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Pour-Abbasi MS, Nikrad N, Farhangi MA, Vahdat S, Jafarzadeh F. Dietary energy density, metabolic parameters, and blood pressure in a sample of adults with obesity. BMC Endocr Disord 2023; 23:3. [PMID: 36600237 PMCID: PMC9814455 DOI: 10.1186/s12902-022-01243-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Several previous studies revealed the role of dietary energy density (DED) in developing obesity and related disorders. However, the possible role of DED in triggering cardiometabolic risk factors of individuals with obesity has not been studied yet. This study aimed to evaluate the association between DED and anthropometric parameters, blood pressure, and components of metabolic syndrome (MetS) (such as glycemic markers, lipid profile, and blood pressure) among individuals with obesity. METHODS In this cross-sectional study, we included 335 adults with obesity (BMI ≥ 30 kg/m2) aged 20-50 years in Tabriz and Tehran, Iran. Dietary intake was assessed by a validated semi-quantitative Food Frequency Questionnaire (FFQ), including 168 food items; then, DED was calculated. MetS was defined based on the guidelines of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III). Enzymatic methods were used to assess serum lipids, glucose, and insulin concentrations. Blood pressure was measured by sphygmomanometer and body composition by bioelectrical impedance analysis (BIA). RESULTS Participants in the higher tertiles of DED had more intake of carbohydrate, dietary fat, saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), polyunsaturated fatty acid (PUFA), and meat, fish, poultry (MFP). Increasing the DED in both methods had no association with systolic blood pressure (SBP), fasting blood sugar (FBS), low-density lipoprotein cholesterol (LDL-C), insulin, triglyceride (TG), and homeostatic model assessment of insulin resistance (HOMA-IR) even after adjustment for confounders. However, diastolic blood pressure (DBP) decreased in second tertile of DED I (β = 0.921, P = 0.004). The quantitative insulin-sensitivity check index (QUICKI) in second tertile of both DED methods had significant positive association with DED. In the second tertile of DED II, while total cholesterol (TC) significantly decreased (P crude = 0.036, P adjusted = 0.024), high-density lipoprotein cholesterol (HDL-C) increased (β = 1.096, p = 0.03). There was no significant changes in biochemical parameters in third tertile of DED I and II even after adjustment for covariates. Also, higher tertiles of DED was associated with reduced prevalence of MetS. CONCLUSION High DED was associated with lower levels of blood pressure and TC but elevated levels of HDL and QUICKI independent of such confounders as age, BMI, sex, and physical activity. Further longitudinal studies are warranted to better elucidate casual associations.
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Affiliation(s)
| | - Negin Nikrad
- Department of Community Nutrition, Faculty of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdieh Abbasalizad Farhangi
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Attar Neyshabouri St, Tabriz, Iran.
| | - Sahar Vahdat
- Isfahan Kidney Disease Research Center, Khorshid Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Faria Jafarzadeh
- Department of Internal Medicine, School of Medicine, North Khorasan University of Medical Sciences, Bojnourd, Iran.
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Bazshahi E, Sheikhhossein F, Amini MR, Shab-Bidar S. The association of dietary energy density and the risk of obesity, type 2 diabetes and metabolic syndrome: A systematic review and meta-analysis of observational studies. Int J Clin Pract 2021; 75:e14291. [PMID: 33932083 DOI: 10.1111/ijcp.14291] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES There is a growing body of evidence linking dietary energy density (DED) with metabolic disorders like obesity, type 2 diabetes (T2D) and metabolic syndrome (MetS). However, according to our knowledge, there has been no systematic review and mate-analysis on T2D and MetS with DED. Therefore, this study aimed to investigate the association between DED with the risk of obesity, T2D and MetS in a systematic review and meta-analysis of observational studies. METHODS We searched all published studies according to the defined keywords up to march 2020 in the PubMed/Medline and Scopus databases. We excluded those that did not calculate DED for total intake, no observed association between obesity, T2D, MetS as the primary or one of the outcomes with DED, no reported odds ratio (OR), relative risk (RR) or hazard ratio (HR) estimates with 95% confidence intervals (CIs), studies in children under 2 years old, patients with cancer and pregnant women. RESULTS From 2282, after deleting the duplicates and irrelevant studies, we entered 58 articles ( 47 systematic reviews and 11 meta-analyse). We indicated an increased risk of T2D in relation to DED (OR: 1.25, 95% CI: 1.18-1.33, P < .001). But studies reviewed were inconsistent. All studies which examined the relationship between DED and MetS showed a positive relationship with an increased significant risk (OR: 1.59, 95% CI: 1.22-2.07, P < .001). Most articles reported a direct association between DED and obesity but the relationship between DED and risk of obesity was not significant (OR: 1.04, 95% CI: 0.92-1.17, P = .543). CONCLUSION In this systematic review and meta-analysis of observational studies, we found that the DED increased the risk of T2D and MetS but was not significant with the risk of obesity.
