Supporting strategies for enhancing vegetable liking in the early years of life: an umbrella review of systematic reviews.

BACKGROUND: Many children worldwide do not eat recommended amounts of vegetables. Disliking vegetables is a key factor associated with low intake. OBJECTIVE: This umbrella review synthesized systematic reviews to determine the effectiveness of sensory and behavioral strategies to facilitate liking of vegetables (primary outcome) in young children up to 5 y of age, as key predictors of vegetable intake (secondary outcome). METHODS: Nine databases were searched up to May 2019 (updated in September 2020). Two reviewers independently conducted study screening and selection, data extraction, and assessment of methodological quality using AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews). Eleven reviews (n = 1 rated strong quality, n = 4 moderate quality, n = 6 low/critically low quality) examining 85 primary studies met the review criteria: systematic reviews and meta-analyses of primary studies (any quantitative design) that examined sensory or behavioral strategies on vegetable liking or intake (outcomes reported separately for children ≤5 y). Strategy effectiveness was synthesized into 3 categories based on evidence strength: 1) promising (large and consistent body of moderate quality evidence), 2) emerging (small to moderate body of mixed consistency and quality evidence), and 3) limited (small body of limited consistency and quality evidence). RESULTS: Promising evidence was identified for repeated exposure to a single or a variety of vegetables. Emerging evidence was identified for several strategies that increase familiarity with vegetable flavors (e.g., via exposure in utero and through breast milk, and a "vegetable first" approach to complementary feeding) and/or willingness to try vegetables (e.g., via parental role modeling, nonfood rewards, and vegetable-based story books). CONCLUSIONS: Current evidence supports incorporation of tailored advice into guideline documents for parents and carers to repeatedly expose their children to a variety of vegetables to increase vegetable intake. Ongoing robust research on strategies to facilitate children's liking of vegetables is warranted to strengthen the evidence base underpinning advice for parents and health professionals.

Comparison of Early Feeding Practices in Mother-Father Dyads and Possible Generalization of an Efficacious Maternal Intervention to Fathers' Feeding Practices: A Secondary Analysis.

To compare feeding practices within mother-father dyads and explore whether outcomes of an efficacious intervention for mothers generalised to fathers' feeding practices. The NOURISH RCT evaluated an early feeding intervention that promoted positive feeding practices to support development of healthy eating habits and growth. The intervention was delivered to first-time mothers via 2 × 12 week modules commencing when children were 4 and 14 months. Mothers self-reported feeding practice outcomes at child age 2 years using validated scales (1 = low to 5 = high) from the Child Feeding Questionnaire (CFQ). Nine months later, an independent cross-sectional descriptive study to investigate fathers' feeding practices was initiated. Fathers were recruited by contacting (via letter) mothers participating in two pre-existing studies, including the NOURISH trial. Fathers completed a feeding practices questionnaire, similar to that used for NOURISH outcome assessments. Seventy-five fathers recruited via the NOURISH cohort (21% response) returned questionnaires. Response data from this subset of fathers were then linked to the corresponding NOURISH maternal data. Complete data were available from 70 dyads. Compared with mothers, fathers self-reported higher concern about child overweight (2.2 vs. 1.3), restriction (3.6 vs. 2.9) and pressure (2.6 vs. 2.1), all p < 0.001. Fathers whose partners were allocated to the intervention group used less pressure (mean difference 0.46, p = 0.045) and were more willing to let the child decide how much to eat (-0.51, p = 0.032). Fathers' higher concern about child weight and more frequent use of non-responsive feeding practices, when compared with mothers, identify them as potentially potent contributors to child feeding. This preliminary evidence for modest generalisation of an efficacious maternal intervention to apparent effects on some paternal feeding practices speaks to the importance and promise of including fathers in early feeding interventions.

Non-responsive feeding practices mediate the relationship between maternal and child obesogenic eating behaviours.

