Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Maternal and pediatric nutrition

The association of problematic eating behaviours with food quality and body mass index at 7 years of age

European Journal of Clinical Nutrition volume 73, pages 549–557 (2019)Cite this article

Subjects

Abstract

Background/objectives

There is scarce evidence of how certain eating behaviours compromise the compliance with dietary guidelines and weight status in school-aged children. This study aims to evaluate the association of children’s problematic eating behaviours with food quality and body mass index at 7 years of age.

Subjects/methods

Participants were children aged 7 years old from a population-based cohort study from Porto, Portugal-Generation XXI. Children’s quantity and speed of ingestion, food refusal at the table and food rewards requesting were evaluated by caregiver’s perception. Food consumption was evaluated by a food frequency questionnaire and compared with age-appropriate guidelines. Children’s weight status was assessed by objective measurements and parent’s perceptions. Associations were estimated by logistic regressions (odds ratio (OR), 95% confidence intervals (95% CI)) adjusted for maternal age, education, smoking during pregnancy, birth type, child’s sex, weight-for-gestational age and sports (n = 3801).

Results

Children eating small amounts of food, refusing to eat at the table with the rest of the family during meals and asking for food rewards showed a higher consumption of energy-dense foods (OR = 1.51; 95% CI:1.23–1.86; OR = 1.58; 95% CI:1.16–2.16; OR = 1.56; 95% CI:1.14–2.12) and presented higher odds of consuming fruit and vegetables below recommendations (OR = 1.41; 95% CI:1.22–1.64; OR = 1.20; 95% CI:1.00–1.45; OR = 1.28; 95% CI:1.05–1.55). Children displaying these eating behaviours were less likely to be overweight/obese, hence their parents were less likely to show concern with their weight. Including food quality as covariate in the final models with obesity status did not change the associations.

Conclusions

Problematic eating behaviours were associated with poorer food quality (more energy-dense foods and low fruit and vegetables), but food quality does not seem to explain the association with obesity status. Parents were less likely to be concerned about their child’s weight if the child ate slowly or poorly, and accordingly the odds of them being overweight or obese were lower.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Oliveira A, Jones L, de Lauzon-Guillain B, Emmett P, Moreira P, Charles MA, et al. Early problematic eating behaviours are associated with lower fruit and vegetable intake and less dietary variety at 4-5 years of age. A prospective analysis of three European birth cohorts. Br J Nutr. 2015;114:763–71.

    Article  CAS  Google Scholar 

  2. Aldridge VK, Dovey TM, Martin CI, Meyer C. Identifying clinically relevant feeding problems and disorders. J Child Health Care. 2010;14:261–70.

    Article  Google Scholar 

  3. Dovey TMSP, Gibson EL, Halford JC. Food neophobia and ‘picky/fussy’ eating in children: a review. Appetite. 2008;50:181–93.

    Article  Google Scholar 

  4. van Dijk M, Bruinsma E, Hauser MP. The relation between child feeding problems as measured by parental report and mealtime behavior observation: a pilot study. Appetite. 2016;99:262–67.

    Article  Google Scholar 

  5. Jacobi C, Agras WS, Bryson S, Hammer LD. Behavioral validation, precursors, and concomitants of picky eating in childhood. J Am Acad Child Adolesc Psychiatry. 2003;42:76–84.

    Article  Google Scholar 

  6. Birch LL, Fisher JO. Development of eating behaviors among children and adolescents. Pediatrics. 1998;101:539–49.

    CAS  PubMed  Google Scholar 

  7. Mascola AJ, Bryson SW, Agras WS. Picky eating during childhood: a longitudinal study to age 11 years. Eat Behav. 2010;11:253–7.

    Article  Google Scholar 

  8. Dubois L, Farmer AP, Girard M, Peterson K. Preschool children’s eating behaviours are related to dietary adequacy and body weight. Eur J Clin Nutr. 2007;61:846–55.

