Jornal de Pediatria · 7 authors, 3 centres
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This cross-sectional study of 160 Brazilian children aged 7–10 found that obese children take larger bites, perform fewer chewing sequences, and finish meals faster than normal-weight children. These altered masticatory patterns may contribute to increased food intake and excess weight gain. The findings suggest that chewing behavior could be a modifiable target in childhood obesity interventions.
**Background:** Childhood obesity is a growing public health concern, affecting approximately 43 million children under 5 years worldwide and 26.6–30% of Brazilian children aged 5–19. Mastication influences feeding behavior and satiety through orosensory signaling, and rapid eating with insufficient chewing has been linked to reduced satiety and increased food intake. Previous research suggests that higher BMI in children is associated with faster eating and shorter masticatory cycles, but detailed masticatory parameters in obese children remain poorly characterized. This study aimed to analyze and compare masticatory characteristics among normal weight, overweight, and obese children aged 7–10 years.
**Methods:** This comparative cross-sectional study was conducted in Vitória de Santo Antão, Pernambuco, northeast Brazil, from October 2017 to May 2018. A stratified probabilistic sample was drawn from municipal schools; three schools were selected based on structural availability. The final sample included 160 children (84 boys, 76 girls) aged 7–10 years whose parents provided written informed consent. Sample size was calculated using WinPepi (estimated population 500, 95% CI, 13% obesity prevalence, 20% sample loss, minimum n=162). Children were divided into normal weight (≥ Z-score -2 and < +1, n=101), overweight (≥ +1 and < +2, n=33), and obesity (≥ +2, n=26) groups per WHO BMI-for-age standards. Exclusion criteria included neurological impairment, orthodontic treatment, speech therapy, dry mouth/salivary gland disease, severe malocclusion, facial surgery, craniofacial malformations, and use of anxiolytics, antidepressants, or anticonvulsants. Anthropometric measurements (weight to 0.1 kg, height to 0.5 cm) were taken by trained technicians. Dental status was assessed by a single trained dentist using DMFT index and WHO malocclusion index. Food intake was evaluated using the SISVAN Food Consumption Markers form via interview. Masticatory parameters were recorded by video (Sony Cyber-Shot DSC-HX300) during free mastication of a chocolate-flavored biscuit after 12h fasting and 24h without exercise. Parameters included number of masticatory sequences, number of masticatory cycles, chewing rate (cycles/min), feeding time (s), and bite size (g, measured using bread). Orofacial myofunction was assessed using the OMES-e protocol (mastication domain only). Two trained examiners evaluated recordings; intraclass correlation coefficients (ICC) ranged from substantial (chewing rate ICC=0.764, OMES-e ICC=0.774) to perfect (feeding time ICC=1.000). Statistical analysis used Kolmogorov-Smirnov normality test, Kruskal-Wallis test with Dunn post-hoc, Pearson's chi-square, and Fisher's exact tests (SPSS v17.0, significance p<0.05).
**Key Results:** Overweight/obese children comprised 36.9% of the sample (n=59). Food intake patterns were similar across groups; approximately 70% of children ate while watching TV or using electronic devices regardless of nutritional status. Obese children had significantly larger bite size (median=6.0g, Q1-Q3=4.0-9.0) compared to normal-weight children (median=5.0g, Q1-Q3=4.0-7.0, p=0.049). Obese children performed fewer masticatory sequences (median=3.0, Q1-Q3=2.0-3.2) than normal-weight children (median=4.0, Q1-Q3=3.0-5.0, p=0.024). Feeding time was shorter in obese children (median=62.5s, Q1-Q3=50.5-70.0) compared to both normal-weight (median=66.0s, Q1-Q3=56.5-78.0, p=0.039) and overweight children (median=66.0s, Q1-Q3=58.0-81.5, p=0.039). No significant differences were found in number of masticatory cycles, chewing rate, or OMES-e score between groups. Dental status (decayed, missing, filled teeth) was similar across groups.
**Clinical Implications:** This study demonstrates that obese children aged 7–10 years exhibit distinct masticatory patterns—larger bite size, fewer chewing sequences, and faster eating—compared to normal-weight peers. These alterations may reduce orosensory signaling and delay satiety onset, potentially promoting overeating and weight gain. The findings suggest that masticatory behavior could serve as a modifiable therapeutic target in childhood obesity interventions, such as training children to chew more thoroughly and eat more slowly. However, the cross-sectional design precludes causal inference; longitudinal studies are needed to determine whether altered mastication precedes or results from obesity. The high prevalence of distracted eating (70% of children) across all weight groups also highlights the need for interventions addressing mealtime attention. Limitations include the cross-sectional design, use of a single test food (chocolate biscuit), and potential selection bias from school-based sampling.