Both genetic and environmental influences underpin complex multidimensional associations between maternal and child eating behaviours, maternal feeding practices and child obesity risk. The aim of the present study was to explore cross-sectional relationships between maternal and child eating behaviours, and to examine whether maternal feeding practices mediate these relationships. Data were available from 478 Australian mothers (M = 38.8 years, SD = 5.6) of a 5-10 year old child (M = 7.0 years, SD = 1.1; 48.2% male). Mothers completed an online survey that included validated measures of maternal eating behaviours, maternal feeding practices and child eating behaviours. Maternal emotional overeating and food responsiveness, were each positively associated with the parallel child eating behaviour (r = 0.29 and r = 0.21, ps < .001, respectively). Mediation analyses showed that both the relationship between maternal and child emotional overeating and between maternal and child food responsiveness, were partially mediated by use of food as a reward and overt restriction (total indirect effect: .04, 95% CI 0.02, 0.07 and 0.82, 95% CI 0.04, 0.13, respectively). Findings suggest a role for feeding practices in explaining the concordance between maternal and child eating behaviours. Moreover, the results highlight the need for interventions that support parents to recognise these eating behaviours in themselves and their children and understand how these may potentially influence the feeding practices they use. Future longitudinal research that confirms the cross-sectional relationships between maternal and child eating behaviours and feeding practices reported here will strengthen the evidence to support the importance of feeding practices in the development of dietary intake patterns and obesity risk.

Interventions commenced by early infancy to prevent childhood obesity-The EPOCH Collaboration: An individual participant data prospective meta-analysis of four randomized controlled trials.

BACKGROUND: Childhood obesity is a significant global problem. Childhood obesity prevention interventions may be more effective when started very early in life before metabolic and behavioural patterns are established. METHODS AND FINDINGS: A prospectively planned, individual participant data meta-analysis of four randomized controlled trials. Participants were first-time mothers of term infants. Trial interventions commenced during pregnancy or early infancy and comprised education and support delivered via group sessions and/or home visits. Control group families accessed existing local well-child health care. The primary outcome was body mass index (BMI) z score at 18 to 24 months; 2196 mother-child dyads were available for analysis. Intervention children had lower BMI z scores at 18 to 24 months than control children (-0.12 adjusted mean; 95% confidence interval, -0.22 to -0.02, P = .017). There was some evidence that the BMI z score reduction was greater in settings with limited well-child health care programmes (interaction P value = .03). Improvements were also detected in television viewing time, feeding practices, and breastfeeding duration. CONCLUSIONS: Parent-focused intervention programmes that commence by early infancy and which aim to establish a trajectory of healthy lifestyle behaviours produced a modest but statistically significant reduction in BMI z score, which if replicated on a wider scale may have important public health implications.

Comparing barriers to breastfeeding success in the first month for non-overweight and overweight women.

BACKGROUND: Women who enter pregnancy overweight or obese tend to have poorer breastfeeding outcomes compared to non-overweight women. Women's experiences of specific breastfeeding-related problems and reasons for use of formula have not been systematically investigated according to pre-pregnancy BMI. The aim of this study was to compare self-reported breastfeeding problems in non-overweight and overweight women and identify the main reasons for use of infant formula during the first month postpartum. METHODS: The present study involved a cross-sectional secondary analysis of data collected as part of a hospital-based longitudinal study of women that commenced in pregnancy (~ 16 weeks). At ~ 4 months postpartum Australian women (N = 477) self-reported breastfeeding problems and reasons for use of infant formula during the first month postpartum. Pre-pregnancy BMI was calculated based on self-reported pre-pregnancy weight and measured height. Binary logistic regression analyses were used to compare pre-pregnancy weight status groups ("non-overweight" [BMI < 25 km/m2] and "overweight" [BMI ≥25 km/m2]) on self-reported breastfeeding problems and reasons for use of infant formula. Analyses were adjusted for covariates that differed between groups (P < .1). RESULTS: Frequency of self-reported breastfeeding problems was similar across weight status groups. "Not enough milk" was the predominant reason for giving infant formula. Overweight women were more likely than non-overweight women to agree that infant formula was as good as breastmilk. CONCLUSIONS: Overall it does not appear that overweight women are more likely to experience a range of specific breastfeeding problems in the first months compared to non-overweight women. However, the severity and duration of the problems needs to be examined. Breastfeeding interventions need to addresses concerns around milk supply as these are common and are likely to be of universal benefit however overweight women in particular may benefit from guidance regarding the benefits of breastfeeding for both themselves and their infants.

A description of health care system factors in the implementation of universal weight management services for children with overweight or obesity: case studies from Queensland and New South Wales, Australia.

