Abstract
ObjectivesFew 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.MethodsWe 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.ResultsBoys 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).ConclusionLower 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.
Highlights
Problematic eating attitudes are common in childhood and early adolescence, with prevalence estimates of up to 20% of girls aged 12–14 years[1] and similar estimates in boys.[2]
Measurement of potential confounders We considered the following as potential confounders: geographical variables i.e. the hospital/polyclinic location; child variables, i.e. child’s age at the measurement of Children’s Eating Attitude Test (ChEAT), sex, gestational age, birth weight, 5 minute Apgar score and body mass index (BMI) at age 6.5 years; family variables, i.e. mother’s age at the child’s birth, parental education, highest household occupation, number of older children in household and maternal smoking during pregnancy
Treatment arm was taken into account, and provided a measure of breastfeeding, since the intervention arm substantially increased duration and exclusivity of breastfeeding.[22]. Inclusion of this variable as a potential confounder was important as we have shown the randomized Promotion of Breastfeeding Intervention Trial (PROBIT) treatment arm to be associated with both intelligence quotient (IQ) at age 6.5 years [26] and ChEAT score at age 11.5 years.[40]
Summary
Problematic eating attitudes are common in childhood and early adolescence, with prevalence estimates of up to 20% of girls aged 12–14 years[1] and similar estimates in boys.[2]. Western 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. Adolescents showing problematic eating behaviours are predisposed to eating disorders later in life.[4,5,6,7] 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,[7,8,9,10] including cognitive and behavioural problems.[11,12]
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