Parental feeding practices and associations with child weight status: Swedish validation of the Child Feeding Questionnaire finds parents of 4-year-olds less

The Child Feeding Questionnaire (CFQ) assesses parental feeding attitudes, beliefs and practices concerned with child feeding and obesity proneness. The questionnaire has been developed in the U.S., and validation studies in other countries are limited. The aim of this study was to examine the psychometric properties of the CFQ in Sweden and the associations between parenting practices and children’s weight status. Based on records from the Swedish population register, all mothers of 4-year-olds (n = 3007) from the third largest city in Sweden, Malmö, were contacted by mail. Those who returned the CFQ together with a background questionnaire (n = 876) received the CFQ again to enable test-retest evaluation; 564 mothers completed the CFQ twice.We used confirmatory factor analysis to test whether the original 7-factor model was supported. Good fit (CFI = 0.94, TLI = 0.95, RMSEA = 0.04, SRMR = 0.05) was obtained after minor modifications such as dropping 2 items on restriction and adding 3 error covariances. The internal reliability and the 2-week test-retest reliability were good. The scores on restriction were the lowest ever reported. When the influence of parenting practices on child BMI (dependent variable) was examined in a structural equation model (SEM), child BMI had a positive association with restriction and a negative association with pressure to eat. Restriction was positively influenced by concern about child weight. The second SEM treated parenting practices as dependent variables. Parental foreign origin and child BMI had direct effects on restriction, while pressure to eat was also influenced by parental education. While the resultsof the studysupport theusefulnessof theCFQ inSweden, carefullydesignedcross-cultural comparisons are needed to explain why the levels of restrictive feeding in Swedish families are the lowest reported. © 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/licenses/by-nc-sa/3.0/). Abbreviations: BMI, Body Mass Index; CN, Concern about child weight (CFQ factor); CFA, Confirmatory Factor Analysis; CFI, Comparative Fit Index; CFQ, Child Feeding Questionnaire; MLR, Maximum Likelihood with Robust standard errors estimation; MN, Monitoring (CFQ factor); NNFI, Non-normed Fit index; PCW, Perceived Child Weight (CFQ factor); PE, Pressure to Eat (CFQ factor); PPW, Perceived Parent Weight (CFQ factor); PR, Perceived Responsibility (CFQ factor); RMSEA, Root Mean Square Error of Approximation; RST, Restriction (CFQ factor); SD, Standard Deviation; SEM, Structural Equation Modeling; SRMR, Standardized Root Mean Square Residual; TLI, Tucker–Lewis Index. ☆ Acknowledgements: We thank all the participating mothers, Anne Normann who helped with data collection and John Barthelemy who entered the data. PN expresses special thanks to Karin Eli, PhD, for text editing and valuable discussions during the writing process. Research relating to this article was funded with unrestricted grants from Swedish Saving Bank, Nestle and Kellogg’s to PN. This work also was supported by VINNOVA Marie Curie International Qualification funds (Grant number 2011-0344) granted to PN. Conflict of interest: The authors declare no competing interests. Author contributions: PN conceived of the study, collected the data, performed the statistical analyses together with KS and wrote the manuscript. KS made a substantial contribution to the analysis and interpretation of the data as well as to manuscript preparation. AP made a substantial contribution to conception and design, and to interpretation of data. CEF and MSF supervised the coordination of the study and manuscript process. All authors read and approved the final manuscript and are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. 1 Shared last authorship. * Corresponding author. E-mail address: [email protected] (P. Nowicka). http://dx.doi.org/10.1016/j.appet.2014.06.027 0195-6663/© 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/licenses/by-nc-sa/ 3.0/). Appetite 81 (2014) 232–241