Faster eating rates are associated with increased energy intake, but little is known about the relationship between children's eating rate, food intake and adiposity. We examined whether children who eat faster consume more energy and whether this is associated with higher weight status and adiposity. We hypothesised that eating rate mediates the relationship between child weight and ad libitum energy intake. Children (n 386) from the Growing Up in Singapore Towards Healthy Outcomes cohort participated in a video-recorded ad libitum lunch at 4·5 years to measure acute energy intake. Videos were coded for three eating-behaviours (bites, chews and swallows) to derive a measure of eating rate (g/min). BMI and anthropometric indices of adiposity were measured. A subset of children underwent MRI scanning (n 153) to measure abdominal subcutaneous and visceral adiposity. Children above/below the median eating rate were categorised as slower and faster eaters, and compared across body composition measures. There was a strong positive relationship between eating rate and energy intake (r 0·61, P<0·001) and a positive linear relationship between eating rate and children's BMI status. Faster eaters consumed 75 % more energy content than slower eating children (Δ548 kJ (Δ131 kcal); 95 % CI 107·6, 154·4, P<0·001), and had higher whole-body (P<0·05) and subcutaneous abdominal adiposity (Δ118·3 cc; 95 % CI 24·0, 212·7, P=0·014). Mediation analysis showed that eating rate mediates the link between child weight and energy intake during a meal (b 13·59; 95 % CI 7·48, 21·83). Children who ate faster had higher energy intake, and this was associated with increased BMI z-score and adiposity.

Picky eating seems to occur at similar prevalence rates in China as has been reported in other countries. Parents' perceptions of food refusal do not reflect actual intakes, nor do nutrient intakes of picky eaters show additional gaps compared to non-picky eating children. In healthy children with typical growth patterns, picky eating seems to be a normal phase of development experienced by some children, without substantial consequences on their nutrient or food group intakes.

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Recent findings confirm that faster eating rates support higher energy intakes within a meal and are associated with increased body weight and adiposity in children. The current study sought to * Author to whom correspondence should be addressed: Ciaran Gerard Forde; Centre for Translational Medicine, 14 Medical Drive #07-02, MD 6 Building, Yong Loo Lin School of Medicine, Singapore 117599; Tel: +65 64070104; ciaran_forde@sics.astar.edu.sg. Clinical Trial Registry Number: NCT01174875; https://clinicaltrials.gov/ Authors' Contributions: This study was conceived and designed by CGF, AF, MFFC and LRF. Clinical analyses were performed by SS, SV, AF, ATG, and CGF and data analysis and interpretation were carried out by AF and CGF. AF and CGF prepared the draft manuscript and all authors reviewed and approved the final draft. This study was given ethical approval by ethical review boards of the KK Women's and Children's Hospital and National University Hospital in Singapore.Author disclosures: Keith Godfrey, Lee Yung-Seng and Yap Seng Chong have received reimbursement for speaking at conferences sponsored by companies selling nutritional products. They are part of an academic consortium that has received research funding from Abbott Nutrition, Nestec and Danone. Lisa Fries is an employee of Nestec SA, working at the Nestlé Research Center. The other authors have no financial or personal conflict of interests. Europe PMC Funders GroupAuthor Manuscript Physiol Behav. Author manuscript; available in PMC 2018 January 01. Europe PMC Funders Author ManuscriptsEurope PMC Funders Author Manuscripts identify the eating behaviours that underpin faster eating rates and energy intake in children, and to investigate their variations by weight status and other individual differences. Children (N=386) from the Growing Up in Singapore towards Healthy Outcomes (GUSTO) cohort took part in a video-recorded ad libitum lunch at 4.5 years of age to measure acute energy intake. Videos were coded for three eating behaviours (bites, chews and swallows) to derive a measure of eating rate (g/min) and measures of eating microstructure: eating rate (g/min), total oral exposure (minutes), average bite size (g/bite), chews per gram, oral exposure per bite (seconds), total bites and proportion of active to total mealtime. Children's BMIs were calculated and a subset of children underwent MRI scanning to establish abdominal adiposity. Children were grouped into faster and slower eaters, and into healthy and overweight groups to compare their eating behaviours. Results demonstrate that faster eating rates were correlated with larger average bite size (r=0.55, p<0.001), fewer chews per gram (r=-0.71, p<0.001) and shorter oral exposure time per bite (r=-0.25, p<0.001), and with higher energy intakes (r=0.61, p<0.001). Children with overweight and higher adiposity had faster eating rates (p<0.01) and higher energy intakes (p<0.01), driven by larger bite sizes (p<0.05). Eating behaviours varied by sex, ethnicity and early feeding regimes, partial...

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