Assessing the Body Composition of "Picky Eaters" Using Body Impedance Analysis: An Experience From a Tertiary Care Center.

BACKGROUND: Picky eating might be associated with a higher risk of being underweight and poor growth. This study aimed to investigate if picky eaters aged between three and 12 years showed differences in height, weight, and body composition compared to their non-picky peers using a body impedance analysis (BIA). METHODS: This cross-sectional study was conducted between March 1, 2022, and July 31, 2022, on children aged three to 12 years who presented to the outpatient pediatric clinics at Al Habib Ar Rayyan in Riyadh, Saudi Arabia. Body composition was measured using BIA after manually inserting the height, gender, and age into the machine, where body mass index (BMI), fat mass, and skeletal muscle mass were recorded. Participants were classified as under/normal/over for each body composition measurement. RESULTS: A total of 2234 children were entered into the final data analysis. Our analysis showed that 1917 (85.8%) were Saudis and 1117 (50%) were males. The mean age of participants was 6.08±2.01 years and 1151 (51.5%) were in the pre-school age. The reported prevalence of picky eaters was 1684 (75.4%), of whom, 606 (27.0%) were selective eaters, 365 (16.2%) were low appetite eaters, and 723 (32.2%) were both selective and low appetite eaters. Being underweight was significantly more common among the picky eaters 487 (28.9%) compared to those non-picky eaters 55 (10.0%) (p<0.001). Significantly, 1280 (76%) picky eaters had below-average skeletal muscle mass compared to 151 non-picky eaters (27.5%) (p<0.001). The low appetite picky eater group had more under skeletal muscle mass children 277 (75.9%) compared to the selective picky eater group 412 (68.0%) (p=0.009). Additionally, the low appetite group possessed lower muscle ratios (p=0.012) and were more underweight than the selective group (p<0.001). Furthermore, the low appetite group showed a higher percentage of children below the 3rd percentile in the height for age category (p=0.003) compared to the selective group. CONCLUSION: This study is the first of its kind in Saudi and globally to evaluate body composition using BIA among children. The study showed that picky eating is more associated with underweight children and low muscular mass. Despite the normal BMI, height, and weight of a picky eater, their skeletal muscle mass might be less than average, which could be associated with an increased risk of morbidity.

Interventions for Picky Eaters among Typically Developed Children-A Scoping Review.

Picky eating in children is often a major source of concern for many parents and caregivers. Picky eaters (PEs) consume limited foods, demonstrate food aversion, and have a limited food repertoire, which hinders their growth and health. These behaviours are common in children with special health care needs despite the rise in typically developing children. This leads to less attention being given to intervention programmes for typically developing children. Therefore, this scoping review aims to investigate the key concept of an existing intervention programme for PE among typically developing children, primarily on the types and approaches selected. A thorough literature search was conducted on three primary databases (PubMed, Emerald In-sight, and Web of Science) using predefined keywords. The literature was then appraised using the Joanna Briggs Institute's guidelines and protocols, and the PRISMScR checklist. Inclusion and exclusion criteria were also specified in the screening procedure. Results showed that the majority of the interventions in these studies were single-component interventions, with the sensory approach being the type that was most frequently utilised, followed by the nutrition approach and parenting approach. Single and multiple intervention components improved the assessed outcome, with a note that other components may or may not show a similar outcome, as they were not assessed in the single-component intervention. Given the evidence that picky eating is influenced by various factors, a multi-component intervention can provide a substantial impact on future programmes. In addition, defining picky eaters using standardised tools is also essential for a more inclusive subject selection.

Picky Eating in School-Aged Children: Sociodemographic Determinants and the Associations with Dietary Intake.

