Association between dietary pattern and cardiometabolic risk in children and adolescents: a systematic review

Independent predictors of insulin resistance in Brazilian adolescents: Results of the study of cardiovascular risk in adolescents-Brazil

Considering the current changes in dietary patterns and the increasing prevalence of excess weight throughout the world, several studies have reported insulin resistance, which is a key driver of many chronic diseases, to be an important public health problem in all age groups. Therefore, the aim of the present study was to identify the prevalence and independent predictors of insulin resistance in Brazilian adolescents. A cross-sectional study was conducted with a probabilistic, representative sample of Brazilian adolescents (n = 37,023) who participated in the Study of Cardiovascular Risk in Adolescents. Data were collected on demographic, socioeconomic, lifestyle, anthropometric, and biochemical characteristics as well as antioxidant micronutrient intake (vitamins A, C, E, zinc, and selenium). Insulin resistance was determined using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and classified based on the 75th percentile of the sample distribution. Insulin resistance was detected in 27% of the adolescents and was more prevalent among those aged 12 to 14 years (PR: 1.26 [95%CI: 1.13;1.41]), those residing in the southern and south-eastern regions of the country (PR: 1.47 [95%CI: 1.27;1.70]), those who were physically inactive (PR: 1.12 [95%CI: 1.02;1.23]), and those did not consume alcohol (PR: 1.50 [95%CI: 1.13;1.99]). The prevalence of insulin resistance was 2.5-fold higher among individuals with severe obesity (PR: 2.49 [95%CI: 2.07;3.00]). Waist circumference indicative of cardiovascular risk and high serum triglyceride levels increased the likelihood of insulin resistance (PR: 1.37 [95%CI: 1.19;1.59] and 1.60 [95%CI: 1.45;1.78], respectively). The prevalence of the outcome was higher among adolescents in the lower quartiles of vitamin E intake (p<0.05). In the present study, the prevalence of insulin resistance was high among Brazilian adolescents and we identified sociodemographic, lifestyle, anthropometric, biochemical, and dietary predictors of this outcome.

Associations of Dietary Intake on Biological Markers of Inflammation in Children and Adolescents: A Systematic Review

BACKGROUND

In children and adolescents, chronic low-grade inflammation has been implicated in the pathogenesis of co- and multi-morbid conditions to mental health disorders. Diet quality is a potential mechanism of action that can exacerbate or ameliorate low-grade inflammation; however, the exact way dietary intake can regulate the immune response in children and adolescents is still to be fully understood.

METHODS

Studies that measured dietary intake (patterns of diet, indices, food groups, nutrients) and any inflammatory biomarkers in children and adolescents aged 2 to19 years and published until November 2020 were included in this systematic review, and were selected in line with PRISMA guidelines through the following databases: Academic Search Complete, CINAHL, Global Health, Medline COMPLETE and Web of Science-Core Collection. A total of 53 articles were identified.

RESULTS

Results show that adequate adherence to healthful dietary patterns such as the Mediterranean diet, or food groups such as vegetables and fruit, or macro/micro nutrients such as fibre or vitamin C and E, are associated with decreased levels of pro-inflammatory biomarkers, mainly c-reactive protein (CRP), interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α), whereas adherence to a Western dietary pattern, as well as intake of food groups such as added sugars, macro-nutrients such as saturated fatty acids or ultra-processed foods, is associated with higher levels of the same pro-inflammatory biomarkers.

CONCLUSIONS

This is the first systematic review examining dietary intake and biological markers of inflammation in both children and adolescents. A good quality diet, high in vegetable and fruit intake, wholegrains, fibre and healthy fats ameliorates low-grade inflammation, and therefore represents a promising therapeutic approach, as well as an important element for disease prevention in both children and adolescents.

Dietary Patterns, Blood Pressure and the Glycemic and Lipidemic Profile of Two Teenage, European Populations

The present study sought to retrospectively investigate the dietary habits of two adolescent, European populations from the cross-sectional Greek TEENAGE Study and French STANISLAS Family Study. We aimed to explore the relation between the populations' dietary patterns and blood pressure, glycemic and lipidemic profile. Dietary patterns were extracted via Principal Component Analysis (PCA), based on data collected from two 24 h dietary recalls for the TEENAGE study and a 3-day food consumption diary for the STANISLAS study. Multiple linear regressions and mixed models analyses, adjusting for confounding factors, were employed to investigate potential associations. A total of 766 Greek teenagers and 287 French teenagers, were included in analyses. Five dietary patterns were extracted for each population accounting for 49.35% and 46.69% of their respective total variance, with similarities regarding the consumption of specific food groups (i.e., western-type foods). In the TEENAGE Study, the "chicken and sugars" pattern was associated with lower CRP levels, after adjusting for confounding factors (p-value < 0.01). The "high protein and animal fat" dietary pattern of the STANISLAS Family Study was related to higher BMI (p-value < 0.01) and higher triglycerides levels (p-value < 0.01). Our findings summarize the dietary habits of two teenage, European populations and their associations with cardiometabolic risk factors.

The influence of ultra-processed food consumption in anthropometric and atherogenic indices of adolescents

ABSTRACT Objective To investigate the influence of ultra-processed food consumption on anthropometric and atherogenic indices. Methods A cross-sectional study was conducted with 327 adolescents aged 14 to 19 years. Sociodemographic, anthropometric, biochemical, and food consumption data were evaluated. The ratios of atherogenic indices were calculated using the Castelli I (Total Cholesterol/High Density Lipoprotein Cholesterol), Castelli II (Low Density Lipoprotein Cholesterol/High Density Lipoprotein Cholesterol), and estimated Low Density Lipoprotein Cholesterol particle size (Atherogenic Index of Plasma=Triglycerides/High-Density Lipoprotein Cholesterol) indices. Logistic regression was used for the unadjusted and adjusted analysis between ultra-processed foods consumption, anthropometric, and atherogenic indices. The level of significance was 5%. Results Most participants were female (59.3%). Girls had a higher consumption of ultra-processed foods (26.6% vs. 20.5%). Of the total number of adolescents, 16.5% were overweight and 65.7% were from public schools. Adolescents with altered values for the Castelli I and II Index, and for the Atherogenic Index of Plasma had significantly higher weights, Waist Circumference, Waist Circumference/ Height and Body Mass Index/ Age values. The adjusted analysis identified a significant association (Odds ratio=2.29; 95% Confidence interval: 1.23-4.28) between the high consumption of ultra-processed foods and the Castelli II index. Conclusion The associations between atherogenic indices and anthropometric indices and the consumption of ultra-processed foods highlight the negative influence of these foods on adolescents’ cardiovascular health.

