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

Toddler dietary patterns from the INSIGHT randomized clinical trial comparing responsive parenting versus control: A latent class analysis

OBJECTIVE

The aim of this study was to examine the effect of a responsive parenting (RP) intervention on toddler diet and explore associations with mothers' infant feeding practices and child weight status.

METHODS

INSIGHT tested an RP intervention designed for the prevention of obesity against a safety control among primiparous mothers and their infants. Mothers reported on feeding practices, as well as toddler diet with a Food Frequency Questionnaire (n = 229). Trained research staff obtained child anthropometrics at age 2 years.

RESULTS

Latent class analysis identified three dietary patterns: high fruits and vegetables (HFV, 31%); meat, potatoes, and added sugars (MPAS, 24%); and high juice, low fruits and vegetables (JLFV, 45%). Toddler dietary pattern was not related to study group (RP, control) or child weight status at age 2 years. Mothers who reported more structure-based feeding had toddlers that were more likely to have the healthier, HFV dietary pattern than MPAS and JLFV. Findings for control-based feeding practices were mixed; maternal restriction was associated with the HFV dietary pattern, whereas the use of food as a reward was associated with MPAS and JLFV.

CONCLUSIONS

Mothers' structure-based feeding practices in infancy, as well as some control-based feeding practices, were associated with later healthier toddler dietary patterns.

Comparison of habitual and meal-specific dietary patterns identified by latent class analysis and confirmatory factor analysis in adults: A cross-sectional study

OBJECTIVE

The aim of this study was to compare characteristics of habitual and meal-specific dietary patterns identified by latent class analysis (LCA) and confirmatory factor analysis (CFA).

METHODS

Participants included 778 adults selected for the present cross-sectional study from local health care centers in Tehran, Iran. Three 24-h dietary recalls evaluated dietary intake. LCA was used to group study participants into exclusive subgroups of individuals with similar patterns of dietary intake. CFA was applied to identify patterns of habitual and meal-specific dietary intake. Analysis of variance was used to compare the average scores of habitual and meal-specific CFA-derived dietary patterns across classes identified by LCA.

RESULTS

Using habitual dietary intake, CFA grouped correlated food items into three major factors: fruits and vegetables, mixed, and Western dietary patterns. LCA grouped study participants with similar patterns of habitual intake into four subgroups of individuals: fruits and vegetables, mixed, Western, and low consumer classes. LCA-fruits and vegetables, LCA-Western, and LCA-mixed classes had, respectively, higher mean scores of CFA-fruits and vegetables, CFA-Western, and CFA-mixed dietary patterns compared with other classes (P < 0.001). Similar findings were observed for meal-specific dietary intake, where classes identified by LCA had the highest mean scores of their corresponding dietary pattern identified by CFA.

CONCLUSION

Habitual and meal-specific classes identified by LCA were well characterized by the dietary patterns derived by CFA, suggesting that LCA may be an appropriate statistical approach to classify study participants with similar patterns of intake into exclusive subgroups of individuals.

Parental child-feeding practices at 4 years of age are associated with dietary patterns of 7-year-olds

BACKGROUND

Parental child-feeding practices have been associated with child body mass index (BMI) and specific food group consumption; however, their role in the development of dietary patterns is less understood. We aim to study the association between parental child-feeding practices at 4 years old and dietary patterns at 7 years that explain BMI z-scores at age 10.

METHODS

Participants were children from the Generation XXI birth cohort (n = 3272). Three patterns of feeding practices at 4 years were previously identified: 'Perceived monitoring', 'Restriction' and 'Pressure to eat'. At 7 years, two dietary patterns were derived: 'Energy-dense foods', higher consumption of energy-dense foods and drinks and processed meats and lower consumption of vegetable soup (significantly associated with BMI z-scores at 10 years) and 'Fish-based', higher in fishery intake and lower in energy-dense food intake. Associations were estimated by linear regression models, adjusted for potential confounders (mother's age, education and pre-pregnancy BMI).