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Affiliation(s)
- Elham Bazshahi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sheikhhossein
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Amini
- Department of Clinical Nutrition, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Reynolds AN, Diep Pham HT, Montez J, Mann J. Dietary fibre intake in childhood or adolescence and subsequent health outcomes: A systematic review of prospective observational studies. Diabetes Obes Metab 2020; 22:2460-2467. [PMID: 32844565 PMCID: PMC7756362 DOI: 10.1111/dom.14176] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/07/2020] [Accepted: 08/23/2020] [Indexed: 12/14/2022]
Abstract
AIM To determine whether higher fibre intakes during childhood or adolescence effect a broad range of intermediate markers of cardiometabolic risk or other health related issues. MATERIALS AND METHODS We used online searches up to January 2020 and manual searches to identify prospective observational studies reporting on childhood or adolescent intakes of dietary fibre, vegetables, fruit and refined or whole grains. Outcomes measured later in life were body weight, blood lipids, blood pressure, glycaemia, bone health, cognition, growth and bowel habits. Potential age-specific ranges for dietary fibre were extrapolated from published adult data. RESULTS We identified 45 publications reporting on 44 354 participants from 30 cohort studies. Mean age at dietary assessment varied from 1 to 19.3 years. Follow-up duration varied from 4 months to 27 years. Although well-conducted studies reported improvements in body weight, blood lipids and glycaemia, the diverse nature of studies precluded meta analysis. The quality of evidence was very low to low given the limited data available per outcome and the inability to synthesize results from multiple studies. Potential dietary fibre intake begins at 13-16 g a day for 2-year-olds and increases until the age of 10 years, when values are comparable with an adult range of 25-30 g a day. CONCLUSIONS Given the inconsistency in findings from cohort studies other than an absence of detrimental effects, it seems appropriate that recommendations regarding childhood fibre intake are extrapolated from relevant adult data.
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Affiliation(s)
| | | | - Jason Montez
- Department of Nutriton and Food SafetyWorld Health OrganizationGenevaSwitzerland
| | - Jim Mann
- Department of MedicineUniversity of OtagoDunedinNew Zealand
- Edgar Diabetes and Obesity Research CentreUniversity of OtagoDunedinNew Zealand
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Notara V, Legkou M, Kanellopoulou A, Antonogeorgos G, Rojas-Gil AP, Kornilaki EN, Konstantinou E, Lagiou A, Panagiotakos DB. Lack of association between dietary fibres intake and childhood obesity: an epidemiological study among preadolescents in Greece. Int J Food Sci Nutr 2020; 71:635-643. [PMID: 31928243 DOI: 10.1080/09637486.2020.1712681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was to evaluate whether dietary fibres intake is associated with childhood obesity. From 2014 to 2016, a sample of 1728 Greek boys and girls students, 10-12 years and their parents were enrolled in the study. Dietary fibres intake was assessed through food questionnaires and child's body mass status was defined according to the International Obesity Task Force (IOTF)'s criteria. Prevalence of combined overweight/obesity was 26.7%, with boys having significantly higher prevalence than girls (31.5 versus 24.7%, p < 0.001). Logistic regression analysis, after various adjustments were made, revealed no association between dietary fibres intake and obesity/overweight (Odds Ratio = 0.76; 95% CI 0.48, 1.19). The lack of an association between dietary fibres intake and overweight/obesity status among pre-adolescents could be attributed to various reasons such as, methodological issues reflecting the study's design, the measurement of exposure or due to true absence of a relationship. Nevertheless, fibres consumption should not be prevented, but, promoted under the context of a balanced diet, because of their numerous pleiotropic health effects.
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Affiliation(s)
- Venetia Notara
- Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece.,Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Marina Legkou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Aikaterini Kanellopoulou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - George Antonogeorgos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Andrea Paola Rojas-Gil
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Greece
| | - Ekaterina N Kornilaki
- Department of Preschool Education, School of Education, University of Crete, Crete, Greece
| | - Eleni Konstantinou
- Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece
| | - Areti Lagiou
- Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.,Faculty of Health, University of Canberra, Canberra, Australia
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Arango‐Angarita A, Shamah‐Levy T, Rodríguez‐Ramírez S. Dietary energy density is associated with body mass index-for-age in Mexican adolescents. MATERNAL & CHILD NUTRITION 2019; 15:e12664. [PMID: 30225859 PMCID: PMC7198965 DOI: 10.1111/mcn.12664] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 07/13/2018] [Accepted: 07/19/2018] [Indexed: 01/08/2023]
Abstract
Dietary energy density (DED) has been widely considered a risk factor for weight gain. In adolescents, however, the evidence is inconclusive, and in Mexico, the ways in which DED is associated with overweight and obesity are unknown. Our study analysed the association of DED with overweight or obesity (OW-O) in Mexican adolescents included in the National Health and Nutrition Survey 2012 (ENSANUT 2012). We analysed the data from a 7-day Food Frequency Questionnaire administered to 2,203 Mexican adolescents aged 12-19 years. DED was calculated excluding all beverages. Plausible and implausible reporters were identified based on the relationship between the reported energy intake and the estimated energy requirement. The association of DED with body mass index (BMI)-for-age and OW-O was analysed using multivariate statistical models restricted to plausible reporters. The combined prevalence of overweight and obesity was 35.4% in the complete sample and 27.8% in the sample of plausible reporters. Mean DED was 177 kcal/100 g, with higher DED in the north of the country. The proportion of plausible reporters was 38.5%. We found a positive association between high DED and the BMI-for-age z-score (β = 0.347; 95% CI [0.101, 0.594]; P = 0.006), controlling for sociodemographic and dietary variables, but no significant association with OW-O. It is necessary to consider the DED in the design and implementation of strategies to reduce energy density in the diets of young Mexicans.