BACKGROUND: The prevalence of childhood obesity poses an urgent global challenge. The World Health Organization (WHO) Commission on Ending Childhood Obesity recommends the provision of appropriate family-based, lifestyle weight management services through universal health care to support families of children with overweight or obesity; however, there are few examples of their implementation 'at scale'. The purpose of this research was to compare and contrast the impact of system and organisational factors on the implementation of childhood obesity management services within two Australian States (New South Wales and Queensland) to comprehensively describe their influence on the achievement of the WHO recommendation. METHODS: Purposeful stratified sampling was used to select health service study sites (n = 16) representative of program implementation (none, discontinued, repeated) and geographic location within each State. Within each health service site, staff involved in program delivery, co-ordination and management roles participated (n = 39). An additional 11 staff involved in implementation at State level also participated. The Consolidated Framework for Implementation Research (CFIR) was used to develop interview scripts. Telephone interviews were recorded and transcribed. Transcripts were thematically coded and scored according to CFIR constructs and rating rules to identify enablers and barriers to implementation according to sample characteristics. RESULTS: New South Wales achieved ongoing implementation; Queensland did not. Enablers included a quality evidence-based program, State government recognition of the urgency of the health issue and a commitment to address it, formally appointed and funded internal implementation leaders, strong communication and reporting at all levels. Barriers included the complexity of the health issue, in particular a lack of clear roles and responsibilities for local health service delivery, inadequate ongoing funding and challenges in meeting the diverse needs of families. CONCLUSIONS: This research is an important progression of the evidence base in relation to the translation of childhood obesity management trials into routine health service delivery. Understanding enablers and barriers to program implementation 'at scale' is imperative to inform future planning and investment by Australia and WHO member states to meet their commitment to deliver childhood weight management services as part of universal health coverage.

Feeding a Fussy Eater: Examining Longitudinal Bidirectional Relationships Between Child Fussy Eating and Maternal Feeding Practices.

Objective: Child fussy eating has been associated with a range of maternal feeding practices; however, whether effects are parent-driven, child-driven, or bidirectional (i.e., both) remains unclear. This study tested for bidirectional relationships between nonresponsive and structure-related maternal feeding practices and child fussy eating at age 2, 3.7, and 5 years using a cross-lagged model approach. Methods: First-time Australian mothers (N = 207) reported four nonresponsive and four structure-related feeding practices and child food fussiness (FF) using validated questionnaires at child age 2, 3.7, and 5 years. Bivariate cross-lagged analyses were conducted for each of the eight feeding practices separately. Results: Both child- and parent-driven associations were observed. Higher FF at 3.7 years predicted higher nonresponsive feeding practices and less structure-related practices at 5 years. Higher structure-related practices at 2 and 3.7 years predicted lower FF at 3.7 and 5 years, respectively. Use of food as a reward for behavior at 3.7 years predicted higher FF at 5 years. Conclusions: Both parent- and child-driven associations explain the relationship between fussy eating and feeding practices. Given that early fussy eating is associated with more nonresponsive feeding, providing parents with anticipatory guidance to manage fussy eating behavior in infants and toddlers may help to avoid the use of these practices. Furthermore, the use of structure-related feeding practices and avoiding the use of food rewards may help to prevent the development of fussy eating.

Pre-post evaluation of a weight management service for families with overweight and obese children, translated from the efficacious lifestyle intervention Parenting, Eating and Activity for Child Health (PEACH).

