Growth trajectories of children who are picky eaters stay on track

Parents of picky eaters need not worry so much about their child’s growth, as evidence from a recent study reveals that mean weight, height and body mass index (BMI) trajectories of picky eaters do not indicate growth faltering when compared with their nonpicky peers.

However, “[t]he prevalence of thinness among some picky eaters is notable, suggesting that some children may need specific early identification, intervention and growth surveillance,” the researchers said.

Picky eaters were identified in the Avon Longitudinal Study of Parents and Children cohort at age 3 years. Height and weight were measured on seven occasions (age 7–17 years) and body composition (via dual-energy x-ray absorptiometry) on five occasions (age 9–17 years).

Using BMI classifications, children were categorized as thin, normal, overweight or obese at each age point. Adjusted multiple regression analysis and mixed-design repeated measures ANOVA were used to analyse the data.

Picky eating showed a main effect on height and weight, as well as on BMI and lean mass index (LMI) in boys only (lower in picky eaters; p-all≤0.044), but not on percentage body fat or fat mass index (p-all>0.2). [Eur J Clin Nutr 2019;73:869-878]

Picky eaters showed mean height, weight and BMI consistently above the 50th centiles of reference growth charts. Although more than two-thirds of picky eaters were not thin at any age point, being picky was associated with an increased likelihood of being thin at a few age points.

A few studies reported evidence of picky eating being predictive of thinness or being protective against becoming overweight. [Int J Behav Nutr Phys Act 2015;doi:10.1186/s12966-015-0313-2; J Hum Nutr Dietetics 2015;doi:10.1111/jhn.12322]

“The only study to our knowledge to include data from teenagers is that of Berger [and colleagues] in the US,” the researchers said. “[G]irls identified as persistent picky children assessed biannually had lower BMIs than nonpicky children at every age point from 5 to 15 years of age and were less likely to become overweight in teenage years.” [Am J Clin Nutr 2016;doi:10.3945/ajcn.116.142430]

The current study broadened the work of Berger and colleagues by including boys as well as girls and extending the top of the age range from 15 to 17 years. The current findings also supported those of Berger’s in that picky eaters also tracked about 10–15 BMI centile points below that of nonpicky children, but picky eaters in this study tracked on about the 75th rather than the 50th centile.

Of note, no between-group difference was noted in energy intake at 3 years of age, but other studies found that picky eaters consumed less or more energy than controls. [Eur J Clin Nutr 2007;61:846-855; J Am Acad Child Adolesc Psychiatry 2003;42:76-84]

In addition, diets of picky eaters tended to be low in key micronutrients that are essential for growth. [J Am Coll Nutr 1998;17:180-186; J Am Coll Nutr 2000;19:771-780]

“There is evidence for continued differences in diet at 10 and 13 years of age, particularly for meat, fruit and vegetables, between picky eaters and nonpicky eaters in this cohort,” the researchers said. [Proc Nutr Soc 2017;76(OCE4):E121]