Associations of body mass index and waist circumference with: energy intake and percentage energy from macronutrients, in a cohort of Australian children

Energy intakes, macronutrient intakes and the percentages of energy from macronutrients with adolescent BMI: results from a 5-year cohort study in Ho Chi Minh City, Vietnam

BACKGROUND

Adolescence is a period of life when dietary patterns and nutrient intakes may greatly influence adult fatness. This study assesses the tracking of energy and nutrient intakes of Ho Chi Minh City adolescents over 5 years. It explores the possible relationships between energy and the percentage of energy from macronutrients with BMI.

METHODS

Height, weight, time spent on physical activity, screen time and dietary intakes were collected annually between 2004 and 2009 among 752 junior high school students with a mean age of 11·87 years at baseline. The tracking was investigated using correlation coefficients and weighted kappa statistics (k) for repeated measurements. Mixed effect models were used to investigate the association between energy intakes and percentage energy from macronutrients with BMI.

RESULTS

There were increases in the mean BMI annually, but greater in boys than in girls. Correlation coefficients (0·2 < r < 0·4) between participants' intakes at baseline and 5-year follow-up suggest moderate tracking. Extended kappa values were lowest for energy from carbohydrate (CHO) in both girls and boys (k = 0·18 & 0·24, respectively), and highest for protein in girls (k = 0·47) and fat in boys (k = 0·48). The multilevel models showed the following variables significantly correlated with BMI: CHO, fat, percentage of energy from CHO, fat, time spent for moderate to vigorous physical activity, screen time, age and sex.

CONCLUSIONS

The poor to fair tracking observed in this cohort suggests that individual dietary patterns exhibited in the first year are unlikely to predict energy and nutrient intakes in the fifth year.

Association between dietary fat quality indices with anthropometric measurements in children and adolescents

Background

The association between anthropometric measures and dietary fat quality indices is unclear in pediatric age groups. The present study aimed to assess the association between dietary lipophilic index (LI) and thrombogenic index (TI) as dietary fat quality indices with anthropometric measurements in children and adolescents.

Method

This nationwide cross-sectional study was conducted on 4323 students aged 6-18 years that were selected by multistage cluster sampling from 31 provinces of Iran. Dietary intake was collected using a validated food frequency questionnaire and dietary LI and TI were calculated by formula. Data on anthropometric measures were collected by standard protocols.

Results

The multivariate regression analysis revealed that TI and LI had inverse association with neck circumference Z-score (β = 0.11, p = 0.013 and β = 0.12 p = 0.006, respectively). There was a positive correlation between LI with height Z-score (β = 0.12, 95% CI: 0.01, p = 0.009). However, there was no significant association between LI and TI with other anthropometric indices (P > 0.05).

Conclusion

The quality of dietary fats was associated with some anthropometric indices. Further large-scale studies are required to highlight the importance of dietary fat quality indices in relation to cardio-metabolic risk factors in pediatric age groups. Reducing intake of saturated fatty acids, increasing consumption of monounsaturated fatty acids and a balanced intake of omega-3 and omega-6 to reduce the risk of cardiovascular diseases risk factors are recommended.

Gender differences in the relationship between dietary energy and macronutrients intake and body weight outcomes in Chinese adults

BACKGROUND

To explore the gender differences in the relationship between dietary energy and macronutrients intake and body weight outcomes in Chinese adults.

METHODS

Data from the China Health and Nutrition Survey (CHNS, 2015) for10,898 participants aged 18-64 years. Three consecutive 24-h dietary recalls was used to assess the dietary intake. Quantile regression models for body mass index (BMI) and waist circumference (WC) were performed separately for each sex.

RESULTS

Adult males showed greater absolute intakes of energy and macronutrients as compared to females as per the body weight outcomes. A 10% increase in BMI resulted in an additional intake of 0.002-0.004 kcal/d of dietary energy, 0.032-0.057 g/d of fats, 0.039-0.084 g/d of proteins, and 0.018-0.028 g/d of carbohydrates across all quantiles in males (p <  0.05). A 10% increase in WC lead to an additional intake of 0.004-0.008 kcal/d of dietary energy, 0.051-0.052 g/d of carbohydrates across the entire quantile in males (p <  0.05), and an increased intake of 0.060-0.150 kcal/d of fat in females (p <  0.05).

