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.

Effectiveness of a paediatric weight management intervention for rural youth (iAmHealthy): Primary outcomes of a cluster randomised control trial.

BACKGROUND: Youth in rural areas are disproportionally affected by obesity. Given the unique barriers rural populations face, tailoring and increasing access to obesity interventions is necessary. OBJECTIVE: This paper evaluates the effectiveness of iAmHealthy, a family-based paediatric obesity intervention delivered to rural children, compared to a Newsletter Control. METHODS: Participating schools (n = 18) were randomly assigned to iAmHealthy or Newsletter Control. iAmHealthy consists of individual health coaching and group sessions delivered via televideo to a participant's home. The child and parent's body mass index (BMI), child physical activity and child dietary intake were assessed at baseline, post-treatment (8 months) and follow-up (20 months). Multilevel modeling estimated the effect of treatment at both time points. RESULTS: Parent and child dyads were recruited (n = 148) and randomised to iAmHealthy (n = 64) or the Control group (n = 84). The Control group had significant increases in child BMIz from baseline to follow-up. iAmHealthy youth had no significant changes in BMIz from baseline to post or follow-up. Child dietary intake, physical activity and parent BMI results are also discussed. CONCLUSIONS: This trial extends previous paediatric obesity work by simultaneously increasing convenience and dose of treatment. Results suggest iAmHealthy resulted in a change in BMIz trajectories and long-term health behaviour for youth.

Anthropometric Changes During Pregnancy and Their Association with Adequacy of Gestational Weight Gain.

Background: Gestational weight gain (GWG) is an expected component of a healthy pregnancy. Gaining weight within the recommended range helps support the mother's health by providing energy reserves and nutrients to meet the increased metabolic demands during pregnancy. Too much or too little GWG has been associated with adverse health outcomes for the mother and child. Objective: The objective of the study was to examine how changes in anthropometric indicators during pregnancy, including fat gain, vary, compare changes among body mass index (BMI) (kg/m2) groups, and examine how the changes were associated with adequacy of GWG defined using the 2009 Institute of Medicine guidelines. Methods: Data came from a cohort of 360 pregnant women with measured anthropometric indicators (weight, midupper arm circumference, and skin folds of the triceps, thigh, and upper iliac) at <12-, 16 to 22-, and 28 to 32-wks of gestation. Fat gain was calculated using a formula. Analysis of variance was used to test for differences in anthropometric changes by BMI and adequacy of GWG in the third trimester. Multiple logistic regression was used to examine associations between changes in anthropometric indicators and GWG recommendations. Results: Women with normal weight had greater increases in all anthropometric indicators, which differed from women with obesity, who had negative changes and gained less weight. Women who gained inadequately (21%) had negative changes that were all less, compared with women who gained adequately (46%) (except in upper iliac) or excessively (34%). Women with BMI of >25 who gained adequately also had negative changes. Logistic regression results indicated that changes in midupper arm circumference, triceps, and thigh skin folds, and fat gain were all inversely associated with inadequate GWG, whereas all indicators were positively associated with excessive GWG. Conclusions: Anthropometric changes during pregnancy differ by BMI and are associated with adequacy of GWG. Women who gained adequately had minimal fat gain, lending support for current GWG guidelines.

Developmental trajectory of appetitive traits and their bidirectional relations with body mass index from infancy to early childhood.

Appetitive traits, including food responsiveness, enjoyment of food, satiety responsiveness and slowness in eating, are associated with childhood body mass index. Change in appetitive traits from infancy to childhood and the direction of causality between appetitive traits and body mass index are unclear. The present study examined the developmental trajectory of appetitive traits and their bidirectional relations with body mass index, from infancy to early childhood. Mothers in the Pregnancy Eating Attributes Study and follow-up (n = 162) reported child appetitive traits using the Baby and Child Eating Behaviour Questionnaires at ages 6 months and 3.5 years, respectively. Standardized body mass index (zBMI) was calculated from child anthropometrics. Cross-lagged panel models estimated bidirectional relations between appetitive traits and zBMI. Food responsiveness, satiety responsiveness and slowness in eating increased from infancy to early childhood. In cross-lagged panel models, lower infant satiety responsiveness (B ± SE = -0.45 ± 0.19, p = .02) predicted greater child zBMI. Infant zBMI did not predict child appetitive traits (p-values >.36). From infancy to early childhood, appetitive traits may amplify. Appetitive traits, particularly satiety responsiveness, appear to influence body mass index during this period, suggesting early intervention targeting these traits may reduce childhood obesity.