Association between eating habits, body mass index, cardiorespiratory fitness, and cardiometabolic risk factors in children

ABSTRACT Objective To verify the multivariate relationships between eating habits, cardiorespiratory fitness, body mass index, and cardiometabolic risk factors in children. Methods This is a cross-sectional study developed in a public elementary school with 60 first- to sixth-graders. Their eating habits were assessed using the Food Frequency Survey, weight, height, and cardiorespiratory fitness, assessed according to the Projeto Esporte Brasil protocol. Moreover, the variables, high-density lipoprotein, low-density lipoprotein, glucose, insulin, C-reactive protein, adiponectin, leptin, diastolic and systolic blood pressure were evaluated. Descriptive statistics were used for data analysis and generalized estimation equations were used for the analysis of direct and indirect relations, in a multivariate analysis model with several simultaneous outcomes. Results It appears that the eating habits and cardiorespiratory fitness explain 20% of the body mass index. Cardiometabolic risk factors are explained by the relationship between eating habits, cardiorespiratory fitness, and body mass index, according to the following percentages: 29% (systolic blood pressure), 18% (diastolic blood pressure), 63% (leptin), 4% (adiponectin), 14% (C-reactive protein), 17% (insulin), 10% (high-density lipoprotein), 1% (low-density lipoprotein), 4% (glucose). It is also observed that the effects of the eating habits on cardiometabolic risk factors are indirect, that is, they are dependent on changes in the body mass index and cardiorespiratory fitness levels. Conclusions The relationship between eating habits and cardiometabolic risk factors in children is dependent on cardiorespiratory fitness and body mass index. Thus, our findings suggest a multivariate relationship between these factors.

An online randomized trial of healthy default beverages and unhealthy beverage restrictions on children's menus

Several U.S. jurisdictions have adopted policies requiring healthy beverage defaults on children's menus, but it is unknown whether such policies or restrictions leads to fewer calories ordered. We recruited 479 caregivers of children for an online choice experiment and instructed participants to order dinner for their youngest child (2-6 years) from two restaurant menus. Participants were randomly assigned to one type of menu: 1) standard beverages on children's menus (Control; n = 155); 2) healthy beverages on children's menus (water, milk, or 100% juice), with unhealthy beverages available as substitutions (Default; n = 162); or 3) healthy beverages on children's menus, with no unhealthy beverage substitutions (Restriction; n = 162). We used linear regression with bootstrapping to examine differences between conditions in calories ordered from beverages. Secondary outcomes included percent of participants ordering unhealthy beverages (full-calorie soda, diet soda, and/or sugar-sweetened fruit drinks) and calories from unhealthy beverages. Calories ordered from beverages did not differ across conditions at Chili's [Default: 97.6 (SD = 69.8); p = 0.82; Restriction: 102.7 (SD = 71.5); p = 0.99; Control: 99.4 (SD = 72.7)] or McDonald's [Default: 90.2 (SD = 89.1); p = 0.55; Restriction: 89.0 (SD = 81.0); p = 0.94; Control: 96.5 (SD = 95.2)]. There were no differences in the percent of orders or calories ordered from unhealthy beverages. Though Restriction participants ordered fewer calories from full-calorie soda [(3.0 (SD = 21.6)] relative to Control participants [13.4 (SD = 52.1); p = 0.04)] at Chili's, we observed no such difference between Default and Control participants, or across McDonald's conditions. Overall, there was no effect of healthy default beverages or restrictions in reducing total calories ordered from unhealthy beverages for children in our experiment.

