A psychobioecological model to understand the income-food insecurity-obesity relationship.

Food insecurity, defined by unpredictable access to food that may not meet a person's nutritional needs, is associated with higher BMI (kg/m2) and obesity. People with food insecurity often have less access to food, miss meals and go hungry, which can lead to psychological and metabolic changes that favor energy conservation and weight gain. We describe a conceptual model that includes psychological (food reinforcement and delay discounting) and physiological (thermic effect of food and substrate oxidation) factors to understand how resource scarcity associated with food insecurity evolves into the food insecurity-obesity paradox. We present both animal and human translational research to describe how behavioral and metabolic adaptations to resource scarcity based on behavioral ecology theory may occur for people with food insecurity. We conclude with ideas for interventions to prevent or modify the behaviors and underlying physiology that characterize the income-food insecurity-obesity relationship.

Associations of Appetitive Traits and Parental Feeding Style With Diet Quality During Early Childhood.

BACKGROUND: Appetitive traits and parent feeding styles are associated with body mass index in children, yet their associations with child diet quality are unclear. OBJECTIVE: The objective was to examine relations of appetitive traits and parental feeding style with diet quality in 3.5-year-old children. DESIGN: The study was a secondary, cross-sectional analysis of data from Sprouts, a follow-up study of the Pregnancy Eating Attributes Study (PEAS). Birthing parents completed the Child Eating Behavior Questionnaire, Caregiver's Feeding Styles Questionnaire, and proxy 24-hour dietary recalls for their children from February 2019 to December 2020. PARTICIPANTS/SETTING: Participants were 162 birthing parents (early pregnancy BMI ≥ 18.5 and absence of preexisting diabetes, any medical condition contraindicating study participation, self-reported eating disorder, or medications that could affect diet or weight) and their children living in North Carolina. MAIN OUTCOME MEASURES: Healthy Eating Index-2015 (HEI-2015) total scores were calculated. STATISTICAL ANALYSES PERFORMED: Path modeling was conducted using PROC CALIS with full information maximum likelihood (FIML) to account for missing data (< 2% of all data in dataset). Associations of child appetitive traits and parental feeding style with child HEI-2015 scores, adjusting for exclusive breastfeeding duration and household income-poverty ratio, were examined. Tests of simple effects were conducted in subsamples split by parental feeding style. Hypotheses were formulated during data collection. RESULTS: A 1-standard deviation (SD) greater food fussiness was associated with a 2.4-point lower HEI-2015 total score (P = .02; 95% confidence interval [CI] [-4.32, -0.48]) in children. When parental feeding style was authoritarian, a 1-SD greater food responsiveness was associated with a 4.1-point higher HEI-2015 total score (P = .007; 95% CI [1.12, 7.01]) in children. When parental feeding style was authoritative, a 1-SD greater slowness in eating was associated with a 5.8-point lower HEI-2015 total score (P = .01; 95% CI [-10.26, -1.33]) in children. CONCLUSIONS: Parental feeding style may modify the association of appetitive traits with diet quality in young children. Future research could determine whether matching parent feeding styles to child appetitive trait profiles improves child diet quality.

Socioeconomic Characteristics and the Home Food Environment Are Associated With Feeding Healthful and Discretionary Foods During the First Year of Life in the Pregnancy Eating Attributes Study.

BACKGROUND: Feeding of nutrient-poor foods begins in infancy and may adversely influence long-term food preferences. OBJECTIVE: To examine associations of socioeconomic characteristics, childbearing parent eating behaviors, and home food environment with infant feeding characteristics. DESIGN: Secondary analysis of a prospective cohort study from first trimester of pregnancy through 12 months postpartum. PARTICIPANTS/SETTING: Participants with uncomplicated singleton pregnancies and no major chronic illness were enrolled from November 2014 through October 2016 from 2 university-based obstetrics clinics in Chapel Hill, NC. Of 458 enrolled, 321 were retained through 12 months postpartum. MAIN OUTCOME MEASURES: Participants completed infant food frequency questionnaires indicating age at introduction and frequency of consuming multiple food groups. Exposures included childbearing parent socioeconomic characteristics, hedonic hunger, addictive-like eating, Healthy Eating Index 2015 calculated from three 24-hour diet recalls, and home food environment fruit/vegetable and obesogenic scores. STATISTICAL ANALYSES PERFORMED: Multiple imputation using Heckman selection model; linear and logistic regressions examining associations with infant feeding characteristics. RESULTS: Lower education and income were associated with later infant age at introduction to, and lower frequency of consuming fruits and vegetables at age 12 months. Socioeconomic characteristics were not associated with age at introduction to discretionary solid foods; however, lower education and income were associated with greater infant frequency of intake of discretionary foods and greater odds of introducing fruit juice and sweetened beverages by age 12 months. Childbearing parent Healthy Eating Index 2015, hedonic hunger, and addictive-like eating were not consistently associated with infant feeding characteristics. A more obesogenic food environment was associated with greater frequency of intake of discretionary foods, lower frequency of intake of fruit, and greater odds of fruit juice introduction by age 12 months. CONCLUSIONS: Infant feeding characteristics may be important intervention targets for addressing socioeconomic disparities in child diet quality. Efforts to reduce routine feeding of discretionary foods across socioeconomic groups are needed; modifying the home food environment may promote healthful infant feeding.