Anna Fogel

Intrinsic and extrinsic influences on children's acceptance of new foods.

The foods that tend to be rejected by children include those which may have greatest importance for later health. This paper reviews some of the intrinsic and extrinsic influences on preschool childrens eating behavior, with particular reference to their acceptance of new foods into their diet. Factors conceptualized as intrinsic to the child in this review include sensory processing, taste perception, neophobia, and temperament. The important extrinsic determinants of childrens food acceptance which are reviewed include parental and peer modeling, the family food environment, infant feeding practices including breastfeeding and age at weaning, concurrent feeding practices including restriction, pressure to eat, prompting and reward, and the taste & energy content of foods. Childrens willingness to accept new foods is influenced by a wide range of factors that likely have individual and also interactive effects on childrens willingness to taste, and then continue to eat, new foods. The literature lacks longitudinal and experimental studies, which will be particularly important in determining interventions most likely to be effective in facilitating childrens acceptance of healthy foods.

Parental modelling and prompting effects on acceptance of a novel fruit in 2-4-year-old children are dependent on children's food responsiveness.

Few children consume the recommended portions of fruit or vegetables. This study examined the effects of parental physical prompting and parental modelling in childrens acceptance of a novel fruit (NF) and examined the role of childrens food-approach and food-avoidance traits on NF engagement and consumption. A total of 120 caregiver-child dyads (fifty-four girls, sixty-six boys) participated in this study. Dyads were allocated to one of the following three conditions: physical prompting but no modelling, physical prompting and modelling or a modelling only control condition. Dyads ate a standardised meal containing a portion of a fruit new to the child. Parents completed measures of childrens food approach and avoidance. Willingness to try the NF was observed, and the amount of the NF consumed was measured. Physical prompting but no modelling resulted in greater physical refusal of the NF. There were main effects of enjoyment of food and food fussiness on acceptance. Food responsiveness interacted with condition such that children who were more food responsive had greater NF acceptance in the prompting and modelling conditions in comparison with the modelling only condition. In contrast, children with low food responsiveness had greater acceptance in the modelling control condition than in the prompting but no modelling condition. Physical prompting in the absence of modelling is likely to be detrimental to NF acceptance. Parental use of physical prompting strategies, in combination with modelling of NF intake, may facilitate acceptance of NF, but only in food-responsive children. Modelling consumption best promotes acceptance in children with low food responsiveness.

Faster eating rates are associated with higher energy intakes during an ad libitum meal, higher BMI and greater adiposity among 4-5 year-old children: results from the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) cohort

Faster eating rates are associated with increased energy intake, but little is known about the relationship between childrens eating rate, food intake and adiposity. We examined whether children who eat faster consume more energy and whether this is associated with higher weight status and adiposity. We hypothesised that eating rate mediates the relationship between child weight and ad libitum energy intake. Children (n 386) from the Growing Up in Singapore Towards Healthy Outcomes cohort participated in a video-recorded ad libitum lunch at 4·5 years to measure acute energy intake. Videos were coded for three eating-behaviours (bites, chews and swallows) to derive a measure of eating rate (g/min). BMI and anthropometric indices of adiposity were measured. A subset of children underwent MRI scanning (n 153) to measure abdominal subcutaneous and visceral adiposity. Children above/below the median eating rate were categorised as slower and faster eaters, and compared across body composition measures. There was a strong positive relationship between eating rate and energy intake (r 0·61, P<0·001) and a positive linear relationship between eating rate and childrens BMI status. Faster eaters consumed 75 % more energy content than slower eating children (Δ548 kJ (Δ131 kcal); 95 % CI 107·6, 154·4, P<0·001), and had higher whole-body (P<0·05) and subcutaneous abdominal adiposity (Δ118·3 cc; 95 % CI 24·0, 212·7, P=0·014). Mediation analysis showed that eating rate mediates the link between child weight and energy intake during a meal (b 13·59; 95 % CI 7·48, 21·83). Children who ate faster had higher energy intake, and this was associated with increased BMI z-score and adiposity.

Association between tactile over‐responsivity and vegetable consumption early in the introduction of solid foods and its variation with age

The main aim of the current study was to test the hypothesis that early reactions to a vegetable in infants may be associated with sensory processing, in particular, tactile over-responsivity. A secondary aim was to see whether the relationship between sensory over-responsivity and vegetable consumption would be moderated by the age of the infant. A sample of 61 infants was recruited from childrens centres and playgroups in South Birmingham, UK. Infants acceptance of carrot was measured in grams during the first week of complementary feeding in one testing situation. Mothers filled in self-report measures of infant sensory processing, as well as their own fruit and vegetable consumption. Infant carrot consumption in the first week of solid food consumption was negatively associated with total sensory over-responsivity across different sensory domains (P < 0.01). Across the sensory domains only tactile over-responsivity predicted carrot consumption, accounting for 10.7% of the variance in consumption scores. Across the sample as a whole, the relationship between carrot consumption and tactile over-responsivity varied according to the age of introduction to solid foods. In particular, those who were weaned later and had high tactile over-responsivity ate less carrot (P < 0.001). Infants who were weaned early ate a similar amount of carrot, regardless of their tactile responsivity (P > 0.05). This study constitutes some of the first evidence to suggest that sensory processing styles be associated with early vegetable acceptance; however, more research is needed to evaluate the best strategies to use when feeding infants who are sensitive to tactile information.

