title: Prospective associations of parental smoking, alcohol use, marital status, maternal satisfaction, and parental and childhood body mass index at 6.5 years with later problematic eating attitudes.
abstract: BACKGROUND
  Few studies have prospectively investigated whether early-life exposures are associated with pre-adolescent eating attitudes.
  
  
  OBJECTIVE
  The objective of this study is to prospectively investigate associations of parental smoking, alcohol use, marital status, measures of maternal satisfaction, self-reported parental body mass index (BMI) and clinically measured childhood BMI, assessed between birth and 6.5 years, with problematic eating attitudes at 11.5 years.
  
  
  METHODS
  Observational cohort analysis nested within the Promotion of Breastfeeding Intervention Trial, a cluster-randomised trial conducted in 31 maternity hospitals and affiliated polyclinics in Belarus. Our primary outcome was a Children's Eating Attitudes Test (ChEAT) score 22.5 (85th percentile), an indicator of problematic eating attitudes. We employed multivariable mixed logistic regression models, which allow inference at the individual level. We also performed instrumental variable (IV) analysis using parents' BMIs as instruments for the child's BMI, to assess whether associations could be explained by residual confounding or reverse causation.
  
  
  METHODS
  Of the 17 046 infants enrolled between 1996 and 1997 across Belarus, 13 751 (80.7%) completed the ChEAT test at 11.5 years.
  
  
  RESULTS
  In fully adjusted models, overweight children at age 6.5 years had a 2.14-fold (95% confidence interval (CI): 1.82, 2.52) increased odds of having ChEAT scores 85th percentile at age 11.5 years, and those who were obese had a 3.89-fold (95% CI: 2.95, 5.14) increased odds compared with normal-weight children. Children of mothers or fathers who were themselves overweight or obese were more likely to score 85th percentile (P for trend 0.001). IV analysis was consistent with a child's BMI causally affecting future eating attitudes. There was little evidence that parental smoking, alcohol use, or marital status or maternal satisfaction were associated with eating attitudes.
  
  
  CONCLUSIONS
  In our large, prospective cohort in Belarus, both parental and childhood overweight and obesity at 6.5 years were associated with pre-adolescent problematic eating attitudes 5 years later.
authors.affiliation: 1] School of Social and Community Medicine, University of Bristol, Bristol, UK [2] Medical Research Council (MRC)/University of Bristol Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK.
authors.forename: K H
authors.initials: KH
authors.lastname: Wade
authors.affiliation: Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus.
authors.forename: O
authors.initials: O
authors.lastname: Skugarevsky
authors.affiliation: Department of Pediatrics and Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
authors.forename: M S
authors.initials: MS
authors.lastname: Kramer
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: R
authors.initials: R
authors.lastname: Patel
authors.affiliation: The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus.
authors.forename: N
authors.initials: N
authors.lastname: Bogdanovich
authors.affiliation: The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus.
authors.forename: K
authors.initials: K
authors.lastname: Vilchuck
authors.affiliation: The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus.
authors.forename: N
authors.initials: N
authors.lastname: Sergeichick
authors.affiliation: 1] School of Social and Community Medicine, University of Bristol, Bristol, UK [2] Medical Research Council (MRC)/University of Bristol Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK.
authors.forename: R
authors.initials: R
authors.lastname: Richmond
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: T
authors.initials: T
authors.lastname: Palmer
authors.affiliation: 1] School of Social and Community Medicine, University of Bristol, Bristol, UK [2] Medical Research Council (MRC)/University of Bristol Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK.
authors.forename: G
authors.initials: G
authors.lastname: Davey Smith
authors.affiliation: Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Gillman
authors.affiliation: Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Oken
authors.affiliation: 1] School of Social and Community Medicine, University of Bristol, Bristol, UK [2] Medical Research Council (MRC)/University of Bristol Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK [3] Bristol Biomedical Research Unit in Nutrition, National Institute for Health Research, Bristol, UK.
authors.forename: R M
authors.initials: RM
authors.lastname: Martin