The prevalence of childhood obesity in Asia has been increasing, resulting in greater interest in potential risk factors, such as infants' health-related quality of life, temperament and eating behaviours.
Researchers from Rutgers University, Nestlé Nutrition Research, Asian Hospital & Medical Center in the Philippines and Wyeth Philippines conducted a pilot study to assess the utility of parent-reported outcome measures (PROMs) to examine the aforementioned factors in Filipino infants, as well as to analyse the relationships between these factors and infant sex, weight, and formula intake over time.
Questionnaire competence
They enrolled 40 healthy, month-old, formula-fed infants (20 males and 20 females) in a six-week prospective uncontrolled study, during which they were exclusively fed a standard tem infant formula enriched with alphalactalbumin.
On the first and 42nd days of treatment, they took the infants' anthropometric measurements, and their mothers completed a 97-item measure of health-related quality of life, known as the Infant Toddler Quality of Life Questionnaire (ITQOL), which covered six infant-focused and three parent-focused concepts.
They also completed a 24-item measure of infant temperament, called the Infant Characteristics Questionnaire (ICQ), and on day 42, an 18-item measure of infant appetite, called the Baby Eating Behaviour Questionnaire (BEBQ).
In addition, a three-day formula intake diary was completed before day 42. The researchers the used non-parametric statistics to evaluate correlations among the outcomes, and to compare outcomes based on visit and sex.
They reported that 39 of the infants enrolled completed the study, and that similar results were observed in both male and female infants.
All PROMs were fully completed (no missing responses), and on a scale of 0 (worst) and 100 (best), median ITQOL scores were 80 or higher, save for the temperament and mood general health perception scores on days one and 42.
In addition, ITQOL scores improved markedly between days one and 42, but not ICQ temperament scores. Mean standard deviation BEBQ scores — ranging from 1 to 5 — were high for enjoyment of food (4.59 to 4.65) and food responsiveness (3.53 to 4.34), but low for satiety responsiveness (2.5 to 3.23) and slowness in eating (1.71 to 2.31).
The researchers added that better health-related quality of life scores were significantly associated with high general appetite scores, greater enjoyment of food, and low levels of slowness in eating.
Future potential
They wrote that the ITQOL, ICQ and BEBQ were indeed feasible and potentially useful for assessing young infants in the Philippines, as they were easy to administer, completed by participants with no difficulty, and successfully scored.
However, a few of the individual PROMs scales were internally consistent, "requiring further adaptations for use in different populations".
At the same time, preliminary data found no sex differences when it came to formula intake, infant weight, and most of the questionnaire scale scores.
Generally, mothers perceived positive health-related quality of life for their infants across a wide range of infant- and parent-focused concepts, and a trend toward better infant temperament over time. Furthermore, the infants' overall eating behaviours indicated healthy appetites.
While a link between infant weight gain and temperament or BMI at 2.5 months was not found, an association between certain aspects of health-related quality of life and eating behaviours, as well as between satiety responsiveness and formula intake was reported.
The researchers concluded: "There are a lack of culturally relevant outcome measures and studies examining parental perceptions of infant behaviours, temperament and health-related quality of life in Asia.
"Preliminary data from this study support the potential utility of these questionnaires in future studies assessing cross-cultural differences in health-related quality of life, temperament and appetite, and the influence of these factors on parent-infant interactions, feeding practices and infant weight."
Source: Health and Quality of Life Outcomes
https://doi.org/10.1186/s12955-018-0944-5
"Health-related quality of life, temperament, and eating behavior among formula-fed infants in the Philippines: a pilot study"
Authors: Sheri Volger, et al.