Research Original Research| Volume 118, ISSUE 7, P1208-1219, July 2018

Child Feeding Style and Dietary Outcomes in a Cohort of Latino Farmworker Families

Published:September 29, 2017DOI:



      The high level of obesity in Latino children, especially in farmworker families, may be partly attributed to feeding styles of parents. Feeding styles used in Latino farmworker families have not been well characterized.


      This study sought to identify and describe feeding styles used by mothers in farmworker families with 2.5- to 3.5-year-old children, describe how styles change over time, and characterize the relationship of feeding styles to dietary outcomes and measures of overweight and obesity.


      This was a longitudinal cohort study, with families participating for a 2-year period; surveys were administered to mothers with varying frequency depending on the instrument, and dietary measurements were collected at baseline and 12 and 24 months.


      Eligible participants were self-identified Latino women with a co-resident child aged 2.5 to 3.5 years old and at least one household member engaged in farm work during the previous year. The sample included 248 farmworker families enrolled between 2011 and 2012 in the Niños Sanos study, a longitudinal investigation of Latino mothers and their young children in rural North Carolina. Eleven families provided incomplete dietary data, so the analysis included 237 families. Fifteen families were lost to follow-up and 12 withdrew during the course of the study.

      Main outcome measures

      Feeding style was assessed using items from the Caregiver’s Feeding Style Questionnaire, selected dietary components were assessed using the Revised Children’s Diet Quality Index, and weight outcomes were determined using body mass index-for-age percentile. Performance on the Caregiver’s Feeding Style Questionnaire items was used to assign mothers to one of four feeding style states.

      Statistical analyses performed

      Exploratory factor analysis was conducted on baseline data to verify the replicability of the factor structure of the instrument Caregiver’s Feeding Style Questionnaire. Hidden Markov Model analysis was used to delineate different subtypes of feeding style. Multivariable mixed-effects regression models were used to assess the impact of feeding style on selected dietary components, energy intake, and body mass index-for-age percentile.


      Four distinct states emerged from the Hidden Markov Model: low parent-centered (PC)/moderate child-centered (CC) feeding style (28% at baseline), high PC/CC without physical control (24%), high PC/CC (26%), and moderate PC/CC (22%). The low PC/moderate CC state increased in prevalence over time. Compared to high PC/CC, the low PC/moderate CC state was associated with greater intake of added sugars (P<0.01), lower intake of whole grains and vegetables (P<0.01), and lower overall diet quality (P<0.05). Children in low PC/moderate CC also had higher mean body mass index percentiles (76.2 percentile vs 66.7 percentile in high PC/CC; P<0.001).


      High PC feeding along with high CC feeding is associated with improved diet quality and weight outcomes for children in the study.


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      E. H. Ip is a professor, Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC.


      S. A. Marshall is a research associate, Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC.


      T. A. Arcury is a professor and vice chair for research, Department of Family and Community Medicine, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC.


      G. Trejo is a project manager, Department of Pediatrics, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC.


      J. A. Skelton is an associate professor, Department of Pediatrics, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC.


      S. A. Quandt is a professor, Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC.


      C. K. Suerken is a senior biostatistician, Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; at the time of the study, she was a biostatistician III, Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC.

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