Parenting, Eating and Activity for Child Health (PEACH) is a multi-component lifestyle intervention for families with overweight and obese children. PEACH was translated from an efficacious randomised-controlled trial (RCT) and delivered at scale as PEACH Queensland (QLD) in Queensland, Australia. The aim of this study is to explore pre-post changes in parenting, and child-level eating, activity and anthropometry, in the PEACH QLD service delivery project. PEACH QLD enrolled 926 overweight/obese children (817 families). Pre-programme evaluation was completed for 752 children and paired pre-post-programme evaluation data were available for 388 children. At baseline, children with pre-post-programme data were (mean) 8·8 years old, and at follow-up were 9·3 years old, with mean time between pre-post-programme measures of 0·46 years. Outcomes reflected each domain of the PEACH programme: parenting, eating behaviour of the child and activity behaviours (means reported). Parents reported improvements in parenting self-efficacy (3·6 to 3·7, P=0·001). Children had improved eating behaviours: eating more daily serves of vegetables (2·0 to 2·6, P=0·001) and fewer non-milk sweetened beverages (0·9 to 0·6, P=0·001) and discretionary foods (2·2 to 1·5, P=0·001). Children spent more time in moderate-to-vigorous physical activity (86 to 105 min/d, P=0·001) and less time in sedentary screen-based behaviours (190 to 148 min/d, P=0·001). Consequently, there were significant improvements in mean BMIz (-0·112; P<0·001) and weight status (healthy weight/overweight/obese/morbidly obese prevalence from 0/22/33/45 % to 2/27/34/37 %, P<0·001). When delivered at scale, PEACH remains an effective family-based, multi-component, lifestyle weight management programme for overweight and obese children whose families engage in the programme.

Bidirectional associations between mothers' feeding practices and child eating behaviours.

BACKGROUND: This study examined bidirectional relationships between maternal feeding practices and child food responsiveness and satiety responsiveness from 2 to 5 years. METHODS: Mothers (N = 207) reported their own feeding practices and child eating behaviours using validated questionnaires at child ages 2, 3.7, and 5 years. Cross-lagged analyses were conducted to test for bidirectional effects, adjusting for child BMI z-score (based on measured weight and height) at 14 months. RESULTS: Eating behaviours and feeding practices showed strong continuity across the three time points. Maternal feeding practices (higher reward for behaviour [ß = 0.12, p = 0.025] and lower covert restriction [ß = -0.14, p = 0.008]) were prospectively associated with higher food responsiveness. Conversely, increased child satiety responsiveness was primarily prospectively associated with mothers' feeding practices (increased structured meal timing [ß = 0.11, p = 0.038], overt [ß = 0.14, p = 0.010] and covert restriction [ß = 0.11, p = 0.022]). The only exception was family meal setting, which was prospectively negatively associated with satiety responsiveness (ß = -0.11, p = 0.035). CONCLUSION: While maternal feeding practices and child satiety and food responsiveness show strong continuity between child age 2 and 5 years, maternal feeding practices appear to be associated with child food responsiveness over time. Conversely, child satiety responsiveness, but not food responsiveness, may also be associated with maternal feeding practices over time. These results are consistent with interventions that provide feeding advice to parents on how to respond appropriately to individual child eating behaviour phenotype. TRIAL REGISTRATION: ACTRN12608000056392 . Registered 29 January 2008.

A prospective study of breastfeeding intentions of healthy weight and overweight women as predictors of breastfeeding outcomes.

OBJECTIVE: Women with a higher BMI are at increased risk of breastfeeding for a shorter duration, however it is unclear if weight status itself or other factors such as feeding intentions are responsible for early breastfeeding cessation. The aim of this study was determine the influence of maternal pre-pregnancy weight status on infant feeding intentions during pregnancy using a validated scale and assess whether high intentions to exclusively breastfeed measured during pregnancy predicted feeding mode at discharge and at 4 months postpartum in both healthy weight (Hwt) (BMI< 25kg/m2) and overweight (Owt)(BMI > 25kg/m2) women. DESIGN: This prospective, observational study commenced when participants were <20 weeks gestation, continuing until four months post partum. Self-administered questionnaires assessed pre-pregnancy weight, infant feeding intentions at 36 weeks gestation, and breastfeeding practices at hospital discharge and 4 months postpartum. Hospital records provided details of delivery mode, gestation and breastfeeding during hospital stay. Binary logistic regression analyses were used to compare weight groups on the breastfeeding beliefs and practices adjusting for selected covariates PARTICIPANTS AND SETTING: A consecutive sample of pregnant women (n = 715) were recruited from an Australian metropolitan hospital between August 2010 and January 2011. All women <20 weeks gestation were eligible unless they had pre-existing Type 1 or 2 diabetes or insufficient English language skills to complete questionnaires. MEASUREMENTS AND FINDINGS: Of 715 women recruited, 402 had complete data at 4 months post-partum. There were no differences in high breastfeeding intentions (66% vs 53%, p = 0.10) or initiation (96% vs. 98%, p = 0.33) between Hwt and Owt women. Owt women were less likely to be exclusively breastfeeding at hospital discharge AOR [95%CI] 0.57 [0.33,0.98] and 4 months post-partum 0.62 [0.40,0.97]. High intention to breastfeed was positively associated with exclusively/fully breastfeeding at hospital discharge in Hwt 3.24 [1.52,6.89] but not Owt women 1.73 [0.75,4.00] and 4 months post partum in both weight groups (Hwt 4.1 [2.4-7.2], Owt 6.5 [2.9-14.3]). KEY CONCLUSIONS: Healthy and overweight women appear to have similar antenatal intentions for infant feeding but overweight mothers are less likely to be exclusive breastfeeding at hospital discharge. High antenatal intentions for breastfeeding are related to exclusively/fully breastfeeding at 4 months post partum in both healthy and overweight women. IMPLICATIONS FOR PRACTICE: Investigation of early hospital practices that support and hinder the establishment of successful breastfeeding in overweight mothers may help to identify effective strategies to protect breastfeeding relationships between mother-infant dyads, particularly those who have experienced a caesarean delivery.