Leveraging behavioral genetics methods to accelerate obesity protection discovery: the Augmented T0 Discordant Sibling Design.

Researchers have been reimagining strategies to accelerate the pacing of translational science progress so that basic T0 discoveries can be converted more efficiently to T1 to T4 interventions. This is certainly true in the context of childhood obesity prevention given its complex etiology and heterogeneity. Here it is submitted that behavioral genetics methods, which have transformed the understanding of childhood obesity risk, have unrealized potential to accelerate translational science into childhood obesity protection (i.e., maintaining healthy weight status despite the presence of reliable risk factors). To illustrate this opportunity, this Perspective proposes the Augmented T0 Discordant Sibling Design (DSD+ ), which leverages the traditional discordant siblings design by recruiting obesity-discordant siblings specifically from families in which parents have obesity and thereby confer heightened risk. This one modification of a tried-and-true behavior genetics design arguably opens a fascinating door of inquiry, illustrating the broader point. Moreover, as most disorders are familial, the DSD+ may stimulate ideas beyond obesity protection.

Health-related behaviors and weight-related outcomes within sibling pairs: A systematic review.

BACKGROUND: Siblings reciprocally contribute to mutual social and physical development. The aim of this review was to examine the health-related behaviors and weight-related outcomes within child-sibling pairs and to determine how these factors vary by sibling composition. METHODS: Following the PRISMA guidelines, a systematic review of studies published since 2000 obtained from MEDLINE, CINAHL, PubMed, Cochrane Reviews, Web of Science, PsycINFO, Health and Wellness, and Science Direct was performed. The eligibility criteria for inclusion were: 1) peer-reviewed and published in English; 2) included children ages 2 to 20 and their siblings; and 3) explored health-related behaviors (i.e., diet) and/or weight-related outcomes (i.e., body weight) within child-sibling dyads. RESULTS: A total of 13 studies were included in the review. The study findings are summarized according to three major themes: 1) sibling concordance in health-related behaviors and weight-related outcomes, 2) differences in health-related behaviors within weight-concordant/weight-discordant sibling dyads, and 3) influence of sibling composition on health-related behaviors and weight-related outcomes. CONCLUSIONS: Family-based interventions for childhood obesity may benefit from including siblings as key family members in promoting children's health-related behaviors and preventing excessive weight gain. Future studies should explore variable sibling dynamics (e.g., adoptive siblings) in more culturally/racially diverse families to further explore the role of a sibling in a child's health. IMPLICATIONS TO PRACTICE: The findings of this study may help healthcare providers in developing effective family-based obesity interventions for families with more than one child in their household.

Associations of parent feeding behaviors and early life food exposures with early childhood appetitive traits in an observational cohort study.

