Associations of appetitive behaviors in 7-year-old children with their cardiometabolic health at 10 years of age

Highlights

• Child appetitive traits are associated with cardiometabolic risk 3 years later

• Food approach behaviors are associated with increased cardiometabolic risk.

• Food avoidant behaviors are associated with lower cardiometabolic risk.

• Associations with cardiometabolic health are highly dependent on child's adiposity.

Abstract

Background and Aims

Atherosclerosis begins early in life, thus optimal cardiovascular health needs to be promoted early. We investigated whether appetitive behaviors among 7 year olds are associated with their cardiometabolic health years later.

Methods and Results

A sample of 2951 children from a Portuguese birth cohort was analyzed. The Children's Eating Behavior Questionnaire assessed eating behaviors, and a measure of cardiometabolic risk (higher risk group: those in the upper quartile of triglycerides, homeostatic model assessment-insulin resistance, waist circumference and systolic blood pressure and in the lower quartile of high-density lipoprotein cholesterol z-scores) was created. Linear and logistic regressions were run. Children with more food avoidant behaviors had lower cardiometabolic risk (Satiety Responsiveness – boys: OR = 0.39, 95% CI 0.16; 0.93, girls: OR=0.37, 95% CI 0.17; 0.82 and Slowness in eating – boys: OR = 0.49, 95% CI 0.25; 0.95, girls: OR = 0.49, 95% CI 0.27; 0.91). Food approach behaviors (Food responsiveness (CEBQ-FR), Enjoyment of food (CEBQ-EF) and Emotional overeating (CEBQ-EOE)) increased cardiometabolic risks (e.g. CEBQ-FR: boys: OR = 2.50, 95% CI 1.45; 4.32, girls: OR = 2.33, 95% CI 1.46; 3.71). CEBQ-EF had stronger effects in boys, while CEBQ-EOE was positively associated with cardiometabolic risk among girls. When adjusting for BMIz at 7y, associations did not remain significant. Appetitive behaviors were also associated with isolated cardiometabolic parameters; the strongest association being with waist circumference.

Conclusions

Appetitive behaviors at 7-years are associated with cardiometabolic risk at age 10. While ‘food avoidant’ behaviors protect against cardiometabolic risk and ‘food approach’ behaviors increase cardiometabolic risk, these associations are largely dependent of child's adiposity.

Introduction

Cardiovascular diseases (CVDs) are end-points of gradual progression of atherosclerosis and this process begins early in life, with clinical manifestations occurring decades later [1]. It is nowadays believed that, by promoting optimal cardiovascular health in adolescents, long-term beneficial effects can be seen in adulthood [2]. Cardiovascular health, as proposed by the American Heart Association (AHA), includes health behaviors (such as being physically active, eating a healthy diet, being in the normal Body Mass Index (BMI) range and not smoking) and risk factors (i.e. having normal blood pressure, glucose and cholesterol levels) [3]. In light of this, weight alone does not seem to be a good measure of CVD risk; children with normal weight but already showing metabolical alterations may not be correctly targeted and still have a higher risk of future CVDs [4]. In addition, cohort studies worldwide have described strong and significant tracking, between childhood and adulthood, of different cardiovascular risk factors, such as having high serum lipids, BMI, and blood pressure [5,6], besides the tracking of health behaviors, such as being physically active [7] and eating a healthy diet [8]. Thus, identifying those children at greater risk, by using a cluster of preclinical CVD markers besides actual weight, may help in the development of targeted interventions that could decrease morbidity and mortality and also be cost-effective [9,10].

The AHA and the World Health Organization (WHO) link chronic diseases, which are the leading cause of death and disabilities worldwide, to social determinants and behavioral risk factors [3,10], such as eating habits. Aiming to measure eating behaviors, a number of psychometric tools have been developed in the past three decades. Studies using the Children's Eating Behavior Questionnaire (CEBQ), a tool designed to assess a range of appetitive traits [11], previously described important predictors of child eating and weight status [[12], [13], [14], [15], [16], [17]]. Positive responses to food, or ‘food approach’ behaviors, such as showing enjoyment in food intake or eating in response to external food cues, are hypothesized to contribute to energy intake [12] and weight gain [[13], [14], [15], [16], [17]] among children. ‘Food avoidant’ behaviors, such as child's fussy eating, child's sensitivity to feelings of fullness and slowness in eating, are likely to reduce food intake [18]. Since nowadays most children dwell within obesogenic environments with great availability of various energy-dense, palatable, cheap, and nutrient-poor foods [19,20], these appetitive traits are likely to enhance the risk of future CVDs.

Studies of obesity-related behaviors have been published in the past years, linking these appetitive behaviors to weight status and body composition [[14], [15], [16], [17],[21], [22], [23], [24], [25]], but there is a lack of studies that associate these appetitive traits to important cardiometabolic risk factors. The aim of this study was to investigate whether appetitive behaviors among 7-year-olds are associated with their cardiometabolic health three years later. We predicted that CEBQ subdomains measuring ‘food approach’ behaviors, i.e. Enjoyment of food, Food responsiveness, Emotional overeating and Desire to drink would be positively associated with cardiometabolic risk, while the ‘food avoidant’ subdomains Satiety responsiveness, Slowness in eating, Food fussiness and Emotional undereating would be higher scored in those children with lower risk.