title: Bidirectional association between parental child-feeding practices and body mass index at 4 and 7 y of age.
abstract: BACKGROUND
  Evidence of the association between parental child-feeding practices and the child's body mass index (BMI) is controversial, and bidirectional effects have been poorly studied.
  
  
  OBJECTIVE
  We aimed to examine bidirectional associations between parental child-feeding practices and BMI at 4 and 7 y of age.
  
  
  METHODS
  This study included 3708 singleton children from the Generation XXI birth cohort with data on parental child-feeding practices and BMI at 4 and 7 y old. Feeding practices were assessed through a self-administered questionnaire by combining the Child Feeding Questionnaire and the Overt/Covert Control scale and then adapting it to Portuguese preschool children. Weight and height were measured according to standardized procedures, and age- and sex-specific BMI z scores were computed based on the WHO Growth References. Linear regression models were used to estimate the bidirectional associations between each practice and BMI z score. Crosslagged analyses were performed to compare the directions of those associations (the mean score of each practice and BMI z score at both ages were standardized to enable effect size comparisons).
  
  
  RESULTS
  After adjustments, pressure to eat and overt control at 4 y of age were associated with a lower BMI z score 3 y later (β: -0.05; 95% CI: -0.08, -0.03 and β: -0.05; 95% CI: -0.09, -0.01, respectively). Regarding the opposite direction of association, a higher BMI z score at 4 y of age was significantly associated with higher levels of restriction and covert control at 7 y of age (β: 0.06; 95% CI: 0.03, 0.08 and β: 0.06; 95% CI: 0.04, 0.08, respectively) and with lower levels of pressure to eat (β: -0.17; 95% CI: -0.20, -0.15). The only bidirectional practice, pressure to eat, was more strongly influenced by the BMI z score than the reverse (βstandardized: -0.17 compared with βstandardized: -0.04; likelihood ratio test: P < 0.001).
  
  
  CONCLUSIONS
  We found that parents both respond to and influence the child's weight; thus, this child-parent interaction should be considered in future research.
authors: Epidemiology Research Unit, Institute of Public Health;
authors: Lisa
authors: L
authors: Afonso
authors: Epidemiology Research Unit, Institute of Public Health; Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine; and.
authors: Carla
authors: C
authors: Lopes
authors: Epidemiology Research Unit, Institute of Public Health; Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine; and.
authors: Milton
authors: M
authors: Severo
authors: Epidemiology Research Unit, Institute of Public Health;
authors: Susana
authors: S
authors: Santos
authors: Epidemiology Research Unit, Institute of Public Health;
authors: Helena
authors: H
authors: Real
authors: Epidemiology Research Unit, Institute of Public Health;
authors: Catarina
authors: C
authors: Durão
authors: Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.
authors: Pedro
authors: P
authors: Moreira
authors: Epidemiology Research Unit, Institute of Public Health; Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine; and acmatos@med.up.pt.
authors: Andreia
authors: A
authors: Oliveira
mesh_terms: D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D010287:Parent-Child Relations; D016487:Parenting; D010290:Parents; D063766:Pediatric Obesity / Q000209:etiology*; D011795:Surveys and Questionnaires
keywords: body mass index; children; cohort studies; feeding behaviors; longitudinal studies