Longitudinal Analysis Between Maternal Feeding Practices and Body Mass Index (BMI): A Study in Asian Singaporean Preschoolers

Abstract

Bidirectional studies between maternal feeding practices with subsequent child weight are limited, with no studies in Asian populations. In longitudinal analyses, we assessed the directionality of the associations between maternal feeding practices and body mass index (BMI) in preschoolers. Participants were 428 mother child dyads from the GUSTO (Growing Up in Singapore Toward healthy Outcomes) cohort. Feeding practices were assessed using the Comprehensive Feeding Practices Questionnaire (CFPQ) at age 5 y. Child BMI was measured at ages 4 and 6 y. BMI and maternal feeding practices subscales were transformed to SD scores and both directions of their associations examined with multivariable linear regression and pathway modeling. Higher BMI at age 4 was associated with lower encouragement of balance and variety (β = −0.33; 95%CI: −0.53, −0.13), lower pressure to eat (β = −0.49; −0.68, −0.29) and higher restriction (β = 1.10; 0.67, 1.52) at age 5, adjusting for confounders and baseline feeding practices at 3 years. In the reverse direction, only pressure and restriction at age 5 were associated with lower and higher child BMI at age 6 years, respectively. After the adjustment for baseline BMI at age 5, the association with pressure was attenuated to non-significance (β = 0.01 (−0.01, 0.03), while the association with restriction remained significant (β = 0.02; 0.002, 0.03). Overall, associations from child BMI to maternal restriction for weight control and pressure feeding practices was stronger than the association from these maternal feeding practices to child BMI (Wald's statistics = 24.3 and 19.5, respectively; p < 0.001). The strength and directionality suggests that the mothers in the Asian population were likely to adopt these feeding practices in response to their child's BMI, rather than the converse. Clinical Trial Registry Number and Website This study was registered at clinicaltrials.gov as NCT01174875 ( www.clinicaltrials.gov , NCT01174875).

Eating in the absence of hunger: Stability over time and associations with eating behaviours and body composition in children

“…Previous research suggests that parental feeding practices, particularly restriction, can independently contribute to and moderate the link between children’s EAH and adiposity (Birch et al, 2003, Cutting et al, 1999, Fisher and Birch, 2002), but parental behaviours can also be a consequence of the child’s weight status (Costanzo and Woody, 1985). A recent study from our GUSTO cohort also showed that the relationship between parental feeding practices and children’s weight gain between 4-6 years is bi-directional (Quah et al ., Under review). Children who show EAH in the laboratory setting may be at risk of weight gain if they have opportunities to habitually express this behaviour in their usual environment, and that will be affected by parenting style and feeding practices.…”

Associations between Children’s Genetic Susceptibility to Obesity, Infant’s Appetite and Parental Feeding Practices in Toddlerhood

“…More recent studies suggested that the associations between children’s BMI and parental feeding practices are bi-directional [ 30 , 32 , 35 , 50 , 51 ]. Longitudinal studies found that parental restrictive practices are developed in reaction to higher BMI in children, whereas parental pressure to eat develops in reaction to lower BMI in children [ 30 , 32 , 33 , 34 , 35 ], and the influence of children’s BMI on parental feeding practices appeared more important than the influence of parental feeding practices on children’s weight gain [ 30 , 32 , 34 , 35 ].…”

Maternal feeding practices and children's food intake during an ad libitum buffet meal: Results from the GUSTO cohort

“…This latter hypothesis would be consistent with our finding that mothers made more attempts to slow children's eating when they were consuming more energy, as this "slowing" behavior has not previously been shown to increase children's intake. The idea that parents adopt feeding practices in reaction to their children's eating behaviors or weight status also has some support from longitudinal studies in the literature [26,32,33,42]. Intervention studies or time-stamped behavioral observations that allow detailed analysis of the order of behaviors would be needed to confirm which behavior precedes the other and if there is a causal link.…”

“…Although the relationships between feeding practices and children's eating behaviors or weight status may differ between families of different ethnicities [21,25], overall, the general patterns found from recent studies in Asian populations reflect those seen in European or American samples. For example, studies consistently find greater pressure to eat when the child has a lower weight status, and more restriction in children with higher weight status [24,26]. A recent study of Singaporean parents has shown that parent-reported modeling healthy eating was associated with greater child intake of vegetables and whole grains, and less intake of sweet snacks and fast foods [27].…”