PURPOSE: Child appetitive traits, eating styles that reflect responsiveness to external influences and internal hunger and satiety signals, are associated with eating behaviors and susceptibility to excess weight gain. However, relatively little is known about early life influences on child appetitive traits. This study investigated relations of early life maternal feeding behaviors and food exposures with appetitive traits at age 3.5 years. METHODS: Participants of the Pregnancy Eating Attributes Study (PEAS) and follow-up study were enrolled in early pregnancy and followed prospectively. This analysis included data collected from baseline through child aged 3.5-years (n = 160). Child appetitive traits at age 3.5 years were measured using the Child Eating Behavior Questionnaire. Age at introduction to fruit, vegetables, discretionary sweets, and discretionary savory foods was assessed, along with intake frequency at infant ages 6, 9, and 12 months, and 2 years. Maternal feeding to soothe was assessed at child aged 3, 6, and 12 months. Maternal permissive feeding was assessed at child aged 2 years. Multiple linear regressions estimated relations of maternal feeding behaviors and infant food exposures with child appetitive traits at age 3.5 years, controlling for sociodemographics and breastfeeding duration. RESULTS: Maternal feeding to soothe at 6 (r = 0.39, p < 0.001) and 12 months (r = 0.39, p < 0.001) was positively associated with permissive feeding at 2 years. Maternal feeding to soothe at 12 months and permissive feeding at 2 years were associated with greater child emotional overeating, emotional undereating, and desire to drink. Older age at introduction to fruit (ß = 0.20±0.08, p = 0.01) and younger age at introduction to discretionary sweet foods (ß = -0.07±0.04, p = 0.06) were associated with greater emotional overeating. Older age at introduction to vegetables (ß = 0.22±0.11, p = 0.04) and less frequent feeding of fruit (ß = -0.20±0.08, p = 0.01) were associated with greater food fussiness. CONCLUSIONS: Associations of emotional eating with parent feeding behaviors and early life food exposures suggest the potential for interventions targeting early life feeding to have long-term impact on child appetitive traits and diet quality.

Effects of COVID-19 lockdown on lifestyle behaviors in children with obesity: Longitudinal study update.

Objective: A previous report from our group identified directionally unfavorable dietary and lifestyle behavior trends in longitudinally monitored children and adolescents with obesity early in the COVID-19 pandemic lockdown. The current study aimed at extending these previous observations in youths with obesity on the dietary and lifestyle behavioral consequences of the extended COVID-19 lockdown in Verona, Italy. Methods: The sample included 32 children and adolescents with obesity participating in the longitudinal OBELIX study. Diet and lifestyle information were collected pre-pandemic, 3 weeks into the national lockdown, and 9 months later when home confinement continued to be mandatory. Changes in outcomes over the study time points were evaluated for significance using repeated-measures ANOVA and post-hoc pairwise t-tests with Bonferroni corrections. Results: As previously reported, meals/day, fried potato intake, and red meat ingestion increased significantly (p < 0.001) during the initial lockdown. Sleep time and screen time increased and sports participation decreased significantly (p < 0.001) during the initial lockdown. These changes in health behaviors remained significantly different from baseline at the second lockdown assessment, with the exception sleep time returned to baseline levels. Conclusions: Unfavorable diet and lifestyle behavioral changes in response to the initial COVID-19 lockdown in children and adolescents with obesity have largely been sustained over the course of the pandemic. There is an urgent need to intervene on these behaviors to prevent further deleterious effects on long-term child health; access to weight management care is critically important for these children. In addition to intervening on these behaviors, our findings should help to inform ongoing lockdown policies.

Prospective relations of maternal reward-related eating, pregnancy ultra-processed food intake and weight indicators, and feeding mode with infant appetitive traits.

