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

Abstract

Background: Parental restrictive feeding (i.e., limiting food intake of children) has been linked to childhood overweight. However, the directionality of the causal pathway remains unknown. Objective: The objectives of this study were to examine the bidirectional association of maternal restrictive feeding with children's weight and body composition across childhood and to explore a possible mediating role of maternal concern about child weight. Design: Data were available for 4689 mother-child dyads participating in Generation R, a prospective birth cohort in the Netherlands. At ages 4 and 10 y, restrictive feeding was assessed with the parent-reported Child Feeding Questionnaire, and children's body mass index (BMI) was measured. At age 6 y, fat mass index (FMI) and fat-free mass index (FFMI) were measured with dual-energy X-ray absorptiometry. Both directions of the relation between restriction and child body composition were examined with multivariable linear regression analyses and cross-lagged modeling. Mediation analyses were performed to examine concern about child weight (mother reported at child age of 10 y) as a potential mediator. Results: Higher child sex-and age-adjusted BMI SD scores (zBMI) at age 4 y predicted more restrictive feeding at age 10 y (B = 0.15; 95% CI: 0.11, 0.18). Both sex-and age-adjusted FMI SD scores (zFMI) and sex-and age-adjusted FFMI SD scores (zFFMI) at 6 y were also positively associated with restrictive feeding at 10 y. Maternal concern about child weight partially mediated these associations from child body composition to restrictive feeding (e.g., for zBMI at 4 y: B indirect = 0.10; 95% CI: 0.07, 0.13). There was no temporal association from restrictive feeding at age 4 y to child zBMI at age 10 y after adjustment for baseline zBMI. Conclusions: The continued use of restrictive feeding practices at age 10 y appeared to be primarily a response of mothers to an unhealthy weight of their child rather than a cause of children's overweight. Guidelines discouraging restrictive feeding for preventing childhood overweight should therefore be reconsidered. Am J Clin Nutr 2017;106:783-90.

A biopsychosocial approach to processes and pathways in the development of overweight and obesity in childhood: Insights from developmental theory and research

“…In the research on eating and weight in childhood, this can be helped by measuring general constructs (such as intrusive parenting, negative control, or pressure to eat) and using two or more measuring occasions that are separated by no more than about 3 years . At times, adjustments to measures are needed across ages, or additional measures included . In developmental research, cross‐lagged designs have been used over longer periods .…”

“…Additionally, instead of bidirectional processes or parent influence processes, other research points to mechanisms where parents respond to the child's weight, so that feeding practices are in response to the parent's concerns about the child's BMI or appetite, rather than BMI being influenced by feeding practices. 272,[283][284][285][286][287] Finally, there are findings of no evidence linking BMI/weight with parent feeding practices. 288,289 When authors have attempted to integrate the mixed set of findings about links between parenting and children's weight, 271 they generally fail to find systematic patterns.…”

“…106,152,231,266,274,289,310,342,343 At times, adjustments to measures are needed across ages, 106,264 or additional measures included. 286 In developmental research, crosslagged designs have been used over longer periods. 230,325 The matter of the degree to which the same construct is being measured at each age is a potential problem with cross-lagged designs, and it is only sometimes recognized or investigated.…”

Appetite-Related Eating Behaviours: An Overview of Assessment Methods, Determinants and Effects on Children’s Weight

“…This reduced ability to respond to internal signals of hunger and satiety has been associated with increased weight in childhood [64-66]. More recent data indicates these associations between parental child-feeding practices and child’s weight may be bidirectional, meaning that the feeding practices could influence child’s weight, but they also could be a reaction to the child’s weight (e.g., parents pressure imposed on a child to eat more often in reaction to a child’s low weight) [56, 67]. …”

Early rapid weight gain among formula‐fed infants: Impact of formula type and maternal feeding styles

“…While the incidence of early rapid weight gain is evident in both breastfed and formula‐fed infants, it has been argued that bottle feeding imparts greater risks than breastfeeding because it yields more control to the mothers than to the infants and that the more controlling, less responsive, and less skilled the mother, the greater the likelihood she will interfere with or override the self‐regulatory abilities of her infant during bottle feeding . While mothers indeed vary in feeding styles and in how responsive they are to their infant's signals of hunger and satiety, the evidence that the dyadic interaction is unidirectional and that such variation in feeding styles causes early weight gain is equivocal …”