Validity and Reliability of the Baby and Child Eating Behavior Questionnaire, Toddler Version (BEBQ-Mex and CEBQ-T-Mex) in a Low Sociodemographic Sample Recruited in a Mexican Hospital

The objective of this study was to validate and measure the internal reliability of the Baby and Child Eating Behavior Questionnaires for Toddlers (BEBQ-Mex and CEBQ-T-Mex), that evaluate appetitive trait (ATs). Mothers recruited from a public hospital in Guadalajara, Mexico, completed the BEBQ-Mex or CEBQ-T-Mex along with information on sociodemographic characteristics. Internal reliability of the BEBQ-Mex was sufficient for Food Responsiveness (FR) (Cronbach α = 0.82), while Enjoyment of Food (EF) and Satiety Responsiveness (SR) showed poor reliability (α = 0.56) and Slowness in Eating (SE) had unacceptable reliability (a = 0.36). All reliability values for the CEBQ-T-Mex were acceptable (>0.70), except for SE (α = 0.64). Confirmatory factor analysis (CFA) revealed an adequate model fit for the BEBQ-Mex, except the SE subscale. CFA for the CEBQ-T-Mex confirmed the six-factor structure. Mothers of a low sociodemographic background were unable to recognize their infants’ ATs; the BEBQ-Mex partly met the criteria for validity and reliability. Mothers from similar sociodemographic characteristics were more able to recognize the ATs of their toddlers than their infants; the CEBQ-T-Mex was found to be a valid and reliable tool. Findings support the need to help mothers’ ability to recognize their infants’ ATs, which have been previously associated with weight and growth.

Prospective relations between maternal emotional eating, feeding to soothe, and infant appetitive behaviors

Background Infant obesogenic appetitive behaviors are associated with greater infant weight and child obesity, yet little is known about maternal influences on infant appetitive behaviors. This study examines the relations between maternal eating behaviors, feeding to soothe, and infant appetitive behaviors in a longitudinal sample of United States mothers. Methods Pregnant women were recruited in the first trimester (< 12 weeks) and followed through 1 year postpartum. Mothers reported their own eating behaviors (eating competence, restrained, emotional, and external eating) in pregnancy; feeding to soothe their infant at 2, 6, and 12 months postpartum; and their infants’ appetitive behaviors (enjoyment of food, food responsiveness, slowness in eating, and satiety responsiveness) at 6 months. Three path models were estimated to examine the direct relations of maternal eating behaviors with infant appetitive behaviors, the indirect relations of maternal eating behaviors with infant appetitive behaviors through feeding to soothe, and the longitudinal relations between feeding to soothe and infant appetitive behaviors. Results Maternal eating behaviors and infant appetitive behaviors were directly and indirectly related in all three models. Greater maternal eating competence was related to greater enjoyment of food but was not related to feeding to soothe. Greater maternal restrained and external eating were not directly related to infant appetitive behaviors but were indirectly related to greater infant responsiveness to food through more frequent feeding to soothe. Additionally, several longitudinal relations between feeding to soothe behaviors and infant appetitive behaviors were present. More frequent feeding to soothe at 2 months was related to greater responsiveness to food at 6 months, which was then related to more frequent feeding to soothe at 6 months. Furthermore, greater satiety responsiveness, faster eating speed, and greater responsiveness to food at 6 months were related to more frequent feeding to soothe at 12 months. Conclusions Maternal eating behaviors were related to infant appetitive behaviors directly and indirectly through feeding to soothe. Additionally, results suggest feeding to soothe and infant appetitive behaviors may be bidirectionally linked. These results underscore the need to examine how parental feeding behaviors are influenced both by parental eating behaviors and child appetitive behaviors throughout infancy. Trial registration Clinicaltrials.gov. Registration ID – NCT02217462. Date of registration – August 13, 2014.

Complementary Feeding Methods—A Review of the Benefits and Risks

Complementary feeding methods have the potential to not only ensure a diet of nutritional adequacy but also promote optimal food-related behaviours and skills. While the complementary feeding practice known as baby-led weaning (BLW) has gained popularity, evidence supporting the potential benefits and/or risks for infant growth, development, and health warrants consideration. A review of 29 studies was conducted with findings indicating that parents who implement BLW typically have higher levels of education, breastfeed for longer, and differ in other personality traits. Fear of choking was an important factor in parents’ decision not to implement BLW; however, this fear was not supported by the literature. Benefits of BLW included lower food fussiness, higher food enjoyment, lower food responsiveness, and higher satiety responsiveness. While this profile of eating behaviours confers a reduced obesity risk, few studies have examined the relationship between BLW and infant growth robustly. BLW does not seem to increase the risk of inadequate zinc or iron intake; however, emphasis needs to be given to ensuring adequate intake of these micronutrients among all infants. A better understanding of the impacts of BLW is needed to inform evidence-based recommendations to support and guide parents in complementary feeding methods.

