Diet and eating behaviour of children in Baseline - the good, the bad and the fattening?

PLUS A brief update on vitamin D in BL 2-year olds…

30/06/2015 M Kiely, UCC 1

Mairead Kiely, Elaine McCarthy & Carol Ni Chaoimh

Vitamin D Research Group and INFANT

University College Cork

• Eating behaviours vary on a continuum from picky eating to overeating and binge eating

• Behaviours influenced by genetic and environmental factors in early life

• In children, eating behaviours measured by

– Behavioural & Psychometric tests

• Children’s Eating Behaviour Questionnaire (CEBQ) (Wardle et al., 2001)

• Associations between eating behaviours and weight status have been identified in children aged >3 years

• Limited research in pre-school age children (<3 years)

What do we know about eating behaviour?

To explore associations between eating behaviours & weight status

Biobanking

TEWL* Body fat %

Anthropometry Neonatal course

Feeding Growth Body fat % Eczema, TEWL* Food allergy General health Childhood illness Developmental screening

Biobanking

Anthropometry Skin prick testing (allergy)

Neurodevelopment assessment Nutritional assessment

2137

Birth 2m 6m 12m 24m

*Trans-epidermal water loss (TEWL)

5 Years

Biobanking Growth Nutrition Body Composition Bone - length, size, BMC, BMD Atopic disease progression Neurodevelopment Muscle strength General health/ illness

Methodology

• Eating behaviours were assessed at the study’s 24 month appointment

• The CEBQ contains 8 eating behaviour subscales

• Enjoyment of Food • Emotional Overeating • Desire to Drink • Food Responsiveness • Satiety Responsiveness • Slowness in Eating • Food Fussiness • Emotional Under-eating

Food Approach Subscales

Food Avoidant Subscales

Methodology • Each subscale contains 3-5 questions related to that eating

behaviour “My child refuses new foods at first” Food Fussiness • Scoring based on a five-point Likert scale

1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always

• Reverse scoring was also applied “My child finishes their meal quickly” Slowness in Eating

IOTF Child Grade Adult BMI

Range (kg/m2)

Thinness Grade 3 <16

Thinness Grade 2 16 to <17

Thinness Grade 1 17 to <18.5

Normal 18.5 to <25

Overweight 25 to <30

Obesity 30+

• Body Mass Index (weight divided by height squared) cut-offs from the International Obesity Task Force (IOTF) for children were used to assign participants into three weight categories IOTF BMI cut-offs for children aged 2-18 years correspond to adult BMI ranges

Underweight

Normal weight

Overweight/Obese

Day of Week

Time

Type of Meal (e.g. snack, drink,

lunch)

Where meal was prepared

(e.g. home, crèche)

Where was meal eaten

(e.g. in car, in front of tv)

Who was with the child

(e.g. parent, childminder)

Fed Self Mainly Yes/No

Office Use

Weight of plate,

bowl, cup (g)

Description of Food or Drink (include brand and cooking method)

Amount/ Weight of

food or drink

(g)

Weight of plate, bowl, cup with

leftovers (g)

Description of Leftovers

Description of dropped food/spillages

Dietary Assessment Methodology

Dietary Assessment Methodology

Subject Characteristics

1189 participants with complete anthropometric and eating behaviour data were included in analysis

– All term infants

– Mean (SD) age of 25 (0.9) months

– Maternal characteristics

99% Caucasian

88% attended 3rd level education

– Child weight status according to IOTF BMI cut-offs

6% underweight

80% normal weight

14% overweight/obese

Results CEBQ Food Avoidant Subscale Median Scores and Gender

* significant difference P<0.05

2.2

2.3

2.4

2.5

2.6

2.7

2.8

2.9

3.0

3.1

Slowness in Eating Food Fussiness SatietyResponsiveness

Emotional Under-eating

Me

dia

n S

core

Males Females*

*

Results CEBQ Food Approach Subscale Median Scores and Weight Status

* significant difference P<0.05

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Enjoyment of Food FoodResponsiveness