Obesogenic eating behaviors mediate the relationships between psychological problems and BMI in children.

OBJECTIVE: To examine the association between psychological problems and weight status in children aged 3.5 to 4 years and test whether obesogenic eating behaviors mediate this relationship. METHODS: This study is a cross-sectional secondary analysis of data from first-time mothers (N = 194) in the control arm of the NOURISH randomized controlled trial. At child age 3.5 to 4 years, maternal-reported child eating behaviors and psychological problems were collected via valid tools, and child weight and height data were collected by trained study staff. Pearson's correlations and linear regressions examined associations between eating behaviors, psychological problems, and BMI z score. Multiple mediation models were tested by assessing indirect effects of psychological problems on BMI z score via obesogenic eating behaviors. RESULTS: Peer problems were associated with both higher food responsiveness and emotional overeating and directly with higher BMI z score. This relationship was partially mediated by emotional overeating. Both emotional overeating and food responsiveness fully mediated the association between emotional problems and BMI z score, and food responsiveness fully mediated the association between conduct problems and BMI z score. CONCLUSIONS: The findings suggest that children with psychological problems may also display obesogenic eating behaviors, which may result in higher BMI. This needs to be considered in the clinical management of both pediatric overweight/obesity and psychological problems.

Prospective Relationships between Health Cognitions and Excess Gestational Weight Gain in a Cohort of Healthy and Overweight Pregnant Women.

BACKGROUND: Excess gestational weight gain (GWG) contributes to long-term obesity in mothers and children. To guide the tailoring of interventions to prevent excess GWG, a better understanding is needed of the lifestyle-related health cognitions that influence women's attempts to manage GWG. OBJECTIVE: To examine the relationship between health cognitions and excess GWG for women who enter pregnancy at a healthy weight (body mass index <25) or overweight (body mass index ≥25). It was hypothesized that health cognitions with a positive (negative) influence on health behavior would be associated with lower (higher) likelihood of excess GWG and that specific associations would differ between weight status groups. DESIGN: This prospective, observational study commenced when participants were <20 weeks' gestation, continuing until the end of their pregnancy. A self-administered quantitative survey at recruitment assessed prepregnancy weight and lifestyle-related health cognitions. Height was measured at 16 weeks and weight at 36 weeks using standard procedures. PARTICIPANTS AND SETTING: A consecutive sample of pregnant women (n=715) were recruited from an Australian metropolitan hospital between August 2010 and January 2011. All women <20 weeks' gestation were eligible unless they had preexisting type 1 or 2 diabetes or insufficient English language skills to complete questionnaires. MAIN OUTCOME MEASURES: Excess GWG defined according to Institute of Medicine 2009 recommendations and predisposing, reinforcing, and enabling cognitions for lifestyle health behaviors. STATISTICAL ANALYSES PERFORMED: Logistic regression analyses examined associations between health cognitions and excess GWG stratified for prepregnancy weight status. RESULTS: For healthy-weight women, higher weight locus of control scores were protective against excess GWG (odds ratio 0.6, 95% CI 0.4 to 0.8), whereas higher perceived risk scores (personal risk and risk arising from prepregnancy weight) (odds ratio 1.3, 95% CI 1.1 to 1.7) were associated with excess GWG. For overweight women higher negative outcome expectation scores were associated with an increased risk of excess GWG (odds ratio 1.4, 95% CI 1.1 to 2.0). CONCLUSIONS: Lifestyle-related health cognitions are associated with excess GWG and differed by prepregnancy weight status, suggesting the need to tailor behavior change interventions accordingly.