Diet dan Sindrom Metabolik pada Remaja Obesitas

ABSTRACTBackground : The prevalence of obesity in adolescents is increasing and causes metabolic syndrome at a young age. Metabolic syndrome results from the interaction of environmental, genetic, and dietary factors. The purpose of this study was to determine the diet profile of obese adolescents suffering from metabolic syndrome.Methods: This study was a cross-sectional study of obese adolescents who visited the Pediatric Nutrition and Metabolic Disease in Dr. Soetomo General Hospital, Surabaya. The anthropometry examination (weight, height and waist circumference), blood pressure, and blood tests (HDL cholesterol, triglycerides and blood glucose levels) were measured. The diagnosis of metabolic syndrome was based on the International Diabetes Federation. Food consumption data was obtained through direct interviews using data collection sheets. Analysis of dietary differences in obese adolescents suffering from metabolic syndrome was performed by chi square using SPSS.Results and Discussions: A total of 59 obese adolescents aged 13-16 years were involved in this study. A total of 27 subjects (45.8%) suffered from metabolic syndrome and 32 subjects (54.2%) did not suffer from metabolic syndrome. The level of the consumption of fish, vegetables, and fruit in obese adolescents were still low. There was no significant difference in the diet profile between obese adolescents who suffer from metabolic syndrome or not.Conclusion: Prevention strategies through food consumption patterns are needed in obese adolescents to control metabolic stress processes and prevent metabolic syndrome in the future. Diet knowledge in obese adolescents needs to be given early to prevent further complications. Increasing foods that contain anti-oxidants, such as fruits and vegetables, is one of the strategies to prevent metabolic syndrome in obese adolescents.ABSTRAKLatar Belakang : Prevalensi obesitas pada remaja semakin meningkat dan menyebabkan sindrom metabolik di usia muda. Sindrom metabolik terjadi akibat interaksi faktor lingkungan, genetik, dan diet. Tujuan dari penelitian ini adalah mengetahui profil diet pada remaja obesitas yang menderita sindrom metabolik.Metode : Penelitian ini merupakan penelitian potong lintang pada remaja obesitas yang berkunjung di Poli Nutrisi dan Penyakit Metabolik Anak di RSUD Dr. Soetomo, Surabaya. Pada subyek dilakukan pemeriksaan antropometri (berat badan, tinggi badan, dan lingkar pinggang), pemeriksaan tekanan darah, dan pemeriksaan darah (kolesterol HDL, trigliserida, dan kadar glukosa darah). Diagnosis sindrom metabolik ditegakkan berdasarkan International Diabetes Federation. Data konsumsi makanan didapatkan melalui wawancara langsung dengan menggunakan lembar pengumpul data. Analisis perbedaan diet pada remaja obesitas yang menderita sindrom metabolik dilakukan dengan chi square menggunakan SPSS.Hasil dan Pembahasan : Sebanyak 59 remaja obesitas yang berusia 13-16 tahun terlibat dalam penelitian ini. Sebanyak 27 subyek (45,8%) menderita sindrom metabolik dan sebanyak 32 subyek (54,2%) tidak menderita sindrom metabolik. Tingkat konsumsi ikan, sayur, dan buah pada remaja obesitas masih rendah. Tidak ada perbedaan yang bermakna pada profil diet antara remaja obesitas yang menderita sindrom metabolik maupun tidak.Kesimpulan : Strategi pencegahan melalui pola konsumsi makanan diperlukan pada remaja obesitas untuk mengontrol proses stres metabolik sehingga dapat mencegah sindrom metabolik di masa datang. Pengetahuan diet pada remaja obesitas perlu diberikan sejak dini untuk mencegah komplikasi lebih lanjut. Memperbanyak makanan yang mengandung anti-oksidan, seperti buah dan sayur merupakan salah satu strategi mencegah sindrom metabolik pada remaja obesitas.

Relationship between nutrition knowledge, education and other determinants of food intake and lifestyle habits among adolescents from urban and rural secondary schools in Tyrol, Western Austria

Objective:

The aim of this study was to investigate the association of the number of hours of nutrition education and teachers’ qualifications with nutrition knowledge and dietary behaviour in students.

Design:

In this representative cross-sectional study, socio-demographic data, anthropometric measurements, socio-economic status (SES), physical fitness, nutrition knowledge and eating habits were assessed. Differences between groups were tested by χ² and t tests. Multiple linear and logistic regression modelling was used to examine the relationship between demographic characteristics, lifestyle and dietary behaviours, nutrition knowledge, nutrition-trained teachers and number of nutrition lessons.

Setting:

Sixteen secondary schools in urban (n 6) and rural regions (n 10) of Tyrol, Western Austria.

Participants:

Students (n 513) aged 14·2 (sd 0·7) years.

Results:

Higher nutrition knowledge was significantly associated with attending rural school (P = 0·001), having no migration background (P < 0·001), (very) good physical activity behaviour (P = 0·040), non-trained teacher (P = 0·006) but higher number of hours of nutrition education (P = 0·013). Regression models showed that higher nutrition knowledge was independently associated with lower intake of meat and iced tea and higher intake of vegetables and plant-based oils. A higher amount of nutrition education (h/week) was significantly associated with higher intake of dark (wholegrain) bread, lower intake of meat and of energy drinks sweetened with sweeteners.

Conclusions:

Our results suggest that more hours in nutrition education result in higher nutrition knowledge and greater nutrition literacy, which may lead to health-promoting dietary habits. School-based nutrition education can be seen as preventive measure to increase nutritional competences in adolescents independent of their SES.

Association of sleep duration and snack consumption in children and adolescents: The CASPIAN-V study

OBJECTIVES

The relationship between sleep deprivation and the risk of overweight and obesity is somewhat known in children and adolescents. This study aimed to investigate the relationship between sleep duration and eating snacks in a national sample of children and adolescents aged 6-18 years old.

METHODS

This cross-sectional study was carried out on the data of the fifth survey of the national school-based surveillance system entitled the "Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable Disease" (CASPIAN-V) study. Short sleeping duration was defined 10 hr per day for children under 10 years and 9 hr per day for children ≥ 10 years. To assess food habits, the consumption frequency of some food groups including sweets, salty snacks, carbonated beverages, diet soft drinks, soft beer, fresh fruits, dried fruits, fresh juices, vegetables, packed juices, dairy products (milk, yogurt, and cheese), fast foods, tea, sugar along with tea, and coffee was asked using Likert scale ( never, rarely, weekly, and daily).

RESULTS

In multivariate model, short sleep versus long sleep in students was associated with increased chance of eating salty snacks (OR = 1.49 [95% CI: 1.38-1.61]; p = .001), soft drinks (OR = 1.12 [95% CI: 1.04-1.20]; p = .002), fast foods (OR = 1.66 [95% CI: 1.54-1.79]; p < .001), tea (OR = 1.49 [95% CI: 1.39-1.61]; p < .001), and tea with sugar (OR = 1.13 [95% CI: 1.05-1.22]; p < .001). In addition, short sleep in students was associated with a decreased odds of daily intake of soft drinks without sugars (OR = 0.64 [95% CI: 0.58-0.70]; p < .001), soft beer (OR = 0.92 [95% CI: 0.85-0.99]; p < .001), fresh fruit (OR = 0.83 [95% CI: 0.76-0.90]; p < .001), dried fruit (OR = 0.43 [95% CI: 0.39-0.46]; p < .001), fresh fruit juice (OR = 0.66 [95% CI: 0.62-0.72]; p < .001), packed juice (OR = 0.91 [95% CI: 0.84-0.98]; p < .009), milk (OR = 0.51 [95% CI: 0.47-0.55]; p < .001), yogurt (OR = 0.86 [95% CI: 0.79-0.93]; p ≤ .001), and coffee (OR = 0.82 [95% CI: 0.76-0.89]; p ≤ .001).

