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Br J Psychiatry. 2019 Aug 5:1-7. doi: 10.1192/bjp.2019.174. [Epub ahead of print]

A longitudinal study of eating behaviours in childhood and later eating disorder behaviours and diagnoses.

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Research Associate,Great Ormond Street Institute of Child Health,University College London,UK.
Professor of Medical Statistics,Great Ormond Street Institute of Child Health,University College London,UK.
PhD Student,Social, Genetic & Developmental Psychiatry Centre,Institute of Psychiatry, Psychology & Neuroscience, King's College London;UK National Institute for Health Research Biomedical Research Centre,South London and Maudsley Hospital,UK; andDepartment of Medical Epidemiology and Biostatistics,Karolinska Institutet,Sweden.
PhD Student,Department of Psychiatry,Faculty of Medicine,University of Geneva,Switzerland.
Senior Research Associate,Medical Research Council Integrative Epidemiology Unit,University of Bristol; andPopulation Health Sciences,Bristol Medical School,University of Bristol,UK.
Professor,The Charles Bronfman Institute for Personalized Medicine,The Mindich Child Health and Development Institute, Icahn Mount Sinai School of Medicine,New York,USA.
Consultant Clinical Psychologist,Great Ormond Street Institute of Child Health,University College London,UK.
Professor of Eating Disorders,Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Sweden;Department of Psychiatry,University of North Carolina at Chapel Hill; andDepartment of Nutrition,University of North Carolina at Chapel Hill,USA.
Senior Lecturer and Honorary Consultant Psychiatrist,Great Ormond Street Institute of Child Health,University College London,UK;Department of Psychiatry,Faculty of Medicine,University of Geneva; andChild and Adolescent Psychiatry Division,Department of Child and Adolescent Health,Geneva University Hospital,Switzerland.



Eating behaviours in childhood are considered as risk factors for eating disorder behaviours and diagnoses in adolescence. However, few longitudinal studies have examined this association.AimsWe investigated associations between childhood eating behaviours during the first ten years of life and eating disorder behaviours (binge eating, purging, fasting and excessive exercise) and diagnoses (anorexia nervosa, binge eating disorder, purging disorder and bulimia nervosa) at 16 years.


Data on 4760 participants from the Avon Longitudinal Study of Parents and Children were included. Longitudinal trajectories of parent-rated childhood eating behaviours (8 time points, 1.3-9 years) were derived by latent class growth analyses. Eating disorder diagnoses were derived from self-reported, parent-reported and objectively measured anthropometric data at age 16 years. We estimated associations between childhood eating behaviours and eating disorder behaviours and diagnoses, using multivariable logistic regression models.


Childhood overeating was associated with increased risk of adolescent binge eating (risk difference, 7%; 95% CI 2 to 12) and binge eating disorder (risk difference, 1%; 95% CI 0.2 to 3). Persistent undereating was associated with higher anorexia nervosa risk in adolescent girls only (risk difference, 6%; 95% CI, 0 to 12). Persistent fussy eating was associated with greater anorexia nervosa risk (risk difference, 2%; 95% CI 0 to 4).


Our results suggest continuities of eating behaviours into eating disorders from early life to adolescence. It remains to be determined whether childhood eating behaviours are an early manifestation of a specific phenotype or whether the mechanisms underlying this continuity are more complex. Findings have the potential to inform preventative strategies for eating disorders.Declaration of interestC.M.B. reports conflict of interest with Shire (grant recipient, Scientific Advisory Board member) and Pearson and Walker (author, royalty recipient). All other authors have indicated they have no conflicts of interest to disclose.


Anorexia nervosa; binge eating disorder; bulimia nervosa; eating behaviour; epidemiology


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