Maternal restrictive feeding practices for child weight control and associated characteristics

Freitas, Fabrícia R.; Moraes, Denise E.B.; Warkentin, Sarah; Mais, Laís A.; Ivers, Júlia F.; Taddei, José Augusto A.C.

doi:10.1016/j.jped.2017.12.009

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Original articles • J. Pediatr. (Rio J.) 95 (2) • Mar-Apr 2019 • https://doi.org/10.1016/j.jped.2017.12.009 copy

Maternal restrictive feeding practices for child weight control and associated characteristics^☆ ☆ Please cite this article as: Freitas FR, Moraes DE, Warkentin S, Mais LA, Ivers JF, Taddei JA. Maternal restrictive feeding practices for child weight control and associated characteristics. J Pediatr (Rio J). 2019;95:201-8. , ^☆☆ ☆☆ Study carried out at Universidade Federal de São Paulo (UNIFESP), Departamento de Pediatria, Disciplina de Nutrologia, São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To identify associations between maternal restrictive feeding practices for child weight control and sociodemographic, behavioral, dietetic, and anthropometric characteristics.

Methods:

Cross-sectional study with mothers of children aged 2-8 years. Maternal feeding practices were measured by the Comprehensive Feeding Practices Questionnaire, in private schools in Brazil. Bivariate and multivariate associations were performed, using nonparametric analyses to estimate odds ratios and significance levels.

Results:

Maternal restrictive feeding practices for weight control were independently associated with the mother's perception of her child being a little overweight/overweight/obese (OR = 4.61, p = 0.001), greater concern about the child's overweight (OR = 2.61, p < 0.001), child's overweight/obesity/severe obesity (OR = 2.18, p < 0.001), and the child's greater intake of ultra-processed foods (OR = 1.40, p = 0.026).

Conclusion:

In this study, the risk variables identified for the use of the maternal restrictive feeding practices to control the child's weight can be used to provide education and guidance interventions in health and education networks directed to groups with similar characteristics to those of the studied population.

KEYWORDS
Obesity; Child; Body weight; Feeding behavior; Maternal behavior; Feeding practices

CFPQ questions	Likert scale score n (%)
	I completely disagree	I partially disagree	I neither agree nor disagree	I partially agree	I completely agree
"I encourage my child to eat less so he/she won't get fat."	377 (40.67)	138 (14.89)	146 (15.75)	173 (18.66)	93 (10.03)
"I give my child small helpings at meals to control his/her weight."	457 (49.30)	164 (17.69)	121 (13.05)	139 (14.99)	46 (4.96)
"If my child eats more than usual at one meal, I try to restrict his/her eating at the next meal."	520 (56.09)	146 (15.75)	93 (10.03)	122 (13.16)	46 (4.96)
"I restrict the food my child eats that might make him/her fat."	238 (25.67)	127 (13.70)	102 (11.00)	287 (30.96)	173 (18.66)
"There are certain foods my child shouldn't eat because they will make him/her fat."	320 (34.52)	141 (15.21)	115 (12.41)	237 (25.57)	114 (12.30)
"I don't allow my child to eat between meals because I don't want him/her to get fat."	475 (51.24)	193 (20.82)	117 (12.62)	110 (11.87)	32 (3.45)
"I often put my child on a diet to control his/her weight."	753 (81.23)	56 (6.04)	63 (6.80)	47 (5.07)	8 (0.86)
Mean of responses to the seven domain questions^a a Mean of the answers contemplating the seven questions.	407 (43.91)	279 (30.10)	196 (21.14)	45 (4.85)	-

