Association between caregivers' responsive feeding practices and the intake of fruit and vegetable among children aged 6–36 months: the mediating role of children's enjoyment of food

Abstract

This study examined the associations and mechanisms between caregivers' responsive/non-responsive feeding practices and fruit/vegetable intake of infants and toddlers in China. A combination of survey and homed-based video observation approach was adopted. In the survey (n = 408), caregivers' feeding practices were assessed using a pre-validated scale. Children's eating behaviors and daily amount (g/day) of fruit/vegetable intake were measured by Children's Eating Behavior Questionnaire and a food frequency questionnaire, respectively. In the video observation (n = 42), feeding episodes of 2–3 main meals captured caregiver-child interactions for description and analysis. Linear regression analysis of the survey data revealed that caregivers' responsiveness to cues was positively related to fruit (β = 0.088, 95 % CI: 0.006, 0.171) and vegetable (β = 0.094, 95 % CI: 0.015, 0.174) intake among children aged 25–36 months. Mediation analysis revealed that children's enjoyment of food eating behavior mediated the above significant association. These survey findings were supported by analysis from the video data. Moreover, the survey demonstrated that caregivers' modelling and controlling were related to fruit intake of children aged 6–24 months and 25–36 months, respectively (P < 0.05). Caregivers' encouraging to eat was positively associated, while emotional and instrumental feeding was negatively associated with vegetable intake among children aged 25–36 months (P < 0.05). To promote children's fruit and vegetable intake, caregivers might be educated to adopt responsive and avoid non-responsive feeding practices, with consideration of age specific strategies; and whose children aged 25–36 months might use responsiveness to cues feeding strategy.