Infant Appetitive Phenotypes: A Group-Based Multi-Trajectory Analysis

Background: Examining appetitive traits with person-centered analytical approaches can advance the understanding of appetitive phenotype trajectories across infancy, their origins, and influences upon them. The objective of the present study was to empirically describe appetitive phenotype trajectories in infancy and examine the associations with infant and parent factors.Materials and Methods: In this longitudinal cohort study of Australian infants, parents completed three online surveys ~3 months apart, beginning when the infant was <6 months. Appetitive traits were assessed with the Baby Eating Behavior Questionnaire (BEBQ) and parent feeding practices with the Feeding Practices and Structure Questionnaire (FPSQ) infant and toddler version. Parent demographics and cognitions were also collected. Infant weight and length were transcribed from health records and converted to a BMI z-score. Group-based trajectory modeling identified appetitive phenotype trajectories using the BEBQ. Multilevel modeling examined change in feeding practices and child BMI z-score over time by appetitive phenotype trajectories.Results: At time 1, 380 participants completed the survey (mean infant age 98 days), 178 at time 2 (mean infant age 198 days), and 154 at time 3 (mean infant age 303 days). Three multi-trajectory appetitive phenotype groups were identified and labeled as (Phenotype 1) food avoidant trending toward low food approach (21.32% of infants), (Phenotype 2) persistently balanced (50.53% of infants), and (Phenotype 3) high and continuing food approach (28.16% of infants). Formula feeding was more common in Phenotype 1 (p = 0.016). Parents of infants in Phenotype 1 were more likely to rate them as being more difficult than average, compared to infants with phenotypes 2 or 3. Phenotype 2 had the greatest increase in persuasive feeding over time [0.30; 95% CI (0.12, −0.47)].Conclusions: Distinct multi-trajectory appetitive phenotype groups emerge early in infancy. These trajectories appear to have origins in both infant and parent characteristics as well as parent behaviors and cognitions. The infant multi-trajectory appetitive phenotype groups suggest that for some infants, difficulties in self-regulating appetite emerge early in life. Investigation of infant multi-trajectory appetitive phenotype groups that utilize a range of measures, examine relationships to key covariates and outcomes, and extend from infancy into childhood are needed.

Examining correlates of feeding practices among parents of preschoolers

Background: Parent feeding practices play a critical role in children’s eating behaviors. Limited research has explored child-level correlates of parent feeding practices. Aim: To identify correlates of feeding practices (responsive and controlling) among parents of preschoolers US. Methods: Participants included parents (n = 273) of preschoolers (3–5 years), recruited from Early Care and Education settings (n = 24) located in a metropolitan city in the US. Analysis included descriptives, correlations, and multiple regression. Results: For responsive feeding practices, positive associations included child's weight with unintentional modeling ( β = .17, 95% CI [0.12, 0.53]), child vegetable consumption with behavioral role modeling ( β = 0.22, 95% CI [0.17, 0.44]), and parent monitoring with verbal modeling ( β = 0.21, 95% CI [0.12, 0.34]). For controlling feeding practices, parent restriction was positively associated with child weight concern ( β = 0.22, 95% CI [0.13, 0.39]) and parent monitoring ( β = 0.13, 95% CI [0.01, 0.19]), whereas child vegetable consumption was negatively associated ( β = −0.16, 95% CI [−0.27, −0.05]). Pressure to eat was negatively associated with child weight concern ( β = −0.18, 95% CI [−0.45, −0.09]), child fruit consumption ( β = −0.12, 95% CI [−0.37, −0.01]), household income ( β = −0.13, 95% CI [−0.30, −0.02]), and parent weight ( β = −0.14, 95% CI [−0.60, −0.05]), Conclusions: Findings highlight the importance of child characteristics when examining correlates of parent feeding practices, demonstrating bidirectional interactions between parent feeding practices and children’s eating behaviors. Considering child-level correlates may improve the implementation of responsive feeding practices and reduce controlling feeding practices.

How Time in the US and Race/Ethnicity Shape Parents Feeding Practices and Child Diet Quality