RESULTS

Girls whose parents used more Restriction, Perceived monitoring and Pressure to eat at 4 years were less likely to follow the 'Energy-dense foods' dietary pattern at 7 years (β̂ = -0.082; 95% confidence intervals [CI]: -0.134; -0.029; β̂ = -0.093; 95% CI: -0.146; -0.039; β̂ = -0.079; 95% CI: -0.135; -0.04, respectively). In both sexes, children whose parents used more Restriction and Perceived monitoring at 4 years were more likely to follow the 'Fish-based' dietary pattern at 7 years (girls: β̂ = 0.143; 95% CI: 0.077; 0.210; β̂ = 0.079; 95% CI: 0.011; 0.148; boys: β̂ = 0.157; 95% CI: 0.090; 0.224; β̂ = 0.104; 95% CI: 0.041; 0.168).

CONCLUSIONS

Children whose parents used more Restriction and Perceived monitoring at preschool age were more likely to follow healthier dietary patterns at age 7.

The Obesity-Related Dietary Pattern Is Associated with Higher Risk of Sleep Disorders: A Cross-Sectional Study from NHANES

Evidence on the association between dietary patterns and sleep disorders is limited and controversial. In addition, studies evaluating the effect of dietary patterns on sleep disorders have seldom considered the critical role of obesity. We aimed to explore obesity-related dietary patterns and evaluate their impact on sleep disorders using data from the National Health and Nutrition Examination Survey 2005–2014. In total, 19,892 participants aged over 20 years with two-day dietary recalls were enrolled. Obesity-related dietary patterns explaining most variance in waist circumference and BMI simultaneously were extracted from twenty-six food groups by the using partial least squares method. Sleep disorder and sleep duration, which were defined by self-reported questions, were the primary and the secondary outcome, respectively. Generalized linear models were performed to estimate the association of sleep disorders and sleep duration with dietary patterns. Two types of dietary patterns were identified. The “high fats, refined grains, and meat” pattern was characterized by high intakes of solid fats, cured meat, potatoes, refined grains, meat, cheese, and added sugars. The “low whole grains, vegetables, and fruits” pattern was characterized by low intakes of oils, whole grains, nuts and seeds, milk, fruits, and several vegetables. Participants with the highest adherence to the “high fats, refined grains, and meat” pattern had a higher risk for sleep disorders (OR (95%CI): 1.43 (1.12, 1.84)) and shorter sleep duration (β (95%CI): −0.17 (−0.26, −0.08)) compared to those with the lowest adherence. The corresponding associations for the “low whole grains, vegetables, and fruits” pattern were only significant for sleep duration (β (95%CI): −0.26 (−0.37, −0.15)). Our results found that the dietary pattern characterized by high solid fats, cured meat, potatoes, refined grains, meat, cheese, and added sugars, was associated with a higher risk for sleep disorders and shorter sleep duration.

Sex-Heterogeneity on the Association between Dietary Patterns at 4 Years of Age with Adiposity and Cardiometabolic Risk Factors at 10 Years of Age

To evaluate the association of dietary patterns (DP) at 4 years with adiposity and cardiometabolic risk factors at 10 years, considering sex-heterogeneity. This prospective analysis included 3823 children enrolled in the population-based birth cohort, Generation XXI (Porto-Portugal, 2005-2006). Diet at 4 years was assessed by FFQ, with three DP being identified: high in energy-dense foods (EDF), intermediate in snacks (snacking), and healthier (reference). BMI at 10 years was considered as the Z-score according to the WHO. Other adiposity indicators-fat mass percentage (FM%), fat mass index (FMI), and waist-to-height ratio (WHtR)-were converted to z-scores using the sample's sex-specific means and standard deviations, as were the cardiometabolic risk factors (systolic and diastolic blood pressure, lipid profile, and insulin resistance). The associations of DP at 4 years with later adiposity or cardiometabolic factors were estimated by linear regression or by multinomial logistic regression models. In fully adjusted models, the EDF DP was significantly positively associated with the BMI (EDF vs. healthier: β = 0.139; 95% CI: 0.031, 0.246, P-interaction = 0.042) and obesity (OR = 2.68; 95% CI 1.55, 4.63, P-interaction = 0.005) only in girls, among whom, it increased insulin (β = 0.165; 95% CI: 0.020, 0.311) and HOMA-IR (β = 0.159; 95% CI: 0.013, 0.306) at 10 years. An EDF DP at 4 years is associated with later adiposity, insulin, and HOMA-IR in girls.

