Sleep duration is associated with appetitive traits in school-age years - results from the Generation XXI birth cohort.

Sleep may influence appetite regulation through physiological and neurocognitive pathways. However, the association between sleep and appetite in childhood has been scarcely reported, particularly using a prospective design. We aimed to test associations between sleep duration at 7 years of age (y) and appetitive traits at both 7 and 10 y. Participants are from the population-based birth cohort Generation XXI (Porto, Portugal), at 7 (n = 2437) and 10 y (n = 1938) follow-ups. Data on sleep was gathered at 7 y and, considering bedtime and get-up time, total mean sleep duration was calculated and further categorized according to the 10th and 90th percentiles. Appetitive traits were assessed at 7 and 10 y using the parent-reported Children's Eating Behaviour Questionnaire. Associations were tested through Generalized Linear Models (co-variates: child's sex; maternal age, education and pre-pregnancy body mass index at 7 y). At 10 y, associations were further adjusted for the respective appetitive trait at 7 y. Children slept a mean of 10.2 h/night, and 13% and 9% slept ≤9.5 and ≥ 11.0 h/night at 7 y, respectively. For each additional hour in sleep duration, children scored 0.078 (99%CI: -0.145; -0.011) lower on Food Responsiveness, 0.065 (99%CI: -0.129; -0.002) lower on Emotional Undereating and 0.096 (99%CI: -0.161; -0.032) lower on Food Fussiness. Lastly, children sleeping ≤9.5 h/night scored higher on Food Responsiveness (ß = 0.145 99%CI: 0.020; 0.271); while those sleeping ≥11.0 h/night scored lower on Food Fussiness (ß = -0.255 99%CI: -0.370; -0.079). No significant prospective associations were found. In conclusion, in 7 y children, sleep duration was cross-sectionally associated with lower scores on food approach (Food Responsiveness) and avoidant traits (Emotional Undereating and Food Fussiness). However, the magnitude of the associations was small and further studies are warranted.

Weight trajectories from birth to 5 years and child appetitive traits at 7 years of age: a prospective birth cohort study.

Rapid prenatal and postnatal weight gain seem to alter appetite regulation and hypothalamic functions through different pathways; however, little is known on how early life growth trajectories may influence appetitive traits in school-age. We aimed to explore the associations between weight trajectories from birth to 5 years and appetitive traits at 7. Participants were from the Generation XXI birth cohort (n 3855). Four weight trajectories were investigated: 'normal weight gain' (closely overlaps the 50th percentile in the weight-for-age curve), 'weight gain during infancy' (low birth weight and weight gain mainly during infancy), 'weight gain during childhood' (continuous weight gain since birth) and 'persistent weight gain' (always showing higher weight than the average). Appetitive traits were assessed through the Children's Eating Behaviour Questionnaire. Associations were tested using generalised linear models, adjusted for maternal and child characteristics. Compared with 'normal weight gain', those in the other growth trajectories showed greater enjoyment of food and eating in response to food stimuli (i.e. Food Responsiveness) but were less able to compensate for prior food intake and ate faster at 7 (i.e. less Satiety Responsiveness and Slowness in Eating). Also, those with 'weight gain during infancy' showed to have greater Emotional Overeating and less Emotional Undereating and were fussier. Associations were stronger if greater weight gain occurred during infancy. Early infancy seems to be a sensitive period in the development of later appetitive traits. The control of rapid growth during infancy, besides strategies focused on the overall environment where children are living, is necessary.

Early life exposures are associated with appetitive traits in infancy: findings from the BiTwin cohort.