CONCLUSIONS

The findings of this study indicate a significant relationship between sleep duration and unhealthy food habits. Therefore, increasing awareness of families in this area may reduce obesity and its complications.

Use of educational technologies in the promotion of children's cardiovascular health: a systematic review

OBJECTIVE

The aim of this study was to investigate the effectiveness of educational technologies for cardiovascular health promotion in children.

METHODS

A systematic review was carried out through a search in Biblioteca Virtual de Saúde, Comissão de Aperfeiçoamento de Pessoal do Nível Superior, EBSCOHot Information Services, and US National Library of Medicine National Institutes of Health databases, using the descriptors: play and plaything, cardiovascular diseases, child, and health promotion, between 2012 and 2019.

RESULTS

Eight articles were selected for this review. The identified technologies were based on low-tech interventions, such as play workshops, using tools such as CARDIOKIDS, the SI! program, MOVI-2, and activities with wide-ranging digital tools such as Fooya!, Fit2Play^TM, and the exergame cycling program.

CONCLUSIONS

It is noteworthy that all of the analyzed interventions were effective and those that involved playing were better accepted by the children.

Dietary patterns are associated with obesity in Mexican schoolchildren

BACKGROUND

The prevalence of overweight and obesity in Mexican schoolchildren has increased in the past three decades. Dietary pattern approaches to assess diet have been used to study the relation between nutrition and chronic conditions.

OBJECTIVE

The objective of this study is to analyze the association between dietary patterns (DP) and overweight and obesity in Mexican schoolchildren.

METHODS

We analyzed information from schoolchildren who participated in the National Health and Nutrition Survey 2012 (ENSANUT-2012). Dietary information was obtained through a 24-h recall of 2751 children (5-11 year). Foods were classified into 33 groups, and the DPs were identified by cluster analysis (k-means method). Weight and height were measured to estimate the body mass index (BMI), by classifying overweight if the Z score was >1 and ≤2 standard deviations (SD), and obesity when the Z score was >2SD. To analyze the association, a Poisson regression model was used, adjusting by age, region, area of residence, socioeconomic status (SES), and the survey design.

RESULTS

Four DPs were identified: "Traditional", "Industrialized", "Varied", and "Modern". The "Modern" DP was associated with obesity (PR = 1.7) (p < 0.05) compared with the "Traditional" DP.

CONCLUSIONS

The "Modern" DP could be influencing the development of obesity in Mexican schoolchildren. The promotion of healthy food and public health strategies to those food groups that should be discouraged are necessary to reverse the obesity epidemic in Mexican children.

Childhood dietary patterns and body composition at age 6 years: the Children of SCOPE study

Dietary patterns describe the quantity, variety, or combination of different foods and beverages in a diet and the frequency of habitual consumption. Better understanding of childhood dietary patterns and antenatal influences could inform intervention strategies to prevent childhood obesity. We derived empirical dietary patterns in 1142 children (average age 6.0 (0.2) years) in Auckland, New Zealand whose mothers had participated in the Screening for Pregnancy Endpoints (SCOPE) cohort study and explored associations with measures of body composition. Participants (Children of SCOPE) had their diet assessed by food frequency questionnaire (FFQ) and empirical dietary patterns were extracted using factor analysis. Three distinct dietary patterns were identified; 'Healthy', 'Traditional' and 'Junk'. Associations between dietary patterns and measures of childhood body composition (waist, hip, arm circumferences, body mass index (BMI), bioelectrical impedance analysis (BIA) derived body fat percentage, and sum of skinfold thicknesses (SST)) were assessed by linear regression, with adjustment for maternal influences. Children who had higher 'Junk' dietary pattern scores had 0.24cm greater arm (0.08 SD (95%CI 0.04, 0.13)) and 0.44cm hip (0.05 SD (95% CI 0.01, 0.10)) circumferences, 1.13cm greater SST (0.07 SD (95%CI 0.03, 0.12)) and were more likely to be obese (OR=1.74 (95%CI 1.07, 2.82)); those with higher 'Healthy' pattern scores were less likely to be obese (OR=0.62 (95%CI 0.39, 1.00)). In a large mother-child cohort, a dietary pattern characterised by high sugar and fat foods was associated with greater adiposity and obesity risk in children aged 6 years, while a 'Healthy' dietary pattern offered some protection against obesity. Targeting unhealthy dietary patterns could inform public health strategies to reduce the prevalence of childhood obesity.

Food insecurity is associated with lower adherence to the Mediterranean dietary pattern among Lebanese adolescents: a cross-sectional national study

PURPOSE

To derive dietary patterns (DPs) of Lebanese adolescents (10-18 years) and evaluate associations between identified DPs and household food insecurity (HFI).

METHODS

Data on adolescents (n = 693) were drawn from a national survey conducted in 2015 on a representative sample of Lebanese households with children. In addition to a sociodemographic questionnaire, data collection included the validated Arabic-version of the Household Food Insecurity Access Scale, used to evaluate HFI. Dietary intake was assessed using a 187-item validated food frequency questionnaire. Associations between HFI scores and DPs were examined using multiple linear regressions.

RESULTS

HFI was observed in 55.2% of the study sample. Two DPs were derived among adolescents: Western and Lebanese-Mediterranean (LM). The Western DP was characterized by higher consumption of sweetened beverages, fast foods, sweets, and refined grains, whereas the LM DP was characterized by higher intakes of fruits, vegetables, dairy products, and whole grains. Scores of the Western DP were negatively associated with fiber, calcium, iron, and vitamins A and D, while the LM DP scores were positively correlated with fiber, proteins, iron, calcium, and vitamins A and D (p < 0.01). LM DP scores were also negatively correlated with total fat, saturated and polyunsaturated fats, p < 0.05. After adjustment for sociodemographics, multiple linear regression showed that higher HFI scores were associated with lower adherence to LM DP among adolescents (β = - 0.026, 95% CI - 0.046, - 0.006).