Association between Marginally Low Birth Weight and Obesity-Related Outcomes and Indirect Effects via Attention-Deficit Hyperactivity Disorder and Abnormal Eating

INTRODUCTION

Evidence of the association between children born with marginally low birth weight (MLBW) and obesity-related outcomes was controversial, and our study aimed to examine the role of attention-deficit hyperactivity disorder (ADHD) and/or abnormal eating in these associations.

METHODS

A retrospective cohort study consisting of 677 Chinese children was conducted. Obesity-related outcomes (body mass index [BMI], waist circumference [WC], skinfold thickness [SF], body fat, blood pressure, lipids, and blood glucose), behaviour problems (ADHD and eating behaviour) and birth weight were collected. Mediation analyses were used to explore whether ADHD and/or abnormal eating was an intermediary factor in the MLBW-OB relationship.

RESULTS

Children with MLBW tended to have higher SF, triglycerides, fasting blood glucose, waistline, body fat, and abdominal obesity risks. Birth weight was negatively related to obesity-related outcomes, and the associations were mediated, partially, by the increased risk of ADHD or abnormal eating behaviour after adjustment for the BMI Z score. Furthermore, lower birth weight predicted higher WC indirectly through emotional overeating caused by ADHD (β: -0.10; 95% confidence interval: -0.19, -0.01).

CONCLUSION

Our study suggests the hypothetical role of ADHD and abnormal eating as underlying mechanisms in the association between MLBW and obesity-related outcomes, providing novel scientific evidence for childhood development interventions.

Dietary Patterns in Portuguese Children and Adolescent Population: The UPPER Project

Considering the nature, extent, and purpose of food processing, this study aims to identify dietary patterns (DPs) and their associations with sociodemographic factors and diet quality in Portuguese children and adolescents. Cross-sectional data were obtained from the National Food, Nutrition and Physical Activity Survey (2015-2016) of the Portuguese population. Dietary intake was obtained from two non-consecutive days and food items were classified according to the NOVA system. The proportion (in grams) of foods in the total daily diet was considered to identify DPs by latent class analysis, with age and sex as concomitant variables. Associations of DPs with sociodemographic characteristics were assessed using multinomial logistic regression. Linear regressions adjusted by sociodemographic characteristics tested associations of DPs with diet quality. DPs identified were: "Unhealthy" (higher sugar-sweetened beverages, industrial breads, and sausages intake), "Traditional" (higher vegetables, fish, olive oil, breads, ultra-processed yogurts, and sausages intake), and "Dairy" (higher intake of milk, yogurt, and milk-based beverages). "Unhealthy" was associated with older ages and lower intake of dietary fibre and vitamins and the highest free sugars and ultra-processed foods (UPF), although all DPs presented significant consumption of UPF. These findings should be considered for the design of food-based interventions and school-feeding policies in Portugal.

Diet quality and cardiometabolic health in childhood: the Generation R Study

Purpose

Diet is an important determinant of cardiometabolic disease risk in adults. We aimed to study associations of diet quality with cardiometabolic health in school-age children.