Desire to Drink EmotionalOvereating

Me

dia

n S

core

Underweight Normal Weight Overweight/Obese

*

*

Results CEBQ Food Approach Grouped Median Score and Weight Status

* significant difference P<0.05

2.1

2.2

2.3

2.4

2.5

2.6

2.7

2.8

Underweight Normal Weight Overweight/Obese

Me

dia

n S

core

*

*

*

Results CEBQ Food Avoidant Subscale Median Scores and Weight Status

* significant difference P<0.05

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

SatietyResponsiveness

Slowness in Eating Food Fussiness Emotional Under-eating

Me

dia

n S

core

Underweight Normal Weight Overweight/Obese

* * *

Results CEBQ Food Avoidant Grouped Median Score and Weight Status

* significant difference P<0.05

2.4

2.5

2.6

2.7

2.8

2.9

3.0

3.1

Underweight Normal Weight Overweight/Obese

Me

dia

n S

core

*

*

*

OR (95% CI) P-value

Food Approach Behaviours

Enjoyment of Food 1.90 (1.46, 2.48) <0.001

Food Responsiveness 1.73 (1.47, 2.03) <0.001

Emotional Overeating 1.30 (0.94, 1.80) 0.112

Desire to Drink 1.11 (0.94, 1.31) 0.225

Food Avoidant Behaviours

Satiety Responsiveness 0.56 (0.43, 0.73) <0.001

Slowness in Eating 0.57 (0.45, 0.73) <0.001

Food Fussiness 0.70 (0.56, 0.88) 0.002

Emotional Under-eating 0.97 (0.81, 1.16) 0.724

*Model adjusted for birth weight, maternal education status, race and smoking status at 15 weeks gestation. Not overweight/obese used as the reference.

CEBQ subscales as risk factors for overweight/obesity at 2 years*

CEBQ subscales as potential risk factors for underweight at 2 years*

OR (95% CI) P-value

Food Approach Behaviours

Enjoyment of Food 0.63 (0.45, 0.89) 0.008

Food Responsiveness 0.49 (0.32, 0.75) <0.001

Emotional Overeating 0.77 (0.47, 1.25) 0.290

Desire to Drink 0.93 (0.73, 1.17) 0.523

Food Avoidant Behaviours

Satiety Responsiveness 2.03 (1.38, 2.98) <0.001

Slowness in Eating 1.44 (1.01, 2.04) 0.042

Food Fussiness 1.15 (0.83, 1.58) 0.411

Emotional Under-eating 0.96 (0.75, 1.23) 0.731

*Model adjusted for gender, birth weight, maternal education status and maternal BMI at 15 weeks gestation. Not underweight used as the reference.

• No significant differences in food or energy, fat, carb or protein intakes between low, medium and high CEBQ subscale scores

• Picky Eating

– 21% of children were identified as picky eaters by parents

– No significant differences in macronutrient intakes between picky and non-picky eaters

– Picky eaters ate more biscuits, cakes and processed meats but less vegetables than non-picky eaters

– Picky eaters were significantly shorter and lighter than non-picky eaters

Results

Results

11

82

7 5

79

16

0

10

20

30

40

50

60

70

80

90

Underweight Normal weight Overweight/obese

Picky Eater

Non-picky Eater

• IOTF BMI classifications of picky and non-picky eaters

*

* *

* significant difference P<0.05

Conclusions

• Eating behaviours are associated with weight status in two-year old children in Ireland

• Food approach behaviours

– positively associated with the risk of overweight/obesity

– negatively associated with the risk of underweight

• Food avoidant behaviours

– negatively associated with the risk of overweight/obesity

– positively associated with the risk of underweight

• Picky eating behaviour associated with a lack of dietary diversity and the risk of underweight at two years

• At what age do these behaviours develop in childhood? Are these behaviours present before two years of age?

• What is the genesis of unhealthy eating behaviours in young children?

– Environmental factors

– Genetic influences

• Can these behaviours be modified in early childhood?

– Potential means of an intervention strategy against later overweight and obesity

Future directions…

Thank you. Any questions?