Eating in the absence of hunger in 18-month-old children in a home setting

Psychometric properties of the Turkish version of the eating in the absence of hunger in children and adolescents (EAH-C)

BACKGROUND AND PURPOSE

Eating in the absence of hunger is a risk factor for excessive energy intake and predisposes children to overweight/obesity. The purpose of this study was to test the validity and reliability of the "Eating in the Absence of Hunger Questionnaire for Children and Adolescents (EAH-C)" in Türkiye.

METHODS

This study was conducted in a total of six schools, with children 8-18 years old between September and December 2022. Factor analysis, item-total score analysis and Cronbach's alpha coefficient were used for the validity and reliability.

RESULTS

The calculated KMO statistic was >0.60, and the Bartlett's test statistic was <0.05. The three subscales accounted for 65.22% of the total variance. Factor loads ranged from 0.41 to 0.84. The value obtained by dividing χ2 by the number of degrees of freedom was <5; the RMSEA was <0.10; the RMR was <0.08; and the TLI, GFI, AGFI, and CFI were >0.90. Cronbach's alpha coefficient was 0.91 for the total scale.

CONCLUSIONS

Our study has confirmed that the Turkish-language version of the EAH-C is a valid and reliable tool.

PRACTICE IMPLICATIONS

In the effort of prevention of childhood obesity, identifying eating behaviors in the absence of hunger in children and adolescents will benefit policymakers to develop intervention and prevention programs, in addition to providing guidance to pediatric nurses, all healthcare professionals, researchers, children, and parents.

Inter-individual differences in children's short-term energy compensation: a systematic review and meta-analysis

BACKGROUND

The ability to regulate energy intake is often assessed using a preloading paradigm to measure short-term energy compensation. In children, large variability exists with this paradigm both within- and across- studies and is poorly understood.

OBJECTIVES

This systematic review and meta-analysis aimed to better understand factors contributing to variability in children's energy compensation. We tested 1) whether children demonstrated "good" energy compensation, defined as adjusting meal intake commensurate with preload intake and 2) differences in children's energy compensation by child age, sex, and weight status (assessed both continuously and categorically).

METHODS

Standard guidelines for systematic review were followed to search PubMed, PsychInfo, and Web of Science. Data on study design (preload form, preload-to-meal interval, preload energy difference, study setting) and participant characteristics (sex, age, weight status) were extracted from 29 experiments meeting inclusion criteria, and 13 were included in meta-analyses. COMPx (energy compensation index), a linear transformation comparing food intake following a high- vs. low-energy preload, was the outcome. Hedge's g was calculated, and random intercept-only models tested associations between COMPx and sex, age, and weight status.

RESULTS

The systematic review revealed mixed results regarding children's energy compensation and the role of inter-individual differences. Meta-analytic models revealed that children undercompensated (overate) for preload energy (β = -0.38; P = 0.008). Sex (β = 0.11; P = 0.76), age (β = 0.03; P = 0.75), and weight (assessed continuously; β = -0.07, P = 0.37) were not related to compensation. Children with overweight/obesity (assessed categorically) undercompensated more than children with healthy weight (β = 0.18; P = 0.04).

CONCLUSIONS

The systematic review highlighted wide variability across studies, while the meta-analysis demonstrated differences in COMPx by child weight status but not by age or sex. Standardizing protocols across studies is recommended, along with designing adequately powered studies aiming to test inter-individual differences a priori. Alternative approaches to the use of COMPx are recommended to allow better characterization of children's energy compensation ability. This study was registered at PROSPERO as CRD42020197748.

Measuring adolescents' eating in the absence of hunger in the home environment using subjective and objective measures

Eating in the absence of hunger (EAH) has been identified as a behavioral phenotype for obesity. Few studies have reported on objective measures of EAH in adolescents, and fewer yet have objectively measured EAH in a naturalistic, home setting. The purpose of this paper was to examine relations between objective, adolescent-report and parent-report measures of EAH, and to examine variation by sex and race. Participants included 295 predominantly low-income and rural adolescents (mean age = 14.2 ± 0.6 years) and their parents, drawn from the Family Life Project. An EAH task was administered in the home following an ad-libitum meal and compulsory milkshake; EAH was also reported on a web-based survey (both adolescent and parent reports) and adolescents' BMIz was calculated from height and weight, measured in the home or self-reported on the web survey. A high degree of variability in EAH intake was observed (range = 8-741 kcals). Parent and adolescent reports of EAH were weakly correlated and unrelated to observed EAH consumption; only adolescent reports of EAH were related to their BMIz. Several relations varied by sex and race. Positive associations between reported and observed EAH was only observed in girls, and positive associations between observed EAH and BMI was only observed in boys and in white adolescents. Overall EAH consumption was significantly greater in boys and in white adolescents. These findings suggest that EAH can be measured in adolescents in the home. In this sample of youth experiencing rural poverty, this home-based measure appears most valid for white adolescent girls.

The Baby's First Bites RCT: Evaluating a Vegetable-Exposure and a Sensitive-Feeding Intervention in Terms of Child Health Outcomes and Maternal Feeding Behavior During Toddlerhood

BACKGROUND

Parenting interventions during the first years of life on what and/or how to feed infants during complementary feeding can promote healthy eating habits.

OBJECTIVES

An intervention promoting repeated exposure to a variety of vegetables [repeated vegetable exposure (RVE); what] and an intervention promoting responding sensitively to child signals during mealtime [video-feedback intervention to promote positive parenting-feeding infants (VIPP-FI); how] were compared, separately and combined (COMBI), with an attention control condition (AC). Primary outcomes were vegetable consumption and self-regulation of energy intake; secondary outcomes were child anthropometrics and maternal feeding practices (sensitive feeding, pressure to eat).

METHODS

Our 4-arm randomized controlled trial included 246 first-time Dutch mothers and their infants. Interventions started when infants were 4-6 mo old and ended at age 16 mo. The present study evaluated effects at 18 (t18) and 24 (t24) mo of age. Vegetable acceptance was assessed using three 24-h dietary recalls, self-regulation of energy intake by an eating-in-the-absence-of-hunger experiment and mother-report, and maternal feeding behavior by observation and mother-report.

RESULTS

Linear mixed model and ANOVA analyses revealed no follow-up group differences regarding child vegetable intake or self-regulatory behavior. The proportion of children with overweight was significantly lower in the COMBI group, compared with the VIPP-FI group at t18 (2% compared with 16%), and with the AC group at t24 (7% compared with 20%), although this finding needs to be interpreted cautiously due to the small number of infants with overweight and nonsignificant effects on the continuous BMI z-score measure (P values: 0.29-0.82). Finally, more sensitive feeding behavior and less pressure to eat was found in the VIPP-FI and COMBI groups, compared with the RVE and AC groups, mostly at t18 (significant effect sizes: d = 0.23-0.64).

CONCLUSIONS

Interventions were not effective in increasing vegetable intake or self-regulation of energy intake. Future research might usefully focus on risk groups such as families who already experience problems around feeding.This trial is registered at clinicaltrials.gov as NCT03348176.