The Children's Eating Behaviour Questionnaire: factorial validity and association with Body Mass Index in Dutch children aged 6–7

International Journal of Behavioral Nutrition and Physical Activity BioMed Central Research Open Access The Children's Eating Behaviour Questionnaire: factorial validity and association with Body Mass Index in Dutch children aged 6–7 Ester FC Sleddens1,3, Stef PJ Kremers*1,3 and Carel Thijs2,3 Address: 1Department of Health Education and Promotion, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands, 2Department of Epidemiology, School of Public Health and Primary Care (Caphri), Maastricht, the Netherlands and 3Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands Email: Ester FC Sleddens - ; Stef PJ Kremers* - ; Carel Thijs - * Corresponding author Published: 20 October 2008 International Journal of Behavioral Nutrition and Physical Activity 2008, 5:49 doi:10.1186/1479-5868-5-49 Received: 7 July 2008 Accepted: 20 October 2008 This article is available from: http://www.ijbnpa.org/content/5/1/49 © 2008 Sleddens et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: The Children's Eating Behaviour Questionnaire (CEBQ) is a parent-report measure designed to assess variation in eating style among children. In the present study we translated the CEBQ and examined its factor structure in a sample of parents of 6- and 7-year-old children in the Netherlands. Additionally, associations between the mean scale scores of the instrument and children's body mass index (BMI) were assessed. Methods: In total, 135 parents of primary school children aged 6 and 7 completed the questionnaire (response rate 41.9%). Children's BMI was converted into standardised z-scores, adjusted for child gender and age to examine the association between mean scale scores and child weight status. Results: Results generally confirmed the theoretical factor structure, with acceptable internal reliability and between-subscale correlations. Linear regression analyses revealed that BMI z-scores were positively associated with the 'food approach' subscales of the CEBQ (food responsiveness, enjoyment of food, emotional overeating) (β's 0.15 to 0.22) and negatively with 'food avoidant' subscales (satiety responsiveness, slowness in eating, emotional undereating, and food fussiness) (β's -0.09 to -0.25). Significant relations with child BMI z-scores were found for food responsiveness (p = 0.02), enjoyment of food (p = 0.03), satiety responsiveness (p = 0.01) and slowness in eating (p = 0.01). Conclusion: The results support the use of the CEBQ as a psychometrically sound tool for assessing children's eating behaviours in Dutch children and the study demonstrates its applicability in overweight-related studies. Background Especially during the last few decades the prevalence rates of childhood overweight and obesity have reached epidemic proportions worldwide [1], and also in the Netherlands [2]. Obese children face difficulties in their social life and run a substantially increased risk of becoming our future generation of obese, chronically diseased adolescents and adults [3,4]. Despite widely held beliefs regarding the importance of factors promoting excessive weight gain in children, it still remains a challenge to discover the Page 1 of 9 (page number not for citation purposes) International Journal of Behavioral Nutrition and Physical Activity 2008, 5:49 underlying child behaviours that might contribute to differences in weight status across children [5-7]. Unravelling these factors will inform the development of evidencebased intervention programs to prevent overweight and obesity in children. In the past, a number of psychometric instruments have been developed to assess eating behaviour in children, including the Children's Eating Behaviour Questionnaire (CEBQ) [7], the Dutch Eating Behaviour Questionnaire (DEBQ) [8,9], the Children's Eating Behavior Inventory (CEBI) [10] and the BATMAN (Bob and Tom's Method of Assessing Nutrition) [11]. The CEBQ is generally regarded as one of the most comprehensive instruments in assessing children's eating behaviour. The instrument was developed and validated in the United Kingdom, and recently the instrument has been validated in a Portuguese sample [6]. To our knowledge, no other validation studies have been performed on the CEBQ, but the instrument has been used for different research purposes, e.g., to examine associations with child body mass index (BMI) [6,12,13]; to compare appetite preferences in children of lean and obese parents [12,14]; to discover continuity and stability in children's eating behaviours across time [15]; and to examine eating behaviours of children with idiopathic short stature [16]. The CEBQ consists of the following eight scales. The scales food responsiveness (FR) and enjoyment of food (EF) reflect eating in response to environmental food cues. In response to these cues appetitive responses and eating rate have been found to strongly increase in overweight or obese children [5,7,13]. The scale desire to drink (DD) reflects the desire of children to have drinks to carry around with them, usually sugar-sweetened drinks [7]. Several studies found that BMI was positively associated with frequent consumption of sugar-sweetened drinks [17,18] and a decline in soft drink consumption would result in a reduction of overweight and obese children [19]. Satiety responsiveness (SR) represents the ability of a child to reduce food intake after eating to regulate its energy intake. Infants tend to be highly responsive to internal hunger and satiety cues, whereas this level of responsiveness decreases with advancing age [5,13,20]. Thus, during childhood, children will gradually lose the ability to effectively self-regulate energy intake, thereby promoting episodes of over-consumption and subsequently excessive weight gain. High scores on the scale slowness in eating (SE) is characterised by a reduction in eating rate as a consequence of lack of enjoyment and interest in food. Compared to their leaner counterparts, obese children have an increased consumption and have less reduction of their eating rate during the end of a meal [21]. Food fussiness (FF) is usually defined as rejection of a substantial amount of familiar foods as well as 'new' http://www.ijbnpa.org/content/5/1/49 foods, thereby leading to the consumption of an inadequate variety of foods [22]. This type of eating style is characterised by a lack of interest in food [23], and slowness in eating [24]. Conflicting findings regarding the relationship between fussy eating and BMI in children have been found [23,25-27]. The scales emotional overeating (EOE) and emotional undereating (EUE) can be characteri (...truncated)