BACKGROUND: Infant appetitive traits including eating rate, satiety responsiveness, food responsiveness, and enjoyment of food predict weight gain in infancy and early childhood. Although studies show a strong genetic influence on infant appetitive traits, the association of parent and infant appetite is understudied. Furthermore, little research examines the influence of maternal pregnancy dietary intake, weight indicators, and feeding mode on infant appetite. The present study investigated relations of maternal reward-related eating, pregnancy ultra-processed food intake and weight indicators, and feeding mode with infant appetitive traits. METHODS: Mothers in the Pregnancy Eating Attributes Study (458 mothers enrolled, 367 retained through delivery) completed self-report measures of reward-related eating, and principal component analysis yielded two components: (1) food preoccupation and responsiveness and (2) reinforcing value of food. Mothers completed 24-h dietary recalls across pregnancy, and the standardized NOVA (not an acronym) system categorized recalled foods based on processing level. Maternal anthropometrics were measured across pregnancy. At infant age 6 months, mothers reported on feeding mode and infant appetitive traits. Linear regressions were conducted predicting infant appetitive traits from household income-poverty ratio (step 1); maternal reward-related eating components (step 2); pregnancy ultra-processed food intake (% of energy intake), early pregnancy body mass index, and gestational weight gain (step 3); and exclusive breastfeeding duration (step 4). RESULTS: A 1-SD greater maternal food preoccupation and responsiveness was associated with 0.20-SD greater infant satiety responsiveness (p = .005). A 1-SD greater % energy intake from ultra-processed foods during pregnancy was associated with 0.16-SD lower infant satiety responsiveness (p = .031). A 1-SD longer exclusive breastfeeding duration was associated with 0.18-SD less infant food responsiveness (p = .014). Other associations of maternal reward-related eating, pregnancy ultra-processed food intake and weight indicators, and feeding mode with infant appetitive traits were non-significant. CONCLUSIONS: Proximal early-life environmental factors including maternal pregnancy dietary intake and feeding mode may facilitate or protect against obesogenic infant appetitive traits, whereas infant appetite may not parallel maternal reward-related eating. Further investigation into the etiology of appetitive traits early in development, particularly during solid food introduction, may elucidate additional modifiable risk factors for child obesity. TRIAL REGISTRATION: Clinicaltrials.gov. Registration ID - NCT02217462 . Date of registration - August 13, 2014.

Body Weight Perception and Health-Related Behaviors Among U.S. Adolescents: Mediating Effects of Body Weight Control Behaviors.

This study examined mediating effects of body weight control behaviors in the relationship between body weight perception and health-related behaviors among 11,458 U.S. adolescents from the 2010 National Youth Physical Activity and Nutrition Survey. Parallel multiple mediation analysis was performed for the secondary data analysis. Nearly one third of adolescents (32.5%) had overweight or obesity; one quarter (25.0%) perceived themselves as slightly overweight and 5.1% thought they were very overweight. More girls (58.6%) had tried to lose weight than boys (32.3%), while boys were more physically active than girls. Healthy and unhealthy weight control behaviors significantly mediated the relationship between adolescents' body weight perception and health-related behaviors (physical activity and screen time). Teachers and parents should help adolescents have accurate weight perception and utilize reliable and healthy weight control strategies. Future studies should consider the intercorrelated relationships among adolescents' perceptions and behaviors regarding weight to provide successful weight control intervention programs.

Added sugars mediate the relation between pre-pregnancy BMI and infant rapid weight gain: a preliminary study.

BACKGROUND: Parental obesity is linked to offspring obesity, though little research has explored factors that might influence this relationship during the complementary feeding period. This study investigated whether infant intakes of added sugars mediate the relationship between a mother's pre-pregnancy body mass index (BMI) and infant rapid weight gain (defined as upward weight-for-age percentile crossing). METHODS: This study was of a cross-sectional design. Anthropometrics for 141 mother-infant dyads (mean age [standard deviation]: 32.6 [4.4] year for mothers, 11.9 [1.9] months for infants) were obtained. Data from three 24-h recalls pertaining to the infants' diets were collected and analyzed. Pearson product-moment correlations and multivariable regressions assessed bivariate relationships between pre-pregnancy BMI, infant added sugar intakes and upward weight-for-age percentile crossing. Mediation models evaluated the effects of added sugars and breastfeeding duration. RESULTS: Pre-pregnancy BMI correlated positively with infants' added sugar intakes (r = 0.230, p = 0.006). Added sugar intakes mediated the impact of pre-pregnancy BMI on upward weight-for-age percentile crossing (indirect effect = 0.007, 95% CI = 0.0001, 0.0197, indirect/total effect ratio = 0.280). Breastfeeding duration also moderated the relationship, with infants who were breastfed for a shorter duration experiencing a greater mediating effect (indirect effect = 0.010, 95% CI = 0.0014, 0.0277, indirect/direct effect ratio = 0.7368). CONCLUSIONS: Mothers who were overweight or obese prior to pregnancy were significantly more likely to give their infants foods and beverages with added sugars, and this practice was found to mediate the relationship between maternal and infant obesity. Breastfeeding duration moderated the mediating effect of added sugars between pre-pregnancy BMI and infant rapid weight gain.