PURPOSE: To determine the stability of appetitive traits during infancy and their association with early life exposures. METHODS: Participants were from the BiTwin birth cohort (longitudinal study of Portuguese infants). Appetitive traits at 3 months were measured using the Baby Eating Behaviour Questionnaire (n = 347) and at 12 months with the Children's Eating Behaviour Questionnaire for toddlers (n = 325). Stability was assessed with multi-level models. The association of early life exposures (weight for gestational age, mode of feeding, prematurity, smoking during pregnancy, maternal pre-pregnancy BMI, gestational weight gain, and diabetes mellitus diagnosis) with infant appetitive traits was estimated by multivariable linear regression models. RESULTS: Appetite traits showed limited stability (ICCs: 0.25-0.34). Associations with early life exposures varied by age. At 3 months, infants of mothers with higher pre-pregnancy BMI and excessive gestational weight gain had low Satiety Responsiveness. In contrast, infants small for gestational age scored high in this trait (ß̂ = 0.241; 95% CI 0.056-0.425). Exclusively formula-fed infants presented weak food approach traits at this age, namely low Enjoyment of Food (ß̂ = - 0.145; 95% CI - 0.270 to - 0.019) and Food Responsiveness (ß̂ = - 0.415; 95% CI - 0.618 to - 0.212). At 12 months, infants who were small for gestational age had low Food Responsiveness (ß̂ = - 0.297; 95% CI - 0.523 to - 0.072), in contrast, infants of mothers who gained excessive gestational weight had high scores in this trait. Formula feeding was related to rapid eating (Slowness in Eating: ß̂ = - 0.252; 95% CI 0.451 to - 0.054). CONCLUSION: Early life exposures may play a role in the development of infants' appetitive traits, which then change during the first year of life. Interventions focussed on maternal and infant health may have the potential to shape appetite in infancy.

Parental child-feeding practices at 4 years of age are associated with dietary patterns of 7-year-olds.

BACKGROUND: Parental child-feeding practices have been associated with child body mass index (BMI) and specific food group consumption; however, their role in the development of dietary patterns is less understood. We aim to study the association between parental child-feeding practices at 4 years old and dietary patterns at 7 years that explain BMI z-scores at age 10. METHODS: Participants were children from the Generation XXI birth cohort (n = 3272). Three patterns of feeding practices at 4 years were previously identified: 'Perceived monitoring', 'Restriction' and 'Pressure to eat'. At 7 years, two dietary patterns were derived: 'Energy-dense foods', higher consumption of energy-dense foods and drinks and processed meats and lower consumption of vegetable soup (significantly associated with BMI z-scores at 10 years) and 'Fish-based', higher in fishery intake and lower in energy-dense food intake. Associations were estimated by linear regression models, adjusted for potential confounders (mother's age, education and pre-pregnancy BMI). RESULTS: Girls whose parents used more Restriction, Perceived monitoring and Pressure to eat at 4 years were less likely to follow the 'Energy-dense foods' dietary pattern at 7 years (ß̂ = -0.082; 95% confidence intervals [CI]: -0.134; -0.029; ß̂ = -0.093; 95% CI: -0.146; -0.039; ß̂ = -0.079; 95% CI: -0.135; -0.04, respectively). In both sexes, children whose parents used more Restriction and Perceived monitoring at 4 years were more likely to follow the 'Fish-based' dietary pattern at 7 years (girls: ß̂ = 0.143; 95% CI: 0.077; 0.210; ß̂ = 0.079; 95% CI: 0.011; 0.148; boys: ß̂ = 0.157; 95% CI: 0.090; 0.224; ß̂ = 0.104; 95% CI: 0.041; 0.168). CONCLUSIONS: Children whose parents used more Restriction and Perceived monitoring at preschool age were more likely to follow healthier dietary patterns at age 7.

Appetitive traits and food groups consumption in school-aged children: prospective associations from the Generation XXI birth cohort.

PURPOSE: Appetite can influence children's dietary choices; however, this relationship in school-aged children is still unclear. We aimed to explore the prospective associations between child appetitive traits at age 7 and food consumption at 10 years of age. METHODS: The study included 3860 children from the Generation XXI birth cohort, recruited in 2005/2006 in Porto, Portugal. The Children's Eating Behaviour Questionnaire was used to evaluate children's appetitive traits at 7 years. Food consumption was measured at 10 years through a validated Food Frequency Questionnaire. Logistic regression models were performed and adjusted for possible confounders. RESULTS: Children with greater Enjoyment of Food at 7 years were 36% more likely to eat fruits ≥ 2 times/day and 54% more likely to eat vegetables > 2.5 times/day at 10 years compared to those with less frequent consumption. Children who ate more in response to negative emotions had higher odds of consuming energy-dense foods (OR = 1.33; 99% CI 1.13-1.58) and salty snacks (OR = 1.28; 99% CI 1.08-1.51) 3 years later. Those with less ability to adjust intake (higher Satiety Responsiveness) and more selective about foods (higher Food Fussiness) at 7 years were less likely to consume vegetables frequently, and were more likely to consume energy-dense foods and sugar-sweetened beverages. CONCLUSIONS: Children's appetitive traits at 7 years were associated with the consumption of several food groups at 10 years of age. Eating more in response to negative emotions (Emotional Eating), with less ability to adjust intake (Satiety Responsiveness) and more food selectivity (Food Fussiness) were associated with worse dietary choices (in general, lower fruit and vegetables, and higher energy-dense foods and sugar-sweetened beverages consumption). LEVEL OF EVIDENCE: Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

