Early childhood appetite traits linked to adolescent eating disorders, study finds

In a recent study published in The Lancet Child & Adolescent Health, researchers investigated the longitudinal relationships between appetitive qualities in early childhood and eating problem symptoms in adolescence.

Study: Early childhood appetitive traits and eating disorder symptoms in adolescence: a 10-year longitudinal follow-up study in the Netherlands and the UK. Image Credit: Oksana Kuzmina/Shutterstock.com

Background

Eating disorders and obesity are common mental health diseases across the world, and hunger is a neurobehavioral risk factor. Eating disorders are frequently associated with other mental problems and have a high death rate.

The lack of efficient preventative strategies warrants epidemiological research to uncover innovative risk factors and treatment options.

Eating disorders and BMI have similarities, such as food intake control and genetic overlap. The behavioral susceptibility theory may apply to eating disorders.

About the study

The present study investigated the association between childhood appetitive qualities and adolescent eating disorders.

The team analyzed the Gemini (Wales and England) and Generation R (Rotterdam) cohort data to measure appetitive traits using the Child Eating Behaviour Questionnaire (CEBQ) based on parent-reported data for four-to-five-year-olds and self-reported data for 12–14-year-olds.

They documented symptoms of overeating eating disorders (binge eating, uncontrolled eating, and emotional eating) and restrained eating disorders (compensatory behaviors and restrained eating).

The Generation R study included pregnant women with an expected delivery date between April 2002 and January 2006, resulting in 9,745 live-born children. The Gemini study cohort comprised 4,804 children (2,402 twin pairs).

The self-reported outcome measures included behavioral eating disorders (compensatory behaviors and binge eating symptoms) and disordered eating behaviors (restrained eating, uncontrolled eating, and emotional eating).

The team assessed compensatory behaviors in the past three months using the Developmental and Well-Being Assessment (DAWBA) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

They assessed restricted eating using the Dutch Eating Behavior Questionnaire (DEBQ) and emotional and uncontrolled eating using the Three Factor Eating Questionnaire (TFEQ).

The researchers used logistic regressions to determine odds ratios (OR), adjusting for sociodemographic covariates (age at outcome assessment, biological sex, gestational age, ethnicity, household income, maternal education, and maternal BMI) and the child’s age- and sex-adjusted body mass index (BMI) scores at ages four to five years.

They examined interaction effects for appetite by biological sex and obtained pooled ORs by meta-analysis, with sensitivity analyses performed using the inverse probability-type weighting method.

Results

The study included 2,801 Generation R participants and 869 Gemini study participants. Emotional overeating during early childhood elevated adolescent compensatory behavior odds (OR, 1.2).

Contrastingly, higher satiety responsiveness decreased adolescent uncontrolled eating odds (OR, 0.9) and compensatory behavior (OR, 0.9) odds.

Slow eating during early childhood reduced the likelihood of restrained eating and compensatory behavior (OR, 0.9 for both) in adolescence.

The study hypothesis was that higher responsiveness to food during early childhood enhanced overeating disorder risk in adolescence, with the highest risk being binge eating (ORpooled, 1.5 for every unit enhancement in response to food).

Contrary to the hypothesis, higher food responsiveness increased restrictive eating risk; in particular, food responsiveness increased moderate to high restricted eating risk (OR 1.2 for every unit increase).

Response to food and emotion-related overeating among young children increased adolescent comprehensive behavior risk (ORpooled, 1.2 for every unit increase). The cohort-specific analysis indicated that higher food enjoyment increased binge eating odds among Gemini (OR Gemini 1.6) but not among Generation R participants.

Emotional overeating during childhood elevated uncontrolled eating odds in adolescents among Gemini participants (ORGemini 1.5).

Contrary to the hypothesis, childhood food aversion traits did not elevate adolescent-restricted eating odds. Instead, slow eating reduced the chances of moderate to highly restrained eating symptoms (ORpooled, 0.9 for every unit increase).

Slow eating and high satiety responsiveness significantly lowered adolescent compensatory behavior odds (ORpooled of 0.9 and 0.9, respectively).

Among Generation R participants, the relationship between slow eating during early childhood and adolescent restrained eating showed lower odds among females.

Only male Gemini participants showed positive associations between emotional overeating during early childhood and emotional and binge eating in adolescence.

Conclusion

The study findings showed that early childhood food responsiveness increases adolescent eating disorder risk.

In contrast, slow eating and high satiety decrease the probability of eating disorders. Appetitive characteristics in children may be early neurobehavioral factors increasing eating disorder risk.

Parental feeding practices that help children establish proper eating habits include educating them to identify internal hunger and fullness, promoting slower eating, and avoiding food for reasons other than homoeostatic hunger.