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.

Body composition, Children, Cohort, Epidemiology, Fussy eating, Underweight,
The International Journal of Behavioral Nutrition and Physical Activity
Department of Psychology

de Barse, L.M, Tiemeier, H.W, Leermakers, E.T.M, Voortman, R.G, Jaddoe, V.W.V, Edelson, L.R, … Jansen, P.W. (2015). Longitudinal association between preschool fussy eating and body composition at 6 years of age: The Generation R Study. The International Journal of Behavioral Nutrition and Physical Activity, 12(1). doi:10.1186/s12966-015-0313-2