Appetitive behaviors and body composition in school-age years: Bi-directional analyses in a population-based birth cohort.

Cross-sectional studies have consistently associated appetitive behaviors with child body mass index. However, few prospective studies have investigated the association between appetite and other measures of body composition and its directionality. We aimed to investigate the bi-directional relationship between appetitive behaviors and body composition in school-aged children. Data from 3668 children of the Generation XXI birth cohort were analyzed. Appetitive behaviors were assessed at 7 and 10 years through the Children's Eating Behavior Questionnaire. Higher fat mass and fat-free mass were measured through tetrapolar bioelectric impedance and waist-to-weight and waist-to-height ratios were calculated. Fat and fat-free mass indexes, waist-to-weight and waist-to-height age- and sex-specific z-scores were then calculated. Cross-lagged analyses were performed (body composition at 7 to appetitive behaviors at 10 and the reverse) to measure the magnitude and direction of associations. Fat mass and waist-to-height ratio at 7y predicted greater food approach behaviors at 10y (Enjoyment of Food, Food Responsiveness, Desire to Drink and Emotional Overeating), but not waist-to-weight, which seems to be consequence of child's avid appetite (e.g. Enjoyment of Food at 7y: ßstandardized = 0.085, 95%CI = 0.041; 0.128, p < 0.001). Child scores on food avoidant behaviors, such as Satiety Responsiveness (ßstandardized = -0.073, 95%CI = -0.110;-0.034, p < 0.001) and Slowness in Eating (ßstandardized = -0.080, 95% CI = -0.120;-0.041, p < 0.001) at 7y predicted lower fat-free mass at 10. Appetitive behaviors may not solely predict weight status, but the path of association between body composition and later appetitive behavior may also be true, especially for food approaching behaviors and adipose tissue. Interventions aiming to prevent excess weight should focus on appetitive behaviors. Moreover, in children with higher adiposity, other pathways also seem to regulate appetite and need to be considered in interventions.

Acculturation, food-related and general parenting, and body weight in Chinese-American children.

Parents' food-related and general parenting behaviors may vary according to cultural background, with consequences for child eating behavior and weight. A better understanding of food-related and general parenting behaviors adopted by Chinese-American parents, and the relationships of all of these behaviors with child weight, is essential to aid the development of culturally appropriate interventions to prevent obesity in Chinese-American children. We investigated cross-sectional relationships of acculturation with parental feeding behaviors assessed with the Child Feeding Questionnaire, Parent Feeding Styles Questionnaire and Caregiver's Feeding Styles Questionnaire, and general parenting behaviors assessed with the Parenting Styles and Dimensions Questionnaire, in a sample of Chinese-American parents of 5-12 year-old children (n = 233). Parental level of acculturation was assessed using the Suinn-Lew Asian Self-Identity Acculturation scale. We performed generalized linear regressions to explore associations of acculturation levels with parental feeding and general parenting subscales and also associations of these factors with child body mass index (BMI) z-score. Acculturation was associated with higher scores on Responsiveness in feeding, lower scores on subscales assessing controlling feeding behaviors (Restriction, Pressure to eat, Demandingness in feeding), lower scores on non-nutritive feeding behaviors (Emotional feeding, Instrumental feeding), and greater likelihood of an indulgent feeding style. With regard to general parenting, acculturation was associated with lower scores on subscales assessing authoritarian parenting. Parental Prompting/Encouragement to eat was associated with lower child BMI z-score, while authoritarian parenting subscales were associated with higher BMI z-score. An appreciation of the impact of cultural variation on food-related and general parenting may help to inform the development of culturally-sensitive obesity prevention interventions.

