Determinants of appetitive traits in children aged 5 and 9-11 years old: Findings from the ROLO longitudinal birth cohort study

Background: Childhood is time of rapid development, when children learn, what, how much and when to eat. At this stage, foundations are laid for future eating patterns. A greater understanding of what drives appetitive traits, particularly problematic traits such as overeating or undereating is vital to ensure a child develops an optimal relationship with food long term. This thesis explores early life, maternal and environmental factors that may contribute to the formation of child appetitive traits. It also describes the ROLO follow-up cohorts at five and nine to eleven years old and explores associations between sleep and body composition and appetitive traits and body composition measurements at these two timepoints. Methods: This thesis uses secondary data from the ROLO (Randomised control trial of low glycaemic index diet in pregnancy) longitudinal birth cohort study. Data from follow-up of the mothers and offspring from pregnancy to nine to eleven-year follow-up (ROLO Preteen study) were used to explore the determinants of children’s appetitive traits at five and nine to eleven years old. Detailed maternal anthropometric measurements and dietary information were collected during pregnancy and comprehensive maternal and child anthropometric measurements, data on dietary intakes, diet quality, sleep, eating behaviours, sensory profiles, lifestyle behaviours and environmental factors were collected at follow-ups post-partum. Children’s appetitive traits were measured using the Children’s Eating Behaviour Questionnaire at five years and again at nine to eleven years old. Results: This research provides new insights into several relationships between early life, maternal, and environmental factors and child appetitive traits at five and nine to eleven years old. As early as in-utero, associations were observed between maternal diet quality during pregnancy and child’s desire to consume beverages. Several maternal factors were associated with child appetitive traits, including maternal socio-economic status, eating behaviours, well-being and sensory processing. Associations observed between environmental factors and child appetitive traits, included screen time, childcare and oral sensory processing. Child sleep duration and child appetitive traits were associated with body composition; however associations were not observed between sleep and child appetitive traits. Aspects of food approach appetitive traits increased from age five to nine to eleven, whereas aspects of food avoidant appetitive traits decreased over both timepoints. Some food avoidant appetitive traits were associated with lower quality diet at both age time points. Conclusion: From in-utero to the preteen years, a variety of factors are at play that will influence how a child’s appetitive traits will develop. Although evidence suggests that genetics contribute, our research demonstrates that early life, maternal and environmental factors also play their part. Children with a more avid appetite are at risk of unhealthy weight status, and as observed, these appetitive traits tend to increase with age. Ensuring that the ecological niche the child is embedded within promotes healthy food choices and eating styles and discourages the obesogenic home/community environment is paramount. Our research suggests that early feeding, maternal influences and the environmental factors are also influential in determining food avoidant appetitive traits in children. Practical support with early feeding and maternal well-being postpartum, positive role modelling of food intake and eating behaviour, reduced screen time, and support for those from disadvantaged households are important modifiable factors that may help to address and manage problematic food avoidant behaviours.