A Longitudinal Investigation of Nutrition and Dietary Patterns in Children of Mothers with Eating Disorders

doi:10.1016/j.jpeds.2012.11.092

The Journal of Pediatrics

Volume 163, Issue 1, July 2013, Pages 173-178.e1

https://doi.org/10.1016/j.jpeds.2012.11.092 Get rights and content

Objective

To investigate dietary patterns and nutritional intake in children of mothers with eating disorders.

Study design

Mothers (N = 9423) from a longitudinal general population birth cohort study, the Avon Longitudinal Study of Parents and Children, completed Food Frequency Questionnaires on their children at 3, 4, 7, and 9 years of age. Macronutrient intake was estimated, and dietary patterns were obtained using principal components analysis. Linear regression and mixed-effects models were used to assess dietary patterns and nutritional intake among children of women with lifetime anorexia nervosa (AN, n = 140), bulimia nervosa (BN, n = 170), or AN+BN (n = 71), compared with children of women without eating disorders (unexposed women, n = 9037).

Results

Children in the maternal AN and BN groups had higher scores on the “health conscious/vegetarian” dietary pattern compared with unexposed children. Less adherence to the “traditional” dietary pattern was observed in children of exposed mothers, with more pronounced differences in early childhood. Children of women with AN and BN had higher intake of energy and children of women with BN had higher intake of carbohydrates and starch and lower intake of fat, compared with children in the unexposed group.

Conclusions

Maternal eating disorders are associated with altered offspring dietary patterns and macronutrient intake. Longitudinal changes in patterns of diet in children of women with eating disorders may increase the risk of weight gain or disordered eating later in life.

Section snippets

Methods

ALSPAC is a longitudinal birth cohort study that enrolled pregnant women living within the former county of Avon, in southwest England, who were due to deliver their baby between the April 1, 1991, and December 31, 1992.¹⁴ The full details the ALSPAC study, including representativeness of the sample, are available on the study Web site (http://www.bristol.ac.uk/alspac). A cohort of 14 541 pregnant women was established, resulting in 13 988 children alive at 12 months.

At 12 weeks’ gestation,

Results

Women included in the study were compared according to eating disorders group on several socioeconomic variables (Table I). Maternal age at delivery, ethnicity, household income, and child sex did not differ across the 4 groups. Mothers with AN and AN+BN were more likely to be educated to Advanced-level (United Kingdom exams taken in different subjects usually at age 18 years) or degree or above level than were the unexposed group, and mothers with BN were less likely to be multiparous,

Discussion

Children of mothers with eating disorders were found to adhere less to a “traditional” dietary pattern than were children of women without eating disorders. This traditional pattern is synonymous with a British “meat and two veg diet,” which would typically be eaten at mealtimes. Family mealtimes are particularly difficult for mothers who have experienced an eating disorder,²⁴ and they have been found to be less likely to regularly cook or eat with their children.²⁵ Although family mealtimes

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Cited by (36)

