Continuity and stability of eating behaviour traits in children

European Journal of Clinical Nutrition (2008) 62, 985–990 & 2008 Macmillan Publishers Limited All rights reserved 0954-3007/08 $30.00 www.nature.com/ejcn ORIGINAL ARTICLE Continuity and stability of eating behaviour traits in children J Ashcroft, C Semmler, S Carnell, CHM van Jaarsveld and J Wardle Cancer Research UK Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, London, UK Objective: To discover whether eating behaviour traits show continuity and stability over childhood. Subjects/Methods: Mothers of 428 twin children from the Twins Early Development Study participated in a study of eating and weight in 1999 when the children were 4 years old. Families were contacted again in 2006 when the children were aged 10 years, with complete data on 322 children; a response rate of 75%. At both times, mothers completed the Child Eating Behaviour Questionnaire (CEBQ) for each child. Continuity was assessed with correlations between scores at the two time points, and stability by changes in mean scores over time. Results: For all CEBQ subscales, correlations between the two time points were highly significant (P-values o0.001). For satiety responsiveness, slowness in eating, food responsiveness, enjoyment of food, emotional overeating and food fussiness, correlations ranged from r ¼ 0.44 to 0.55, with lower continuity for emotional undereating (r ¼ 0.29). Over time, satiety responsiveness, slowness in eating, food fussiness, and emotional undereating decreased, while food responsiveness, enjoyment of food and emotional overeating increased. Conclusions: Eating behaviours, including those associated with a tendency to overeat, emerge early in the developmental pathway and show levels of individual continuity comparable to stable personality traits. Appetitive traits related to higher satiety tended to decrease with maturation, while those associated with food responsiveness tended to increase. This pattern is consistent with strong tracking of body mass index alongside a progressive increase in the risk of obesity. European Journal of Clinical Nutrition (2008) 62, 985–990; doi:10.1038/sj.ejcn.1602855; published online 8 August 2007 Keywords: appetite; hunger; satiety; tracking; stability; child Introduction There is increasing evidence that adiposity ‘tracks’ across the life course, that is, fatter children mature into fatter adolescents and fatter adults, while thinner children tend to stay thinner adults (Serdula et al., 1993; Whitaker et al., 1997; Wang et al., 2000; Steinberger et al., 2001). Energy balance is part of the process that mediates adiposity and therefore, energy intake and expenditure might also be expected to show some degree of individual continuity (tracking). Despite most measures of diet having only moderate reliability, longitudinal studies of dietary intake Correspondence: Professor J Wardle, Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, UK. E-mail: Contributors: JW had the idea for the study and obtained funding. JA and CS carried out the home visits. JA, CHMvJ and CS participated in analysis of the data. All authors took part in the interpretation of results and drafting the manuscript, and approved the final version of the manuscript. Received 8 March 2007; revised 19 June 2007; accepted 20 June 2007; published online 8 August 2007 indicate some degree of continuity in food choices over childhood (Skinner et al., 2002; Zive et al., 2002), and even from adolescence to adulthood (Lien and Klepp, 1999; Lake et al., 2006). The Framingham Children’s Study reported correlations of 0.74 and 0.66 for fruit/vegetable and dairy intake respectively, in children from ages 3 to 12 years (Moore et al., 2005). Another way to look at dietary continuity is to investigate tracking of eating behaviour traits. Hunger, external responsiveness, satiety sensitivity and emotional eating are aspects of appetite that have been shown to be associated with adiposity (Van Strien et al., 1985; Barkeling et al., 1992; Epstein et al., 1996; Braet and Van Strien, 1997; Jansen et al., 2003; Wardle, 2006; Wardle, 2007). Modest continuity in ‘eating in the absence of hunger’ (Fisher and Birch, 2002) and dietary restraint (Marchi and Cohen, 1990; Shunk and Birch, 2004) have been reported in childhood. Variations in appetite have also been observed in infancy, with infants who show greater enthusiasm for feeding gaining more weight (Stunkard et al., 1999; Wright and Birks, 2000). Continuity of eating behaviour traits J Ashcroft et al 986 While research in adults has typically used psychometric measures (for example, Three Factor Eating Questionnaire, Stunkard and Messick, 1985; Dutch Eating Behaviour Questionnaire (DEBQ), Van Strien et al., 1986), most research in children has used behavioural measures (for example, reduction of intake after a preload and increase in intake with highly palatable foods). Behavioural measures have the advantage of avoiding subjectivity but they are difficult to use in larger scale, longitudinal studies because of the practicalities of carrying out repeated behavioural assessments. Two psychometric measures of appetite have been developed recently for use with children. A paediatric, parent-completed version of the DEBQ assesses restrained, external and emotional eating and has been valuable in the clinical context (Braet and Van Strien, 1997), showing good test–retest reliability and internal consistency (Caccialanza et al., 2004). The Child Eating Behaviour Questionnaire (CEBQ) is a parent-completed measure designed to assess normal variation in eating behaviour, with scales measuring a larger number of constructs, including satiety responsiveness (SR), slowness in eating (SE), food responsiveness (FR), enjoyment of food (EF), food fussiness (FF), emotional overeating (EOE) and emotional undereating (EUE; Wardle et al., 2001b). Short-term reliability is good and significant validity has been demonstrated against measured food intake (Wardle et al., 2001a; Carnell and Wardle, 2007). The present study examined continuity and change in CEBQ scores from ages 4 to 11 in a sample of 322 twin children. There is no hard and fast rule about the magnitude of correlation required to support a claim for ‘tracking’, so we based our predictions on longitudinal correlations for other traits that are generally accepted to be stable aspects of temperament or personality. A meta-analysis of longitudinal studies of personality (with a mean time interval between testing of 6.7 years) showed correlations that varied with age, rising from 0.41 within childhood to 0.55 at age 30 years and 0.70 after age 50 years (Fraley and Roberts, 2005). Because the children in the present study were young, correlations in the range 0.3–0.5 would be consistent with the hypothesis of trait continuity. We also assessed changes in mean CEBQ scores, because alo (...truncated)