Effects of sucrose detection threshold and weight status on intake of fruit and vegetables in children

Past research on the relationship between taste sensitivity and fruit and vegetable (FV) intake in children has focused on sensitivity to bitter taste. The effects of sensitivity to sweet taste on intake of FV have never been investigated. Furthermore, the effects of childrens weight on intake of FV are inconclusive. This study measured the effects of Sucrose Detection Threshold (SDT) and weight status on intake of FV in children. The participants of this study were 99 children between 5-9 years old. Parents reported their own and their childrens 24 hour intake of FV and completed a measure of childrens sensory sensitivity. Children completed the triangle test with suprathreshold concentrations of sucrose ranging between 0.2% and 1.6%, in 0.2% increments. Two MANCOVAs showed that, controlling for parental intake and childrens sensory sensitivity, there was a main effect of SDT on intake of fruit (p < 0.05), which was exclusive to non-astringent fruit (p < 0.05), and cruciferous vegetables (p < 0.01). Weight status had no effect on intake of FV. Mechanisms behind the effects of SDT are discussed in the context of past research on bitter taste sensitivity.

Eating in the absence of hunger: Stability over time and associations with eating behaviours and body composition in children

BACKGROUND/OBJECTIVES Eating in the absence of hunger (EAH) has been linked to obesity in adults and children. This study examined the stability of EAH in children between 4.5 and 6 years old, and associations with energy intake and portion selection, as well as cross-sectional and prospective associations with body composition. METHODS The participants were 158 boys and girls from the Growing Up in Singapore Towards healthy Outcomes cohort. At ages 4.5 and 6 years old children were provided lunch ad libitum, and immediately afterwards were exposed to palatable snacks to measure energy intake in the absence of hunger. At age 6 children completed an additional computer-based task to measure ideal portion size, where they selected pictures of the portions they would like to eat across eight foods. Measures of anthropometry (height/weight/skinfolds) were collected at both ages. RESULTS Children who consumed energy during the EAH task at age 4.5 years were 3 times more likely to also do so at age 6 years. Children with high EAH intakes at age 4.5 years had high EAH intakes at age 6, highlighting stability of this behaviour over time. Energy consumed at lunch was unrelated to energy consumed during the EAH task, but children who ate in the absence of hunger cumulatively consumed more energy over lunch and the EAH task. Children who showed EAH tended to select larger ideal portions of foods during the computer task. EAH was not associated with measures of body composition. CONCLUSIONS EAH is a stable behavioural risk factor for increased energy intake, but was not associated with body composition in this cohort. The majority of children ate in the absence of hunger, suggesting that interventions aimed at reducing responsiveness to external food cues could help to reduce energy intakes. Trial Registry Number: NCT01174875; https://clinicaltrials.gov/.

Oral processing behaviours that promote children's energy intake are associated with parent-reported appetitive traits: Results from the GUSTO cohort

Oral processing behaviours associated with faster eating rates have been consistently linked to increased energy intakes, but little is known about their links to childrens appetitive traits. This study used the Child Eating Behaviour Questionnaire (CEBQ) to explore cross-sectional and prospective associations between parent-reported appetitive traits and observed oral processing behaviours. Participants were 195 children from the Growing Up in Singapore Towards healthy Outcomes cohort, who participated in a video-recorded ad libitum lunch at 4.5 (Time 1) and 6 years (Time 2). Their mothers completed the CEBQ around the same time points. Childrens bites, chews and swallows were coded, and used to calculate their eating rate, bite size, chews per bite, chew rate, oral exposure time and oral exposure per bite. At Time 1, children with higher scores in slowness in eating had lower eating and chew rates. At Time 2, higher scores for food enjoyment and lower for satiety responsiveness, slowness in eating, and food fussiness were linked with higher eating rates and greater energy intakes (r > 0.16, p < 0.05). Post-hoc analyses revealed that these associations were moderated by BMI and only present among children with higher BMI. Faster eating rates mediated the associations between greater food enjoyment, lower slowness in eating, lower food fussiness and higher intakes of energy. Children with higher slowness in eating scores had lower increases in eating rates over time, and children with higher BMI who had greater food enjoyment and food responsiveness scores had greater increases in eating rates over time. The findings suggest that oral processing behaviours linked with increased obesity risk may be underpinned by appetitive traits and may be one of the behavioural pathways through which these appetitive traits influence energy intakes.

Past exposure to fruit and vegetable variety moderates the link between fungiform papillae density and current variety of FV consumed by children

Higher fungiform papillae density (FPD) has been associated with lower taste sensitivity thresholds and greater perceived taste intensity along with consumption of fewer fruit and vegetables (FV). Children exposed to greater variety of FV tend to habitually consume more FV, however, it is unknown whether exposure effects are attenuated by individual differences in FPD or whether these effects vary according to sensory properties of FV. This study examined the links between childrens FPD, current variety of FV consumed, and past experiences with variety of fruit and vegetables. FPD counts were obtained from 61 children between 5 and 9years old, in schools from affluent areas of Birmingham (UK). Parents completed food frequency questionnaires indicating the variety of FV consumed by children in the last 7days. Parents also indicated the number of different FV types the children had tasted in their lifetime. FV were subdivided to reflect differences in their sensory properties. The results showed that children with higher FPD who in their lifetime had tasted a greater variety of FV ate a larger variety of FV compared to children with higher FPD, but with lower past exposure. When examining effects within specific subcategories of fruits and vegetables, this pattern held for non-astringent fruit and showed a trend for non-bitter vegetables. Children with lower FPD consumed similar variety of FV irrespective of past experiences with variety of FV. The results suggest that when strong or irritant sensory food properties are not a barrier to intake, higher FPD in the presence of supportive home food environment may be beneficial for FV intake. Individual phenotypic differences may affect responsiveness to environmental factors in childrens intake of FV.