Table 2.

Characteristics and Main Findings of Included Studies

First author (year)	Study design	Age range	Sample size	Definition of picky eating (PE) or food neophobia (FN)	Prevalence of PE or FN	Measure of PE or FN	Weight status variable	Relationship between PE or FN and weight status
Antoniou (2015)32	Longitudinal	5–9 years	2814	PE: five-point Likert scale assessing: diet consists of only a few foods, unwilling to eat many of the foods that our family eats at mealtimes, fussy or picky about what child eats; used quartile split for analysis	14% at 5 years	CFQ	Parent report; categorical weight categories	PE more often underweight (23% vs. 18%) and less often overweight (6% vs. 10%) at 5 years; PE less likely to be overweight at 9 years if BMI is above median for age/gender at 5 years [OR 0.21 (95% CI: 0.06–0.76)] and no association if BMI is below median at 5 years [OR 0.95 (0.47–1.94)], adjusting for baseline BMI
Brown (2015)33	Cross sectional	18–24 months	298	PE: food fussiness subscale	Not reported	CEBQ	Parent report; weight z-scores	Weight inversely associated with PE (Pearson's r = −0.171, p = 0.003)
Cao (2012)34	Cross sectional	12–18 months	219	PE: food fussiness subscale	Not reported	CEBQ	Measured; BMIz (Chinese growth curves)	No association
Carruth (1998)25	Longitudinal	2 of: 24, 28, 32, or 36 months	118	PE: based on response to 20 feeding behavior questions; unclear how participants labeled as picky vs. nonpicky	36%	Picky eating questionnaire (modified from Pelchat and Pliner)	Measured; weight and height as continuous variables	No significant differences between picky and nonpicky males and females by t-test; did not adjust for baseline weight
Carruth (2000)17	Longitudinal	42, 60, 72, and 84 months	71	PE: caregiver asked, “is your child a picky eater?” (yes/no)	32% never; 46% >3 times in the interviews; 10% at every interview; 17% consistently	Picky eating questionnaire (modified from Pelchat and Pliner)	Measured; weight and height as continuous variables	No significant differences between picky and nonpicky males and females by t-test at each time point; did not adjust for baseline weight
Carruth (2004)18	Cross sectional	4–24 months	3022	PE: caregiver reported their child is somewhat or a very picky eater (as opposed to not a picky eater)	19% of 4–6-month olds; 50% of 19–24-month olds.		Parent report; WFA percentiles	Children in higher weight-for-age percentiles were less likely to be picky (WFA 0%–25% referent; WFA 25%–50%, 50%–75%, and 75%–100% had OR 0.6 (95% CI: 0.5–0.9)
Chatoor (2000)22	Cross sectional	12–37 months	102	PE: responded often or always to whether their child is a picky eater (as opposed to sometimes or never)	NA		Measured; percent ideal body weight	PE mean% ideal body weight 102.4, healthy eater mean% ideal body weight 107.7 (p < 0.05)
Dubois (2007)11	Longitudinal	2.5, 3.5 and 4.5 years	1498	PE: children who “always” eat different meals than rest of family, “often” refuse to eat the right food, or “often” refuse to eat	14% at 2.5 years, 17% at 3.5 years, and 16% at 4.5 years. 30% classified as picky eaters at some point. 5.5% classified as picky eaters all 3 years.	Survey completed by mothers, EBQ	Measured; BMI categorical	Increased odds of being underweight at 4.5 years [OR 2.4 (95% CI 1.4–4.2)] if picky at all three ages compared to children who were never picky eaters; no association with weight if never picky or only at one/two ages; increased proportion of underweight with increased PE (13.2% if never picky, 18.3% if once or twice, 26.8% if picky at all three ages, p < 0.05); mean BMI at 4.5 years significantly lower (16.4 vs. 16.7) if ever or always reported at picky vs. those who were never picky eaters (p = 0.05); did not adjust for baseline weight
Ekstein (2010)12	Case–control	14–92 months	170	PE: caretakers described “unwillingness to eat familiar foods or try new foods, severe enough to interfere with daily routines to an extent that was problematic to the parent, child, or parent–child relationship” for more than one month	NA	Cases: Identified by referral to a clinic for PE behaviors Controls: From primary care offices without history of picky eating	Obtained from medical record; weight (continuous) and WFL (categorical)	Increased risk of being underweight [OR 3.6 (95% CI: 1.2–10.7), 20.6% vs. 6.6%, p = 0.02]
Equit (2013)35	Cross sectional	4–7 years	1090	PE: selective eating—avoiding certain foods, eating a narrow range of foods, and unwillingness to try new foods	34%	Latent class analysis of novel questionnaire	BMI categorical (>90% overweight, <3% underweight)	No association