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Affiliation(s)
- Andrea Arango‐Angarita
- Center for Evaluation and Surveys ResearchNational Institute of Public HealthCuernavacaMorelosMexico
| | - Teresa Shamah‐Levy
- Center for Evaluation and Surveys ResearchNational Institute of Public HealthCuernavacaMorelosMexico
| | - Sonia Rodríguez‐Ramírez
- Center for Nutrition and Health ResearchNational Institute of Public HealthCuernavacaMorelosMexico
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Arango-Angarita A, Rodríguez-Ramírez S, Serra-Majem L, Shamah-Levy T. Dietary Energy Density and Its Association with Overweight or Obesity in Adolescents: A Systematic Review of Observational Studies. Nutrients 2018; 10:E1612. [PMID: 30388849 PMCID: PMC6266059 DOI: 10.3390/nu10111612] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 01/15/2023] Open
Abstract
Dietary energy density (DED) has been identified as a crucial dietary factor in body weight control, in that higher DED has been associated with weight gain. To our knowledge, no review studies have explained this association specifically in adolescents. The aim of this study was to describe the association of DED with overweight or obesity (OW/O) in adolescents, as derived from observational studies. We conducted a systematic search of the MEDLINE/PubMed and Science Direct databases, including studies published between January 2000 and December 2017. We selected the studies that included adolescents (aged 10⁻19 years) and contained DED-related information and anthropometric measurements of OW/O. From 1149 candidate studies, 30 were selected, though only 12 met all the inclusion criteria. Of these, only four found a positive association between DED and certain OW/O indicators, six found no association and two showed an inverse association with weight gain. These studies differed in several aspects such as design, DED calculation method and dietary assessment tool, leading to inconsistent results. Methodological differences found among the examined studies did not allow us to establish a clear conclusion of this association. Evidence in adolescents was also poor. New, standardized methodological approaches should be considered in future studies.
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Affiliation(s)
- Andrea Arango-Angarita
- Center for Evaluation and Surveys Research, National Institute of Public Health, Cuernavaca, 62100 Morelos, Mexico.
| | - Sonia Rodríguez-Ramírez
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, 62100 Morelos, Mexico.
| | - Lluis Serra-Majem
- Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, CP, Spain.
| | - Teresa Shamah-Levy
- Center for Evaluation and Surveys Research, National Institute of Public Health, Cuernavaca, 62100 Morelos, Mexico.
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Naude CE, Visser ME, Nguyen KA, Durao S, Schoonees A. Effects of total fat intake on bodyweight in children. Cochrane Database Syst Rev 2018; 7:CD012960. [PMID: 29974953 PMCID: PMC6513603 DOI: 10.1002/14651858.cd012960.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND As part of efforts to prevent childhood overweight and obesity, we need to understand the relationship between total fat intake and body fatness in generally healthy children. OBJECTIVES To assess the effects and associations of total fat intake on measures of weight and body fatness in children and young people not aiming to lose weight. SEARCH METHODS For this update we revised the previous search strategy and ran it over all years in the Cochrane Library, MEDLINE (Ovid), MEDLINE (PubMed), and Embase (Ovid) (current to 23 May 2017). No language and publication status limits were applied. We searched the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov for ongoing and unpublished studies (5 June 2017). SELECTION CRITERIA We included randomised controlled trials (RCTs) in children aged 24 months to 18 years, with or without risk factors for cardiovascular disease, randomised to a lower fat (30% or less of total energy (TE)) versus usual or moderate-fat diet (greater than 30%TE), without the intention to reduce weight, and assessed a measure of weight or body fatness after at least six months. We included prospective cohort studies if they related baseline total fat intake to weight or body fatness at least 12 months later. DATA COLLECTION AND ANALYSIS We extracted data on participants, interventions or exposures, controls and outcomes, and trial or cohort quality characteristics, as well as data on potential effect modifiers, and assessed risk of bias for all included studies. We extracted body weight and blood lipid levels outcomes at six months, six to 12 months, one to two years, two to five years and more than five years for RCTs; and for cohort studies, at baseline to one year, one to two years, two to five years, five to 10 years and more than 10 years. We planned to perform random-effects meta-analyses with relevant subgrouping, and sensitivity and funnel plot analyses where data allowed. MAIN RESULTS We included 24 studies comprising three parallel-group RCTs (n = 1054 randomised) and 21 prospective analytical cohort studies (about 25,059 children completed). Twenty-three studies were conducted in high-income countries. No meta-analyses were possible, since only one RCT reported the same outcome at each time point range for all outcomes, and cohort studies were too heterogeneous to combine.Effects of dietary counselling to reduce total fat intake from RCTsTwo studies recruited children aged between 4 and 11 years and a third recruited children aged 12 to 13 years. Interventions were combinations of individual and group counselling, and education sessions in clinics, schools and homes, delivered by dieticians, nutritionists, behaviourists or trained, supervised teachers. Concerns about imprecision and poor reporting limited our confidence in our findings. In addition, the inclusion of hypercholesteraemic children in two trials raised concerns about applicability.One study of dietary counselling to lower total fat intake found that the intervention may make little or no difference to weight compared with usual diet at 12 months (mean difference (MD) -0.50 kg, 95% confidence interval (CI) -1.78 to 0.78; n = 620; low-quality evidence) and at three years (MD -0.60 kg, 95% CI -2.39 to 1.19; n = 612; low-quality