Prospective relations between maternal emotional eating, feeding to soothe, and infant appetitive behaviors.

BACKGROUND: Infant obesogenic appetitive behaviors are associated with greater infant weight and child obesity, yet little is known about maternal influences on infant appetitive behaviors. This study examines the relations between maternal eating behaviors, feeding to soothe, and infant appetitive behaviors in a longitudinal sample of United States mothers. METHODS: Pregnant women were recruited in the first trimester (< 12 weeks) and followed through 1 year postpartum. Mothers reported their own eating behaviors (eating competence, restrained, emotional, and external eating) in pregnancy; feeding to soothe their infant at 2, 6, and 12 months postpartum; and their infants' appetitive behaviors (enjoyment of food, food responsiveness, slowness in eating, and satiety responsiveness) at 6 months. Three path models were estimated to examine the direct relations of maternal eating behaviors with infant appetitive behaviors, the indirect relations of maternal eating behaviors with infant appetitive behaviors through feeding to soothe, and the longitudinal relations between feeding to soothe and infant appetitive behaviors. RESULTS: Maternal eating behaviors and infant appetitive behaviors were directly and indirectly related in all three models. Greater maternal eating competence was related to greater enjoyment of food but was not related to feeding to soothe. Greater maternal restrained and external eating were not directly related to infant appetitive behaviors but were indirectly related to greater infant responsiveness to food through more frequent feeding to soothe. Additionally, several longitudinal relations between feeding to soothe behaviors and infant appetitive behaviors were present. More frequent feeding to soothe at 2 months was related to greater responsiveness to food at 6 months, which was then related to more frequent feeding to soothe at 6 months. Furthermore, greater satiety responsiveness, faster eating speed, and greater responsiveness to food at 6 months were related to more frequent feeding to soothe at 12 months. CONCLUSIONS: Maternal eating behaviors were related to infant appetitive behaviors directly and indirectly through feeding to soothe. Additionally, results suggest feeding to soothe and infant appetitive behaviors may be bidirectionally linked. These results underscore the need to examine how parental feeding behaviors are influenced both by parental eating behaviors and child appetitive behaviors throughout infancy. TRIAL REGISTRATION: Clinicaltrials.gov. Registration ID - NCT02217462 . Date of registration - August 13, 2014.

'eatNplay' - a rurally-tailored, family-based, telehealth intervention for childhood obesity: Protocol for a mixed-methods randomized newsletter controlled pilot study.

BACKGROUND: Childhood obesity disproportionately affects rural communities where access to pediatric weight control services is limited. Telehealth may facilitate access to these services. OBJECTIVE: This paper describes the rationale, curriculum, and methodology for conducting a randomized controlled pilot trial of a rural, family-based, telehealth intervention that aims to improve weight-related behaviors among children, compared to monthly newsletters. METHODS: A mixed-methods randomized design will randomly assign 44 rural families with one or more children aged 5 to 11 years identified as overweight or obese to an intervention or newsletter control group. The intervention group will attend 'eatNplay' group videoconferencing telehealth sessions, conducted weekly by a registered nurse and a motivational interviewing expert, to discuss diet, exercise, sleep, and peer group influences. The control group will receive newsletters covering these topics. Outcome measures at baseline, 12, and 26 weeks will assess 1) participant engagement and satisfaction with 'eatNplay'; 2) child's BMI, dietary behavior, physical activity, and sleep behavior; and 3) parent/guardians' self-reported beliefs, behaviors, attitudes, perceived stress, and perceived quality of life. Analyses will employ 1) thematic analysis of semi-structured parent/guardian interviews after follow-up to help refine the intervention (e.g., curriculum), and 2) linear mixed models to compare outcomes between groups pre- and post-intervention and reduce bias from unobserved variables. Results of this pilot study could refine methodology for conducting telehealth studies, acceptability of healthcare provider-involved recruitment, interdisciplinary team approach, and addressing childhood obesity in rural communities through telehealth.

