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

Abstract

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.

Bidirectional associations between parental feeding practices, infant appetitive traits and infant BMIz: a longitudinal cohort study

“…As excepted, this study found the mean scores of feeding practices, some child appetitive traits and BMIz increase with age, which is consistent with previous studies [ 7 , 9 , 24 , 42 – 44 ]. Two of the feeding practices (food to calm and feeding on demand) plateaued between the last two timepoints.…”

“…Future studies would be strengthened with the use of multiple informants and multiple methods (including objective measures) to temper some of these measurement limitations. Additionally, the study also used the BEBQ to examine the child appetitive traits, which has limited data on validity and was originally developed for retrospective use with exclusively milk fed infants [ 30 ]; however, many studies have used the BEBQ in the same way as the current study [ 7 , 55 – 57 ]. Lastly, there was a time difference between the date the parents completed the survey and the date of the last weight and length measurements by primary care providers (a mean of 18 days at T1, 24 days at T2 and 34 days at T3), and a different time length between each wave.…”

“…Biological characteristics affecting such processes include infant/child temperament, neurocognitive functioning and genetics [5]. These psychosocial and biological processes, among others, have been linked to infant/child appetitive traits (defined as individual differences in patterns of behaviours and attitudes related to food and eating) [7][8][9] and weight, as well as to parent cognitions and feeding practices [5]. The current literature examining such processes has focussed largely on children older than two years [5].…”

“…Parental feeding practices, such as pressure to eat and restriction, have also been shown to be associated with child appetitive traits (i.e., satiety responsiveness, food fussiness, emotional undereating, eating in the absence of hunger, food responsiveness and slowness in eating) [11,[14][15][16][17][18]. While, infant appetitive traits have also been shown to be associated with parental feeding practices [7] and weight outcomes [19]. However, the majority of these studies were conducted beyond the first year of life (2-9 years of age) [11][12][13][14][15][16][17][18], which does not allow for the examination of the early origins of these processes.…”

Children’s eating behaviours and related constructs: conceptual and theoretical foundations and their implications

“…Its contribution at present seems mainly to suggest the presence of different phenotypes that involve a combination or pattern of individual eating behaviours and eating behaviour trajectories. For example, a phenotype of food avoidance trending towards low food approach in infancy, or a phenotype of high and continuing food approach in infancy [ 194 ] or a phenotype of dysregulated behaviour (low inhibitory control and high impulsivity) together with higher food approach and lower food avoidance in childhood [ 102 ]. The person-centred approach therefore moves the conceptualisation of eating behaviour from individual variables to integrated combinations of variables and trajectories [ 102 , 193 , 194 ].…”