Health-related quality of life, temperament, and eating behavior among formula-fed infants in the Philippines: A pilot study

Abstract

Background: The rising prevalence of childhood obesity in Asia has led to interest in potential risk factors such as infant health-related quality of life (HRQoL), temperament and eating behaviors. This pilot study evaluated the utility of administering parent-reported outcome measures (PROMs) to explore these factors in Filipino infants and examined the relationships between these factors and infant sex, formula intake and weight, over time. Methods: Forty healthy, 4-week-old, formula-fed infants (n=20 males) were enrolled in this 6-week, prospective, uncontrolled study during which infants were exclusively fed a standard term infant formula enriched with alpha-lactalbumin. On Day-1 and 42, anthropometrics were measured and mothers completed a 97-item measure of HRQoL [Infant Toddler Quality of Life Questionnaire (ITQOL)] covering 6 infant-focused and 3 parent-focused concepts and a 24-item measure of infant temperament [Infant Characteristics Questionnaire (ICQ)]. At Day-42, mothers also completed an 18-item measure of infant appetite [Baby Eating Behaviour Questionnaire (BEBQ)]. A 3-day formula intake diary was completed before Day-42. Nonparametric statistics were used to evaluate correlations among outcomes and compare outcomes by visit and sex. Results: Thirty-nine infants completed the study; similar results were observed in males and females. Completion of PROMs was 100% with no missing responses, but Cronbach's α was low for many concept scales scores. ITQOL scores [range 0 (worst)-100 (best)] were generally high (median≥80) except for Day-1 and Day-42 Temperament and Mood and Day-1 General Health Perceptions scores. ITQOL but not ICQ temperament scores improved significantly between Day-1 and Day-42 (P<0.01). Mean±standard deviation BEBQ scores (range 1-5) were high for Enjoyment of Food (4.59±0.60) and Food Responsiveness (3.53±0.81), and low for Satiety Responsiveness (2.50±0.73) and Slowness in Eating (1.71±0.60). Better HRQoL scores were significantly (P<0.05) associated with high General Appetite scores (3 ITQOL concepts, r=0.32 to 0.54), greater Enjoyment of Food (4 ITQOL concepts, r=0.35 to 0.42) and low levels of Slowness in Eating (7 ITQOL concepts, r=-0.32 to -0.47). Conclusion: Findings demonstrated the utility of the ITQOL, ICQ and BEBQ for measuring HRQoL, temperament and eating behavior, and the need for further adaptations for use in Filipino infants.