CONCLUSIONS

HFI was associated with lower adherence to the Mediterranean pattern among Lebanese adolescents. Preventive strategies are needed to promote better diet quality among food-insecure youth.

Dietary Patterns and Cardiovascular Risk Factors in Spanish Adolescents: A Cross-Sectional Analysis of the SI! Program for Health Promotion in Secondary Schools

Previous studies on the association between dietary habits and cardiovascular risk factors (CVRF) in adolescents have generated conflicting results. The aim of this study was to describe dietary patterns (DP) in a large sample of Spanish adolescents and to assess their cross-sectional relationship with CVRF. In total, 1324 adolescents aged 12.5 ± 0.4 years (51.6% boys) from 24 secondary schools completed a self-reported food frequency questionnaire. DPs were derived by cluster analysis and principal component analysis (PCA). Anthropometric measurements, blood pressure, lipid profile, and glucose levels were assessed. Linear mixed models were applied to estimate the association between DPs and CVRF. Three DP-related clusters were obtained: Processed (29.2%); Traditional (39.1%); and Healthy (31.7%). Analogous patterns were obtained in the PCA. No overall differences in CVRF were observed between clusters except for z-BMI and z-FMI values, total cholesterol, and non-HDL cholesterol, with the Processed cluster showing the lowest mean values. However, differences were small. In conclusion, the overall association between DPs, as assessed by two different methods, and most analyzed CVRF was weak and not clinically relevant in a large sample of adolescents. Prospective analysis may help to disentangle the direction of these associations.

Association between Sociodemographic Factors and Dietary Patterns in Children Under 24 Months of Age: A Systematic Review

BACKGROUND

Understanding early-life complementary feeding dietary patterns and their determining factors could lead to better ways of improving nutrition in early childhood. The purpose of this review was to evaluate evidence of the association between sociodemographic factors and dietary patterns (DPs) in children under 24 months.

METHODS

Medline (PubMed), Cochrane Central, NICE guidelines, and Trip database were searched for observational studies that evaluated sociodemographic factors and their associations with DP.

RESULTS

Seven studies were selected for the present review. High education level among mothers was inversely associated with unhealthy DPs and positively associated with healthy DPs. Higher household income was negatively associated with unhealthy DPs. Four studies showed a positive association between low household income and unhealthy DPs and three studies showed a positive association between higher household income and healthy DPs. Additionally, in younger mothers, body mass index (BMI ≥ 30.0 kg/m2) and number of children were positively associated with unhealthy DPs.

CONCLUSIONS

This review provides evidence of a positive association between mothers' higher education level, higher household income, higher maternal age, and healthy dietary patterns as well as a negative association between these factors and unhealthy dietary patterns. Further studies from low- and middle-income countries are needed for comparison with associations showed in this review.

Associations of Sitting Behavior Patterns With Cardiometabolic Risk in Children: The Sit Less for Health Cross-Sectional Study

BACKGROUND

The objective of this study was to investigate the associations between sedentary behavior patterns and cardiometabolic risk in children using a monitor that accurately distinguishes between different postures.

METHODS

In this cross-sectional study, 118 children (67 girls) aged 11-12 years had adiposity, blood pressure, lipids, and glucose measured, and then they wore an activPAL device to record sitting, standing, and stepping for 7 consecutive days. Data were analyzed using multiple linear regression.

RESULTS

After adjustment for potential confounders and moderate to vigorous physical activity, the number of breaks in sitting was significantly negatively associated with adiposity (standardized β ≥ -0.546; P ≤ .001) and significantly positively associated with high-density lipoprotein cholesterol (β = 0.415; P ≤ .01). Time in prolonged sitting bouts was significantly negatively associated with adiposity (β ≥ -0.577; P ≤ .001) and significantly positively associated with high-density lipoprotein cholesterol (β = 0.432; P ≤ .05). Standing time was significantly negatively associated with adiposity (β ≥ -0.270; P ≤ .05) and significantly positively associated with high-density lipoprotein cholesterol (β = 0.312; P ≤ .05).

CONCLUSIONS

This study suggests that increasing the number of breaks in sitting and increasing standing time are beneficially associated with cardiometabolic risk and should be considered in health promotion interventions in children.

Association of Dietary Patterns with Excess Weight and Body Adiposity in Brazilian Children: The Pase-Brasil Study

BACKGROUND

Obesity is a multifactorial disease and a serious public health problem. Some of the associated factors are modifiable and, among them, the diet is highlighted.

OBJECTIVE

To evaluate the association of dietary patterns of schoolchildren with obesity and body adiposity.

METHODS

A cross-sectional study was carried out with 378 children aged 8 and 9 years, enrolled in urban schools in the city of Viçosa, Minas Gerais, Brazil. A semi-structured questionnaire was applied to the children and their caregivers on sociodemographic characteristics and life habits. Three 24-hour food recalls were used to identify dietary patterns; the Principal Component Analysis was employed. Weight and height were measured for the calculation of the body mass index (BMI) of the children and their mothers, waist circumference and neck circumference. Body composition was also evaluated through dual-energy X-ray absorptiometry (DXA). For all performed tests, the level of significance was set at 5%.

RESULTS

Five dietary patterns (DP) were identified: "unhealthy", "snacks", "traditional", "industrialized" and "healthy". There was an association between excess weight (prevalence ratio [PR]: 1.38, 95% confidence interval [95%CI]: 1.02 to 1.87) and body fat (PR: 1.32, 95%CI : 1.07 to 1.64) with industrialized DP. There was an association between excess body fat (PR: 1.31, 95%CI: 1.01 to 1.74) and lower adherence to traditional DP. The other patterns were not associated with obesity and body adiposity.