Objectives Childhood obesity is a critical public health issue with short and long-term health and financial burdens. Studies show that childhood obesity is higher among children of immigrant/refugee households compared to children whose parents were born in the United States. Poor child dietary intake is a critical risk factor for elevated obesity prevalence. Nonetheless, parents feeding practices are known to be associated with child dietary intake. Thus, this study aimed to examine the associations between length of residence time in the US of migrants/refugees, parents feeding practices, and child diet quality while also taking into consideration race/ethnicity. Methods Data are from baseline measures of a longitudinal cohort study called Family Matters. The sample includes 1307 children ages 5–9 and their families from six racial/ethnic backgrounds. Results Results showed that feeding practices of immigrant/refugee parents changed in relation to their length of residency in the US, in particular, with regard to using directive (e.g., restriction), non-directive (e.g., modeling), and emotional feeding practices. Additionally, race/ethnicity was found to influence the relation between time length in the US and parents feeding practices. Moreover, the diet quality score changed in relation to parents' length of time in the US. For example, Hmong children had the poorest diet quality compared to African American, Native American, Hispanic, Somali, and White children. Conclusions Future research should consider studying more in-depth why parent feeding practices may change when parents move to the US and explore whether there is a combination of parent feeding practices that are most useful in promoting healthful child diet quality. It is also important to further examine why child diet quality declines (e.g., Hmong children) with parents' time living in the US as a migrant/refugee. Funding Sources Research is supported by grant number R01HL126171 from the National Heart, Lung, and Blood Institute (PI: Berge). Content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute of the National Institutes of Health.

Describing Ecological Momentary Assessment Methods for Collecting Dietary Intake in a Racially/Ethnically Diverse Sample

Objectives Ecological momentary assessment (EMA) is an innovative tool being used in the obesity field to capture real-time information about people's health. A recent systematic review regarding the use of EMA to assess dietary intake and physical activity in youth found the need for standardized reporting of EMA measures and methods. This presentation will discuss EMA methods used in the NIH-funded Family Matters study, including survey design, registration/technology, EMA protocols, implementation, and lessons learned for future EMA studies. Methods Family Matters is an incremental, two-phased (Phase I = 150 participants; Phase II = 627 participants), mixed-methods study conducted with a racially/ethnically diverse and immigrant/refugee sample from largely low-income households. Across two phases, the Family Matters research team designed and administered EMA surveys to parents of 5–9 year olds to measure momentary factors of importance to child weight and weight-related behaviors including parent feeding practices, child eating behaviors, meal preparation, and foods served at family meals. Results EMA data allowed for many cutting-edge research questions to be addressed, innovative analyses to be run, and methodological approaches to be advanced. Many diet-related topics were investigated, including 1) the investigation of both within-and across-day relationships between transient and chronic stress and parent feeding practices; 2) parental stress and mood earlier in the day and its association with parent feeding practices later in the day; and 3) family meal characteristics by meal type and day of the week. Additionally, concordance between diet-related EMA measures and objectively collected 24-hour dietary recalls was examined. Family Matters EMA diet-related measures will be presented and related results discussed. Conclusions This presentation will be valuable for researchers interested in using EMA for collecting obesity-related measures, such as dietary intake, physical activity, parent feeding practices, and stress/mood. Funding Sources Research is supported by grant number R01HL126171 from the National Heart, Lung, and Blood Institute (PI: Berge).

A thematic cluster analysis of parents’ online discussions about fussy eating (Preprint)

BACKGROUND Food fussiness is common in toddlerhood. Fussiness is associated with nonresponsive parent feeding practices, such as persuasive and instrumental feeding. Such feeding practices may reinforce fussy eating behaviors and are associated with poorer dietary intake and suboptimal growth trajectories. Parent feeding practices are known to cluster; however, no previous research has examined how feeding practices cluster in parents of fussy eaters. OBJECTIVE This study explored how feeding practices and factors known to influence these clustered among parents who perceived their toddler to be a fussy eater. METHODS Data were collected from parent discussions of fussy eating on an online parenting forum on the social media site, Reddit (80,366 posts). Latent Dirichlet Allocation was used to identify discussions of fussy eating. Relevant posts (1,542) made by users who identified as a parent of a fussy eater (n=630) underwent qualitative coding and thematic analysis. RESULTS Five clusters of parents were identified, ranging in size from 53 to 189 users. These were primarily characterized by parents’ degree of concern and feeding practices: 1) High Concern, Nonresponsive; 2) Concerned, Nonresponsive; 3) Low Concern, Responsive; 4) Low Concern, Mixed Strategies; 5) Low Concern, Indulgent. Parents who used responsive practices tended to be less concerned for fussy eating, have greater trust in their child’s ability to self-regulate hunger, have longer-term feeding goals, and exhibit a greater ability for personal self-regulation. CONCLUSIONS Factors related to parent feeding practices may cluster among parents who perceive their toddler to be a fussy eater. Future research should examine these constructs to identify how they may relate to each other and to parents’ feeding practices in order to learn how they could be leveraged in parent feeding interventions.

Parent Feeding Practices in the Context of Food Insecurity

The process of feeding is complex and highly dependent on parent, child, social, and environmental factors. Given the rising rates of food insecurity and concomitant poor nutrition and health, the purpose of this article was to outline the important and complex ways in which the context of food insecurity can impact parent feeding practices. Key factors discussed here include the impact of food insecurity on: expectations for motherhood, structural constraints, stress and depression, parents’ perceptions of health and child weight, and intergenerational transmission of parent feeding practices. Future research needs are also identified and discussed.