Parental eating disorders: A systematic review of parenting attitudes, behaviours, and parent-child interactions
2021, Clinical Psychology Review
Citation Excerpt :
Hoffman et al. (2014) reported that mothers with lifetime eating disorders were more likely to report a specific approach to feeding; most frequently to limit processed foods. In contrast, Easter et al. (2013) found that children were comparable in the amount of processed foods eaten. Although diet type did not differ significantly for children of mothers with AN or EDNOS-p and mothers without eating disorders, Torgersen et al. (2015) reported that infants of mothers with BN were less likely to eat homemade traditional foods than commercially prepared baby food, compared to infants of control mothers.
A substantial proportion of adults with eating disorders are parents. Studies suggest these parents may experience a range of parenting challenges, and their children may be at an increased risk for the development of eating disorders themselves. With parenting practices being one potential environmental mechanism for the intergenerational transmission of eating disorders, we systematically searched Scopus, Web of Science, PubMed, MEDLINE, PsychINFO, and PsychArticles for controlled studies in which parenting attitudes, behaviours, and parent-child interactions were examined for parents with and without probable eating disorders. 26,512 abstracts were screened, and 167 full-text manuscripts were retrieved, with 33 studies meeting the review inclusion criteria. Studies suggest that parents with eating disorders experience higher levels of parenting stress than control parents, and may on average be more intrusive, less sensitive, and provide less structuring/facilitation in non-feeding interactions with their children. These parents also appear, on average, to experience increased concern about their children's weight, and parent-child mealtime interactions may be problematic and characterised by high levels of conflict. Suggestions for future research are made with a view to enhancing understandings of the intergenerational transmission of eating disorders, which may lead to the identification of intervention targets for parents with eating disorders and their children.
Maternal Eating Disorders and Eating Disorder Treatment Among Girls in the Growing Up Today Study
2019, Journal of Adolescent Health
The aim of the study was to assess whether girls with mothers who have had an eating disorder (ED) have greater odds of developing ED symptoms and whether girls with ED symptoms have greater odds of receiving ED treatment if their mothers have an ED history.
Data came from 3,649 females in the Growing Up Today Study. Data were collected via questionnaires that were mailed every 12–24 months from 1996 to 2013. Girls who reported on ED treatment in 2013 and whose mothers completed a questionnaire in 2004 about maternal and child EDs were included in main analyses. Generalized estimating equations were used.
Among complete cases, 28.3% of girls reported symptoms meeting criteria for an ED in at least 1 year and, of these, 12.4% reported receiving treatment. Girls with mothers with ED histories had nearly twice the odds of reporting symptoms of any ED (adjusted odds ratio: 1.89; 95% confidence interval: 1.38–2.60). Girls who reported symptoms meeting criteria for any ED had more than twice the odds of reporting treatment if their mother had an ED history (adjusted odds ratio: 2.23; 95% confidence interval: 1.25–3.99).
Girls with mothers with an ED history had greater odds of both reporting ED symptoms and receiving ED treatment. Screening both girls and their mothers for current or previous disordered eating may be important for the prevention and detection of ED symptoms. More research is needed to examine reasons for the association between maternal ED history and ED treatment in girls.
Eating disordered mothers and their children
2018, Eating Disorders and Obesity in Children and Adolescents
The aim of this chapter is to summarize and describe key findings and theoretical models of the intergenerational effects of maternal eating disorders (EDs). In particular, this chapter will focus on effects of developmental aspects, across the spectrum of psychological, cognitive, and eating behavior development. We will also touch on the limited literature on EDs in children of mothers with EDs. Although the last 20 years have seen a growth in research in this field, many questions remain unanswered.
Paternal psychopathological risk and psychological functioning in children with eating disorders and Disruptive Behavior Disorder
2017, Psychiatry Research
Citation Excerpt :
It is important to note, nonetheless, that most of the research in the field has focused either on young children (0–5 years of life) or on adolescents. There is a dearth of studies, instead, on the specific school-age developmental stage, which has been studied profusely within a psychoanalytic framework, but much less through a psychodynamic or behavioral-cognitive approach (Easter et al., 2013). Families with children diagnosed with ED and DBD could share similar functioning, based on common individual and relational characteristics.
Several studies demonstrated that maternal psychopathological risk is related to child’s maladjustment, but until recently research has relatively neglected fathers. Disruptive Behavior Disorder (DBD) and Eating disorders (ED) have a large prevalence during childhood but a few studies have focused on their association with paternal psychopathological risk. One-hundred and thirty-nine children and their fathers were recruited from pediatric hospitals and outpatient clinics and paired with a healthy control group (CG). Fathers were administered the SCL-90/R and the CBCL 6–18 to assess: 1) psychopathological risk of fathers of children with DBD, ED and CG; 2) significant differences between ED and DBD fathers’ psychopathological profiles; and 3) associations between specific fathers’ psychopathological symptoms and children’s emotional-behavioral problems. Fathers of children with ED showed a higher psychopathological risk than fathers of DBD offspring. Children with DBD showed higher externalizing symptoms. Paternal hostility was associated with internalizing problems in children with DBD. Paternal hostility showed a non-significant but clinically interesting association with internalizing problems in DBD children; interpersonal sensitivity was associated with internalizing problems in ED children. This study can constitute a contribution to a better understanding of the clinical characteristics of fathers of children with DBD and ED.
Maternal history of eating disorders: Diet quality during pregnancy and infant feeding
2017, Appetite
We studied associations of maternal history of eating disorders (EDs) with diet quality of pregnant women and their infants, and breastfeeding practices. We included 6196 mother-child pairs from Generation R, a population-based cohort in the Netherlands. Maternal history of lifetime EDs was assessed during pregnancy with a questionnaire. Dietary intake during pregnancy and in infancy was assessed with food-frequency questionnaires and diet quality scores were calculated, reflecting adherence to dietary guidelines. Breastfeeding practices were assessed with questionnaires at 2, 6, and 12 months. We observed that, after adjustment for socioeconomic and lifestyle factors, women with a history of EDs had a higher diet quality than women without a history of EDs (B = 0.24 SD, 95%CI: 0.15; 0.33). Mothers with a history of EDs were less likely to breastfeed (unadjusted OR = 0.68, 95%CI: 0.51; 0.93), although no longer statistically significant after adjustment (OR = 0.75, 95%CI: 0.55; 1.03). These findings suggest that mothers with a history of EDs seem slightly less likely to initiate breastfeeding, however, this warrants further investigation. At the age of 1 year, infants of mothers with a history of EDs had a higher diet quality (B = 0.15 SD, 95%CI: 0.02; 0.27). We conclude that mothers with a history of EDs and their infants have a relative good diet quality, although follow-up studies are needed to assess long-term associations with diet in later childhood and adolescence.
Vegetarianism and veganism lifestyle: Motivation and psychological dimensions associated with selective diet
2016, Presse Medicale
Le végétarisme est un mode de consommation alimentaire qui se définit par l’exclusion d’aliments d’origine animale. Le végétarisme, au sens large du terme, regroupe plusieurs modes d’alimentation en fonction du degré de restriction (partiel ou total) des produits animaux (carnés ou lactés). Parmi ceux-ci, on distingue par ordre de restriction les régimes flexitarien, semi-végétarien, pesco-végétarien, ovo-lacto-végétarien, végétalien, crudivore et frugivore. Ces trois derniers modes d’alimentation peuvent s’étendre à un mode de vie appelé véganisme qui se définit par l’absence d’usage des produits animaux dans la vie quotidienne (cosmétiques, vêtements, matériaux, etc.). Cette diversité au sein du végétarisme s’explique notamment par des caractéristiques motivationnelles individuelles et psychologiques. Les principales motivations rapportées par les individus ayant entrepris ce mode d’alimentation sont la santé et l’éthique. En fonction de la principale motivation, découlent des différences en termes de comportements, d’attitudes et de réactions quant à la perception des animaux vivants, à l’aversion des produits animaux et à la justification du mode d’alimentation choisi par rapport à ceux qui ont des pratiques différentes d’eux, notamment les omnivores.
Vegetarianism is a food consumption pattern. Vegetarianism, at large, includes several diets depending on exclusion's degree (partial or total) of animal products (meat or dairy). Among them we distinguish, according to the restriction order, flexitarian, semi-vegetarian, pesco-vegetarian, lacto-ovo-vegetarian, vegan food, raw food and fruit diets. These three last modes can extend to a lifestyle called veganism, which is defined as the lack of use of animal products in daily life (cosmetics, clothing, materials, etc.). This diversity can be explained by individual, psychological and motivational characteristics. Main reasons reported by individuals who have undertaken this feeding method are health and ethics. We observe differences in behaviors, attitudes and reactions about animals, disgust and justification of each diet vs. others’ diets especially the omnivorous diet.