Variables	Categories	n (%)
Characteristics of parents
Mother's age	>38 years ≤38 years	414 (44.85) 509 (55.15)
Father's age	>40 years ≤40 years	409 (45.75) 485 (54.15)
Mother's nutritional status (BMI)	Obesity Overweight Normal weight Low weight	51 (5.57) 217 (23.69) 628 (68.56) 20 (2.18)
Father's nutritional status (BMI)	Obesity Overweight Normal weight Low weight	140 (15.96) 470 (53.59) 265 (30.22) 2 (0.23)
Maternal schooling	<College/university Finished college/university	106 (11.43) 821 (88.57)
Paternal schooling	<College/university Finished college/university	169 (18.49) 475 (81.51)
Family income (monthly)^a a Minimum wage in 2014: R$ 724.00.	≤15 minimum wages >15 minimum wages	372 (42.71) 499 (57.29)
Presence of parents during meals	Present in all meals Absent from one of main meals	835 (90.37) 89 (9.63)
Perception of the child's nutritional status	Fat Slightly fat Normal weight A little thin Very thin	5 (0.54) 52 (5.63) 684 (74.03) 156 (16.88) 27 (2.92)
Frequency at which they feel responsible for the child's feeding	Always Very often/sometimes/rarely/never	467 (50.71) 454 (49.29)
Concern about the child's excess weight	Very concerned/reasonably concerned/concerned A little concerned/Unconcerned	476 (51.97) 440 (48.03)
Child's characteristics
Age range	≥5 years <5 years	542 (58.47) 385 (41.53)
Gender	Female Male	455 (49.08) 472 (50.92)
Nutritional status (BMI z-score/age)	Obesity^b b BMI z-score/age for children <5 years. /severe obesity^c c BMI z-score/age for children ≥5 years. Overweight^b b BMI z-score/age for children <5 years. /obesity^c c BMI z-score/age for children ≥5 years. Overweight risk^b b BMI z-score/age for children <5 years. /overweight^c c BMI z-score/age for children ≥5 years. Normal weight Low weight Very low weight	21 (2.36) 73 (8.22) 177 (19.93) 587 (66.10) 17 (1.91) 13 (1.46)
Number of hours a day watching TV and using electronic devices	>2 hours using both ≤2 hours using both or at least one	382 (41.21) 545 (58.79)
TV and electronic devices turned on during most meals	Yes No	317 (34.42) 604 (65.58)
Ultraprocessed food consumption	Consumption No consumption	431 (49.03) 448 (50.97)

Variables	Category of risk	Univariate analysis			Multiple analysis^a a Model adjusted for the child's gender and age (continuous variable) and mother's BMI (continuous variable). n = 835
		OR	CI (95%)	p	OR	CI (95%)	p-value
Parents' characteristics
Mother's age	>38 years	1.36	1.045-1.760	0.022	-		-
Father's age	>40 years	1.36	1.046-1.775	0.022	-		-
Mother's BMI	Overweight/obesity	1.30	0.978-1.723	0.070	-		-
Father's BMI	Overweight/obesity	1.06	0.793-1.412	0.701	-		-
Maternal schooling	<College/University education	1.68	1.212-2.532	0.012	-		-
Paternal schooling	<College/University education	1.17	0.837-1.631	0.361	-		-
Family income (monthly)	≤15 minimum wages	1.06	0.809-1.386	0.679	-		-
Presence of parents during meals	Present in all meals	0.82	0.529-1.261	0.363	-		-
Perception of the child's nutritional status	Slightly fat/fat/very fat	11.20	4.869-25.766	<0.001	4.61	1.848-11.524	0.001
Perception of the child's degree of physical activity	Little active/sedentary	2.99	0.984-9.072	0.054	-		-
Frequency at which they feel responsible for the child's feeding	Always	0.94	0.726-1.219	0.644	-		-
Concern about the child's excess weight	Very concerned/Reasonably concerned/Concerned	2.84	2.166-3.714	<0.001	2.61	1.938-3.511	<0.001
Child's characteristics
Age range	≥5 years	1.44	1.107-1.876	0.006	-		-
Gender	Female	1.20	0.925-1.552	0.170	-		-
Nutritional status^b b BMI z-score/age for children <5 years: overweight risk/overweight/obesity. BMI z-score/age for children ≥5 years: overweight/obesity/severe obesity.	Excess weight	2.72	2.030-3.653	<0.001	2.18	1.562-3.054	<0.001
Number of hours a day watching TV and using electronic devices	>2 hours using both or at least one	0.96	0.743-1.255	0.793	-		-
TV and electronic devices turned on during most meals	Yes	0.83	0.631-1.091	0.182	-		-
Ultraprocessed food consumption	Consumption	1.29	0.989-1.683	0.060	1.40	1.041-1.886	0.026

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[1] * Corresponding author. E-mail:bri.freitas@gmail.com (F.R. Freitas).