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…
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