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: The UK Medical Research Council, the Wellcome Trust, and the University of Bristol provide core support for Avon Longitudinal Study of Parents and Children. This article presents research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0606-1043). N.M. received a Clinical Scientist Award from the NIHR. The views expressed in this article are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health. The authors declare no conflicts of interest.

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Original ArticleA Longitudinal Investigation of Nutrition and Dietary Patterns in Children of Mothers with Eating Disorders

Objective

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

Am J Clin Nutr

Appetite

Development of eating behaviors among children and adolescents

Pediatrics

Parents are key players in the prevention and treatment of weight related problems

Nutr Rev

Diagnostic and statistical manual of mental disorders, fourth edition, text revision

The offspring of mothers with eating disorders

Eur Child Adolesc Psychiatry

The children of mothers with eating disorders

Clin Child Fam Psychol Rev

Infant feeding and weight in the first year of life in babies of women with eating disorders

J Pediatr

A prospective study of the influence of eating-disordered mothers on their children

Int J Eating Disord

Children of mothers with bulimia nervosa

Br Med J

Bulimia nervosa. The impact of pregnancy on mother and baby

Br J Psychiatry

An observational study of mothers with eating disorders and their infants

J Child Psychol Psychiatry

Eating habits and attitudes among 10-year-old children of mothers with eating disorders: longitudinal study

Br J Psychiatry

Offspring of women with eating disorders

Int J Eating Disord

ALSPAC: the Avon Longitudinal Study of Parents and Children. I. Study methodology

Paediatr Perinat Epidemiol

Factor analyses

Original Article
A Longitudinal Investigation of Nutrition and Dietary Patterns in Children of Mothers with Eating Disorders