Genetic and environmental contributions to variations on appetitive traits at 10 years of age: a twin study within the Generation XXI birth cohort.

PURPOSE: Given the variability in adiposity despite ubiquitous exposure to obesogenic food environments, it has been suggested that individuals respond in divergent ways to the environment they live in. The food environment becomes more 'permissive' as children age; therefore, genetic predisposition for a more avid appetite can be better expressed, influencing dietary quality, energy intake and weight gain. Our aim was to explore the genetic and environmental contribution of variations on appetitive traits in a sample of 10-year-old Portuguese children. METHODS: Participants were twins enrolled in the Generation XXI birth cohort (n = 86 pairs). Parents reported twin's zygosity and child appetitive traits at 10 years of age through the Children's Eating Behavior Questionnaire. Intra-class correlations (ICCs) for all appetitive traits were calculated for monozygotic and dizygotic twins separately to examine patterns of resemblance, and structural equation modeling was conducted aiming to estimate the genetic (A), shared (C) and non-shared (E) environmental variances. RESULTS: Moderate to strong heritability were found for child appetitive traits, with higher ICCs among monozygotic twin pairs. For all appetitive traits, with the exception of emotional undereating, genetic and non-shared environmental effects contributed to appetite variability. For emotional undereating, environmental effects seem to be more important than genetic effects (C: 0.81; 95% CI 0.71; 0.88 and E: 0.19; 95% CI 0.12; 0.29). CONCLUSION: There was a significant genetic contribution, followed by non-shared environmental contribution, towards variation in appetitive traits in school-age children. Variation in emotional undereating was primarily explained by shared and non-shared environmental factors. LEVEL OF EVIDENCE: Evidence obtained from well-designed cohort or case-control analytic studies.

Parents' perceptions and dissatisfaction with child silhouette: associated factors among 7-year-old children of the Generation XXI birth cohort.

PURPOSE: We compared parent's perceived child's silhouette, and investigated predictors of their dissatisfaction. METHODS: Participants were 4930 mother-child dyads enrolled at a Portuguese birth cohort. Parents' perceptions of child's current and desired silhouette was assessed and dissatisfaction with child's silhouette was defined as the discrepancy between these ratings (current-desired body). Multinomial logistic regressions, adjusted for potential confounders, were performed. RESULTS: Mothers were more dissatisfied with child's silhouette, compared to fathers, in all weight categories. Mothers and fathers of girls were more dissatisfied, preferring thinner silhouettes (OR = 2.77, 95% CI 2.19; 3.51 and OR = 2.08, 95% CI 1.18; 3.66, respectively), compared to parents of boys. Lower birth weight increased maternal desire for a heavier child silhouette. Younger (< 20 years) and less educated (≤ 9 years of schooling) mothers were more dissatisfied with their child's silhouette, preferring heavier children (OR = 1.65, 95% CI 1.10; 2.48 and OR = 1.73, 95% CI 1.42; 2.09, respectively). Parents' own dissatisfaction was also associated with child's silhouette dissatisfaction. CONCLUSION: Sociodemographic characteristics and parents' dissatisfaction with their own silhouette influenced their dissatisfaction with child's silhouette and should be considered when developing obesity interventions. LEVEL OF EVIDENCE: Level III, case-control analytic study.

Leptin at birth and at age 7 in relation to appetitive behaviors at age 7 and age 10.