Faith (2013)26	Cross sectional	4–7 years	132	FN: “tendency to avoid eating unfamiliar foods”	40%	CFNS	Measured; BMIz	No association (r = −0.003, p = 0.78)
Ferreira (2008)27	Cross-sectional	6–10 years	1225	PE: parents answered no to “eats everything”	23.1% overall; 26% if normal weight, 14% if overweight, and 7% if obese (P < 0.001)	Novel questionnaire	Measured; BMI, categorical	Decreased risk of obesity: Boys OR 0.15 (95% CI: 0.04–0.63), girls OR 0.19 (95% CI: 0.06–0.64)
Finistrella (2012)13	Cross sectional	2–6 years	127	FN: “unwillingness to eat novel foods.” PE: diet consists of only a few foods; unwilling to eat many of the foods that family eats at mealtimes; fussy or picky about what child eats	Not reported	CFNS, CFQ	Measured; BMIz, BMI categorical	Overweight/obese children were more picky (6.9 ± 2.2 vs. 5.7 ± 1.5, p = 0.03) and neophobic (18.8 ± 6.4 vs. 15.7 ± 7.6, p = 0.03) than normal weight children
Galloway (2005)28	Cross sectional	9 years	173	PE: diet consists of only a few foods; unwilling to eat many of the foods that our family eats at mealtimes; fussy or picky about what child eats	25% with score of 3 or greater; 48% by median split of the data	CFQ	Measured, BMI, categorical	Lower proportion of PE were overweight/obese (20% vs. 43%, p < 0.01); PE had lower BMIs (t = 2.10, p < 0.05)
Gregory (2010)36	Longitudinal	2–4 and 3–5 years	156	PE: food fussiness subscale	Not reported	CEBQ	Measured; BMIz	No association (r2change = 0.01, p = 0.707) adjusting for baseline BMiz
Hittner (2011)37	Longitudinal	1 and 3 years	487	PE: fussy eaters—highly reactive eaters, small appetite, distractible; identified through factor analysis	9%	Novel questionnaire	Measured; weight-for height z-score (age 1), BMIz (age 3)	Lower weight-for-height z-score at year 1 (mean −1.02, SD 1.26); no association with change in standardized weight from year 1 to year 3 (mean 0.48, SD 1.25, p = 0.4)
Jacobi (2003)19	Longitudinal	4 and 5 years	135	PE: “is your child a picky eater” at 4 and 5 years old; picky if “sometimes” at and 5 years or “often” at least once	21%	SFQ	Measured; BMI	No association overall; picky girls had increase in BMI (15.3–15.7) over one year compared to nonpicky girls (BMI 16.4–16.3)
Jansen (2012)38	Cross sectional	4 years	4987	PE: food fussiness subscale	Not reported	CEBQ	Measured; BMIz	BMIz inversely associated with FF [bta = −0.07 (95 CI: −0.1, −0.04)]
Jiang (2014)39	Cross sectional	3–6 years	603	PE: food fussiness subscale	Not reported	CPEBQ	Measured; BMI categorical (Chinese standards)	Increased FF associated with increased weight status (NW 2.25 ± 0.7, OW 2.69 ± 0.69, OB 3.36 ± 0.72, p < 0.02)
Johnson (2015)40	Cross sectional	4 years	180	FN: score >35	44%	CFNS	Measured; BMIz	No association
Laureati (2015)41	Cross sectional	6–9 years	528	FN: score categorized as low (lower quartile), medium (25–75%ile), and high (highest quartile)	Not reported	FNS (Italian adaptation)	Measured; BMI/BMIz, categorical	No association
Lewinsohn (2005)42	Cross sectional	3 years	93	PE: subscore based on factor analysis	Not reported	ORI-CEBI	Parent report; BMI	No association
Li (2008)53	Cross sectional	11–17 years	1792	PE: fussy eaters—“only having favorite food and avoid unfavorite foods”	55%		Measured; BMI	Nonfussy eaters were 1.5 (95% CI: 1.2–2.2) times more likely to be overweight/obese
Loh (2013)43	Cross sectional	13 years	646	PE: food fussiness subscale, split into two components through factor analysis; “dislike toward food” and “trying new foods”	Not reported	CEBQ	Measured; BMIz	Negative association with “dislike toward food” [beta −0.12 (95% CI: −0.23, −0.02)]; no association with “trying new foods” [beta −0.05 (−0.12, 0.02)]
Mackenbach (2012)44	Cross sectional	3–4 years	3137	PE: food fussiness subscale		CEBQ	Measured, BMIz and BMI categorical	Negative correlation with BMIz (Pearson correlation coefficient −0.07, p < 0.01)
Mascola (2010)20	Longitudinal	2–11 years	120	PE: parents responded to “Is your child a picky eater?” with “often” or “always” (as opposed to never, rarely, or sometimes)	13–22% at any time point; 39% at some point	SFQ	Measured; BMI	No association; did not adjust for baseline BMI
Moroshko (2013)45	Cross sectional	2–5 years	90	PE: diet consists of only a few foods; unwilling to eat many of the foods that our family eats at mealtimes; fussy or picky about what child eats FN: “caution around unfamiliar foods”	Not reported	CFQ, CFNS	Parent report; BMIz	No association
Morrison (2013)29	Cross sectional	2.8–5.8 years	222	PE: food fussiness, slowness in eating, emotional under-eating, satiety responsiveness, and enjoyment of food (loaded together in principal component analysis)	Not reported	CEBQ	Measured; BMIz	Negative correlation (−0.24, p < 0.01)
