Development of an Eating Behavior Risk Score

Functional magnetic resonance imaging (fMRI) will be used to measure brain activation in response to images of palatable, energy-dense food portions of varying sizes. Activation will be assessed in brain regions involved in visceral interoception (e.g., insula, cerebellum) and self-regulation (e.g., dorsolateral prefrontal cortex). These neural responses will be correlated with children's PACE phenotype scores to explore neurobiological underpinnings of eating behaviors.

The PACE score will be calculated as a composite measure including: 1) children's food intake during two laboratory meals with varying portion sizes, 2) parent-reported appetite traits via the Children's Eating Behavior Questionnaire, 3) loss of control eating measured with the Pediatric Eating Disorder Screener, and 4) eating rate quantified through video-recorded meals and behavioral coding of bite rate and eating speed. This score reflects obesogenic eating phenotypes.

Child body fat percentage and adiposity will be measured using DXA scans, a validated imaging technique providing precise assessment of body composition. This measure will serve as the primary dependent variable to evaluate associations with PACE phenotype and changes over time.

Family SES will be assessed via parent self-report questionnaires, including family income levels and parental educational attainment. SES will be analyzed as a moderator of the relationship between PACE scores and child adiposity to explore social determinants of obesity risk.

PACE scores obtained at baseline and 12-month follow-up will be compared to evaluate the stability and trajectory of obesogenic eating behaviors in children over one year.

Parent-reported information on the child's race and ethnicity collected via standardized questionnaire to capture demographic diversity and potential confounding factors.

Highest level of education completed by parents, self-reported, to help understand socioeconomic context and potential impact on child health and behavior.

Highest level of education completed by parents, self-reported, to help understand socioeconomic context and potential impact on child health and behavior.

Parent-reported assessment of food security in the household using a validated food security questionnaire, to examine potential impact on child eating behaviors and adiposity.

Determined by family home zip code to classify rural versus urban residency, assessing environmental influences on child health and behavior.

Parent questionnaires assessing feeding styles, strategies, and control over child's food intake, providing insight into family eating environment.

Parent assessment of child's appetite-related behaviors using standardized questionnaires to capture tendencies influencing eating patterns.

Parent-reported measures of child temperament characteristics to explore behavioral factors that might influence eating and activity.

Pubertal development stage assessed by parent report using Tanner scale, to account for physiological maturation impacting metabolism and behavior.

Parent-reported child sleep duration and quality via standardized sleep questionnaires to evaluate potential effects on weight and behavior.

Direct child assessment of executive functions such as working memory, attention, and cognitive flexibility using the NIH Toolbox standardized tests.

Standardized assessment of child intelligence quotient using WASI-II.

Child's hedonic ratings of food items consumed during laboratory meals to assess preferences influencing intake.

Child's ratings of liking and wanting for foods presented during fMRI scans to correlate brain activation with subjective food reward.

Child self-reported hunger and fullness before meals using visual analog scales to control for appetite state during intake measures.

Assessment of child's awareness of internal bodily signals via heartbeat perception task, indicating sensitivity to visceral cues potentially linked to eating behavior.

Child self-reported questionnaire measuring awareness of internal bodily sensations relevant to appetite and satiety.

Objective measurement of physical activity through accelerometer devices combined with parent and child questionnaires to quantify movement levels.

Sleep duration in hours per night

Amount of food consumed by the child during a standardized meal in the laboratory setting to assess baseline intake independent of portion manipulation.

Measurement of child's consumption of palatable snacks offered after a meal when not hungry, assessing loss of control or hedonic eating.

Behavioral task evaluating the motivational value of food compared to alternative rewards, indicating reward sensitivity.

Sleep fragmentation index is the number of 1 minute bouts of sleep divided by the total sleep time. Higher scores equal worse quality sleep.

Percent of time in bed that is spent asleep, with higher scores equal to better quality sleep.

Minutes awake after onset of sleep.