    Article  CAS  Google Scholar 

  9. Dovey TM, Staples PA, Gibson EL, Halford JCG. Food neophobia and ‘picky/fussy’ eating in children: a review. Appetite. 2008;50:181–93.

    Article  Google Scholar 

  10. Galloway AT, Fiorito L, Lee Y, Birch LL. Parental pressure, dietary patterns, and weight status among girls who are “picky eaters”. J Am Diet Assoc. 2005;105:541–8.

    Article  Google Scholar 

  11. Galloway AT, Lee Y, Birch LL. Predictors and consequences of food neophobia and pickiness in young girls. J Am Diet Assoc. 2003;103:692–8.

    Article  Google Scholar 

  12. Carruth BR, Ziegler PJ, Gordon A, Barr SI. Prevalence of picky eaters among infants and toddlers and their caregivers’ decisions about offering a new food. J Am Diet Assoc. 2004;104:s57–64.

    Article  Google Scholar 

  13. de Lauzon-Guillain B, Jones L, Oliveira A, Moschonis G, Betoko A, Lopes C, et al. The influence of early feeding practices on fruit and vegetable intake among preschool children in 4 European birth cohorts. Am J Clin Nutr. 2013;98:804–12.

    Article  Google Scholar 

  14. de Barse LM, Tiemeier H, Leermakers ET, Voortman T, Jaddoe VW, Edelson LR, et al. Longitudinal association between preschool fussy eating and body composition at 6 years of age: the Generation R Study. Int J Behav Nutr Phys Act. 2015;12:153.

    Article  Google Scholar 

  15. Fildes A, Mallan KM, Cooke L, van Jaarsveld CH, Llewellyn CH, Fisher A, et al. The relationship between appetite and food preferences in British and Australian children. Int J Behav Nutr Phys Act. 2015;12:116.

    Article  Google Scholar 

  16. Taylor CM, Northstone K, Wernimont SM, Emmett PM. Macro- and micronutrient intakes in picky eaters: a cause for concern? Am J Clin Nutr. 2016;104:1647–56.

    Article  CAS  Google Scholar 

  17. van der Horst K, Deming DM, Lesniauskas R, Carr BT, Reidy KC. Picky eating: associations with child eating characteristics and food intake. Appetite. 2016;103:286–93.

    Article  Google Scholar 

  18. Cooke LJ, Wardle J. Age and gender differences in children’s food preferences. Br J Nutr. 2005;93:741–6.

    Article  CAS  Google Scholar 

  19. Russell CG, Worsley A. Do children’s food preferences align with dietary recommendations? Public Health Nutr. 2007;10:1223–33.

    Article  CAS  Google Scholar 

  20. Webber L, Hill C, Saxton J, Van Jaarsveld CH, Wardle J. Eating behaviour and weight in children. Int J Obes (Lond). 2009;33:21–8.

    Article  CAS  Google Scholar 

  21. Viana V, Sinde S, Saxton JC. Children’s Eating Behaviour Questionnaire: associations with BMI in Portuguese children. Br J Nutr. 2008;100:445–50.

    Article  CAS  Google Scholar 

  22. Vallejo M, Cortes-Rodriguez BA, Colin-Ramirez E. Maternal underestimation of child’s weight status and health behaviors as risk factors for overweight in children. J Pediatr Nurs. 2015;30:e29–33.

    Article  Google Scholar 

  23. Rodgers RF, Paxton SJ, Massey R, Campbell KJ, Wertheim EH, Skouteris H, et al. Maternal feeding practices predict weight gain and obesogenic eating behaviors in young children: a prospective study. Int J Behav Nutr Phys Act. 2013;10:24.

    Article  Google Scholar 

  24. Gregory JE, Paxton SJ, Brozovic AM. Maternal feeding practices, child eating behaviour and body mass index in preschool-aged children: a prospective analysis. Int J Behav Nutr Phys Act. 2010;7:55.

