The Association of Early Childhood Cognitive Development and Behavioural Difficulties with Pre-Adolescent Problematic Eating Attitudes
et al. (2014) The Association of Early Childhood Cognitive Development and Behavioural
Difficulties with Pre-Adolescent Problematic Eating Attitudes. PLoS ONE 9(8): e104132. doi:10.1371/journal.pone.0104132
The Association of Early Childhood Cognitive Development and Behavioural Difficulties with Pre- Adolescent Problematic Eating Attitudes
Rebecca C. Richmond
Oleg Skugarevsky
Seungmi Yang
Michael S. Kramer
Kaitlin H. Wade
Rita Patel
Natalia Bogdanovich
Konstantin Vilchuck
Natalia Sergeichick
George Davey Smith
Emily Oken
Richard M. Martin
Stephen E. Gilman, Harvard School of Public Health, United States of America
Objectives: Few studies have prospectively investigated associations of child cognitive ability and behavioural difficulties with later eating attitudes. We investigated associations of intelligence quotient (IQ), academic performance and behavioural difficulties at 6.5 years with eating attitudes five years later. Methods: We conducted an observational cohort study nested within the Promotion of Breastfeeding Intervention Trial, Belarus. Of 17,046 infants enrolled at birth, 13,751 (80.7%) completed the Children's Eating Attitude Test (ChEAT) at 11.5 years, most with information on IQ (n = 12,667), academic performance (n = 9,954) and behavioural difficulties (n = 11,098) at 6.5 years. The main outcome was a ChEAT score $85th percentile, indicative of problematic eating attitudes. Results: Boys with higher IQ at 6.5 years reported fewer problematic eating attitudes, as assessed by ChEAT scores $85th percentile, at 11.5 years (OR per SD increase in full-scale IQ = 0.87; 0.79, 0.94). No such association was observed in girls (1.01; 0.93, 1.10) (p for sex-interaction = 0.016). In both boys and girls, teacher-assessed academic performance in non-verbal subjects was inversely associated with high ChEAT scores five years later (OR per unit increase in mathematics ability = 0.88; 0.82, 0.94; and OR per unit increase in ability for other non-verbal subjects = 0.86; 0.79, 0.94). Behavioural difficulties were positively associated with high ChEAT scores five years later (OR per SD increase in teacher-assessed rating = 1.13; 1.07, 1.19). Conclusion: Lower IQ, worse non-verbal academic performance and behavioural problems at early school age are positively associated with risk of problematic eating attitudes in early adolescence.
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Funding: Support was provided by the European Union Early Nutrition Programming Long-term Efficacy and Safety Trials (grant no. FOOD-DT-2005-007036,
http://www.metabolic-programming.org/researchprogramme.htm); Canadian Institutes of Health Research (MOP 53155, http://www.cihr-irsc.gc.ca/e/193.html);
and the USA National Institutes of Health (R01 HD050758, http://www.nih.gov/). Emily Oken was supported by US National Institute of Child Health and
Development (K24 HD069408, http://www.nichd.nih.gov/). The Integrative Epidemiology Unit is supported by the MRC and the University of Bristol (http://www.
bristol.ac.uk/integrative-epidemiology/). The Nutrition Biomedical Research Unit is supported by the National Institute for Health Research (http://www.nihr.ac.uk/
Pages/default.aspx). Rebecca C. Richmond and Kaitlin H. Wade were in receipt of 4-year PhD studentships from the Wellcome Trust (grant code: WT083431MF and
WT097097MF, respectively, http://www.wellcome.ac.uk/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation
of the manuscript.
Competing Interests: Emily Oken has given an invited talk for Nestle Nutrition Institute in 2011 on secular trends in birth weight. Richard M. Martin gave an
invited talk for the Nestle Nutrition Institute in 2010 on the role of the insulin-like growth factor system in growth and chronic disease risk. Michael S. Kramer has
received unrelated meeting expenses from the Nestle Nutrition Institute. All other authors declare no conflict of interest. This does not alter the authors
adherence to PLOS ONE policies on sharing data and materials.
Problematic eating attitudes are common in childhood and
early adolescence, with prevalence estimates of up to 20% of girls
aged 1214 years[1] and similar estimates in boys.[2] Studies
indicate that the prevalence of abnormal eating attitudes in
nonWestern countries is lower than that of Western countries but
appears to be gradually increasing.[3] These unhealthy eating and
weight-related attitudes do not meet the criteria for an eating
disorder, but may have health-related consequences. In addition,
adolescents showing problematic eating behaviours are
predisposed to eating disorders later in life.[47] In one study, children
who had early eating conflicts and struggles with food were at a
six-fold increased risk of anorexia nervosa in later adolescence or
young adulthood.[6] A number of social, familial, psychological,
biological and genetic risk factors have been implicated in the
aetiology of problematic eating,[710] including cognitive and
behavioural (...truncated)