Bidirectional association between parental child-feeding practices and body mass index at 4 and 7 y of age

• Published in: The American journal of clinical nutrition 2016-03, Vol.103 (3), p.861-867
• Main Authors: Afonso, Lisa, Lopes, Carla, Severo, Milton, Santos, Susana, Real, Helena, Durão, Catarina, Moreira, Pedro, Oliveira, Andreia
• Format: Article
• Language: English
• Subjects: Body Mass Index; Body Weight; Child; Child, Preschool; Children & youth; Diet; Feeding Behavior; Female; Humans; Male; Parent-Child Relations; Parenting; Parents; Parents & parenting; Pediatric Obesity - etiology; Regression analysis; Surveys and Questionnaires
• ISSN: 0002-9165; 1938-3207
• DOI: 10.3945/ajcn.115.120824

Evidence of the association between parental child-feeding practices and the child's body mass index (BMI) is controversial, and bidirectional effects have been poorly studied. We aimed to examine bidirectional associations between parental child-feeding practices and BMI at 4 and 7 y of age. This study included 3708 singleton children from the Generation XXI birth cohort with data on parental child-feeding practices and BMI at 4 and 7 y old. Feeding practices were assessed through a self-administered questionnaire by combining the Child Feeding Questionnaire and the Overt/Covert Control scale and then adapting it to Portuguese preschool children. Weight and height were measured according to standardized procedures, and age- and sex-specific BMI z scores were computed based on the WHO Growth References. Linear regression models were used to estimate the bidirectional associations between each practice and BMI z score. Crosslagged analyses were performed to compare the directions of those associations (the mean score of each practice and BMI z score at both ages were standardized to enable effect size comparisons). After adjustments, pressure to eat and overt control at 4 y of age were associated with a lower BMI z score 3 y later (β: -0.05; 95% CI: -0.08, -0.03 and β: -0.05; 95% CI: -0.09, -0.01, respectively). Regarding the opposite direction of association, a higher BMI z score at 4 y of age was significantly associated with higher levels of restriction and covert control at 7 y of age (β: 0.06; 95% CI: 0.03, 0.08 and β: 0.06; 95% CI: 0.04, 0.08, respectively) and with lower levels of pressure to eat (β: -0.17; 95% CI: -0.20, -0.15). The only bidirectional practice, pressure to eat, was more strongly influenced by the BMI z score than the reverse (βstandardized: -0.17 compared with βstandardized: -0.04; likelihood ratio test: P < 0.001). We found that parents both respond to and influence the child's weight; thus, this child-parent interaction should be considered in future research.