Using food network analysis to understand meal patterns in pregnant women with high and low diet quality.

BACKGROUND: Little is known about how meal-specific food intake contributes to overall diet quality during pregnancy, which is related to numerous maternal and child health outcomes. Food networks are probabilistic graphs using partial correlations to identify relationships among food groups in dietary intake data, and can be analyzed at the meal level. This study investigated food networks across meals in pregnant women and explored differences by overall diet quality classification. METHODS: Women were asked to complete three 24-h dietary recalls throughout pregnancy (n = 365) within a prospective cohort study in the US. Pregnancy diet quality was evaluated using the Healthy Eating Index-2015 (HEI, range 0-100), calculated across pregnancy. Networks from 40 food groups were derived for women in the highest and lowest HEI tertiles at each participant-labeled meal (i.e., breakfast, lunch, dinner, snacks) using Gaussian graphical models. Network composition was qualitatively compared across meals and between HEI tertiles. RESULTS: In both HEI tertiles, breakfast food combinations comprised ready-to-eat cereals with milk, quick breads with sweets (e.g., pancakes with syrup), and bread with cheese and meat. Vegetables were consumed at breakfast among women in the high HEI tertile only. Combinations at lunch and dinner were more varied, including vegetables with oils (e.g., salads) in the high tertile and sugary foods with nuts, fruits, and milk in the low tertile at lunch; and cooked grains with fats (e.g., pasta with oil) in the high tertile and potatoes with vegetables and meat in the low tertile at dinner. Fried potatoes, sugar-sweetened beverages, and sandwiches were consumed together at all main meals in the low tertile only. Foods were consumed individually at snacks in both tertiles; the most commonly consumed food were fruits in the high HEI tertile and cakes & cookies in the low tertile. CONCLUSIONS: In this cohort of pregnant women, food network analysis indicated that food combinations differed by meal and between HEI tertiles. Meal-specific patterns that differed between diet quality tertiles suggest potential targets to improve food choices at meals; the impact of meal-based dietary modifications on intake of correlated foods and on overall diet quality should be investigated in simulations and intervention studies. TRIAL REGISTRATION: PEAS was registered with number NCT02217462 in Clinicaltrials.gov on August 13, 2014.

Interplay between Prepregnancy Body Mass Index, Early Childhood Negative Temperament, and Slowness in Eating on Early Childhood Rapid Weight Gain.

Background: Early childhood eating behaviors and temperament have been linked to excess weight gain in separate lines of research. However, the interplay among these variables along with maternal prepregnancy body mass index (BMI) in predicting rapid weight gain is poorly understood. Methods: This observational study tested superfactors of early childhood temperament using the Infant Behavior Questionnaire-Revised, and their relationships with eating behavior using the Baby Eating Behavior Questionnaire on rapid weight gain among 9-18 months children (n = 283). The bivariate relationships were evaluated using Pearson correlations. Two-way interactions assessed whether childhood temperament moderated the relationship between childhood eating behaviors and rapid weight gain, with prepregnancy BMI as a higher order moderator. Results: Food responsiveness positively correlated with Negativity [r = 0.256, adjusted (adj) p < 0.001] and inversely with Regulation (r = -0.203, adj p = 0.006). Slowness in eating positively correlated with Negativity (r = 0.196, p = 0.006) and inversely with Surgency (r = -0.188, adj p = 0.008) and Regulation (r = -0.181, p = 0.007). Slowness in eating was significantly correlated with rapid weight gain (r = -0.168, p = 0.005). Prepregnancy BMI was a moderator of slowness in eating and Negativity such that children of mothers with high prepregnancy BMI in conjunction with high Negativity and low in slowness in eating experienced the greatest rapid weight gain, whereas children of mothers with low prepregnancy BMI in conjunction with low Negativity and high in slowness in eating experienced the least rapid weight gain. Conclusions: Assessing early childhood temperament may bolster health care and parenting interventions to increase early eating regulation and to promote healthier weight trajectories.

