A Longitudinal Investigation of Nutrition and Dietary Patterns in Children of Mothers with Eating Disorders Abigail Easter, PhD 1,4 , Ulrike Naumann, MSc 2 , Kate Northstone, PhD 3 , Ulrike Schmidt, MD, FRCPsych, PhD 1 , Janet Treasure, FRCP, FRCPsych, PhD 1 , and Nadia Micali, MD, MRCPsych, PhD 4 Objective To investigate dietary patterns and nutritional intake in children of mothers with eating disorders. Study design Mothers (N = 9423) from a longitudinal general population birth cohort study, the Avon Longitudinal Study of Parents and Children, completed Food Frequency Questionnaires on their children at 3, 4, 7, and 9 years of age. Macronutrient intake was estimated, and dietary patterns were obtained using principal components analysis. Linear regression and mixed-effects models were used to assess dietary patterns and nutritional intake among children of women with lifetime anorexia nervosa (AN, n = 140), bulimia nervosa (BN, n = 170), or AN+BN (n = 71), compared with children of women without eating disorders (unexposed women, n = 9037). Results Children in the maternal AN and BN groups had higher scores on the “health conscious/vegetarian” dietary pattern compared with unexposed children. Less adherence to the “traditional” dietary pattern was observed in children of exposed mothers, with more pronounced differences in early childhood. Children of women with AN and BN had higher intake of energy and children of women with BN had higher intake of carbohydrates and starch and lower intake of fat, compared with children in the unexposed group. Conclusions Maternal eating disorders are associated with altered offspring dietary patterns and macronutrient intake. Longitudinal changes in patterns of diet in children of women with eating disorders may increase the risk of weight gain or disordered eating later in life. (J Pediatr 2013;163:173-8). T he family provides an important context for the development of dietary attitudes and behaviors 1,2 ; accordingly, maternal diet has been shown to be one of the strongest predictors of childhood food consumption. 3 Eating disorders are char- acterized by severely disrupted eating habits and preoccupations with body weight and shape 4 ; therefore, such mothers may find catering for the nutritional needs of their children especially challenging. Previous research has indicated that children of women with eating disorders have an increased risk of feeding difficulties, which may in turn increase the risk for the de- velopment of an eating disorder. 5-7 Mothers with eating disorders have also be found to hold more distorted perceptions of their child’s weight and shape 8 and fear that preparing food for their children may lead to episodes of bingeing. 9,10 In the only long-term investigation of eating habits in children of women with eating disorders, Stein et al 11 reported that mothers with an eating disorder exerted more intrusive and controlling behaviors over their child’s eating and displayed higher levels of conflict at mealtimes when their children were 12-14 months old. At 10 years, their children displayed more disturbed eating habits and attitudes, compared with children of women without eating disorders. 12 Only one small study (N = 20) has investigated the quality of diet in children whose mothers have had an eating disorder. 13 Although the authors reported no major differences in dietary intake compared with children in the control group, there was some indication that less junk food was consumed by children of women with eating disorders. The purpose of this study was to investigate adherence to dietary patterns and nutrient intake in children of women with eating disorders, compared with children of women without eating disorders (unexposed group), in a longitudinal fashion across childhood using data from a large prospective cohort, the Avon Longitu- dinal Study of Parents and Children (ALSPAC). Methods ALSPAC is a longitudinal birth cohort study that enrolled pregnant women living within the former county of Avon, in southwest England, who were due to deliver their baby between the April 1, 1991, and December 31, 1992. 14 From the 1 Section of Eating Disorders, Department of Psychological Medicine and Psychiatry, Institute of Psychiatry, and 2 Department of Biostatistics and Computing, Kings College London, London, United Kingdom; 3 School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; and 4 Behavioral and Brain Sciences Unit, University College London, Institute of Child Health, London, United Kingdom The UK Medical Research Council, the Wellcome Trust, and the University of Bristol provide core support for Avon Longitudinal Study of Parents and Children. This article presents research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0606-1043). N.M. received a Clinical Scientist Award from the NIHR. The views expressed in this article are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health. The authors de- clare no conflicts of interest. 0022-3476/$ - see front matter. Copyright ª 2013 Mosby Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2012.11.092 ALSPAC Avon Longitudinal Study of Parents and Children AN Anorexia nervosa BN Bulimia nervosa FFQ Food Frequency Questionnaire PCA Principal component analysis 173