evidence). Education delivered as a classroom curriculum probably decreased BMI in children at 17 months (MD -1.5 kg/m2, 95% CI -2.45 to -0.55; 1 RCT; n = 191; moderate-quality evidence). The effects were smaller at longer term follow-up (five years: MD 0 kg/m2, 95% CI -0.63 to 0.63; n = 541; seven years; MD -0.10 kg/m2, 95% CI -0.75 to 0.55; n = 576; low-quality evidence).Dietary counselling probably slightly reduced total cholesterol at 12 months compared to controls (MD -0.15 mmol/L, 95% CI -0.24 to -0.06; 1 RCT; n = 618; moderate-quality evidence), but may make little or no difference over longer time periods. Dietary counselling probably slightly decreased low-density lipoprotein (LDL) cholesterol at 12 months (MD -0.12 mmol/L, 95% CI -0.20 to -0.04; 1 RCT; n = 618, moderate-quality evidence) and at five years (MD -0.09, 95% CI -0.17 to -0.01; 1 RCT; n = 623; moderate-quality evidence), compared to controls. Dietary counselling probably made little or no difference to HDL-C at 12 months (MD -0.03 mmol/L, 95% CI -0.08 to 0.02; 1 RCT; n = 618; moderate-quality evidence), and at five years (MD -0.01 mmol/L, 95% CI -0.06 to 0.04; 1 RCT; n = 522; moderate-quality evidence). Likewise, counselling probably made little or no difference to triglycerides in children at 12 months (MD -0.01 mmol/L, 95% CI -0.08 to 0.06; 1 RCT; n = 618; moderate-quality evidence). Lower versus usual or modified fat intake may make little or no difference to height at seven years (MD -0.60 cm, 95% CI -2.06 to 0.86; 1 RCT; n = 577; low-quality evidence).Associations between total fat intake, weight and body fatness from cohort studiesOver half the cohort analyses that reported on primary outcomes suggested that as total fat intake increases, body fatness measures may move in the same direction. However, heterogeneous methods and reporting across cohort studies, and predominantly very low-quality evidence, made it difficult to draw firm conclusions and true relationships may be substantially different. AUTHORS' CONCLUSIONS We were unable to reach firm conclusions. Limited evidence from three trials that randomised children to dietary counselling or education to lower total fat intake (30% or less TE) versus usual or modified fat intake, but with no intention to reduce weight, showed small reductions in body mass index, total- and LDL-cholesterol at some time points with lower fat intake compared to controls. There were no consistent effects on weight, high-density lipoprotein (HDL) cholesterol or height. Associations in cohort studies that related total fat intake to later measures of body fatness in children were inconsistent and the quality of this evidence was mostly very low. Most studies were conducted in high-income countries, and may not be applicable in low- and middle-income settings. High-quality, longer-term studies are needed, that include low- and middle-income settings to look at both possible benefits and harms.
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Affiliation(s)
- Celeste E Naude
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health SciencesFrancie van Zijl DriveCape TownSouth Africa
| | - Marianne E Visser
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health SciencesFrancie van Zijl DriveCape TownSouth Africa
- South African Medical Research CouncilCochrane South AfricaCape TownSouth Africa
| | - Kim A Nguyen
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health SciencesFrancie van Zijl DriveCape TownSouth Africa
| | - Solange Durao
- South African Medical Research CouncilCochrane South AfricaCape TownSouth Africa
| | - Anel Schoonees
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health SciencesFrancie van Zijl DriveCape TownSouth Africa
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Naude CE, Visser ME, Nguyen KA, Durao S, Schoonees A. Effects of total fat intake on bodyweight in children. Cochrane Database Syst Rev 2018; 2:CD012960. [PMID: 29446437 PMCID: PMC6491333 DOI: 10.1002/14651858.cd012960] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND As part of efforts to prevent childhood overweight and obesity, we need to understand the relationship between total fat intake and body fatness in generally healthy children. OBJECTIVES To assess the effects of total fat intake on measures of weight and body fatness in children and young people not aiming to lose weight. SEARCH METHODS For this update we revised the previous search strategy and ran it over all years in the Cochrane Library, MEDLINE (Ovid), MEDLINE (PubMed), and Embase (Ovid) (current to 23 May 2017). No language and publication status limits were applied. We searched the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov for ongoing and unpublished studies (5 June 2017). SELECTION CRITERIA We included randomised controlled trials (RCTs) in children aged 24 months to 18 years, with or without risk factors for cardiovascular disease, randomised to a lower fat (30% or less of total energy (TE)) versus usual or moderate-fat diet (greater than 30%TE), without the intention to reduce weight, and assessed a measure of weight or body fatness after at least six months. We included prospective analytical cohort studies in these children if they related baseline total fat intake to weight or body fatness at least 12 months later. We duplicated inclusion decisions and resolved disagreement by discussion with other authors. DATA COLLECTION AND ANALYSIS We extracted data on participants, interventions or exposures, controls and outcomes, and trial or cohort quality characteristics, as well as data on potential effect modifiers, and assessed risk of bias for all included studies. We extracted outcome data using the following time point ranges, when available: RCTs: baseline to six months, six to 12 months, one to two years, two to five years and more than five years; cohort studies: baseline to one year, one to two years, two to five years, five to 10 years and more than 10 years. We planned to perform random-effects meta-analyses with relevant subgrouping, and sensitivity and funnel plot analyses where data allowed. MAIN RESULTS We included 24 studies comprising three parallel-group RCTs (n = 1054 randomised) and 21 prospective analytical cohort studies (about 25,059 children completed). Twenty-three were conducted in high-income countries. No meta-analyses were possible, since only one RCT reported