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 Mairead Kiely, Elaine McCarthy & Carol Ni Chaoimh Vitamin D Research Group and INFANT University College Cork 30/06/2015 M Kiely, UCC 1
What do we know about eating behaviour? 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)
To explore associations between eating behaviours & weight status
2137 Birth 2m 6m 12m 24m 5 Years Biobanking TEWL Body fat % Anthropometry Neonatal course Feeding Growth Body fat % Eczema, TEWL Food allergy General health Childhood illness Developmental screening Biobanking Growth Nutrition Body Composition Bone - length, size, BMC, BMD Atopic disease progression Neurodevelopment Muscle strength General health/ illness Trans-epidermal water loss (TEWL) Biobanking Anthropometry Skin prick testing (allergy) Neurodevelopment assessment Nutritional assessment
Methodology Eating behaviours were assessed at the study s 24 month appointment The CEBQ contains 8 eating behaviour subscales Enjoyment of Food Emotional Overeating Food Approach Desire to Drink Subscales Food Responsiveness Satiety Responsiveness Slowness in Eating Food Fussiness Emotional Under-eating 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
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 IOTF Child Grade Adult BMI Range (kg/m 2 ) 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+
Dietary Assessment Methodology 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
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 3 rd level education Child weight status according to IOTF BMI cut-offs 6% underweight 80% normal weight 14% overweight/obese
Median Score Results CEBQ Food Avoidant Subscale Median Scores and Gender 3.1 3.0 Males Females 2.9 2.8 2.7 2.6 2.5 2.4 2.3 2.2 Slowness in Eating Food Fussiness Satiety Responsiveness significant difference P<0.05 Emotional Undereating
Median Score Results CEBQ Food Approach Subscale Median Scores and Weight Status 5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 Enjoyment of Food Underweight Normal Weight Overweight/Obese Food Responsiveness Desire to Drink Emotional Overeating significant difference P<0.05
Median Score Results CEBQ Food Approach Grouped Median Score and Weight Status 2.8 2.7 2.6 2.5 2.4 2.3 2.2 2.1 Underweight Normal Weight Overweight/Obese significant difference P<0.05
Median Score Results CEBQ Food Avoidant Subscale Median Scores and Weight Status 3.5 3.0 Underweight Normal Weight Overweight/Obese 2.5 2.0 1.5 1.0 0.5 0.0 Satiety Responsiveness significant difference P<0.05 Slowness in Eating Food Fussiness Emotional Undereating
Median Score Results CEBQ Food Avoidant Grouped Median Score and Weight Status 3.1 3.0 2.9 2.8 2.7 2.6 2.5 2.4 Underweight Normal Weight Overweight/Obese significant difference P<0.05
CEBQ subscales as risk factors for overweight/obesity at 2 years Food Approach Behaviours OR (95% CI) P-value 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 potential risk factors for underweight at 2 years Food Approach Behaviours OR (95% CI) P-value 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.
Results 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 nonpicky eaters
Results IOTF BMI classifications of picky and non-picky eaters 90 Picky Eater 80 70 82 79 Non-picky Eater 60 50 40 30 20 10 0 11 5 7 Underweight Normal weight Overweight/obese 16 significant difference P<0.05
Conclusions Eating behaviours are associated with weight status in twoyear 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
Future directions 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
Thank you. Any questions?