Leptin contributes to the control of food intake and energy balance. However, its association with appetitive behaviors during childhood is not well understood. We aimed to investigate the association between leptin, assessed at birth and at 7 years of age (y), and appetitive behaviors assessed at 7 and 10 y. Children from a Portuguese cohort with assessment of leptin levels at birth from umbilical cord blood (n = 645) and at 7 y from venous blood samples (n = 587), were included. The Children's Eating Behavior Questionnaire assessed appetitive behaviors at 7 and 10 y. Weight and height were measured at 7 and 10 y to derive BMI z-scores (BMIz). A series of Generalized Linear Models tested relationships between leptin and appetitive behaviors, adjusting for potential confounders (maternal age, education, pre-pregnancy BMI, smoking during pregnancy, child physical activity and child BMIz), and interaction terms for child sex and child BMIz. At 7 y, 116 boys and 118 girls were classified as having overweight/obesity, and these children had higher leptin levels. Cross-sectional analyses using the 7 y data produced the strongest results. Higher leptin at 7 y was significantly associated with lower scores on Satiety Responsiveness, Food Fussiness and Slowness in Eating, and higher scores on Food Responsiveness, Enjoyment of Food and Emotional Overeating at 7 y. Only the association with Emotional Overeating remained when adjusting for child BMIz. Significant interaction effects between child sex and leptin were found for appetite at 7 y, such that higher leptin was associated with higher Food Responsiveness (p < 0.001) and lower Slowness in Eating (p < 0.001) to a greater extent among boys. Umbilical cord blood leptin was not associated with appetitive behaviors at 7 or 10 y. Our results show that leptin levels are positively associated with food approach and negatively with food avoidant behaviors. Associations were more consistent in cross-sectional analyses (at 7 y), were largely dependent on child weight, and tended to be stronger among boys. Our findings support a role for leptin in affecting appetite, with potential consequences for current weight status and future weight gain.

Associations of appetitive behaviors in 7-year-old children with their cardiometabolic health at 10 years of age.

BACKGROUND AND AIMS: Atherosclerosis begins early in life, thus optimal cardiovascular health needs to be promoted early. We investigated whether appetitive behaviors among 7 year olds are associated with their cardiometabolic health years later. METHODS AND RESULTS: A sample of 2951 children from a Portuguese birth cohort was analyzed. The Children's Eating Behavior Questionnaire assessed eating behaviors, and a measure of cardiometabolic risk (higher risk group: those in the upper quartile of triglycerides, homeostatic model assessment-insulin resistance, waist circumference and systolic blood pressure and in the lower quartile of high-density lipoprotein cholesterol z-scores) was created. Linear and logistic regressions were run. Children with more food avoidant behaviors had lower cardiometabolic risk (Satiety Responsiveness - boys: OR = 0.39, 95% CI 0.16; 0.93, girls: OR=0.37, 95% CI 0.17; 0.82 and Slowness in eating - boys: OR = 0.49, 95% CI 0.25; 0.95, girls: OR = 0.49, 95% CI 0.27; 0.91). Food approach behaviors (Food responsiveness (CEBQ-FR), Enjoyment of food (CEBQ-EF) and Emotional overeating (CEBQ-EOE)) increased cardiometabolic risks (e.g. CEBQ-FR: boys: OR = 2.50, 95% CI 1.45; 4.32, girls: OR = 2.33, 95% CI 1.46; 3.71). CEBQ-EF had stronger effects in boys, while CEBQ-EOE was positively associated with cardiometabolic risk among girls. When adjusting for BMIz at 7y, associations did not remain significant. Appetitive behaviors were also associated with isolated cardiometabolic parameters; the strongest association being with waist circumference. CONCLUSIONS: Appetitive behaviors at 7-years are associated with cardiometabolic risk at age 10. While 'food avoidant' behaviors protect against cardiometabolic risk and 'food approach' behaviors increase cardiometabolic risk, these associations are largely dependent of child's adiposity.

Maternal pressure to eat: Associations with maternal and child characteristics among 2-to 8-year-olds in Brazil.

Maternal pressure for the child to eat may have counterproductive effects on child's eating behavior, such as impairing their ability to self-regulate intake and generating greater refusal of the pressured foods. Associated factors with this feeding practice are still poorly studied. The aim of this study was to investigate the relationship between the use of pressure to eat by mothers and anthropometric, sociodemographic and behavioral characteristics of mothers and their children. Nine hundred and twenty seven mothers of 2-to-8-year-old children participated in the study. The maternal use of pressure to eat was measured using the Brazilian version of the Comprehensive Feeding Practices Questionnaire (CFPQ) along with supplementary questions on maternal responsibility and concern about child feeding and child weight status, and anthropometric and sociodemographic information. Data was analyzed using descriptive, bivariate and multivariate analyses. The final multivariate logistic regression model revealed that maternal use of pressure to eat was independently associated with maternal greater concern about the child eating too little when the mother was not around (OR = 2.40, p ≤ 0.001), and child (OR = 0.86, p = 0.008) and mother lower BMI weight (OR = 0.93, p = 0.001). The results found in this study point out to the importance of interventions in the routine of pediatric health services, directed to the maternal behavior of pressure for the child to eat. The actions should mainly consider maternal concerns about child feeding, and maternal and child weight status. These findings also contribute to the expansion of data in the literature on the factors associated with this food practice and for future research on the subject. The results found in this study are risk factors for maternal practice of pressure to eat and support the construction of new ways to deepen the knowledge of the subject in future research, such as the influence of mother and child weight and subjective aspects in the practice of pressure to eat.