Methods

This study was embedded in the Generation R Study a prospective population-based cohort in Rotterdam, the Netherlands and included 3991 children. Food intake was assessed with a Food-Frequency Questionnaire at age 8 years. A diet quality score (0–10) was calculated reflecting adherence to age-specific dietary guidelines. The following outcome variables were measured at age 10 years and used to create a continuous cardiometabolic risk factor score: body fat percentage, insulin, triglycerides, HDL cholesterol, and systolic and diastolic blood pressure. Outcomes were expressed in age- and sex-specific standard deviation scores (SDS). Multivariable linear regression models were used to assess associations between the diet quality score and the cardiometabolic risk factor score and with the individual cardiometabolic risk factors.

Results

In models adjusted for socioeconomic and lifestyle factors and BMI, a higher diet quality was associated with a lower cardiometabolic risk factor score [− 0.08 per point higher diet score, (95% CI − 0.15, − 0.001)]. This association was mainly driven by associations of higher diet quality with lower systolic [− 0.04 SD (95% CI − 0.06, − 0.01)] and diastolic blood pressure [− 0.05 SD, (95% CI − 0.07, − 0.02)]. No statistically significant associations were found for insulin, triglycerides, HDL cholesterol, or body fat percentage as individual factors.

Conclusions

We found an association between higher diet quality and better cardiometabolic health in childhood, mainly driven by a lower blood pressure. Further research is needed to explore associations of diet quality in childhood with long-term cardiometabolic health.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00394-021-02673-2.

Use of a hybrid method to derive dietary patterns in 7 years olds with explanatory ability of body mass index at age 10

BACKGROUND/OBJECTIVES

The usual definition of dietary patterns only accounts for the explanation of dietary choices and not a specific health outcome. This could partially explain the lack of consistent associations between diet and related diseases. This study aims to identify dietary patterns in 7 years olds explaining body mass index (BMI) at age 10 and to assess their association with early-life factors (sociodemographic, birth, and infancy characteristics).

METHODS

Children from the birth cohort Generation XXI at ages 7 and 10 were included (n = 4698). Diet was assessed by a validated food-frequency questionnaire. Measured BMI z-scores (zBMI) were calculated. Principal component analysis (PCA) and partial least squares (PLS) were run to derive dietary patterns.

RESULTS

The component scores of PCA was able to explain 13.0% of food groups and only 0.2% of zBMI, while the PLS scores explained the variance of both food groups (10.1%) and zBMI at age 10 (4.2%). By using PLS, two dietary patterns were derived, but only one, higher in processed meats and energy-dense foods and lower in vegetable soup consumption, was significantly associated with an increased zBMI in 10 years olds (adjusted β̂ 0.032; 95% CI:0.017; 0.047). It was more likely followed by children from younger and less educated mothers and who were born heavier.

CONCLUSIONS

A dietary pattern higher in processed and energy-dense foods and with lower vegetable soup intake in 7 years olds significantly explained zBMI of 10 years olds, and was predicted by early-life characteristics. The other dietary patterns were not significantly associated with zBMI at age 10.

Family influence on the nutritional status and eating habits of six to nine year-old children

ABSTRACT Objective To investigate whether caregivers’ attitudes, beliefs, practices, alimentary habits, and nutritional status influence the alimentary habits and nutritional status of children aged six to nine years. Methods This cross-sectional study included 164 children and a family member (caregiver) each (n=164), carried out in the family health units of the municipality of Ribeirão Preto (SP), Brazil. Weight and height measurements were performed; each child was then evaluated by the application of both the Child Feeding Questionnaire and 24h recall (for calculating the Healthy Eating Index Revised), in addition to the assessment of adherence to healthy eating steps of the Ministry of Health, through a questionnaire. Results The results showed that the prevalence of being overweight was 18.3% in children and 32.9% in caregivers, and the prevalence of obesity was 15.9% and 37.9%, respectively. Most of the 56 children categorized as overweight also had overweight caregivers (82.1%; n=46). Concerns regarding children’s weight control were higher among caregivers responsible for overweight children (3.6±1.29). In contrast, caregivers responsible for children below or at normal weight demonstrated a greater tendency toward getting children to eat (3.3±0.97 and 3.9±0.99, respectively). The average score; of the children’s Brazilian Healthy Eating Index Revised (50.0±13.6) was similar to that of their caregivers (56.5±12.1). Conclusions Caregivers have a direct influence on the nutritional status and eating habits of children; therefore, they should be targeted in the processes of nutritional intervention for the prevention and treatment of childhood obesity.

