A 3-Year Longitudinal Study of Effects of Parental Feeding Practices on Child Weight Status: The Childhood Obesity Study in China Mega-Cities

This study examined the longitudinal associations between parental feeding practices and child weight status, and their potential modification effects by child sex, age, and maternal and paternal educations among children. Data were collected from 2015 to 2017 of 2139 children aged 6-17 years and their parents in five Chinese mega-cities. Parental feeding practices were assessed using 11-items from Child Feeding Questionnaire. Waist-to-height ratio (WHtR), body mass index (BMI), and general and central obesity were measured and analyzed using a mixed-effects model. Three parental feeding patterns were identified by factor analysis including "concern", "pressure to eat", and "control". Concern was associated with higher BMI z-score, WHtR (beta s ranged from 0.01 to 0.16), and general obesity (ORs ranged from 1.29 to 6.41) among children aged <= 12 years and >12 years, regardless of child sex and parental educations. Pressure to eat was associated with lower BMI z-score (beta = -0.08, p < 0.001), WHtR (beta = -0.004, p < 0.01), and general (OR = 0.53, 95% CI = 0.42, 0.66) and central obesity (OR = 0.72, 95% CI = 0.58, 0.90) among children aged <= 12 years. Further analyses showed that significant associations were found for children with maternal or paternal education of college and above. Control was associated with increased risk of general and central obesity among children with maternal education of college and above, regardless of age. Our study indicates that higher concern and lower pressure to eat were associated with increased risk of obesity among children. Control was associated with increased risk of obesity among children with maternal education of college and above. Future childhood obesity preventions may optimize parental feeding practices.