research participation scheme and online social network sites completed an online version of the AEBQ and self-reported demographic and anthropometric data. Of the sample, 84.8% were females, 29.6% had completed a university degree and the overall mean age was 24.32 years (SD = 8.32). Confirmatory factor analysis (CFA) was used to test three alternative factor structures (derived from issues raised in the original development study): the original 8 factor model, a 7 factor model with Food Responsiveness and Hunger scales combined, and a 7 factor model with the Hunger scale removed.

RESULTS

The CFA revealed that the original 8 factor model was a better fit to the data than the 7 factor model in which Food Responsiveness and Hunger scales were combined. However, while reliability estimates for 7 of the 8 scales were good (Cronbach's α between 0.70-0.86), the reliability of the Hunger scale was modest (0.67) and dropping this factor resulted in a good fitting model. All food avoidance scales (except Food Fussiness) were negatively associated with body mass index (BMI) whereas Emotional Overeating was the only food approach scale positively associated with BMI.

CONCLUSIONS

The study supports the use of the AEBQ as a reliable and valid measure of food approach and avoidance appetitive traits in adults. Longitudinal studies that examine continuity and stability of appetitive traits across the lifespan will be facilitated by the addition of this measurement tool to the literature.

FTO genotype and weight status among preadolescents: Assessing the mediating effects of obesogenic appetitive traits

Polymorphisms in the Fat Mass and Obesity Associated (FTO) gene are robustly associated with overweight and obesity among children, although the underlying mechanisms are poorly understood. We tested if appetitive traits partially mediated the association between FTO genotype and increased BMI among a sample of US preadolescents. Data were from 178 unrelated 9-10 year olds who participated in an experimental study between 2013 and 2015. Children's DNA was isolated from buccal swabs, and the rs9939609 SNP in the FTO gene was genotyped. Children's age- and sex-adjusted BMI z-scores were computed using height and weight measured at the laboratory. Parents completed the Child Eating Behavior Questionnaire that includes three validated scales of habitual appetitive traits related to drive and regulation: satiety responsiveness, enjoyment of food and food responsiveness. Structural equation modeling was used to assess if those traits mediated the relationship between FTO and BMI z-score. The sample of children was 48.9% male and 91.0% non-Hispanic white. FTO distribution was in Hardy Weinberg equilibrium, and 16.3% of participants were homozygous for the high-risk allele. Mean BMI z-score was greatest among those with the high-risk genotype (ANOVA P < 0.01). In separate structural equation models adjusted for the child's sex and maternal education, decreased satiety responsiveness and increased food responsiveness each partially mediated the positive association between the high-risk genotype and increased BMI z-score (P-value for each indirect effect <0.05). Continued research is needed to better understand how other known genetic obesity risk factors may impact appetitive traits among children.

Family food talk, child eating behavior, and maternal feeding practices

Families discuss food and eating in many ways that may shape child eating habits. Researchers studying how families talk about food have examined this process during meals. Little work has examined parent-child food-related interactions outside of mealtime. We assessed family food talk at home outside of mealtime and tested whether food talk was associated with obesogenic child eating behaviors, maternal feeding practices, or child weight. Preschool and school-aged mother-child dyads (n = 61) participated in naturalistic voice recording using a LENA (Language ENvironment Analysis) recorder. A coding scheme was developed to reliably characterize different types of food talk from LENA transcripts. Mothers completed the Children's Eating Behavior Questionnaire (CEBQ) and Child Feeding Questionnaire (CFQ) to assess child eating behaviors and maternal feeding practices. Child weight and height were measured and body mass index z-score (BMIz) calculated. Bivariate associations among food talk types, as a proportion of total speech, were examined and multivariate regression models used to test associations between food talk and child eating behaviors, maternal feeding practices, and child BMIz. Proportion of child Overall Food Talk and Food Explanations were positively associated with CEBQ Food Responsiveness and Enjoyment of Food (p's < 0.05). Child food Desire/Need and child Prep/Planning talk were positively associated with CEBQ Enjoyment of Food (p < 0.05). Child Food Enjoyment talk and mother Overt Restriction talk were positively associated with CEBQ Emotional Over-Eating (p < 0.05). Mother Monitoring talk was positively associated with CFQ Restriction (p < 0.05). Mother Prep/Planning talk was negatively associated with child BMIz. Food talk outside of mealtimes related to child obesogenic eating behaviors and feeding practices in expected ways; examining food talk outside of meals is a novel way to consider feeding practices and child eating behavior.

