Bidirectional association between parental child-feeding practices and body mass index at 4 and 7 y of age

Abstract

Background: Evidence of the association between parental childfeeding practices and the child's body mass index (BMI) is controversial, and bidirectional effects have been poorly studied. Objective: We aimed to examine bidirectional associations between parental child-feeding practices and BMI at 4 and 7 y of age. Design: This study included 3708 singleton children from the Generation XXI birth cohort with data on parental child-feeding practices and BMI at 4 and 7 y old. Feeding practices were assessed through a self-administered questionnaire by combining the Child Feeding Questionnaire and the Overt/Covert Control scale and then adapting it to Portuguese preschool children. Weight and height were measured according to standardized procedures, and age-and sex-specific BMI z scores were computed based on the WHO Growth References. Linear regression models were used to estimate the bidirectional associations between each practice and BMI z score. Crosslagged analyses were performed to compare the directions of those associations (the mean score of each practice and BMI z score at both ages were standardized to enable effect size comparisons). Results: After adjustments, pressure to eat and overt control at 4 y of age were associated with a lower BMI z score 3 y later (b: 20.05; 95% CI: 20.08, 20.03 and b: 20.05; 95% CI: 20.09, 20.01, respectively). Regarding the opposite direction of association, a higher BMI z score at 4 y of age was significantly associated with higher levels of restriction and covert control at 7 y of age (b: 0.06; 95% CI: 0.03, 0.08 and b: 0.06; 95% CI: 0.04, 0.08, respectively) and with lower levels of pressure to eat (b: 20.17; 95% CI: 20.20, 20.15). The only bidirectional practice, pressure to eat, was more strongly influenced by the BMI z score than the reverse (b standardized : 20.17 compared with b standardized : 20.04; likelihood ratio test: P , 0.001). Conclusions: We found that parents both respond to and influence the child's weight; thus, this child-parent interaction should be considered in future research.Am J Clin Nutr 2016;103:861-7.

Testing the direction of effects between child body composition and restrictive feeding practices: results from a population-based cohort

“…Apparently, mothers are sensitive to their child's weight status and adapt their feeding practices accordingly, probably with the intention to reduce children's food intake and improve health and well-being (29). This result is in line with results from a Portuguese longitudinal study (28) and also corresponds with research on other controlling feeding practices, which showed that parents use more coercive feeding strategies when their child is very thin (27,35).…”

“…However, this hypothesis was examined only a few times with contradictory findings. A longitudinal study in a UK cohort found no evidence for this hypothesis (12), whereas in the Dutch Generation R and Portuguese Generation XXI cohorts, associations between child weight and later restriction were found (27,28). It can be speculated that parental concern about children becoming overweight might drive the restriction of children's food intake.…”

Reducing childhood obesity: opportunities to influence transitional infant feeding

“…These findings along with the significant relationship found between pressure-to-eat and both current and birth weight, also provides evidence earlier than previously reported, 172,173 that this controlling feeding practice may be influenced by, as well as having an impact on, weight status, reinforcing the need to address weight expectations.…”

“…23,166,170,171 Current longitudinal evidence now supports the bidirectional relationship between these feeding practices and child weight, with a few large studies suggesting that feeding practice adaption in response to child's weight as the dominant direction. 172,173 If infant weight status is a driver of inappropriate feeding practices, then parental perceptions of their child's weight and identification of healthy weight is important.…”

Translational medicine and its contribution to public health

“…Research focused on growth and human developments [4][5][6][7] has been highlighted and since its establishment in the 1990s it has been the central theme of this Journal. In the current issue of JHGD these studies evaluate technologies that involve the improvement of health conditions and/or issues for public health investigating the health situation of the population, especially children and adolescents [8][9][10] , which corroborate the themes in the health promotion field within the context of primary care focusing on teens and their vulnerabilities [11][12][13] , nutrition and influence on child and adolescent development [14][15][16][17][18] and themes focused on translational medicine, describing results to improve the health indicators of the population [19][20][21][22] .…”