Sociodemographic, anthropometric and behavioural risk factors for ultra-processed food consumption in a sample of 2-9-year-olds in Brazil.

OBJECTIVE: The present study aimed to identify food patterns among 2-9-year-olds and investigate sociodemographic, anthropometric and behavioural predictors of less healthy dietary patterns. DESIGN: Cross-sectional study. Parents of 2-9-year-olds completed an FFQ and factor analysis was applied to identify dietary patterns. Parents also completed questionnaires assessing sociodemographic, anthropometric and behavioural characteristics of parents and children, including parental feeding practices. SETTING: Participants were recruited from private schools of Campinas and São Paulo, SP, Brazil, between April and June 2014. SUBJECTS: Parents of 2-9-year-olds (n 929). RESULTS: Two dietary patterns emerged: 'traditional food' and 'ultra-processed food'. Lower maternal education (OR=2·05, P=0·010) and higher maternal weight status (OR=1·43, P=0·044) were associated with a greater likelihood of the ultra-processed food pattern. Lower perceived parental responsibility for adequacy of food group intake (OR=2·41, P=0·020), and lower scores on the parental feeding practices of 'Healthy Eating Guidance' (OR=1·83, P<0·001) and 'Monitoring' (OR=2·52, P<0·001), were also associated with the presence of this pattern, as was higher child's screen use during mealtimes (OR=1·61, P=0·004). CONCLUSIONS: The present study is the first to evaluate associations between less healthy dietary patterns of Brazilian 2-9-year-olds and parental feeding practices. Our findings highlight sociodemographic, anthropometric and behavioural factors within families that could be used to target tailored policies to at-risk populations.

Relationships between parent feeding behaviors and parent and child characteristics in Brazilian preschoolers: a cross-sectional study.

BACKGROUND: Eating habits formed in early childhood are influenced by parental feeding behaviors, warranting investigation of predictors and correlates of parent feeding. We aimed to describe relationships between parental feeding practices and parent and child characteristics in a sample of Brazilian preschoolers. METHODS: Four hundred and two parents of preschoolers enrolled in private schools of São Paulo and Campinas, Brazil, completed a Brazilian version of the Comprehensive Feeding Practices Questionnaire, as well as questions about parental attitudes, child food intake, other obesity-associated behaviors, and socioeconomic and demographic characteristics. We ran bivariate logistic regression models examining associations between independent variables and each feeding practice. Next, we ran multiple logistic regression models predicting each parental feeding practice. RESULTS: Greater 'Restriction for Weight Control' and 'Restriction for Health' were associated with lower maternal education (OR = 2.42 (CI 95% 1.07-5.48) and 2.79 (CI 95% 1.25-6.22), respectively), and with higher concern about child overweight (OR = 2.46, CI 95% 1.64-3.69 for 'Restriction for Weight Control', only), while greater 'Pressure' was associated with greater concern about child underweight (OR = 2.30, CI 95% 1.53-3.47) and lower maternal BMI (OR = 0.94, CI 95% 0.88-1.00). Greater use of 'Emotion Regulation/ Food as Reward' was associated with lower maternal education (OR = 2.22, CI 95% 1.05-4.71). In analyses of positive feeding practices, lesser use of 'Healthy Eating Guidance' and 'Monitoring' was associated with greater intake of less healthy foods in children (OR = 1.53 (CI 95% 1.01-2.32) and OR = 1.94 (CI 95% 1.27-2.97), respectively), and greater use of screen devices (OR = 1.59 (CI 95% 1.04-2.44) and OR = 1.57 (CI 95% 1.03-2.39), respectively). Lesser use of 'Healthy Eating Guidance' was additionally associated with higher maternal BMI (OR = 1.09, CI 95% 1.03-1.16), and lesser use of 'Monitoring' with lesser perceived parent responsibility for child feeding (OR = 1.68, CI 95% 1.12-2.52). CONCLUSIONS: Our results demonstrate diverse socioeconomic, anthropometric and behavioral correlates of parent feeding in a large Brazilian sample of parents of preschoolers.