    Article  Google Scholar 

  25. Cooke L. The importance of exposure for healthy eating in childhood: a review. J Hum Nutr Diet. 2007;20:294–301.

    Article  CAS  Google Scholar 

  26. Shloim N, Edelson LR, Martin N, Hetherington MM. Parenting styles, feeding styles, feeding practices, and weight status in 4-12 year-old children: a systematic review of the literature. Front Psychol. 2015;6:1849

    Article  Google Scholar 

  27. Larsen PS, Kamper-Jorgensen M, Adamson A, Barros H, Bonde JP, Brescianini S, et al. Pregnancy and birth cohort resources in Europe: a large opportunity for aetiological child health research. Paediatr Perinat Epidemiol. 2013;27:393–414.

    Article  Google Scholar 

  28. Husted JA, Cook RJ, Farewell VT, Gladman DD. Methods for assessing responsiveness: a critical review and recommendations. J Clin Epidemiol. 2000;53:459–68.

    Article  CAS  Google Scholar 

  29. Kramer MS, Platt RW, Wen SW, Joseph KS, Allen A, Abrahamowicz M, et al. A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics. 2001;108:E35.

    Article  CAS  Google Scholar 

  30. Wardle J, Guthrie CA, Sanderson S, Rapoport L. Development of the Children’s Eating Behaviour Questionnaire. J Child Psychol Psychiatry. 2001;42:963–70.

    Article  CAS  Google Scholar 

  31. Carnell S, Wardle J. Measuring behavioural susceptibility to obesity: validation of the child eating behaviour questionnaire. Appetite. 2007;48:104–13.

    Article  Google Scholar 

  32. Svensson V, Lundborg L, Cao Y, Nowicka P, Marcus C, Sobko T. Obesity related eating behaviour patterns in Swedish preschool children and association with age, gender, relative weight and parental weight--factorial validation of the Children’s Eating Behaviour Questionnaire. Int J Behav Nutr Phys Act. 2011;8:134.

    Article  Google Scholar 

  33. Ashcroft J, Semmler C, Carnell S, van Jaarsveld CH, Wardle J. Continuity and stability of eating behaviour traits in children. Eur J Clin Nutr. 2008;62:985–90.

    Article  CAS  Google Scholar 

  34. Albuquerque G, Severo M, Oliveira A. Early life characteristics associated with appetite-related eating behaviors in 7-year-old children. J Pediatr. 2017;180:e2.

    Article  Google Scholar 

  35. Durão C, Andreozzi V, Oliveira A, Moreira P, Guerra A, Barros H, et al. Maternal child-feeding practices and dietary inadequacy of 4-year-old children. Appetite. 2015;92:15–23.

    Article  Google Scholar 

  36. Stewart A, Marfell-Jones M, Olds T, de Ridder H. International Standards for Anthropometric Assessment. New Zeland: The International Society for the Advancement of Kinanthropometry; 2011.

    Google Scholar 

  37. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85:660–7.

    Article  Google Scholar 

  38. Real H, Oliveira A, Severo M, Moreira P, Lopes C. Combination and adaptation of two tools to assess parental feeding practices in pre-school children. Eat Behav. 2014;15:383–7.

    Article  Google Scholar 

  39. Swinburn B, Sacks G, Ravussin E. Increased food energy supply is more than sufficient to explain the US epidemic of obesity. Am J Clin Nutr. 2009;90:1453–6.

    Article  CAS  Google Scholar 

  40. Powell F, Farrow C, Meyer C, Haycraft E. The importance of mealtime structure for reducing child food fussiness. Matern Child Nutr. 2017;13..

    Article  Google Scholar 

  41. Jacobi C, Schmitz G, Agras WS. Is picky eating an eating disorder? Int J Eat Disord. 2008;41:626–34.

    Article  Google Scholar 

  42. Sleddens E, Kremers S, Thijs C. The Children’s Eating Behaviour Questionnaire: factorial validity and association with Body Mass Index in Dutch children aged 6–7. Int J Behav Nutr Phys Act. 2008;5:49.

    Article  Google Scholar 

  43. Rietmeijer-Mentink M, Paulis WD, van Middelkoop M, Bindels PJ, van der Wouden JC. Difference between parental perception and actual weight status of children: a systematic review. Matern Child Nutr. 2013;9:3–22.

