Parents Matter: Associations of Parental BMI and Feeding Behaviors With Child BMI in Brazilian Preschool and School-Aged Children

Abstract

Background: Brazil is undergoing nutritional transition and rates of obesity in preschool and school-aged children are increasing. Excess weight in the first years of life could predict excess weight in adulthood, making it essential to study risk factors in this population.Objective: Our goal was to investigate associations of parent feeding behaviors, as well as more distal familial influences including family SES and maternal and paternal weight, with BMI z-score in preschool and school-aged children in a Brazilian sample.Methods: Cross-sectional study. Data were collected in 14 Brazilian private schools. Parents of children aged 2–8 years (n = 1,071) completed a questionnaire assessing parent feeding behaviors, as well as sociodemographic and anthropometric information. Hierarchical linear regression models were fitted to investigate relationships between parent and child characteristics and child BMI z-score in preschool (2–5 years, n = 397) and school-aged (6–8 years, n = 618) children.Results: Final models indicated that higher maternal BMI and “restriction for weight control” were associated with higher child BMI z-score in both age groups (excessive weight, i.e., BMI ≥ +1 z-score, in preschoolers and school-aged children: 24.4 and 35.9%, respectively). In preschoolers only, “healthy eating guidance” and “pressure” were associated with lower child BMI z-score. For school-aged children, male sex, higher father BMI, and “restriction for health” were associated with higher child BMI z-score.Conclusions: Parent feeding behaviors and parent weight, as well as child sex, are associated with child BMI z-score, with evidence for differential relationships in preschool and school-aged children. Optimal obesity prevention and treatment strategies may differ by child age.

The Associations between Body Mass Index of Seven- and Eight-Year-Old Children, Dietary Behaviour and Nutrition-Related Parenting Practices

“…As mentioned previously, our study identified a positive association between unhealthy food consumption, control of unhealthy food intake and higher BMI in children. Warkentin also observed a positive association between parental restriction and BMI z-scores of children [31]. Other authors have also found similar results [10,32,33,34,35].…”

Concordância entre dados antropométricos reportados vs. medidos e relação com as práticas parentais alimentares em idade pré-escolar

“…Relativamente ao segundo objetivo, verificou-se uma associação positiva entre a "restrição por controlo de peso" e a altura e peso percecionados pelos pais e, por outro lado, uma associação negativa entre a "pressão" e o peso, IMC e z-score de IMC percecionados pelos pais. Estes resultados são consistentes com estudos anteriores (Afonso et al, 2016;Jansen et al, 2014;Warkentin, Mais, Latorre, Carnell, & Taddei, 2018;Webber et al, 2010). Deste modo, níveis mais elevados de restrição estão associados a níveis mais elevados de altura e peso das crianças percecionados pelos pais.…”

“…Assim, por exemplo, pais com filhos de peso normal ou baixo peso que percecionem incorretamente os mesmos como tendo mais peso do que realmente têm, podem exercer desnecessariamente maiores níveis de restrição, o que poderá levar a uma menor ingestão e perda de peso (Campbell et al, 2010), podendo passar as crianças de peso normal para um grupo de risco (e.g., baixo peso) e agravar o estado das crianças de baixo peso. Esta ideia reflete uma associação negativa entre a prática restrição e estado ponderal, porém, mais uma vez, neste estudo e em estudos anteriores (Warkentin et al, 2018), verificou-se uma associação positiva. Assim, poderá antes sugerir que pais com filhos de peso normal que percecionem os mesmos como tendo mais peso, podem exercer maiores níveis de restrição, o que poderá resultar num efeito contraproducente, levando a uma maior ingestão e aumento de peso, podendo estas crianças passar a ter excesso de peso ou obesidade.…”

Mealtime Environment and Control of Food Intake in Healthy Children and in Children with Gastrointestinal Diseases

“…Parental control over eating is another factor that has received much attention in the past decade. Notably, existing work has mainly focused on specific measures of parental control such as the pressure to eat and the restriction of unhealthy foods and has yielded contradictory findings, associating these parental strategies with both negative and positive outcomes concerning weight and diet variables [ 25 ]. On the other hand, few studies to date have focused on the preservation of a child’s autonomy and control over eating, especially in families that have to adapt to dietary restrictions [ 15 , 26 , 27 , 28 ].…”

“…It is well-documented that feeding environment significantly influences children’s feeding behavior, especially during the first years of life [ 12 , 13 , 17 , 25 , 33 , 34 ]. Mealtime environment is influenced by a number of parent characteristics such as parental age, education and child characteristics such as gender, child age, weight status, birth order and feeding behavior [ 26 , 35 , 36 , 37 , 38 ].…”