Mosli (2015)46	Cross sectional	4–8 years	274	PE: food fussiness subscale	Not reported	CEBQ	Measured; BMI categorical	Overweight/obese with lower mean FF subscale score compared to healthy weight (2.58 ± 0.79 vs. 2.80 ± 0.72, p = 0.02)
Perry (2015)47	Cross sectional	2 years	330	FN: total CFNS score (range 6–24)	Not reported	CFNS	Measured; BMIz	No association (beta = −0.061, p = 0.24)
Rodenburg (2012)48	Longitudinal	7–10 years	1275	PE: food fussiness subscale	Not reported	CEBQ	Measured; BMIz	No association (beta = 0.00, p > 0.05) if adjust for baseline BMIz; negative association (beta = −0.08, p < 0.01) if do not adjust for baseline BMIz
Sleddens (2008)49	Cross sectional	6–7 years	135	PE: food fussiness subscale	Not reported	CEBQ	Parent report; BMIz	No association (beta = −0.10, p = 0.3)
Spence (2011)50	Cross sectional	4–5 years	1730	PE: food fussiness subscale	Not reported	CEBQ	Measured; BMI categorical	Negative association with weight status and mean FF subscale score: obese 2.87, overweight 2.98, normal weight 3.08, and underweight 3.27 (ptrend < 0.01)
Svensson (2011)51	Cross sectional	1–6 years	174	PE: food fussiness subscale	Not reported	CEBQ	Parent report; BMIz categorical	No association
Tan (2012)30	Cross sectional	3–12 years	85	FN: “fear of new foods, rejecting foods that are unfamiliar”	Not reported	CFNS	Parent report; BMIz	No association (correlation −0.09, p > 0.05)
Tharner (2014)31	Cross sectional	4 years	3117	PE: fussy eating—high food fussiness, slow eating, low enjoyment of food (loaded together in latent profile analysis)	5.8%	CEBQ at 4 years old	Measured; BMI and BMIz categorical	Increased proportion of underweight (19.3% vs. 12.3%, p = 0.02) and lower (−0.18 ± 0.07 vs. 0.10 ± 0.02, p < 0.01)
Webber (2009)52	Cross sectional	7–12 years	406	PE: food fussiness subscale	Not reported	CEBQ	Measured; BMIz categorical	Negative association with weight and mean FF subscale score (ptrend = 0.023 for girls and ptrend = 0.045 for boys)
Werthmann (2015)16	Cross sectional	2.5–4 years	32	PE: food fussiness subscale and laboratory assessment of food acceptance (number of spoonfuls consumed of yogurt with a variety of textures, colors, and tastes)	Not reported	CEBQ; food acceptance test	Weight measured, height parental report; BMI categorical	No association with parental report or behavioral measures of food acceptance
Wright (2007)21	Cross sectional	30 months	455	Faddy/PE: parents responded definitely/maybe/no to the question “is your child a faddy eater” Limited variety of foods: parents responded definitely/maybe/no to the question “does your child eat a limited variety of foods”	Faddy: 8.2% definitely 7.7% maybe Limited variety: 17.6%	Novel questionnaire	Parent report; weight SD scores and BMIz	Increased proportion of underweight at 2 years for faddy eaters (11.1% vs. 3.5%, p = 0.01); no difference in proportions for eating limited variety of foods; no association with faddy eating or limited variety and BMIz
Xue, Lee (2015)23	Cross sectional	7–12 years	793	PE: consume “an inadequate variety and amount of food(s) through rejection of foods that were familiar (and unfamiliar)”; parents asked “Do you consider your child as having picky eating behavior?” and if answered somewhat or always then classified as picky	59.3%		Measured; BMIz	Lower BMI [beta −1.198 (95% CI: −1.653, −0.743)] and BMIz [beta −0.383 (95% CI: −0.563, −0.203)]
Xue, Zhao (2015)24	Cross sectional	3–7 years	937	PE: defined as consuming “an inadequate variety and amount of food(s) through rejection of foods that were familiar (and unfamiliar)”; parents asked “Do you consider your child as having picky eating behavior?” and if answered somewhat or always then classified as picky	54%; 42% lasted 0–2 years, 25% lasted 2–3 years, and 21% lasted >3 years		Measured; BMI	No association during first or second year of PE [beta 0.01 (95% CI: −0.14, 0.16)] or third year of PE [beta −0.17 (95% CI: −0.36, 0.01)]; decreased BMI if PE >3 years [beta −0.25 (95% CI: −0.45, −0.06)]

BMIz, body mass index z-score; CEBQ, Child Eating Behavior Questionnaire; CFNS, Child Food Neophobia Scale; CFQ, Child Feeding Questionnaire; CPEBQ, Chinese Preschoolers' Eating Behavior Questionnaire; EBQ, Eating Behavior Questionnaire; FF, food fussiness; FN, food neophobia; ORI-CEBI, Oregon Research Institute Child Eating Behavior Inventory; PE, picky eating; SD, standard deviation; SFQ, Stanford Feeding Questionnaire; WFA, weight for age; WFL, weight for length.