CONCLUSION

Children with excess weight and body adiposity showed greater adherence to the industrialized DP and lower adherence to the traditional DP. We suggest that early assessments of dietary habits should be undertaken for monitoring and modifying these habits when necessary.

An Interdisciplinary Weight Loss Program Improves Body Composition and Metabolic Profile in Adolescents With Obesity: Associations With the Dietary Inflammatory Index

Background and Aims: The prevalence of overweight and obesity consitutes a global epidemic and it is growing around the world. Food and nutrition are essential requirements for promoting health and protecting against non-communicable chronic diseases, such as obesity and cardiovascular disease. Specific dietary components may modulate inflammation and oxidative stress in obese individuals. The Dietary Inflammatory Index (DII®) was developed to characterize the anti- and pro-inflammatory effects of individuals' diet. Few studies have investigated the role of diet-associated inflammation in adolescents with obesity. The present study aims to investigate the effects of an interdisciplinary weight loss therapy on DII scores and cardiometabolic risk in obese adolescents and possibles correlations.

Methods: A total of 45 volunteers (14–19 years old) were recruited and enrolled for long-term interdisciplinary therapy including clinical, nutritional, psychological counseling, and exercise training. Adolescents had access to videos about health education weekly. Body composition and inflammatory and serum profiles were evaluated at baseline and after intervention. The food intake was obtained by 24-h food recall. Data was used to calculate energy-adjusted DII (E-DII) scores. Negative scores indicate an anti-inflammatory diet and positive scores indicates a pro-inflammatory diet. The sample was divided according to whether individuals increased or decreased E-DII scores after therapy.

Results: After therapy the body mass index (BMI), body weight, body fat, abdominal, waist, neck, and hip circumferences decreased significantly. The mean of high-density lipoprotein cholesterol (HDL-c) increased after the therapy. There was found an improvement of inflammatory and cardiometabolic parameters. In exploratory analyses, this occurred mainly when the EDII improved.

Conclusion: Long-term interdisciplinary therapy combined with a health education website improved inflammatory serum markers in obese adolescents. Reduction in DII scores was associated with reduction of cardiometabolic parameters, suggesting that an anti-inflammatory diet may be an effective strategy to prevent and treat obesity and related comorbidities.

Trial:http://www.ensaiosclinicos.gov.br/rg/RBR-6txv3v/, Register Number: RBR-6txv3v

Associations between Physical Activity and Food Intake among Children and Adolescents: Results of KiGGS Wave 2

A balanced diet and sufficient physical activity are essential for the healthy growth of children and adolescents and for obesity prevention. Data from the second wave of the population-based German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2; 2014-2017) were used to analyse the association between food intake and physical activity among 6- to 17-year-old children and adolescents (n = 9842). Physical exercise (PE) and recommended daily physical activity (RDPA) were assessed with self-administered questionnaires and food intake by a semi-quantitative food frequency questionnaire. Multivariable logistic regression was used to analyse the association between food group intake (dependent variable) and level of PE or RDPA. High levels of physical activity (PE or RDPA) were associated with higher consumption of juice, water, milk, dairy products, fruits, and vegetables among both boys and girls, and among boys with a higher intake of bread, potatoes/pasta/rice, meat, and cereals. Higher PE levels were also less likely to be associated with a high soft drink intake. High levels of RDPA were associated with high intake of energy-dense foods among boys, which was not observed for PE. This study indicates that school-aged children and adolescents with higher levels of physical activity consume more beneficial foods and beverages compared to those with lower physical activity levels.

Dietary patterns at 7 year-old and their association with cardiometabolic health at 10 year-old

BACKGROUND & AIMS

Diet is usually represented as single foods or dietary patterns not related with a specific outcome, and its cardiometabolic effects at early ages are not clearly understood. This study aims to assess whether dietary patterns derived at 7 years of age have an effect on cardiometabolic health at 10 year-old.

METHODS

This study uses data from the Generation XXI birth cohort (northern Portugal, 2005-2006). Dietary data were collected by a validated food frequency questionnaire at 7 year-old and dietary patterns were previously derived through partial least squares (PLS), principal component analysis and latent class analysis. At 10 year-old, systolic (SBP) and diastolic (DBP) blood pressure were measured, and blood samples were drawn to analyze cardiometabolic parameters. Linear regression coefficients and 99% confidence intervals [βˆ (99% CI)] were computed (covariates: birth weight, gestational age, physical activity, maternal age and education) (n = 3350).

RESULTS

A dietary pattern that explains the BMI z-score at 10 year-old (PLS-1, characterized by the intake of processed meat, energy-dense foods and low in vegetables) was significantly associated with SBP (βˆ = 0.052, 99% CI:0.022; 0.082), DBP (βˆ = 0.043, 99% CI: 0.022; 0.065), triglycerides (βˆ = 0.065, 99% CI: 0.026; 0.104), HDL-cholesterol (βˆ = -0.059, 99% CI: -0.099; -0.019), LDL-cholesterol (βˆ = 0.040, 99% CI: 0.001; 0.080) and HOMA-IR (βˆ = 0.110, 99% CI: 0.071; 0.149). After further adjustment for BMI at 10 year-old, the magnitude of the associations was weakened. No associations were observed between the other derived dietary patterns and cardiometabolic health.

CONCLUSIONS

Adherence at 7 years of age to a dietary pattern rich in energy-dense foods, processed meat and low in vegetables, may increase several cardiometabolic parameters at 10 years of age. BMI at 10 year-old explained part of these effects.

