Research Original Research| Volume 117, ISSUE 11, P1749-1756, November 2017

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Food Reluctance of Preschool Children Attending Daycare Centers Is Associated with a Lower Body Mass Index

Published:September 14, 2017DOI:



      Food reluctance can present as fussiness, picky eating, slowness in eating, and high satiety responsiveness. It can be associated with inadequate weight gain during early childhood. Although a majority of preschoolers attend daycare centers, associations between their eating behaviors at daycare and their body composition have not been studied.


      Our aim was to develop an estimate of food reluctance and to assess the relationship between food reluctance at daycare and body mass index (BMI) and waist circumference of preschoolers.


      We conducted a cross-sectional secondary analyses. Food reluctance was estimated using weighted digital plate waste analysis. Intra-rater, inter-rater, and test−retest reliability and convergent validity of the food reluctance score were tested. The food reluctance score was then compared to preschool children’s BMI and waist circumference.


      Participants included 309 children aged 3 to 5 years in 24 daycare centers across the Canadian province of New Brunswick.

      Main outcome measures

      Preschool children’s waist circumference and age-adjusted BMI derived from objectively measured height and weight were analyzed.

      Statistical analyses performed

      Intraclass correlations were used to determine the reliability of the new estimate. Spearman correlation was used to compare the estimate with parental report of food reluctance. Multivariate linear regressions were used to examine the relationship between food reluctance and waist circumference and age-adjusted BMI.


      The estimated food reluctance score demonstrated excellent inter- and intra-rater reliability (intraclass correlation>0.97; P<0.0001) and good test−retest reliability (intraclass correlation=0.72; P<0.0001). It also provided evidence of convergent validity through correlation with reluctance-related subscales of the Child Eating Behavior Questionnaire (ρ=.53, P<0.0001). Greater demonstration of food reluctance at the daycare center was associated with a lower age-adjusted BMI (adjusted β −1.41; 95% CI −.15 to −2.67), but was not associated with children’s waist circumference (adjusted β −.60; 95% CI −2.06 to .86).


      Signs of food reluctance can be observed in daycare and relate to lower BMI among preschoolers.


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      V. Surette is a registered dietician and territory manager, Nestlé Canada, Montreal, Quebec; at the time of the study, she was a graduate student, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada.


      S. Ward is assistant professor of nutrition, Université de Moncton, Moncton, Canada; at the time of the study, she was a PhD candidate, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada.


      P. Morin is an associate professor, Faculty of Physical Activity Sciences, Université de Sherbrooke, Sherbrooke, Canada.


      H. Vatanparast is an associate professor, University of Saskatchewan, School of Public Health, Saskatoon, Canada.


      M. Bélanger is an associate professor and director of research, Université de Sherbrooke, Centre de formation médicale du Nouveau-Brunswick, Moncton, Canada, and an epidemiologist, Réseau de santé Vitalité, Bathurst, Canada.