Leading dietary determinants identified using machine learning techniques and a healthy diet score for changes in cardiometabolic risk factors in children: a longitudinal analysis

BACKGROUND

Identifying leading dietary determinants for cardiometabolic risk (CMR) factors is urgent for prioritizing interventions in children. We aimed to identify leading dietary determinants for the change in CMR and create a healthy diet score (HDS) to predict CMR in children.

METHODS

We included 5676 children aged 6-13 years in the final analysis with physical examinations, blood tests, and diets assessed at baseline and one year later. CMR score (CMRS) was computed by summing Z-scores of waist circumference, an average of systolic and diastolic blood pressure (SBP and DBP), fasting glucose, high-density lipoprotein cholesterol (HDL-C, multiplying by - 1), and triglycerides. Machine learning was used to identify leading dietary determinants for CMR and an HDS was then computed.

RESULTS

The nine leading predictors for CMRS were refined grains, seafood, fried foods, sugar-sweetened beverages, wheat, red meat other than pork, rice, fungi and algae, and roots and tubers with the contribution ranging from 3.9 to 19.6% of the total variance. Diets high in seafood, rice, and red meat other than pork but low in other six food groups were associated with a favorable change in CMRS. The HDS was computed based on these nine dietary factors. Children with HDS ≥8 had a higher decrease in CMRS (β (95% CI): - 1.02 (- 1.31, - 0.73)), BMI (- 0.08 (- 0.16, - 0.00)), SBP (- 0.46 (- 0.58, - 0.34)), DBP (- 0.46 (- 0.58, - 0.34)), mean arterial pressure (- 0.50 (- 0.62, - 0.38)), fasting glucose (- 0.22 (- 0.32, - 0.11)), insulin (- 0.52 (- 0.71, - 0.32)), and HOMA-IR (- 0.55 (- 0.73, - 0.36)) compared to those with HDS ≦3. Improved HDS during follow-up was associated with favorable changes in CMRS, BMI, percent body fat, SBP, DBP, mean arterial pressure, HDL-C, fasting glucose, insulin, and HOMA-IR.

CONCLUSION

Diets high in seafood, rice, and red meat other than pork and low in refined grains, fried foods, sugar-sweetened beverages, and wheat are leading healthy dietary factors for metabolic health in children. HDS is strongly predictive of CMR factors.

Negative feelings and behaviour are associated with low nutritional level, unhealthy lifestyle, and cardiometabolic risk factors in Chilean schoolchildren

