Research reportDevelopment and factor structure of the Baby Eating Behaviour Questionnaire in the Gemini birth cohort☆
Highlights
► A parent-report psychometric measure of appetite for exclusively milk-fed infants. ► There are 4 scales that are internally reliable across many sub-groups of infants. ► A single item correlates with all 4 scales measuring ‘general appetite’. ► A research tool for assessing weight-related appetitive traits during 0–3 months.
Introduction
Rapid weight gain in infancy is associated with obesity in childhood and adulthood (Baird et al., 2005). Faster growing infants have higher energy intakes than those growing more slowly (Ong, Emmett, Noble, Ness, & Dunger, 2006); as do infants at higher risk of obesity by virtue of familial obesity (Stunkard, Berkowitz, Schoeller, Maislin, & Stallings, 2004). Infant appetite is not well understood and research is needed to identify the feeding behaviours that characterize a larger appetite.
In both children and adults, several appetitive behaviours have been associated with higher weight. Greater consumption after exposure to food cues or in the presence of palatable food (Fisher et al., 2007, Jansen et al., 2003) is seen in obese children compared with their normal-weight counterparts. Faster eating speed has been observed in obese or overweight children compared with leaner peers (Barkeling et al., 1992, Drabman et al., 1979, Llewellyn et al., 2008), and obese children are prepared to ‘work’ harder for a food reward under conditions of reinforcement (Hill et al., 2009, Temple et al., 2008). Obese children also show lower sensitivity to internal satiety signals characterized by non-decelerated eating over the course of a meal (Barkeling et al., 1992, Lindgren et al., 2000), and poorer compensation following a calorie ‘preload’ (Johnson & Birch, 1994).
There has been relatively little research into appetite in infancy and outside of the context of failure to thrive (e.g. Wright & Birks, 2000). However, there is some evidence that conceptually similar feeding behaviours are present in infancy. Two studies have shown that infants at higher risk of obesity (indexed with parental weight status) have a more avid sucking style (Millstein, 1980, Stunkard et al., 2004). A vigorous milk-feeding style at 2–4 weeks of age (characterised by long bursts of rapid, high pressure sucking with shorter resting periods) was found to be associated with higher adiposity 2 years later (Agras, Kraemer, Berkowitz, & Hammer, 1990), and another study showed that infant-initiated bottle-emptying in the first six months of life predicted excess weight during the second six months (Li, Fein, & Grummer-Strawn, 2008). Variation in appetitive traits associated with susceptibility to obesity may therefore be present in the first few weeks of life.
While behavioural studies provide objectivity and detail, the effort and expense associated with direct observations of feeding behaviour makes it difficult to carry out the large-scale studies that are needed to detect small effects. Psychometric measures which can be completed by parents make it possible to collect appetite data in large samples, and have the additional advantage that parental evaluations aggregate the infant's behaviours over many situations rather than being limited to the single feed usually observed in behavioural studies.
The Children's Eating Behaviour Questionnaire (CEBQ (Wardle, Guthrie, Sanderson, & Rapoport, 2001)) is a validated parent-report psychometric instrument for children aged 3–13 years that measures eight eating behaviours related to overweight and under-weight. Two of the eight sub-scales are indicative of a larger appetite or greater interest in food: ‘food responsiveness’ measures the child's drive to want to eat (e.g. ‘If allowed to, my child would eat too much’) and ‘enjoyment of food’ captures the level of subjective pleasure experienced from eating (e.g. ‘My child enjoys eating’). Three scales describe traits related to better appetitive control or a lower interest in food: ‘slowness in eating’ evaluates the pace at which the child consumes their food (e.g. ‘My child takes more than 30 min to finish a meal’), ‘satiety responsiveness’ measures a child's fullness threshold (‘My child cannot eat a meal if s/he has had a snack just before’), and the ‘fussiness’ scale assesses pickiness with regard to the type of food the child is willing to eat (e.g. ‘My child decides that s/he doesn’t like a food even without tasting it’). Two scales measure eating in response to emotions: ‘emotional overeating’ and ‘emotional under-eating’ tap tendencies to either overeat or undereat in negative emotional states (e.g. ‘My child eats more when worried’, and ‘My child eats less when upset’). Lastly, ‘desire to drink’ identifies behaviours that are indicative of a persistent desire to consume (e.g. ‘My child is always asking for a drink’).
Consistent associations between these appetitive traits and adiposity have been reported – e.g. higher ‘food responsiveness’ and ‘enjoyment of food’ have been associated with higher weight while greater ‘satiety responsiveness’ and ‘slowness in eating’ relate to lower weight (Carnell and Wardle, 2008, Sleddens et al., 2008, Spence et al., 2010, Webber et al., 2009).
In response to the need for a similar psychometric measure of infant appetite, we have developed an infant version of the CEBQ that characterizes important dimensions of feeding behaviour in the period that infants are still exclusively fed milk. The Baby Eating Behaviour Questionnaire (BEBQ) measures four appetitive traits that are thought to be important for weight. This paper describes the development and factor structure of the BEBQ.
Section snippets
Development of the Baby Eating Behaviour Questionnaire
Generation of constructs and items. The appetitive constructs to be included in the BEBQ were based on: (i) existing scales in the CEBQ deemed appropriate for infants who are still exclusively milk-fed, (ii) a review of the literature on milk-feeding to identify distinctive appetitive behaviours during early postnatal life, and (iii) interviews with mothers of young infants.
Six of the eight CEBQ scales were considered potentially appropriate for infants: ‘food responsiveness’, ‘enjoyment of
Sample characteristics
The characteristics of the full Gemini cohort and the analysis sample (one infant from each family) are shown in Table 1. There were equal numbers of male and female infants. The mean age of the infants when the BEBQ was completed was 8 months (range 4–20 months); approximately half of the infants were between 4 and 8 months old when the BEBQ was completed.
Factor structure of the BEBQ
PCA produced four factors with eigenvalues of 3.6, 3.5, 3.3 and 2.7. The same factors emerged in the Pattern and Structure matrices,
Discussion
This paper describes the development of a psychometric, parent-report measure of appetite during the milk-feeding phase of infancy. Four dimensions emerged, with 17 items tapping four distinct feeding traits and one item describing general appetite. ‘Enjoyment of food’ (4 items) related to the infant's perceived liking of milk and of feeding in general, ‘food responsiveness’ (6 items) evaluates how demanding the infant is with regard to being fed and his or her level of responsiveness to cues
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2023, Journal of the Academy of Nutrition and DieteticsCitation Excerpt :In this cohort, the Baby Eating Behavior Questionnaire (BEBQ),68 which was developed for children younger than age 1 year based on the CEBQ, was collected at age 1 month. Food responsiveness is a subscale of the BEBQ.68 When food responsiveness at age 1 month was added as a covariate in analyses, results remained unchanged (not shown), suggesting that earlier introduction to complementary foods is predictive of food responsiveness independent of the child’s baseline food responsiveness at age 1 month.
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We should like to thank the mothers who took part in the pilot study and the Gemini families who provided data for the factor analysis. C.H. Llewellyn and J. Wardle drafted the paper, C.H. Llewellyn and C.H.M. van Jaarsveld analyzed the data, S. Carnell was involved in the development of the BEBQ, and L. Johnson contributed to the development of the BEBQ and the data collection. All authors provided critical feedback on the manuscript and approved the final version. J. Wardle designed the study and is PI on the Cancer Research UK grant that supported the work (C1418/A7974). Clare Llewellyn is funded jointly by the Medical Research Council and the Economic and Social Research Council.