Temperament and eating self-regulation in young children with or at risk for obesity: An exploratory report.

BACKGROUND: Few studies have examined the relationship between temperament and eating self-regulation in early childhood, despite emerging evidence for associations with pediatric obesity. METHOD: The aim of this exploratory report was to examine the associations between three eating behaviors and three facets of temperament among 4- to 8-year-olds with or at risk for obesity. RESULTS: Among 28 participants in a family intervention to reduce eating speed, we found at baseline that slower child eating speed was associated with less surgency (r = -.39, p = .04) and higher food responsiveness was associated with higher negative affect (r = .40, p = .03). CONCLUSIONS: These findings support the potential yield of integrating temperament with eating self-regulation assessments in studies of early obesity risk. A better understanding is needed regarding ways in which parents differentially feed in response to child temperament.

Poorer mental health and sleep quality are associated with greater self-reported reward-related eating during pregnancy and postpartum: an observational cohort study.

BACKGROUND: Depression, stress, and poor-quality sleep are common during pregnancy and postpartum, but the relationship of these factors with reward-related eating is not well understood. This observational cohort study examines associations of depression, stress, and sleep quality with self-reported reward-related eating in pregnancy and postpartum. METHODS: Participants were enrolled at < 12 weeks gestation and followed through 1 year postpartum. Self-reported measures obtained at baseline and 23-31 weeks postpartum included the Edinburgh Postnatal Depression Scale, Perceived Stress Scale, Pittsburgh Sleep Quality Index; reward-related eating measures included the Power of Food Scale (assessing hedonic hunger), modified Yale Food Addiction Scale (assessing addictive-like eating), and frequency and intensity of cravings. Linear and logistic regression models estimated associations of depressive symptoms, stress, and sleep quality with reward-related eating during pregnancy and postpartum, as well as change in each predictor with change in outcome. RESULTS: During pregnancy, greater depressive symptoms (ß ± SE = 0.03 ± 0.01, p < .01), higher stress (0.03 ± 0.01, p < .01), and worse sleep quality (0.03 ± 0.01, p = 0.03) were associated with greater hedonic hunger. Similarly, greater depressive symptoms (OR = 1.08, 95% CI: 1.02, 1.14, p = .01), higher stress (OR = 1.09, 95% CI: 1.04, 1.14, p = <.01), and worse sleep quality (OR = 1.09, 95% CI: 1.00, 1.18, p = .04) were associated with greater odds of addictive-like eating. These associations were also significant in postpartum except that sleep quality was not associated with hedonic hunger. Greater depressive symptoms (ß ± SE = 0.06 ± 0.02, p < .01; 0.08 ± 0.02, p = <.01), higher stress (0.04 ± 0.01, p < .01; 0.06 ± 0.02, p < .01), and worse sleep quality (0.11 ± 0.03, p < .01; 0.13 ± 0.03, p < .01) during pregnancy were associated with stronger and more frequent cravings, respectively. Increased depressive symptoms from pregnancy to postpartum was associated with increased hedonic hunger (ß ± SE = 1.17 ± 0.57, p = 0.01) and addictive-like eating (0.88 ± 0.33, p = 0.01), and increased stress was associated with increased hedonic hunger (1.71 ± 0.76, p = 0.02). Change in stress was not associated with change in addictive-like eating and change in sleep quality was not associated with change in either hedonic hunger or addictive-like eating. CONCLUSIONS: Greater depressive symptoms, perceived stress, and poorer sleep quality are associated with greater self-reported reward-related eating during pregnancy and postpartum, suggesting that efforts to improve diet during and after pregnancy may benefit from addressing mental health and sleep. TRIAL REGISTRATION: Clinicaltrials.gov Registration ID - NCT02217462 . Date of registration - August 13, 2014.