Children exhibiting picky eating behavior often demonstrate strong food preferences and rejection of particular foods or food texture, which may lead to limited dietary variety and possibly inadequate or unhealthy diet. Yet, the relationship between picky eating and nutrient intake in school-aged children has not been established previously. This study aimed to investigate the sociodemographic determinants of picky eating and the associations between picky eating and dietary intake in children. Data of 424 healthy Saudi children aged 6-12 years were collected from their mothers. A child's picky eating habits were captured using a validated questionnaire. Sociodemographic characteristics of the children were assessed. Dietary data, including 24 h dietary recalls and frequency of fruit, vegetable, and milk consumption, were collected by dietetic professionals using phone-administered interviews. Compared to those of normal-weight mothers, children of mothers with obesity had higher odds of being in the highest tertile of picky eating (OR = 1.93; 95% CI 1.02, 3.63). Children exhibiting higher levels of picky eating consumed less fruits (B = -0.03; 95% CI -0.06, -0.01), vegetables (B = -0.05; 95% CI -0.07, -0.02), and protein (B = -0.21; 95% CI -0.33, -0.09), and had higher consumption of trans fatty acid intake (B = 1.10; 95% CI 0.06, 2.15). Children with higher levels of picky eating presented unhealthy dietary behaviors. Future studies are needed to examine the long-term effect of picky eating on cardiovascular health. Dietary behaviors of mothers with obesity must be taken into consideration when designing intervention programs aiming to improve eating behaviors of children.

What does it mean to be a 'picky eater'? A qualitative study of food related identities and practices.

Picky eaters are defined as those who consume an inadequate variety of food through rejection of a substantial amount of food stuffs that are both familiar and unfamiliar. Picky eating is a relatively recent theoretical concept and while there is increasing concern within public health over the lack of diversity in some children's diets, adult picky eaters remain an under researched group. This paper reports on the findings of a qualitative study on the routine food choices and practices of 26 families in Sandwell, West Midlands, UK. Photo elicitation and go-along interview data collection methods were used to capture habitual food related behaviours and served to describe the practices of nine individuals who self identified or were described as picky eaters. A thematic analysis revealed that those with the food related identity of picky eater had very restricted diets and experienced strong emotional and physical reactions to certain foods. For some this could be a distressing and alienating experience that hindered their ability to engage in episodes of social eating. Further research is needed to illuminate the specific practices of adult picky eaters, how this impacts on their lives, and how possible interventions might seek to address the challenges they face.

The Eating Identity Type Inventory (EITI). Development and associations with diet.

People with healthy eating identities report healthier diets and demonstrate greater receptivity to nutrition interventions, but other types of eating identity are likely important. We developed the Eating Identity Type Inventory (EITI) to assess affinity with four eating identity types; healthy, meat, picky, and emotional. This study assessed factorial validity, using confirmatory factor analysis (CFA) and established reliability and convergent validity of the EITI. In a telephone survey, 968 primary household food shoppers completed the EITI and a dietary questionnaire; 101 repeated the EITI approximately 1month later.CFA revealed that an 11-item model provided acceptable fit (χ(2)=206; df=38), CFI=.938, NNFI=.925, RMSEA=.070; SRMR=.059). The EITI demonstrated acceptable internal consistencies with Cronbach alpha's ranging from .61 to .82 and good test-retest reliability for healthy, emotional, and picky types (Pearson's correlations ranging from .78 to .84). Ordinary Least Squares (OLS) used to assess relationships between eating identity type and diet analyses demonstrated significant hypothesized relationships between healthy eating identity and healthier dietary intake and meat and picky eating identities and less healthy dietary intake. The EITI could facilitate behavioral and cognitive research to yield important insights for ways to more effectively design messages, interventions, and policies to promote healthy dietary behaviors.

The Characteristics of Infants' Temperament, Maternal Feeding Behavior and Feeding Practices in Picky Eaters / 대한지역사회영양학회지

The purpose of this study was to determine the characteristics of infants' temperaments, maternal feeding behaviors and feeding practices in picky eaters. Participants were 83 infants (aged 12 - 24 months) from "A" hospital (Seoul) and "B" public health center (Kyunggido). Mothers completed questionnaires that assessed their own feeding behavior, feeding practices, infants' temperament and infants' feeding behavior. Picky eaters' demographics were not significantly different from non-picky eaters after adjusting sex and age. The average of thiamin, niacin and vitamin E intakes of picky eaters were below 75% Korean RDA, whereas vitamin A intakes exceed 120% RDA in both groups. Activity level of infants' temperament and disinhibition of maternal feeding behavior in picky eaters were significantly higher than those in non-picky eater. All constructs of infants feeding behavior were significantly associated with certain constructs of infants' temperament, maternal feeding practice and maternal feeding behavior. The pickiness of infants feeding behavior was positively correlated with activity level of infants' temperament, pickiness and disinhibition of maternal feeding behavior and negatively correlated with adaptability of infants' temperament. Findings suggest that maternal feeding behavior and feeding practices as well as infants' temperament should be addressed in nutrition education for picky eaters.