Behavioural Susceptibility Theory: Professor Jane Wardle and the Role of Appetite in Genetic Risk of Obesity

PURPOSE OF REVIEW

There is considerable variability in human body weight, despite the ubiquity of the 'obesogenic' environment. Human body weight has a strong genetic basis and it has been hypothesised that genetic susceptibility to the environment explains variation in human body weight, with differences in appetite being implicated as the mediating mechanism; so-called 'behavioural susceptibility theory' (BST), first described by Professor Jane Wardle. This review summarises the evidence for the role of appetite as a mediator of genetic risk of obesity.

RECENT FINDINGS

Variation in appetitive traits is observable from infancy, drives early weight gain and is highly heritable in infancy and childhood. Obesity-related common genetic variants identified through genome-wide association studies show associations with appetitive traits, and appetite mediates part of the observed association between genetic risk and adiposity. Obesity results from an interaction between genetic susceptibility to overeating and exposure to an 'obesogenic' food environment.

Meal size is a critical driver of weight gain in early childhood

Larger serving sizes and more frequent eating episodes have been implicated in the rising prevalence of obesity at a population level. This study examines the relative contributions of meal size and frequency to weight gain in a large sample of British children. Using 3-day diet diaries from 1939 children aged 21 months from the Gemini twin cohort, we assessed prospective associations between meal size, meal frequency and weight gain from two to five years. Separate longitudinal analyses demonstrated that every 10 kcal increase in meal size was associated with 1.5 g/wk or 4% (p = 0.005) faster growth rate, while meal frequency was not independently associated with growth (β = 0.3 g/wk p = 0.20). Including both meal parameters in the model strengthened associations (meal size: β = 2.6 g/wk, p < 0.001; meal frequency: β = 1.0 g/wk, p = 0.001). Taken together, the implication is that meal size promotes faster growth regardless of frequency, but meal frequency has a significant effect only if meal size is assumed to be held constant. Clearer advice on meal size and frequency, especially advice on appropriate meal size, may help prevent excess weight gain.

Lunch-time food choices in preschoolers: Relationships between absolute and relative intakes of different food categories, and appetitive characteristics and weight

Children's appetitive characteristics measured by parent-report questionnaires are reliably associated with body weight, as well as behavioral tests of appetite, but relatively little is known about relationships with food choice. As part of a larger preloading study, we served 4-5year olds from primary school classes five school lunches at which they were presented with the same standardized multi-item meal. Parents completed Child Eating Behavior Questionnaire (CEBQ) sub-scales assessing satiety responsiveness (CEBQ-SR), food responsiveness (CEBQ-FR) and enjoyment of food (CEBQ-EF), and children were weighed and measured. Despite differing preload conditions, children showed remarkable consistency of intake patterns across all five meals with day-to-day intra-class correlations in absolute and percentage intake of each food category ranging from 0.78 to 0.91. Higher CEBQ-SR was associated with lower mean intake of all food categories across all five meals, with the weakest association apparent for snack foods. Higher CEBQ-FR was associated with higher intake of white bread and fruits and vegetables, and higher CEBQ-EF was associated with greater intake of all categories, with the strongest association apparent for white bread. Analyses of intake of each food group as a percentage of total intake, treated here as an index of the child's choice to consume relatively more or relatively less of each different food category when composing their total lunch-time meal, further suggested that children who were higher in CEBQ-SR ate relatively more snack foods and relatively less fruits and vegetables, while children with higher CEBQ-EF ate relatively less snack foods and relatively more white bread. Higher absolute intakes of white bread and snack foods were associated with higher BMI z score. CEBQ sub-scale associations with food intake variables were largely unchanged by controlling for daily metabolic needs. However, descriptive comparisons of lunch intakes with expected amounts based on metabolic needs suggested that overweight/obese boys were at particularly high risk of overeating. Parents' reports of children's appetitive characteristics on the CEBQ are associated with differential patterns of food choice as indexed by absolute and relative intake of various food categories assessed on multiple occasions in a naturalistic, school-based setting, without parents present.