Introduction

Background: feelings and behaviours are an important tool that should be considered to prevent early unhealthy lifestyles. Objective: the objective was to determine the association between feelings (i.e., sadness, loneliness, and school behaviour) with lifestyle (i.e., physical activity patterns and nutritional level), and as secondary endpoint to determine the relationship between health-related quality of life (HRQoL) and lifestyle with obesity and cardiometabolic risk (CMR) factors in Latin American schoolchildren. Methods: this cross-sectional study included a sample of 634 schoolchildren (girls, n = 282, 11.86 ± 0.82 years, and boys, n = 352, 12.02 ± 0.87 years) from publics schools in Chile. Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), body fat (BF), lifestyle, nutritional level, HRQoL, and CMR (i.e., WtHR > 0.5) were evaluated. Results: schoolchildren who have felt sadness and loneliness presented an association with low nutritional level (OR: 4.26, 95 % CI: 2.0-9.0, p < 0.001, and OR: 4.47, 95 % CI: 2.5-7.9, p < 0.001, respectively), bad lifestyle (OR: 2.14, 95 % CI: 1.0-4.54, p = 0.048, and OR: 1.78, 95 % CI: 1.01-3.1, p = 0.045, respectively), and obesity (OR: 2.0, 95 % CI; 0.89-4.54, p = 0.09, and OR: 2.05, 95 % CI; 1.04-4.0, p = 0.037, respectively). Schoolchildren who have had enough time for themselves reported an association with bad lifestyle (OR: 0.69, 95 % CI: 0.47-1.02, p = 0.06), and those who have could not pay attention presented the highest association with bad lifestyle (OR: 4.64, 95 % CI: 72-12.56, p = 0.002). Conclusion: Latin American schoolchildren who have felt sadness and loneliness reported unhealthy lifestyles (i.e., lower nutritional level, increased screen time, and low physical activity), obesity, and thus a higher CMR burden.

The Clustering of Low Diet Quality, Low Physical Fitness, and Unhealthy Sleep Pattern and Its Association with Changes in Cardiometabolic Risk Factors in Children

The clustering of diet quality, physical activity, and sleep and its association with cardiometabolic risk (CMR) factors remains to be explored. We included 5315 children aged 6–13 years in the analysis. CMR score (CMRS) was computed by summing Z-scores of waist circumference, an average of systolic and diastolic blood pressure, fasting glucose, high-density lipoprotein cholesterol (multiplying by −1), and triglycerides. Low diet quality and low cardiorespiratory fitness (CRF) were more likely to be seen in a pair, but low diet quality was less likely to be clustered with unhealthy sleep patterns. Low diet quality, low CRF, and unhealthy sleep pattern was associated with a 0.63, 0.53, and 0.25 standard deviation (SD) higher increase in CMRS, respectively. Compared to children with no unhealthy factor (−0.79 SD), those with ≥1 unhealthy factor had a higher increase (−0.20 to 0.59 SD) in CMRS. A low diet quality-unhealthy sleep pattern resulted in the highest increase in CMRS, blood pressure, and triglycerides. A low diet quality–low CRF-unhealthy sleep pattern resulted in the highest increase in fatness and fasting glucose. Unhealthy factor cluster patterns are complex; however, their positive associations with changes in CMR factors are consistently significant in children. Some specific patterns are more harmful than others for cardiometabolic health.

Food Consumption Patterns and Body Composition in Children: Moderating Effects of Prop Taster Status

This cross-sectional study determined whether 6-n-propylthiouracil (PROP) taster status moderates the relationship between food consumption patterns and body composition in children. Children were recruited (n = 342, 50% female, 8-10 y) from across New Zealand. Using a food frequency questionnaire, these food consumption patterns were derived: Processed Foods, Fruit and Vegetables, and Breakfast Foods. Body composition variables included: body fat (%), fat mass (kg), fat mass index (FMI, kg/m²), body mass index (kg/m²) and waist to height ratio (W:Ht). Following adjustment for confounders, Processed Foods were positively associated with %fat (p = 0.015), fat mass (p = 0.004) and FMI (p = 0.016). Taste test strips determined PROP status. For Breakfast Foods, there were small negative associations with all body composition variables (p ≤ 0.001 to 0.037). The population sample was also stratified by PROP taster status. For the non-tasters, there were small to moderate negative associations between Breakfast Foods and each body composition variable (p = 0.003-0.045) except W:Ht (p = 0.112), and these relationships were stronger for girls compared to boys. For the tasters, there were small to moderate positive associations between Processed Foods with %fat (p = 0.030), fat mass (p ≤ 0.001) and FMI (p = 0.014). In conclusion, sensitivity to bitterness may moderate the relationship between food consumption patterns and body composition in children.