Association of Picky Eating With Weight Status and Dietary Quality Among Low-Income Preschoolers

Acad Pediatr. 2018 Apr;18(3):334-341. doi: 10.1016/j.acap.2017.08.014. Epub 2017 Sep 5.


Background: Picky eating is common in children. Few studies have examined predictors of picky eating, and the association of picky eating with weight status and dietary quality is inconsistent in the literature. We aimed to identify predictors of picky eating and to test the association of picky eating with child body mass index z-score (BMIz), dietary quality, and micronutrient intake.

Methods: This was a cross-sectional analysis of baseline data from a randomized controlled trial to prevent obesity among 506 preschoolers attending Head Start. Parents completed questionnaires to assess picky eating and child temperament. Three 24-hour dietary recalls were collected to assess dietary intake. Multivariate regression models assessed child, parent, and family predictors of picky eating; additional models tested adjusted associations of picky eating with child BMIz, dietary quality (measured using the Healthy Eating Index-2010), and micronutrient intake.

Results: Picky eating was predicted by male sex, older child age, and more difficult temperament but not race/ethnicity, maternal body mass index, maternal depressive symptoms, household food insecurity, or single parent home. Picky eating was not associated with child BMIz or micronutrient deficiencies; it was inversely associated with total Healthy Eating Index-2010 score and servings of whole fruit, total vegetables, greens and beans, and total protein foods.

Conclusions: Pediatric providers should support parents in expanding the number of healthy foods the child eats to improve dietary quality, but reassure parents that picky eating is not associated with children's weight status or micronutrient deficiencies.

Keywords: children; nutrition; obesity; pediatrics; picky eating; weight.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Age Factors
  • Body Mass Index
  • Child, Preschool
  • Cross-Sectional Studies
  • Depression / epidemiology
  • Diet, Healthy*
  • Dietary Proteins
  • Fabaceae
  • Feeding Behavior
  • Female
  • Food Preferences*
  • Fruit
  • Humans
  • Male
  • Micronutrients*
  • Mothers / psychology
  • Mothers / statistics & numerical data
  • Pediatric Obesity / epidemiology*
  • Poverty*
  • Thinness / epidemiology*
  • Vegetables


  • Dietary Proteins
  • Micronutrients