Mealtime Structure and Responsive Feeding Practices Are Associated With Less Food Fussiness and More Food Enjoyment in Children.

OBJECTIVE: To identify associations between structure-related and non-responsive feeding practices and children's eating behaviors. DESIGN: Cross-sectional online survey design. PARTICIPANTS: Parents (n = 413) of 1- to 10-year-old children. MAIN OUTCOME MEASURES: Parental feeding practices and child eating behaviors were measured via the validated Feeding Practices and Structure and Children's Eating Behaviour questionnaires. ANALYSIS: Associations between parental feeding practices and children's eating behaviors were tested using hierarchical multivariable linear regression models, adjusted for covariates. RESULTS: Feeding practices accounted for 28% and 21% of the variance in food fussiness and enjoyment of food, respectively (P < .001). For all other eating behaviors the amount of variance explained by feeding practices was < 10% (P < .001). Key findings were that more structure and less non-responsive practices were associated with lower food fussiness and higher enjoyment of food. CONCLUSIONS AND IMPLICATIONS: Overall, the findings suggested that mealtime structure and responsive feeding are associated with more desirable eating behaviors. Contrary to predictions, there was no evidence to indicate that these practices are associated with better self-regulation of energy intake. Longitudinal research and intervention studies are needed to confirm the importance of these feeding practices for children's eating behaviors and weight outcomes.

A Cross Sectional Comparison of Predisposing, Reinforcing and Enabling Factors for Lifestyle Health Behaviours and Weight Gain in Healthy and Overweight Pregnant Women.

Objectives Little is known about the antecedents to dietary and physical activity behaviours that can support healthy gestational weight gain (GWG) across different weight status groups in pregnancy. The aim of this study was to use constructs common to dominant health behaviour theories to determine if predisposing, reinforcing and enabling factors for healthy eating, physical activity and weight gain differed between healthy and overweight pregnant women. Methods Pregnant women (n = 664) aged 29 ± 5 (mean ± SD) years were recruited at 16 ± 2 weeks gestation. Measures were self-reported pre-pregnancy weight, psychosocial constructs for healthy eating, physical activity and GWG and demographic data. Height was measured at 16 weeks. Psychosocial constructs were compared between women with pre-pregnancy weight status of healthy (BMI < 25 kg/m2) and overweight (BMI ≥ 25 kg/m2). Results Health behaviour intentions, positive outcome expectations and social support for healthy eating and physical activity were not different between healthy (66 %) and overweight (34 %) women. Overweight women had lower self-efficacy for healthy eating, physical activity and GWG (p < 0.001), higher negative outcome expectations for GWG (p = 0.004), and higher barriers to healthy eating (p = 0.002), and physical activity (p = 0.006). Conclusions for practice Both healthy and overweight women appear motivated to follow a healthy diet, exercise and avoid excess gestational weight during pregnancy. However many psychosocial factors associated with achieving these goals were different between healthy and overweight women. Health behaviour interventions tailored to overweight pregnant women should consider improving self-efficacy, providing support to overcome perceived barriers, validate positive changes made, and assist in managing negative expectations.

The relationship between maternal feeding beliefs and practices and perceptions of infant eating behaviours at 4 months.

Parental feeding practices and children's eating behaviours are inter-related and both have been implicated in the development of childhood obesity. However, research on the parent-child feeding relationship during the first few months of life is limited. The aim of this study was to examine the cross-sectional relationship between maternal feeding beliefs and practices and infant eating behaviours in a community sample. Mothers (N = 413) of 4 month old infants recruited during pregnancy for the New Beginnings: Healthy Mothers and Babies study self-reported feeding beliefs/practices and eating behaviours of their infants on established tools. Data on a comprehensive range of maternal and infant characteristics were also collected. Multivariable regression models were used to assess the associations between five feeding beliefs and practices and four eating behaviours, adjusting for key maternal and infant covariates. Mothers concerned about their infant becoming underweight rated the infant higher on satiety responsiveness and lower on enjoyment of food. Higher awareness of infant feeding cues was associated with higher infant enjoyment of food. Mothers concerned about their infant becoming overweight and those who used food to calm their baby rated the infant as higher on food responsiveness. Feeding to a schedule (vs on demand) was not associated with any of the infant eating behaviours. A relationship between maternal feeding beliefs and practices and infant eating behaviours is apparent early in life, therefore longitudinal investigation to establish the directions of this relationship is warranted.