Ethnic differences in parental feeding behaviors in UK parents of preschoolers.

Childhood obesity is prevalent among ethnic minorities in the UK but little is known about parent feeding practices in these populations. We administered questionnaires assessing parental feeding behaviors and perceptions and concerns relating to child weight to White British (n = 271), South Asian (n = 59), and Black Afro-Caribbean (n = 42) parents of UK 3-5 year-olds. Child BMI z-scores were determined from measured heights and weights. South Asian and Black Afro-Caribbean parents exhibited greater pressure to eat than White British parents. Black Afro-Caribbean parents additionally scored higher on instrumental feeding and lower on monitoring, while South Asian parents scored higher on emotional feeding. Black Afro-Caribbean parents reported the greatest concern about both child overweight and underweight. Ethnic differences were unchanged by controlling for perceptions and concerns relating to child weight, or for actual BMI z, parent education, or household income. Exploratory analyses suggested some evidence for sex differences within ethnic groups. For example, South Asian parents of daughters scored higher than White British parents of daughters on emotional feeding, with no ethnic differences apparent for parents of sons. Our findings support considering variation in parent feeding behaviors and weight-related attitudes by parental ethnicity and child sex when developing obesity interventions.

Validation of the comprehensive feeding practices questionnaire in parents of preschool children in Brazil.

BACKGROUND: Recent national surveys in Brazil have demonstrated a decrease in the consumption of traditional food and a parallel increase in the consumption of ultra-processed food, which has contributed to a rise in obesity prevalence in all age groups. Environmental factors, especially familial factors, have a strong influence on the food intake of preschool children, and this has led to the development of psychometric scales to measure parents' feeding practices. The aim of this study was to test the validity of a translated and adapted Comprehensive Feeding Practices Questionnaire in a sample of Brazilian preschool-aged children enrolled in private schools. METHODS: A transcultural adaptation process was performed in order to develop a modified questionnaire (43 items). After piloting, the questionnaire was sent to parents, along with additional questions about family characteristics. Test-retest reliability was assessed in one of the schools. Factor analysis with oblique rotation was performed. Internal reliability was tested using Cronbach's alpha and correlations between factors, discriminant validity using marker variables of child's food intake, and convergent validity via correlations with parental perceptions of perceived responsibility for feeding and concern about the child's weight were also performed. RESULTS: The final sample consisted of 402 preschool children. Factor analysis resulted in a final questionnaire of 43 items distributed over 6 factors. Cronbach alpha values were adequate (0.74 to 0.88), between-factor correlations were low, and discriminant validity and convergent validity were acceptable. CONCLUSIONS: The modified CFPQ demonstrated significant internal reliability in this urban Brazilian sample. Scale validation within different cultures is essential for a more comprehensive understanding of parental feeding practices for preschoolers.

Prevalence and determinants of vitamin A deficiency among Brazilian children under 2 years of age from the 2006 National Demographic Health Survey.

BACKGROUND: Vitamin A deficiency is prevalent among infants, primarily in undeveloped communities, compromising immune system competence and raising morbidity and mortality rates. Understanding the risk factors associated with vitamin A deficiency is essential to create informed health policies. OBJECTIVE: To identify and quantify risk factors for vitamin A deficiency in a probabilistic sample of children under 2 years of age participating in a national survey in Brazil and to provide a comprehensive risk factor model to inform health strategies and policies. METHODS: We analyzed data from a cross-sectional study of 1,436 children from the 2006 Brazilian National Survey on Demography and the Health of Women and Children. Vitamin A deficiency was defined as retinol levels below 0.70 µg/dL. RESULTS: The prevalence of vitamin A deficiency was estimated at 16.1% (95% CI, 12.7 to 20.2). The Poisson regression model identified three risk factors for vitamin A deficiency: urban residence (prevalence ratio [PR] = 1.47, p = .023), no consumption of animal meat within the past week (PR = 1.41, p = .031), and a mother older than 25 years (PR = 1.31, p = .048). CONCLUSIONS: Strategies to control infant vitamin A deficiency should include health promotion and nutrition education for families from all socioeconomic levels. Improvements in lifestyle quality, based on adequate food consumption by all infants, must be achieved by communities, especially in urban areas and for older mothers.