Association Between State-Based and Trait-Based Responsiveness to Satiety Cues Differs by Child Risk for Overweight/Obesity

Objectives The relationship between parentally reported satiety responsiveness (i.e., trait) and laboratory-assessed satiety responsiveness (i.e., state) in children is not known, making it difficult to interpret and generalize lab-based findings. In addition, while many studies have shown weight-related differences in children's eating behaviors, less is known about appetitive traits that are present before obesity develops. Therefore, we examined associations between trait- and state-based satiety responsiveness among children with healthy weight who differed by familial risk for obesity. Methods Data from an ongoing longitudinal study were analyzed for 59 healthy-weight, 7–8 year-old children (BMI-for-age% &lt; 85). Familial risk for obesity was determined by parental weight status as low-risk (N = 34, both parents’ BMIs &lt; 25 kg/m2) or high-risk (N = 25, mothers’ BMI ≥ 30 kg/m2; fathers’ BMI ≥ 25 kg/m2). Parents completed the Children's Eating Behavior Questionnaire to assess satiety responsiveness (SR), a measure of children's tendency to stop eating once sated (trait). To assess state-based satiety, the Satiety Quotient (SQ) was calculated from an ad-libitum laboratory meal [(Pre-meal hunger – post-meal hunger)/meal intake in grams]. A higher SQ indicates a greater reduction in hunger per gram (i.e., better satiety responsiveness). Results Overall, SR and SQ were not correlated (P = 0.57). However, a linear regression controlling for pre-meal hunger and child BMI percentile revealed a risk status-by-SR interaction (β = 0.804, P = 0.04) such that SR was positively associated with SQ in high-risk children (95% CI [0.003, 0.430]), but there was no relationship between SR and SQ in low-risk children (95% CI [−0.203, 0.085]). No differences in SR, SQ, pre-meal hunger, or post-meal hunger were observed between risk groups. Conclusions Parentally reported (trait-based) satiety was positively associated with laboratory-assessed satiety, but only among healthy weight children at high-familial risk for obesity. Parents of children who are at high-risk for developing obesity may be more observant of children's appetitive traits compared to parents of low-risk children, and this may be helpful in the prevention of obesity. Funding Sources NIH RO1: DK110060.

Anxiety is associated with appetitive traits in university students during the COVID-19 pandemic

Background COVID-19 has impacted mental health globally, however, associations between anxiety and appetitive traits during the pandemic are unreported. This study evaluated anxiety symptom severity and associations with appetitive traits in students at a large public University in the U.S. during the pandemic. Methods Current undergraduate and graduate/professional students completed a cross-sectional survey in fall 2020. Demographic information, anxiety symptoms in the past 2 weeks assessed by the Generalized Anxiety Disorder Scale (GAD-7), and appetitive traits assessed by the Adult Eating Behavior Questionnaire (AEBQ) were evaluated. Mean scores for eight AEBQ scales (four food approach and four food avoidance traits) were calculated. Differences in mean scores were examined between participants with moderate to severe anxiety symptoms (GAD-7 score ≥ 10) and those with mild to no anxiety symptoms (GAD-7 score < 10) via independent samples t-tests and effect sizes. Associations between GAD-7 score and individual appetitive traits were also examined, adjusting for age and gender. Results Of the 1243 students who completed the survey (57% undergraduates; mean age = 26.5 years), 51.9% reported moderate to severe anxiety symptoms. Groups experiencing the highest degree of moderate to severe anxiety symptoms included transgender, gender fluid, and other-gendered participants (73.6%); the youngest age group [18–20 years (62%)]; undergraduate students (60.7%); and Hispanic/Latinx participants (57.7%). Participants with moderate to severe anxiety symptoms had higher scores for most food approach and avoidance traits but lower scores for enjoyment of food than those with mild to no anxiety symptoms. Effect sizes were largest for hunger and emotional over-eating (Cohen’s d = 0.31 and 0.30, respectively). Adjusting for age and gender, GAD-7 score was significantly and positively associated with hunger, emotional over-eating, food and satiety responsiveness, and food fussiness and negatively associated with enjoyment of food. Conclusions Over half of students at a U.S. University reported moderate to severe anxiety symptoms during COVID-19. More severe anxiety symptoms were associated with increased hunger, emotional over-eating, and food and satiety responsiveness and decreased enjoyment of food. Universities must consider strategies to address anxiety, particularly in younger students; transgender, gender fluid, and students of other genders; and across race/ethnicities keeping in mind associations with appetitive traits.