the same outcome at each time point range for all outcomes, and cohort studies were too heterogeneous.For the RCTs, concerns about imprecision and poor reporting limited our confidence in our findings. In addition, the inclusion of hypercholesteraemic children in two trials raised concerns about applicability. Lower versus usual or modified total fat intake may have made little or no difference to weight over a six- to twelve month period (mean difference (MD) -0.50 kg, 95% confidence interval (CI) -1.78 to 0.78; 1 RCT; n = 620; low-quality evidence), nor a two- to five-year period (MD -0.60 kg, 95% CI -2.39 to 1.19; 1 RCT; n = 612; low-quality evidence). Compared to controls, lower total fat intake (30% or less TE) probably decreased BMI in children over a one- to two-year period (MD -1.5 kg/m2, 95% CI -2.45 to -0.55; 1 RCT; n = 191; moderate-quality evidence), with no other differences evident across the other time points (two to five years: MD 0.00 kg/m2, 95% CI -0.63 to 0.63; 1 RCT; n = 541; greater than five years; MD -0.10 kg/m2, 95% CI -0.75 to 0.55; 1 RCT; n = 576; low-quality evidence). Lower fat intake probably slightly reduced total cholesterol over six to 12 months compared to controls (MD -0.15 mmol/L, 95% CI -0.24 to -0.06; 1 RCT; n = 618; moderate-quality evidence), but may make little or no difference over longer time periods. Lower fat intake probably slightly decreased low-density lipoprotein (LDL) cholesterol over six to 12 months (MD -0.12 mmol/L, 95% CI -0.20 to -0.04; 1 RCT; n = 618, moderate-quality evidence) and over two to five years (MD -0.09, 95% CI -0.17 to -0.01; 1 RCT; n = 623; moderate-quality evidence), compared to controls. However, lower total fat intake probably made little or no difference to HDL-C over a six- to 12-month period (MD -0.03 mmol/L, 95% CI -0.08 to 0.02; 1 RCT; n = 618; moderate-quality evidence), nor a two- to five-year period (MD -0.01 mmol/L, 95% CI -0.06 to 0.04; 1 RCT; n = 522; moderate-quality evidence). Likewise, lower total fat intake probably made little or no difference to triglycerides in children over a six- to 12-month period (MD -0.01 mmol/L, 95% CI -0.08 to 0.06; 1 RCT; n = 618; moderate-quality evidence). Lower versus usual or modified fat intake may make little or no difference to height over more than five years (MD -0.60 cm, 95% CI -2.06 to 0.86; 1 RCT; n = 577; low-quality evidence).Over half the cohort analyses that reported on primary outcomes suggested that as total fat intake increases, body fatness measures may move in the same direction. However, heterogeneous methods and reporting across cohort studies, and predominantly very low-quality evidence, made it difficult to draw firm conclusions and true relationships may be substantially different. AUTHORS' CONCLUSIONS We were unable to reach firm conclusions. Limited evidence from three trials that randomised children to a lower total fat intake (30% or less TE) versus usual or modified fat intake, but with no intention to reduce weight, showed small reductions in body mass index, total- and LDL-cholesterol at some time points with lower fat intake compared to controls, and no consistent differences in effects on weight, high-density lipoprotein (HDL) cholesterol or height. Associations in cohort studies that related total fat intake to later measures of body fatness in children were inconsistent and the quality of this evidence was mostly very low. Twenty-three out of 24 included studies were conducted in high-income countries, and may not be applicable in low- and middle-income settings. High-quality, longer-term studies are needed, that include low- and middle-income settings and look at both possible benefits and risks.
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Affiliation(s)
- Celeste E Naude
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health SciencesFrancie van Zijl DriveCape TownSouth Africa
| | | | - Kim A Nguyen
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health SciencesFrancie van Zijl DriveCape TownSouth Africa
| | - Solange Durao
- South African Medical Research CouncilCochrane South AfricaCape TownSouth Africa
| | - Anel Schoonees
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health SciencesFrancie van Zijl DriveCape TownSouth Africa
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Rouhani MH, Haghighatdoost F, Surkan PJ, Azadbakht L. Associations between dietary energy density and obesity: A systematic review and meta-analysis of observational studies. Nutrition 2016; 32:1037-47. [PMID: 27238958 DOI: 10.1016/j.nut.2016.03.017] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/01/2016] [Accepted: 03/16/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Although many studies have shown an association between dietary energy density (DED) and obesity, there has been no systematic review and meta-analysis on this topic. Therefore, the objective of this study was to qualitatively and quantitatively review and summarize the literature on association between DED and obesity. METHODS We searched titles, abstracts, and keywords of articles indexed in ScienceDirect, ProQuest, MEDLINE, and Google Scholar databases until January 2015 to identify eligible studies. We excluded studies that did not examine DED for whole diet and studies that included patients with cancer, pregnant women, the elderly (>60 y old), and children (<2 y old). There were no language or publication date restrictions. RESULTS Of the 37 studies included in this review, most articles reported a direct association between DED and obesity. We performed a meta-analysis on 23 of these studies. In comparison with the lowest NTILE of DED, subjects in the highest NTILE of DED had significant weight gain (2.26 kg, 95% confidence interval [CI]: 1.00-3.53), greater adjusted mean body mass index (BMI) (0.50 kg/m(2), 95% CI: 0.02-0.98 for males and 0.85 kg/m(2), 95% CI: 0.51-1.19 for females), and risk of excess adiposity (odds ratio [OR]: 1.27, 95% CI: 1.04-1.55). We did not observe significant associations between DED and risk of elevated BMI (OR: 1.13, 95% CI: 1.00-1.27) and abdominal obesity (OR: 1.17, 95% CI: 0.19-7.38). We found no evidence of publication bias. CONCLUSION The present review showed that DED was directly associated with risk of excess adiposity, higher weight change, and BMI. Lower DED should be considered a prevention strategy for obesity.