The Feeding Practices and Structure Questionnaire (FPSQ-28): A parsimonious version validated for longitudinal use from 2 to 5 years.

Prospective studies and intervention evaluations that examine change over time assume that measurement tools measure the same construct at each occasion. In the area of parent-child feeding practices, longitudinal measurement properties of the questionnaires used are rarely verified. To ascertain that measured change in feeding practices reflects true change rather than change in the assessment, structure, or conceptualisation of the constructs over time, this study examined longitudinal measurement invariance of the Feeding Practices and Structure Questionnaire (FPSQ) subscales (9 constructs; 40 items) across 3 time points. Mothers participating in the NOURISH trial reported their feeding practices when children were aged 2, 3.7, and 5 years (N = 404). Confirmatory Factor Analysis (CFA) within a structural equation modelling framework was used. Comparisons of initial cross-sectional models followed by longitudinal modelling of subscales, resulted in the removal of 12 items, including two redundant or poorly performing subscales. The resulting 28-item FPSQ-28 comprised 7 multi-item subscales: Reward for Behaviour, Reward for Eating, Persuasive Feeding, Overt Restriction, Covert Restriction, Structured Meal Setting and Structured Meal Timing. All subscales showed good fit over 3 time points and each displayed at least partial scalar (thresholds equal) longitudinal measurement invariance. We recommend the use of a separate single item indicator to assess the family meal setting. This is the first study to examine longitudinal measurement invariance in a feeding practices questionnaire. Invariance was established, indicating that the subscales of the shortened FPSQ-28 can be used with mothers to validly assess change in 7 feeding constructs in samples of children aged 2-5 years of age.

Breastfeeding Duration and Authoritative Feeding Practices in First-Time Mothers.

BACKGROUND: Longer breastfeeding duration appears to have a protective effect against childhood obesity. This effect may be partially mediated by maternal feeding practices during the first years of life. However, the few studies that have examined links between breastfeeding duration and subsequent feeding practices have yielded conflicting results. OBJECTIVE: Using a large sample of first-time mothers and a newly validated, comprehensive measure of maternal feeding (the Feeding Practices and Structure Questionnaire), this study examined associations between breastfeeding duration and maternal feeding practices at child age 24 months. METHODS: Mothers (n = 458) enrolled in the NOURISH trial provided data on breastfeeding at child age 4, 14, and 24 months, and on feeding practices at 24 months. Structural equation modeling was used to examine associations between breastfeeding duration and 5 nonresponsive and 4 structure-related "authoritative" feeding practices, adjusting for a range of maternal and child characteristics. RESULTS: The model showed acceptable fit (χ(2)/df = 1.68; root mean square error of approximation = .04, comparative fit index = .91, and Tucker-Lewis index = .89) and longer breastfeeding duration was negatively associated with 4 out of 5 nonresponsive feeding practices and positively associated with 3 out of 4 structure-related feeding practices. Overall, these results suggest that mothers who breastfeed longer reported using more appropriate feeding practices. CONCLUSION: These data demonstrate an association between longer breastfeeding duration and authoritative feeding practices characterized by responsiveness and structure, which may partly account for the apparent protective effect of breastfeeding on childhood obesity.

The Relationship between Number of Fruits, Vegetables, and Noncore Foods Tried at Age 14 Months and Food Preferences, Dietary Intake Patterns, Fussy Eating Behavior, and Weight Status at Age 3.7 Years.

