title: Longitudinal association between preschool fussy eating and body composition at 6 years of age: The Generation R Study.
abstract: BACKGROUND
  Children's fussy eating behavior has been related to both underweight and overweight in cross-sectional studies, but the direction of these associations and the relation with more detailed measures of body composition remains unclear. We aimed to examine whether fussy eating at age 4 years is longitudinally related to body mass index (BMI), fat mass index (FMI) and fat-free mass index (FFMI) at 6 years of age.
  
  
  METHODS
  This study was embedded in Generation R, a population-based, prospective cohort. Data were available for 4191 children. The Children's Eating Behaviour Questionnaire (CEBQ), administered at age 4 years, was used to derive a fussy eating profile. This profile is characterized by high scores on food avoidant scales and low scores on food approach scales. At age 6 years, height and weight were measured at our research center. Body fat and fat-free mass were measured using Dual-energy-X-ray absorptiometry. We used age- and sex-specific standard deviation scores (SDS) for all outcomes.
  
  
  RESULTS
  After adjustment for confounders, the fussy eating profile was related to lower BMI-SDS (B = -0.37, 95% CI: -0.47;-0.26), lower FMI-SDS (B = -0.22, 95 % CI: -0.33;-0.12) and lower FFMI-SDS (B = -0.41, 95% CI: -0.54;-0.29). When adjusting for baseline BMI at 4 years, the fussy eating profile predicted a 0.11 lower BMI-SDS at age 6 (95% CI: -0.19;-0.04). This change in BMI was mainly due to a decrease in FFMI (B = -0.19, 95% CI: -0.29;-0.09). Fussy eaters also had a higher risk of becoming underweight than non-fussy eaters (OR = 2.28, 95% CI: 1.34;3.87).
  
  
  CONCLUSIONS
  Our findings suggest that young fussy eaters are at risk of having a lower fat free mass and of becoming underweight over a 2-year period. This implies that fussy eaters may benefit from careful monitoring to prevent an adverse growth development.
authors.affiliation: The Generation R Study Group, Erasmus MC-University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands. l.debarse@erasmusmc.nl.|Department of Epidemiology, Erasmus MC-University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands. l.debarse@erasmusmc.nl.
authors.forename: Lisanne M
authors.initials: LM
authors.lastname: de Barse
authors.affiliation: Department of Epidemiology, Erasmus MC-University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands. h.tiemeier@erasmusmc.nl.|Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-University Medical Center, PO Box 2060, 3000, CB, Rotterdam, The Netherlands. h.tiemeier@erasmusmc.nl.|Department of Psychiatry, Erasmus MC-University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands. h.tiemeier@erasmusmc.nl.
authors.forename: Henning
authors.initials: H
authors.lastname: Tiemeier
authors.affiliation: Department of Epidemiology, Erasmus MC-University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands. e.leermakers@erasmusmc.nl.
authors.forename: Elisabeth T M
authors.initials: ET
authors.lastname: Leermakers
authors.affiliation: Department of Epidemiology, Erasmus MC-University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands. trudy.voortman@erasmusmc.nl.
authors.forename: Trudy
authors.initials: T
authors.lastname: Voortman
authors.affiliation: The Generation R Study Group, Erasmus MC-University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands. v.jaddoe@erasmusmc.nl.|Department of Epidemiology, Erasmus MC-University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands. v.jaddoe@erasmusmc.nl.|Department of Pediatrics, Erasmus MC-University Medical Center, PO Box 2060, 3000, CB, Rotterdam, The Netherlands. v.jaddoe@erasmusmc.nl.
authors.forename: Vincent W V
authors.initials: VW
authors.lastname: Jaddoe
authors.affiliation: Taste and Behavioral Sciences, Nestlé Research Center, Lausanne, Switzerland. LisaRobin.Edelson@rdls.nestle.com.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Edelson
authors.affiliation: Department of Epidemiology, Erasmus MC-University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands. o.franco@erasmusmc.nl.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Franco
authors.affiliation: Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-University Medical Center, PO Box 2060, 3000, CB, Rotterdam, The Netherlands. p.w.jansen@erasmusmc.nl.|Institute of Psychology, Erasmus University Rotterdam, PO Box 1738, 3000, DR, Rotterdam, The Netherlands. p.w.jansen@erasmusmc.nl.
authors.forename: Pauline W
authors.initials: PW
authors.lastname: Jansen
mesh_terms: D015502:Absorptiometry, Photon; D000273:Adipose Tissue; D001823:Body Composition / Q000502:physiology*; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D002652:Child Behavior / Q000523:psychology*; D015331:Cohort Studies; D005247:Feeding Behavior / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009765:Obesity / Q000517:prevention & control; D011446:Prospective Studies; D011795:Surveys and Questionnaires