[Do children and adolescents who consume ultra-processed foods have a worse lipid profile? A systematic review]

The increase in the input of ultra-processed ingredients in the food of children and adolescents is related to the development of noncommunicable diseases such as dyslipidemia. The scope of this study was to conduct a systematic review of the literature on the relationship of consumption of ultra-processed foods in the lipid profile of children and adolescents. A search in the PubMed, Scopus, Cochrane and LILACS databases was carried out to locate cross-sectional and longitudinal studies, with or without intervention, in apparently healthy children and/or adolescents, who had the intake of ultra-processed food as an exposure variable and the lipid profile as an outcome. After screening, 14 studies were included, of which nine demonstrated that ultra-processed food consumption was related to increased LDL-c, total cholesterol, triglycerides and a reduction in HDL-c. Three studies found no relationship and two demonstrated that the increased intake of ready-to-eat cereals was related to the decrease in total cholesterol and LDL-c. There was a high consumption of ultra-processed foods and positive relation with blood lipids among children and adolescents, which calls attention to interventions, such as nutritional education, with a view to reducing the intake of these foods.

Dietary and physical activity patterns related to cardio-metabolic health among Malaysian adolescents: a systematic review

BACKGROUND

A sedentary lifestyle and an unhealthy diet are major factors in the increasing prevalence of obesity among Malaysian adolescents. The purpose of this systematic review is to compile the evidence from observational and intervention studies among Malaysian adolescents to evaluate the associations between diet and physical activity (PA) as determinants of cardio-metabolic risk factors.

METHODS

A systematic search of Medline via the PubMed, Science Direct, Cochrane Review and Web of Science databases was conducted for studies on the associations between diet and PA factors and cardio-metabolic risk factors among Malaysian adolescents aged 13-18 years that were published until 31 August 2017. The search results were independently screened and extracted by two reviewers.

RESULTS

From over 2,410 references retrieved, 20 full texts articles were screened as potentially relevant. Seventeen (16 cross-sectional and one intervention) met the inclusion criteria for data extraction and analysis. All 17 studies were rated as poor quality and the majority had made insufficient adjustment for confounders. As regards the effect of diet and PA on cardio-metabolic health, the intakes of energy (n = 4) and macronutrients (n = 3) and meal frequency (n = 5) were the most commonly studied dietary factors, while the PA score and level were the most commonly studied PA factors. In addition, BMI and body weight were the most common cardio-metabolic health outcomes. The studies showed that obese and overweight adolescents consume significantly more energy and macronutrients. They are also more likely to skip their daily meals compared to their normal weight peers. In most studies, the direction of the PA effect on body weight was unclear. Some studies found that higher PA is associated with a lower risk of overweight and obesity. However, the associations are often small or inconsistent, with few studies controlling for confounding factors.

CONCLUSIONS

This review identified a lack of evidence and well-conducted prospective studies on the effect of diet and PA on cardio-metabolic health of Malaysian adolescents.

Consumption of ultraprocessed foods, nutritional status, and dyslipidemia in schoolchildren: a cohort study

This study evaluates the relation between consumption of ultraprocessed foods, nutritional status, and dyslipidemia in schoolchildren from Recife/PE, Brazil. This is a cohort study conducted in 2008-2009 and 2012-2013, with 238 students recruited from the public school system of the city of Recife, Northeast Brazil. Demographic data, stage of sexual maturation, socioeconomic, lifestyle, anthropometric, and lipid profiles were collected. There was a high prevalence of overweight, abdominal obesity, and dyslipidemia in both the time periods. The number of teenagers sufficiently active was higher in 2012-2013. There was a positive correlation between the consumption of ultraprocessed foods and age in 2008-2009. In 2008-2009, high consumption of ultraprocessed foods occurred in the majority of adolescents with normal total serum cholesterol values. In 2012-2013, low maternal schooling proved to be an important factor for a lower consumption of ultraprocessed foods. The consumption of ultraprocessed foods showed no direct relationship with overweight, abdominal obesity, and dyslipidemia in adolescents.

Dietary inflammatory index and cardiovascular risk factors in Spanish children and adolescents

Dietary inflammatory potential is an established risk factor for adverse cardiovascular events. In this study we analyzed the relation between the Dietary Inflammatory Index (DII) and cardiovascular risk factors, based on anthropometric, body composition, blood pressure, and heart rate parameters in children and adolescents. We conducted a cross-sectional study of 428 Spanish schoolchildren (mean age 12.32 ± 1.84), whose DII was calculated, based on a 24-hr diet recall over 3 days. Anthropometric measurements were taken, and body composition analyzed by bioelectrical impedance analysis. Blood pressure and heart rate parameters were assessed with an automatic monitor. Pubertal stage was assessed based on Tanner criteria. We analyzed the DII both as a continuous variable and as a category variable based on quartiles. Linear regression analysis revealed that the DII was significantly associated with waist to height ratio (WHtR) (p = .026; B = 0.128, 95% CI [.001-.016]) after adjusting for age, sex, total energy intake, and Tanner stage. All macro- and micronutrient intakes were found to be higher in the DII Q1 (anti-inflammatory diet) except for caffeine. This study provides preliminary evidence of a significant association between the DII and WHtR, an index of cardiovascular risk. The results obtained indicate that the inflammatory potential of the diet may play a role in children and adolescents becoming overweight or developing obesity. Future studies in young people should be conducted to validate and further explore these relationships.

Do Chinese Preschool Children Eat a Sufficiently Diverse Diet? A Cross-Sectional Study in China

BACKGROUND

This study aimed to comprehensively evaluate dietary diversity and its associated factors in Chinese preschoolers and explore whether the daily food consumption of children with different dietary diversity-associated characteristics met recommended dietary amounts.

METHODS

A cross-sectional study covering seven cities and two villages was conducted and included 697 preschool children aged 3⁻7 years old. Dietary diversity score (DDS) and DDS 10 were calculated based on 24-h dietary recall. The food-intake differences among children with different DDS 10 predictors were examined.

RESULTS

The mean DDS and DDS 10 in Chinese preschool children were 7.4 ± 1.5 (ranged from 3 to 9) and 7.0 ± 3 (ranged from 3 to 9) respectively. Positive predictors of dietary diversity included residing in an urban environment, a higher household expenditure on children’s food, and a higher frequency of eating outside. Food-intake differences existed among the predictors.