Pregnant Women Consume a Similar Proportion of Highly vs Minimally Processed Foods in the Absence of Hunger, Leading to Large Differences in Energy Intake.

BACKGROUND: The eating in the absence of hunger (EAH) experimental paradigm measures intake of highly palatable, highly processed foods when sated. However, no studies have examined EAH in pregnant women. OBJECTIVE: The objectives were to investigate whether EAH in pregnant women differs by level of food processing and to examine relationships of EAH with hedonic hunger, addictive-like eating, and impulsivity. DESIGN: EAH was assessed in a counterbalanced crossover feeding substudy in which participants completed two free-access eating occasions following a standardized meal during their second pregnancy trimester. Hedonic hunger (Power of Food Scale), addictive-like eating (modified Yale Food Addiction Scale), and impulsivity (Barratt Impulsiveness Scale-15) were assessed by self-report during early pregnancy. PARTICIPANTS AND SETTING: Data were collected from March 2015 through September 2016 from a subsample of participants (n = 46) enrolled at ≤12 weeks gestation in an observational, prospective cohort study (the Pregnancy Eating Attributes Study) in North Carolina. INTERVENTION: Participants were presented with highly processed and minimally processed foods in two separate assessments. MAIN OUTCOME MEASURES: Energy intake (EAH-kcal) and percent consumed (EAH-%) (calculated as 100 × [amount consumed (g) / amount served (g)]) was measured overall and separately for sweet and savory foods. STATISTICAL ANALYSES PERFORMED: Linear mixed models estimated the effect of condition on EAH. Hedonic hunger, addictive-like eating, impulsivity and their interaction were examined separately. RESULTS: EAH-% was similar across conditions (16.3% ± 1.1% highly processed vs 17.9% ± 1.2% minimally processed; P = 0.76), resulting in 338.5 ± 34.2 kcal greater energy intake in the highly processed vs minimally processed condition (P < 0.001). Hedonic hunger was not significantly associated with EAH; reward-related eating was positively associated with EAH-kcal and EAH-% of savory foods, and Barratt Impulsivity was positively associated with EAH-kcal and EAH-% overall, and with EAH-% of sweet foods (P < 0.05). There was little evidence of an interaction of Barratt Impulsivity with hedonic hunger or reward-related eating. CONCLUSIONS: EAH in pregnant women occurs for both highly processed and minimally processed foods and correlates positively with self-reported addictive-like eating, but not hedonic hunger. Impulsivity did not modify associations of addictive-like eating with EAH in this sample.

High intake of added sugars is linked to rapid weight gain in infancy, breastfeeding ≥12 months may protect against this: A preliminary investigation.

BACKGROUND: Consumption of added sugars is linked to excess adiposity in older age groups and breastfeeding has been shown to protect against later obesity. OBJECTIVES: This investigation aimed to determine whether intake of added sugars associates with rapid weight gain in individuals under 2 years of age, if intake of added sugars associates with breastfeeding duration, and how both influence body weight. METHODS: A cross-sectional analysis of data from three 24-hours dietary recalls collected from 141 infants/toddlers (age 11.9 ± 1.9 months, 44.7% male) was performed. Multivariable regressions assessed relationships between added sugar intakes, breastfeeding duration, and weight status. Hierarchical regressions examined added variance accounted for in rapid weight gain (specifically, upward weight-for-age percentile [WFA %tile] crossing) through the interaction of added sugars * breastfeeding duration. RESULTS: Added sugars correlated positively with upward WFA %tile crossing (r = 0.280, P < .001) and negatively with breastfeeding duration (r = -0.468, P < .001). Consumption of added sugars was a significant predictor of rapid weight gain when breastfeeding duration was short (<12 months, ß = 0.020, P = .029), but not long (≥12 months, ß = 0.001, P = .875). CONCLUSIONS: A high intake of added sugars in individuals below age 2 associates with rapid weight gain, though breastfeeding ≥12 months appears protective against this. Further studies are necessary to substantiate these findings and provide insight into underlying mechanisms.