Patterns of Eating Behavior among 13-Year-Old Adolescents and Associated Factors: Findings from the Generation XXI Birth Cohort.

Eating behavior adopted during adolescence may persist into adulthood. The aims of this study were to identify eating behavior patterns among Portuguese adolescents and to explore whether groups differ in terms of early life and family characteristics, severity of depressive symptoms, and body mass index (BMI) z-score. Participants were 3601 13-year-olds enrolled in the birth cohort Generation XXI. Eating behavior was assessed using the self-reported Adult Eating Behavior Questionnaire (AEBQ), validated in this sample. The severity of depressive symptoms was measured through the Beck Depression Inventory (BDI-II), and data on sociodemographic and anthropometrics were collected at birth and 13-years-old. Latent class analysis was conducted, and associations were estimated using multinomial logistic regression models. Five patterns of individuals were identified: "Picky eating", "Disinterest towards food", "Food neophilia", "Emotional eating", and "Food attractiveness". The adolescents' sex, maternal education, BMI z-score, and severity of depressive symptoms were significantly associated with the identified patterns. In particular, adolescents with a higher BMI z-score were more likely in "Food neophilia" while individuals with more severe depressive symptoms were in the "Picky eating", "Emotional eating", and "Food attractiveness" patterns. These findings suggest a starting point for the development and planning of targeted public health interventions.

Changes in air pollution exposure after residential relocation and body mass index in children and adolescents: A natural experiment study.

Air pollution exposure may affect child weight gain, but observational studies provide inconsistent evidence. Residential relocation can be leveraged as a natural experiment by studying changes in health outcomes after a sudden change in exposure within an individual. We aimed to evaluate whether changes in air pollution exposure due to residential relocation are associated with changes in body mass index (BMI) in children and adolescents in a natural experiment study. This population-based study included children and adolescents, between 2 and 17 years, who moved during 2011-2018 and were registered in the primary healthcare in Catalonia, Spain (N = 46,644). Outdoor air pollutants (nitrogen dioxides (NO2), particulate matter <10 µm (PM10) and <2.5 µm (PM2.5)) were estimated at residential census tract level before and after relocation; tertile cut-offs were used to define changes in exposure. Routinely measured weight and height were used to calculate age-sex-specific BMI z-scores. A minimum of 180 days after moving was considered to observe zBMI changes according to changes in exposure using linear fixed effects regression. The majority of participants (60-67% depending on the pollutant) moved to areas with similar levels of air pollution, 15-49% to less polluted, and 14-31% to more polluted areas. Moving to areas with more air pollution was associated with zBMI increases for all air pollutants (ß NO2 = 0.10(95%CI 0.09; 0.12), ß PM2.5 0.06(0.04; 0.07), ß PM10 0.08(0.06; 0.10)). Moving to similar air pollution areas was associated with decreases in zBMI for all pollutants. No associations were found for those moving to less polluted areas. Associations with moving to more polluted areas were stronger in preschool- and primary school-ages. Associations did not differ by area deprivation strata. This large, natural experiment study suggests that increases in outdoor air pollution may be associated with child weight gain, supporting ongoing efforts to lower air pollution levels.

Sugar-sweetened beverages, effects on appetite and public health strategies to reduce the consumption among children: a review.

Sugar-sweetened beverages (SSBs) consumption have been of public health concern and a target of interventions due to their high consumption and burden in health-related consequences, particularly in children and adolescents. SSBs provide high energy intake with low nutritional value and are a major contributor for added and free sugars intake of Portuguese in all age-groups, especially adolescents. Despite its recognized effect on weight gain, it might also disrupt appetite regulation. Research on the effect of SSBs on appetitive traits is still scarce and unclear, and the current knowledge of these potential effects will be discussed in this review. This review also aims to describe public health strategies implemented to decrease SSBs consumption among children, particularly in Portugal, such as: (i) implemented taxation measures and its impact in sales and in preventable cases of disease and death, (ii) marketing regulations applied to children and adolescents, and ultimately (iii) the intention of application of a single Front-of-Package labeling system in all countries, aiming to increase consumers' food literacy.