    Article  Google Scholar 

  44. Brown CL, Pesch MH, Perrin EM, Appugliese DP, Miller AL, Rosenblum K, et al. Maternal concern for child undereating. Acad Pediatr. 2016;16:777–82.

    Article  Google Scholar 

  45. Guevara-Cruz M, Serralde-Zuniga AE, Frigolet Vazquez-Vela ME, Blancas Galicia L, Islas-Ortega L. Association between maternal perceptions and actual nutritional status for children in a study group in Mexico. Nutr Hosp. 2012;27:209–12.

    CAS  PubMed  Google Scholar 

  46. Moore LC, Harris CV, Bradlyn AS. Exploring the relationship between parental concern and the management of childhood obesity. Matern Child Health J. 2012;16:902–8.

    Article  Google Scholar 

  47. Warschburger P, Kroller K. “Childhood overweight and obesity: maternal perceptions of the time for engaging in child weight management”. BMC Public Health. 2012;12:295.

    Article  Google Scholar 

  48. Gerards SM, Gubbels JS, Dagnelie PC, Kremers SP, Stafleu A, de Vries NK, et al. Parental perception of child’s weight status and subsequent BMI z change: the KOALA birth cohort study. BMC Public Health. 2014;14:291.

    Article  Google Scholar 

  49. Bjelland M, Brantsaeter AL, Haugen M, Meltzer HM, Nystad W, Andersen LF. Changes and tracking of fruit, vegetables and sugar-sweetened beverages intake from 18 months to 7 years in the Norwegian Mother and Child Cohort Study. BMC Public Health. 2013;13:793.

    Article  Google Scholar 

  50. Northstone K, Emmett PM. Are dietary patterns stable throughout early and mid-childhood? A birth cohort study. Br J Nutr. 2008;100:1069–76.

    Article  CAS  Google Scholar 

  51. Biro FM, Wien M. Childhood obesity and adult morbidities. Am J Nutr. 2010;91:1499s–505s.

    Article  Google Scholar 

  52. Cornette R. The emotional impact of obesity on children. World Evid Based Nurs. 2008;5:136–41.

    Article  Google Scholar 

Download references

Acknowledgements

We are indebted to all participants for providing the data used in the Generation XXI birth cohort, as well as to all members of the research team and its coordinators (Henrique Barros and Ana Cristina Santos). The authors acknowledge the support from the Epidemiology Research Unit (EPIUnit: UID-DTP/04750/2013).

Funding

Generation XXI was funded by the Health Operational Programme—Saúde XXI, Community Support Framework III and the Regional Department of Ministry of Health. This study was supported through FEDER from the Operational Programme Factors of Competitiveness (COMPETE) and through national funding from the Foundation for Science and Technology (FCT; Portuguese Ministry of Education and Science) under the project PTDC/SAU-EPI/121532/2010 (FCOMP-01-0124-FEDER-021177) and through the Investigator Programme (IF/01350/2015–Andreia Oliveira and IF/01060/2015–Ana Cristina Santos). It also had support from the Calouste Gulbenkian Foundation.

Author information

Authors and Affiliations

  1. EPIUnit–Institute of Public Health, University of Porto, Porto, Portugal

    Sara Costa, Andreia Pinto, Ana Cristina Santos & Andreia Oliveira

  2. Department of Public Health and Forensic Sciences, and Medical Education, Unit of Epidemiology, Faculty of Medicine, University of Porto, Porto, Portugal

    Ana Cristina Santos & Andreia Oliveira

Authors
  1. Sara Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andreia Pinto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ana Cristina Santos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andreia Oliveira
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreia Oliveira.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Costa, S., Pinto, A., Santos, A.C. et al. The association of problematic eating behaviours with food quality and body mass index at 7 years of age. Eur J Clin Nutr 73, 549–557 (2019). https://doi.org/10.1038/s41430-018-0169-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-018-0169-z

Search

Advanced search

Quick links