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Affiliation(s)
- Mohammad Hossein Rouhani
- Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Haghighatdoost
- Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Leila Azadbakht
- Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
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Hebestreit A, Barba G, De Henauw S, Eiben G, Hadjigeorgiou C, Kovács É, Krogh V, Moreno LA, Pala V, Veidebaum T, Wolters M, Börnhorst C. Cross-sectional and longitudinal associations between energy intake and BMI z-score in European children. Int J Behav Nutr Phys Act 2016; 13:23. [PMID: 26879850 PMCID: PMC4754870 DOI: 10.1186/s12966-016-0344-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 02/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence for the effect of dietary energy on BMI z-scores in young children is limited. We aim to investigate cross-sectional and longitudinal effects of daily energy intake (EI) on BMI z-scores of European boys and girls considering growth-related height dependencies of EI using residual EI. METHODS To investigate cross-sectional and longitudinal effects of daily energy intake (EI) on BMI z-scores of European boys and girls considering growth-related height dependencies of EI using residual EI. METHODS Subjects were children aged 2- < 10 y old (N = 2753, 48.2% girls) participating in the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS) baseline and follow-up examination. Usual EI (kcal/day) was calculated based on the National Cancer Institute-method excluding subjects with implausible reported EI. Effect of age, height and sex-adjusted residuals of EI on BMI z-score was investigated stratified by baseline age -group (2- < 4 y, 4- < 6 y, 6- < 8 y and 8- < 10 y) cross-sectionally using linear regression models adjusted for relevant confounders (crude model: age, sex, country; fully adjusted model: plus parental ISCED level, parental BMI, screen time; subgroup analysis: plus objectively measured physical activity). Longitudinal associations were estimated between changes in (Δ) residual EI per year and ΔBMI z-score per year with adjustments analogously to the cross-sectional models but with additional adjustment for residual EI at baseline. RESULTS Cross-sectionally, positive associations were observed between residual EI and BMI z-score for the full study sample, for boys and in older (≥6 years) but not in younger children in the crude and fully adjusted model. Longitudinally, small positive associations were observed between Δresidual EI per y on ΔBMI z-score per y for the full study sample and in 4- < 6 y olds in the crude and fully adjusted model. CONCLUSION In conclusion, EI above the average intakes for a certain sex, age and height are weakly associated with BMI z-scores in European children. Residual EI may be considered as a useful exposure measure in children as it accounts for growth-related changes in usual EI during childhood.
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Affiliation(s)
- Antje Hebestreit
- Leibniz-Institute for Prevention Research and Epidemiology - BIPS GmbH, Achterstr. 30, D-28359, Bremen, Germany.
| | | | | | - Gabriele Eiben
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
| | | | - Éva Kovács
- Department of Pediatrics, University of Pécs, Pécs, Hungary and Institute for Medical Information Processing, Biometrics and Epidemiology and German Centre for Vertigo and Balance Disorders, Ludwig Maximilian University, Munich, Germany.
| | - Vittorio Krogh
- Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Luis A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.
| | - Valeria Pala
- Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Toomas Veidebaum
- Department of Chronic Diseases, National Institute for Health Development, Tallinn, Estonia.
| | - Maike Wolters
- Leibniz-Institute for Prevention Research and Epidemiology - BIPS GmbH, Achterstr. 30, D-28359, Bremen, Germany.
| | - Claudia Börnhorst
- Leibniz-Institute for Prevention Research and Epidemiology - BIPS GmbH, Achterstr. 30, D-28359, Bremen, Germany.
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von Hippel PT, Nahhas RW, Czerwinski SA. How much do children's body mass indices change over intervals of 6-12 months? Statistics from before and during the obesity epidemic. Pediatr Obes 2015; 10:468-75. [PMID: 25704952 DOI: 10.1111/ijpo.12008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 11/20/2014] [Accepted: 12/05/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Researchers need to evaluate changes in children's body mass index (BMI) over periods of 6 or 12 months, yet reference statistics are limited for change in BMI. OBJECTIVES We aim to estimate the distribution of changes in children's BMIs over periods of 6 and 12 months. METHODS We analyze data on two cohorts of children in the Fels Longitudinal Study: an older cohort born 1946-1970 and a recent cohort born 1971-1995. Between ages 3 and 18 years, we calculate changes in BMI over intervals of 6 and 12 months. For each age, sex and cohort, we estimate the mean, standard deviation, skewness, kurtosis and percentiles of change in BMI. RESULTS Median BMI growth peaks around age 12-13 years for girls and 13-15 years for boys. Large BMI gains are common in adolescence, and BMI losses are not uncommon at any age. Percentiles of BMI change are quite dispersed, especially for girls and especially in adolescence. In the recent cohort, the adiposity rebound is earlier and BMI gains are larger, especially at the high percentiles. CONCLUSIONS Researchers can use these estimates to evaluate data quality, evaluate effect sizes and calculate the sample size needed to detect an effect.
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Affiliation(s)
- P T von Hippel
- LBJ School of Public Affairs, University of Texas at Austin, Austin, TX, USA
| | - R W Nahhas
- Division of Morphological Sciences and Biostatistics, Lifespan Health Research Center, Department of Community Health, Boonshoft School of Medicine, Wright State University, Kettering, OH, USA
| | - S A Czerwinski
- Division of Epidemiology, Lifespan Health Research Center, Department of Community Health, Boonshoft School of Medicine, Wright State University, Kettering, OH, USA
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The Cross-Sectional Association of Energy Intake and Dietary Energy Density with Body Composition of Children in Southwest China. Nutrients 2015; 7:5396-412. [PMID: 26151177 PMCID: PMC4517005 DOI: 10.3390/nu7075228] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 06/12/2015] [Accepted: 06/27/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We examined whether dietary energy intake (EI) and dietary energy density (ED) were cross-sectionally associated with body composition of children living in Southwest China. DESIGN AND METHODS Multivariate regression analyses were performed on three day, 24 h dietary recall data and information on potential confounders from 1207 participants aged 8-14 years. EI was calculated from all foods and drinks and ED was classified into five categories. Body mass index (BMI) z-scores, percentage of body fat (%BF), fat mass index (FMI), fat-free mass index (FFMI) and ratio of waist to hip circumference (WHR) were used to describe body composition. RESULTS Boys with higher total EI had higher BMI z-scores, %BF, and FMI than boys with lower total EI both before and after measurements were adjusted for confounders (age, fiber intake, physical activity, the timing of adding complementary foods, paternal education level and maternal BMI) (p ≤ 0.04). However, EI was not associated with body composition in girls. Dietary ED, in any category, was not associated with body composition in either gender. CONCLUSIONS Dietary ED was not associated with body composition of children in Southwest China, while dietary EI in boys, not girls, was positively associated with body composition. Reducing dietary energy intake may help to prevent obesity and related diseases in later life among boys living in Southwest China.