Food avoidance behaviour among children aged 2 – 6 years in North Jakarta and its correlation with weight and energy intake

Background: Children generally facing food avoidance or food refusal behaviour and it may affect their food consumption. But there is limited information on food avoidance behaviour among Indonesian children. Therefore, this study aimed to assess whether energy intake and body weight are influenced by food avoidance behaviour in children aged 2-6 years in North Jakarta.Methods: Participants (N=168) were recruited between February – March 2020. Data collection was obtained via interviews with the mother or caregiver of the children. Food avoidance behaviour consisting of satiety responsiveness, slowness in eating, emotional under-eating, and food fussiness was measured with the Child Eating Behaviour Questionnaire. The child’s weight and dietary intake were assessed using a digital weighing scale and 2 x 24 hours food recall. Spearman test was performed to analyse the correlation between these variables. Multivariate analysis was done using linear regression to determine predictors of a child’s body weight and energy intake.Results: Energy intake among children was below the recommendation, and it was significantly correlated with the child’s body weight. Satiety responsiveness was negatively correlated with the child’s body weight (r = -0.166; p-value < 0.05) and energy intake (r = -0.210; p-value < 0.05). After running a linear regression test, we found that satiety responsiveness along with family income and child’s age was a significant predictor of energy intake among children.Conclusions: Children who are more responsive to satiety had lower body weight and energy intake. Understanding the child’s food avoidance behaviour is useful for designing intervention programs related to optimizing intake in children and malnutrition.

Anxiety is associated with undesirable eating behaviors in university students during the COVID-19 pandemic

Background COVID-19 has impacted mental health globally, however, relationships between anxiety and eating behaviors during the pandemic have not been explored. This study evaluated anxiety, eating attitudes and behaviors, and associations between anxiety and eating behaviors in students at a large public University in the United States during the COVID-19 pandemic. Methods Current undergraduate and graduate/professional students completed a cross-sectional survey in fall 2020. Demographic information, indicators of anxiety in the past two weeks assessed by the Generalized Anxiety Disorder Screener (GAD-7), and eating behaviors assessed by the Adult Eating Behavior Questionnaire (AEBQ) were evaluated. A score ≥ 10 on the GAD-7 indicated anxiety (≥ 15 indicated severe anxiety). Eating behaviors were reported via Likert scale and combined into eight AEBQ subscales; subscale mean and standard deviation were reported. Differences in mean AEBQ subscale scores were examined between participants with and without anxiety via Mann-Whitney U tests. Multivariate linear regression was utilized to examine associations between GAD-7 score and individual AEBQ subscale scores, adjusting for age, gender, race/ethnicity, and student status. Results The final sample included 1243 students (57% undergraduates). In the full sample, 51.9% experienced anxiety in the past two weeks; 24.6% had severe anxiety. Subgroups with the highest prevalence of anxiety included non-cisgender participants (73.6%), the youngest age group [18–20 years of age (62%)], undergraduate students (60.7%), and Hispanic/Latino participants (57.5%). Participants with anxiety had significantly lower AEBQ scores for enjoyment of food and significantly higher scores for emotional over and under-eating, food fussiness, food and satiety responsiveness, and hunger than those with no anxiety (p < 0.01). In adjusted analyses, GAD-7 score was significantly and positively associated with hunger, food responsiveness, emotional over-eating, satiety responsiveness, and food fussiness and negatively associated with enjoyment of food. Conclusions The prevalence of anxiety is overwhelming in undergraduate and graduate/professional students amidst the COVID-19 pandemic. Eating behaviors differ significantly in those with anxiety; increasing anxiety severity was associated with undesirable eating behaviors including hunger and emotional over-eating. Universities and health professionals must consider strategies to address anxiety, particularly in younger students, non-cis-gender students, and across race/ethnicities keeping in mind associations between anxiety and eating behaviors.

Eating Behaviors in Relation to Child Weight Status and Maternal Education

Background: The eating behavior of children is important to maintain a healthy weight. This current study explored the differences in children’s eating behaviors and their relation to weight status and maternal education level, using the child eating behavior questionnaire (CEBQ). Methods: The study recruited 169 participants aged between six and ten years. Multinomial logistic regression was conducted to examine the association between the CEBQ factors and children’s body weight status. The association between the CEBQ scores and maternal educational levels was examined using a one-way analysis of variance (ANOVA). Results: The multinomial logistic regression findings indicate that children in the obese group exhibited a significant increase in food responsiveness, enjoyment of food, emotional overeating, and a decrease in satiety responsiveness compared to normal weight children. The one-way ANOVA showed a significant difference in subscales under the food approach (food responsiveness, desire to drink, emotional overeating) and food avoidance (satiety responsiveness) based upon the child’s weight status. The three subscales under the food approach category were significantly dependent upon the maternal education but did not have a significant association with food avoidance. Conclusions: The results suggest that the increase in food responsiveness and emotional overeating in obese children is influenced by maternal education.