CONCLUSIONS

Education and intervention should be strengthened to improve the dietary diversity of preschool children, especially in rural areas. The overall dietary pattern of children requires attention, which means not only increasing dietary diversity but also avoiding an unbalanced diet.

Dietary patterns and cardiometabolic risk factors among adolescents: systematic review and meta-analysis

This study systematised and synthesised the results of observational studies that were aimed at supporting the association between dietary patterns and cardiometabolic risk (CMR) factors among adolescents. Relevant scientific articles were searched in PUBMED, EMBASE, SCIENCE DIRECT, LILACS, WEB OF SCIENCE and SCOPUS. Observational studies that included the measurement of any CMR factor in healthy adolescents and dietary patterns were included. The search strategy retained nineteen articles for qualitative analysis. Among retained articles, the effects of dietary pattern on the means of BMI (n 18), waist circumference (WC) (n 9), systolic blood pressure (n 7), diastolic blood pressure (n 6), blood glucose (n 5) and lipid profile (n 5) were examined. Systematised evidence showed that an unhealthy dietary pattern appears to be associated with poor mean values of CMR factors among adolescents. However, evidence of a protective effect of healthier dietary patterns in this group remains unclear. Considering the number of studies with available information, a meta-analysis of anthropometric measures showed that dietary patterns characterised by the highest intake of unhealthy foods resulted in a higher mean BMI (0·57 kg/m²; 95 % CI 0·51, 0·63) and WC (0·57 cm; 95 % CI 0·47, 0·67) compared with low intake of unhealthy foods. Controversially, patterns characterised by a low intake of healthy foods were associated with a lower mean BMI (−0·41 kg/m²; 95 % CI −0·46,−0·36) and WC (−0·43 cm; 95 % CI −0·52,−0·33). An unhealthy dietary pattern may influence markers of CMR among adolescents, but considering the small number and limitations of the studies included, further studies are warranted to strengthen the evidence of this relation.

Health- and Taste-Related Attitudes Associated with Dietary Patterns in a Representative Sample of Polish Girls and Young Women: A Cross-Sectional Study (GEBaHealth Project)

Attitudes can be predictors of certain health-related behaviours. The attitudes of young females towards health and taste have not been yet fully examined and their associations with dietary behaviours remain unclear. The aim of the study was to investigate if attitudes are associated with dietary patterns in a representative sample of Polish girls. The study population consisted of 1107 girls, aged 13-21 and living in Poland. Attitudes were assessed using the Health and Taste Attitudes Scale (HTAS) and categorised as negative, neutral or positive. Dietary data was obtained using a Food Frequency Questionnaire. Dietary patterns (DPs), derived previously with a Principal Component Analysis (PCA), were 'Traditional Polish', 'Fruit and vegetables', 'Fast food and sweets' and 'Dairy and fats'. The associations between attitudes and DPs were assessed using Spearman's correlation coefficients and logistic regression. The reference group were girls with neutral attitudes. Odds ratios (ORs) were adjusted for age, socioeconomic status (SES), and body mass index (BMI). The correlations between attitudes and DPs ranged from -0.28 for attitudes towards health and 'Fast food and sweets' and 'Traditional Polish' DPs to 0.33 for attitudes towards health and the 'Fruit and vegetables' DP (p < 0.05). In the logistic regression analysis, the strongest associations within health-related HTAS subscales were observed between negative attitudes towards natural products and the 'Fast food and sweets' DP (OR: 10.93; 95% CI: 3.32-36.01) and between positive attitudes towards health and the 'Fruit and vegetables' DP (OR: 5.10; 3.11-8.37). The strongest associations within taste-related HTAS subscales were observed between positive attitudes towards craving for sweet foods and the 'Traditional Polish' DP (OR: 1.93; 1.43-2.61) and between positive attitudes towards using food as a reward and the 'Dairy and fats' DP (OR: 2.08; 1.22-3.55) as well as the 'Fast food and sweets' DP (OR: 2.07; 1.14-3.74). Positive attitudes towards health were associated with a pro-healthy dietary pattern characterised by the consumption of fruit and vegetables, while negative attitudes towards natural products as well as a strong craving for sweets and using food as a reward were associated with less healthy dietary patterns. To improve the dietary habits of girls and young women, positive attitudes towards health should be strengthened and supported by emphasizing the sensory values of pro-healthy foods.

Association of dietary patterns with continuous metabolic syndrome in children and adolescents; a nationwide propensity score-matched analysis: the CASPIAN-V study

OBJECTIVE

This study aims to determine the association of dietary patterns with metabolic syndrome (MetS) and its components in children and adolescents.

METHODS

This nationwide study was conducted in 2015 among 4200 students aged 7-18 years, who lived in 30 provinces in Iran. The analysis was conducted based on the propensity score using a matched case-control study design. Three dietary patterns were obtained conducting a principal component analysis with a varimax rotation on 16 dietary groups. Continuous MetS score was computed by standardizing the residuals (z-scores) of MetS components by regressing them according to age and sex. The gold standard diagnosis of MetS was considered based on the International Diabetes Federation criteria. Moreover, for the purpose of data analysis, matched logistics analysis was used.

RESULTS

The study participants consisted of 3843 children and adolescents (response rate 91.5%) with mean (SD) age of 12.45 (3.04) years. Totally 49.4% of students were girls and 71.4% lived in urban areas. Three dietary patterns were obtained: Healthy, Western, and Sweet. Prevalence of MetS was 5% (boy 5.5 and girl 4.5%). Results of multivariate analysis show that students with Sweet dietary patterns were at higher risk for abdominal obesity (OR 1.29; 95% CI 1.01-1.66), elevated blood pressure (OR 1.35; 95% CI 1.01-1.81) and MetS (OR 1.33; 95% CI 1.02-1.74). The two other dietary patterns were not associated with MetS and its components.

CONCLUSION

Sweet dietary pattern increase the risk of MetS and some its components in Iranian children and adolescents. This finding provides valuable information for effective preventive strategies of MetS based on diet rather than medication to maintain healthy lifestyle habits.