OBJECTIVE: We examined whether exposure to a greater number of fruits, vegetables, and noncore foods (ie, nutrient poor and high in saturated fats, added sugars, or added salt) at age 14 months was related to children's preference for and intake of these foods as well as maternal-reported food fussiness and measured child weight status at age 3.7 years. METHODS: This study reports secondary analyses of longitudinal data from mothers and children (n=340) participating in the NOURISH randomized controlled trial. Exposure was quantified as the number of food items (n=55) tried by a child from specified lists at age 14 months. At age 3.7 years, food preferences, intake patterns, and fussiness (also at age 14 months) were assessed using maternal-completed, established questionnaires. Child weight and length/height were measured by study staff at both age points. Multivariable linear regression models were tested to predict food preferences, intake patterns, fussy eating, and body mass index z score at age 3.7 years adjusting for a range of maternal and child covariates. RESULTS: Having tried a greater number of vegetables, fruits, and noncore foods at age 14 months predicted corresponding preferences and higher intakes at age 3.7 years but did not predict child body mass index z score. Adjusting for fussiness at age 14 months, having tried more vegetables at age 14 months was associated with lower fussiness at age 3.7 years. CONCLUSIONS: These prospective analyses support the hypothesis that early taste and texture experiences influence subsequent food preferences and acceptance. These findings indicate introduction to a variety of fruits and vegetables and limited noncore food exposure from an early age are important strategies to improve later diet quality.

Extending the validity of the Feeding Practices and Structure Questionnaire.

BACKGROUND: Feeding practices are commonly examined as potentially modifiable determinants of children's eating behaviours and weight status. Although a variety of questionnaires exist to assess different feeding aspects, many lack thorough reliability and validity testing. The Feeding Practices and Structure Questionnaire (FPSQ) is a tool designed to measure early feeding practices related to non-responsive feeding and structure of the meal environment. Face validity, factorial validity, internal reliability and cross-sectional correlations with children's eating behaviours have been established in mothers with 2-year-old children. The aim of the present study was to further extend the validity of the FPSQ by examining factorial, construct and predictive validity, and stability. METHODS: Participants were from the NOURISH randomised controlled trial which evaluated an intervention with first-time mothers designed to promote protective feeding practices. Maternal feeding practices (FP) and child eating behaviours were assessed when children were aged 2 years and 3.7 years (n = 388). Confirmatory Factor analysis, group differences, predictive relationships, and stability were tested. RESULTS: The original 9-factor structure was confirmed when children were aged 3.7 ± 0.3 years. Cronbach's alpha was above the recommended 0.70 cut-off for all factors except Structured Meal Timing, Over Restriction and Distrust in Appetite which were 0.58, 0.67 and 0.66 respectively. Allocated group differences reflected behaviour consistent with intervention content and all feeding practices were stable across both time points (range of r = 0.45-0.70). There was some evidence for the predictive validity of factors with 2 FP showing expected relationships, 2 FP showing expected and unexpected relationships and 5 FP showing no relationship. CONCLUSIONS: Reliability and validity was demonstrated for most subscales of the FPSQ. Future validation is warranted with culturally diverse samples and with fathers and other caregivers. The use of additional outcomes to further explore predictive validity is recommended as well as testing test-retest reliability of the questionnaire.

Food neophobia and its association with diet quality and weight in children aged 24 months: a cross sectional study.

BACKGROUND: Food neophobia, the rejection of unknown or novel foods, may result in poor dietary patterns. This study investigates the cross-sectional relationship between neophobia in children aged 24 months and variety of fruit and vegetable consumption, intake of discretionary foods and weight. METHODS: Secondary analysis of data from 330 parents of children enrolled in the NOURISH RCT (control group only) and SAIDI studies was performed using data collected at child age 24 months. Neophobia was measured at 24 months using the Child Food Neophobia Scale (CFNS). The cross-sectional associations between total CFNS score and fruit and vegetable variety, discretionary food intake and BMI (Body Mass Index) Z-score were examined via multiple regression models; adjusting for significant covariates. RESULTS: At 24 months, more neophobic children were found to have lower variety of fruits (ß = -0.16, p = 0.003) and vegetables (ß = -0.29, p < 0.001) but have a greater proportion of daily energy from discretionary foods (ß = 0.11, p = 0.04). There was no significant association between BMI Z-score and CFNS score. CONCLUSIONS: Neophobia is associated with poorer dietary quality. Results highlight the need for interventions to (1) begin early to expose children to a wide variety of nutritious foods before neophobia peaks and (2) enable health professionals to educate parents on strategies to overcome neophobia.