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ZHOU X, ZHANG L. The Influence of Dietary Energy Density on Childhood Obesity. IRANIAN JOURNAL OF PUBLIC HEALTH 2014; 43:1587-8. [PMID: 26060730 PMCID: PMC4449512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 10/10/2014] [Indexed: 11/06/2022]
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Jones JA, Hartman TJ, Klifa CS, Coffman DL, Mitchell DC, Vernarelli JA, Snetselaar LG, Van Horn L, Stevens VJ, Robson AM, Himes JH, Shepherd JA, Dorgan JF. Dietary energy density is positively associated with breast density among young women. J Acad Nutr Diet 2014; 115:353-359. [PMID: 25300225 DOI: 10.1016/j.jand.2014.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 08/06/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Breast density is an established predictor of breast cancer risk, and there is considerable interest in associations of modifiable lifestyle factors, such as diet, with breast density. OBJECTIVE To determine whether dietary energy density (ED) is associated with percent dense breast volume (%DBV) and absolute dense breast volume (ADBV) in young women. DESIGN A cross-sectional analysis was conducted with women who participated in the Dietary Intervention Study in Children Follow-Up Study. %DBV and ADBV were measured by magnetic resonance imaging. Diet was assessed by three 24-hour recalls. Dietary ED (kilocalories/gram) was calculated using three methods: food only, food and caloric beverages, and food and all beverages. PARTICIPANTS/SETTING One hundred seventy-two women (aged 25 to 29 years) who were enrolled in the Dietary Intervention Study in Children Follow-Up Study. Participants who reported breast augmentation or reduction surgery or were pregnant or lactating within 3 months before breast density assessment were excluded. MAIN OUTCOME MEASURES ADBV and %DBV. STATISTICAL ANALYSES PERFORMED Multivariable linear mixed effects models were used. Final models were adjusted for race, smoking status, education, parity, duration of sex hormone use, whole body percent fat, childhood body mass index z score, and energy from beverages. RESULTS After adjustment, each 1 kcal/g unit increase in food-only ED was associated with a 25.9% (95% CI 6.2% to 56.8%) increase in %DBV (P=0.01). Childhood body mass index z score modified the association between food-only ED and %DBV such that a significant positive association was observed only in women who were heavier as children. Food-only ED was not associated with ADBV in all women, but a borderline significant positive association was observed in women who had higher childhood body mass index z scores. CONCLUSIONS This is the first report to suggest a potential role for dietary ED in breast density; the effects of long-term exposure to high-ED diets on breast cancer risk remain unknown.
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Cardel M, Willig AL, Dulin-Keita A, Casazza K, Cherrington A, Gunnarsdottir T, Johnson SL, Peters JC, Hill JO, Allison DB, Fernández JR. Home-schooled children are thinner, leaner, and report better diets relative to traditionally schooled children. Obesity (Silver Spring) 2014; 22:497-503. [PMID: 24039204 PMCID: PMC3946420 DOI: 10.1002/oby.20610] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 08/06/2013] [Accepted: 08/16/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine and compare the relationships among diet, physical activity, and adiposity between home-schooled children (HSC) and traditionally schooled children (TSC). DESIGN AND METHODS Subjects were HSC (n = 47) and TSC (n = 48) aged 7-12 years old. Dietary intakes were determined via two 24-h recalls and physical activity was assessed with 7 days of accelerometry. Fat mass (FM), trunk fat, and percent body fat (%BF) were measured by dual-energy X-ray absorptiometry (DXA). RESULTS Relative to HSC, TSC demonstrated significantly higher BMI percentiles, FM, trunk fat, and %BF; consumed 120 total kilocalories more per day; and reported increased intakes of trans fats, total sugar, added sugars, calcium, and lower intakes of fiber, fruits, and vegetables (P < 0.05). At lunch, TSC consumed significantly more calories, sugar, sodium, potassium, and calcium compared to HSC (P < 0.05). Physical activity did not differ between groups. Traditional schooling was associated with increased consumption of trans fat, sugar, calcium (P < 0.05); lower intakes of fiber, and fruits and vegetables (P < 0.05); and higher FM, %BF, and trunk fat (P < 0.01), after adjustment for covariates. CONCLUSIONS These data suggest HSC may consume diets that differ in energy and nutrient density relative to TSC, potentially contributing to differences in weight and adiposity.
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Affiliation(s)
- Michelle Cardel
- Department of Pediatric Nutrition, University of Colorado Denver, Aurora, CO
| | - Amanda L. Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Akilah Dulin-Keita
- Department of Behavioral and Social Sciences Program in Public Health, Brown University, Providence, RI
| | - Krista Casazza
- Department of Nutrition Sciences and the Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL
| | - Andrea Cherrington
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Susan L. Johnson
- Department of Pediatric Nutrition, University of Colorado Denver, Aurora, CO
| | - John C. Peters
- Department of Endocrinology, University of Colorado Denver, Aurora, CO
| | - James O. Hill
- Department of Pediatric Nutrition, University of Colorado Denver, Aurora, CO
| | - David B. Allison
- Department of Nutrition Sciences and the Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL
| | - José R. Fernández
- Department of Nutrition Sciences and the Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL
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Murakami K, Miyake Y, Sasaki S, Tanaka K, Arakawa M. An energy-dense diet is cross-sectionally associated with an increased risk of overweight in male children, but not in female children, male adolescents, or female adolescents in Japan: the Ryukyus Child Health Study. Nutr Res 2012; 32:486-94. [DOI: 10.1016/j.nutres.2012.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 05/25/2012] [Accepted: 05/25/2012] [Indexed: 10/28/2022]
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Hauner H, Bechthold A, Boeing H, Brönstrup A, Buyken A, Leschik-Bonnet E, Linseisen J, Schulze M, Strohm D, Wolfram G. Evidence-based guideline of the German Nutrition Society: carbohydrate intake and prevention of nutrition-related diseases. ANNALS OF NUTRITION AND METABOLISM 2012; 60 Suppl 1:1-58. [PMID: 22286913 DOI: 10.1159/000335326] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The relative contribution of nutrition-related chronic diseases to the total disease burden of the society and the health care costs has risen continuously over the last decades. Thus, there is an urgent necessity to better exploit the potential of dietary prevention of diseases. Carbohydrates play a major role in human nutrition - next to fat, carbohydrates are the second biggest group of energy-yielding nutrients. Obesity, type 2 diabetes mellitus, dyslipoproteinaemia, hypertension, metabolic syndrome, coronary heart disease and cancer are wide-spread diseases, in which carbohydrates could have a pathophysiologic relevance. Correspondingly, modification of carbohydrate intake could have a preventive potential. In the present evidence-based guideline of the German Nutrition Society, the potential role of carbohydrates in the primary prevention of the named diseases was judged systematically. The major findings were: a high carbohydrate intake at the expense of total fat and saturated fatty acids reduces the concentrations of total, LDL and HDL cholesterol. A high carbohydrate consumption at the expense of polyunsaturated fatty acids increases total and LDL cholesterol, but reduces HDL cholesterol. Regardless of the type of fat being replaced, a high carbohydrate intake promotes an increase in the triglyceride concentration. Furthermore, a high consumption of sugar-sweetened beverages increases the risk of obesity and type 2 diabetes mellitus, whereas a high dietary fibre intake, mainly from whole-grain products, reduces the risk of obesity, type 2 diabetes mellitus, dyslipoproteinaemia, cardiovascular disease and colorectal cancer at varying evidence levels. The practical consequences for current dietary recommendations are presented.
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Affiliation(s)
- Hans Hauner
- Technical University of Munich, Freising-Weihenstephan, Germany
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Olsen A, van Belle C, Meyermann K, Keller KL. Manipulating fat content of familiar foods at test-meals does not affect intake and liking of these foods among children. Appetite 2011; 57:573-7. [PMID: 21801772 DOI: 10.1016/j.appet.2011.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 07/08/2011] [Accepted: 07/11/2011] [Indexed: 11/29/2022]
Abstract
We investigated effects of manipulating fat content of familiar foods at two test-meals in 74, 4-6-year-old children. Liking, energy intake, and weight-based food intake were assessed for a meal consisting of macaroni and cheese, pudding, chocolate milk and regular milk in high-fat and low-fat versions. Liking ratings and consumption by weight did not differ between versions, but energy intake was 59% greater with the high-fat version. We conclude that manipulating fat content had little effect on liking and weight-based food intake, but markedly influenced overall energy intake, and thus might provide a means of lowering children's energy consumption.
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Affiliation(s)
- Annemarie Olsen
- Department of Food Science/Sensory Science, Faculty of Life Sciences, University of Copenhagen, Rolighedsvej 30, 1958 Frederiksberg C, Denmark
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Relationship between whole grain and fiber consumption and body weight measures among 6- to 18-year-olds. J Pediatr 2010; 157:578-83. [PMID: 20542284 DOI: 10.1016/j.jpeds.2010.04.041] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 04/01/2010] [Accepted: 04/23/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine the relationship between whole grain and fiber consumption and body weight measures in children 6 to 12 (n=3868) and adolescents 13 to 18 (n=4931) years old. STUDY DESIGN Combined 1999 to 2004 National Health and Nutrition Examination Survey data were analyzed. Mean body mass index (BMI), BMI percentile, BMI z-score, waist circumference, and prevalence of overweight/obesity were compared across categories of whole grain consumption (0 to <0.6, >or=0.6 to <1.5, >or=1.5 to <3, and >or=3 servings) with (1) a sex, ethnicity, and total energy intake-adjusted model and (2) a cereal fiber plus model 1 covariates profile. RESULTS Mean whole grain intake was 0.59 and 0.63 servings/d among children 6 to 12 years and adolescents 13 to 18 years, respectively. In children, consumption of >or=3 servings of whole grain was not associated with body weight measures; however, consumption of 1.5 to <3 servings was positively associated with all weight measures. In adolescents, BMI z-score was significantly lower in the highest whole grain consumption group compared with the lowest 2 groups; BMI percentile and waist circumference (model 1 only) were also significantly lower in the highest whole grain consumption group. CONCLUSIONS Overall consumption of whole grain was below current recommendations of at least 3 servings per day. Only in adolescents was this level of whole grain intake associated with lower BMI z-scores.
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Affiliation(s)
- Manfred J. Müller
- Institute of Human Nutrition and Food Science, Christian-Albrechts-University Kiel, Essen, Germany
- *Prof. Dr. Manfred James Müller, Institut für Humanernährung und Lebensmittelkunde, Christian-Albrechts-Universität zu Kiel, Düsternbrooker Weg 17, 24105 Kiel, Germany, Tel.: +49 431 880 56-70, Fax -79,
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Essen, Germany
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