CONCLUSIONS

Dietary fat intake could be the risk factor of abdominal obesity in women. The importance of gender-specific evidence should be considered before promoting macronutrient allocation for the prevention and treatment of obesity.

Association of Sports Participation and Diet with Motor Competence in Austrian Middle School Students

Physical activity and diet are important contributors to overall health and development in adolescents. There remains, however, limited research on the combined association of sports participation and dietary pattern on motor competence, which is crucial for an active lifestyle during and beyond adolescence. The present study, therefore, examined the association between sports participation, dietary pattern, and motor competence in 165 middle school students (55% male) between 11 and 14 years of age. Body weight and height were measured, and motor competence was determined via the German motor test during regular Physical Education (PE). Further, participants completed a food frequency questionnaire and reported their engagement in club sports. Of the total sample 20% were overweight/obese and 49% reported participation in club sports, with no differences between boys and girls. Interaction effects of sports participation and dietary pattern on motor competence were limited, but sports participation and healthy diet were independently associated with higher motor performance. Healthy dietary choices, along with participation in club sports, therefore, should be promoted in adolescents in order to facilitate motor development. As adolescence is a crucial time for the establishment of lifelong behaviors, such efforts could facilitate a healthy lifestyle throughout adulthood.

Cardiorespiratory Fitness as a Mediator of the Influence of Diet on Obesity in Children

The association between diet and obesity has been widely studied and it continues to be controversial; however, the extent to which cardiorespiratory fitness (CRF) acts as a confounder or mediator in this relation has not been analyzed. The aim of this study is to examine if the relation between diet and obesity is mediated by CRF. In this cross-sectional study, fat mass (by electronic bioimpedance) was measured in 320 schoolchildren, aged 9–11 years. Diet was measured through two computerised 24-h dietary recalls and CRF was assessed by the 20-m shuttle run test. Simple mediation analyses were fitted. CRF acts as a partial mediator in the negative relationship between dietary factors (energy intake/weight, carbohydrate intake/weight, protein intake/weight, and fat intake/weight) and fat mass. The percentage of mediation ranged from 24.3 to 33.2%. Thus, Spanish schoolchildren with higher levels of energy and macronutrients intake had lower adiposity levels, especially when they had good levels of CRF.

Intake of Energy and Protein is Associated with Overweight Risk at Age 5.5 Years: Results from the Prospective TEDDY Study

OBJECTIVE

The associations of energy, protein, carbohydrate, and fat intake with weight status up to the age of 5.5 years were prospectively assessed in The Environmental Determinants of Diabetes in the Young (TEDDY) study.

METHODS

Food record data (over 3 days) and BMI measurements between 0.25 and 5.5 years were available from 5,563 children with an increased genetic risk for type 1 diabetes followed from shortly after birth. Odds ratios (ORs) were calculated for overweight and obesity by previous intake of energy, protein, carbohydrate, and fat with adjustment for potential confounders.

RESULTS

Having overweight or obesity at the age of 5.5 years was positively associated with mean energy intake in previous age intervals (e.g., adjusted OR [95% CI] for overweight: 1.06 [1.04-1.09] per 100 kcal intake at the age of 4.5-5.0 years) and with protein intake after the age of 3.5 and 4.5 years, respectively (e.g., adjusted OR for overweight: 1.06 [1.03-1.09] per 1% of energy intake at the age of 4.5-5.0 years). The respective associations with carbohydrate and fat intake were less consistent.

CONCLUSIONS

These findings indicate that energy and protein intake are positively associated with increased risk for overweight in childhood but yield no evidence for potential programming effects of protein intake in infancy.

Nutritional Status of Korean Children and Adolescents with Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) has been associated with an elevated risk for obesity but this seems to be paradoxical to the fact that many youths with ADHD have symptoms of hyperactivity. People diagnosed with ADHD tend to have a high risk of developing undesirable diet habits and consequently have health related problems. However, less attention has been paid to obesity in ADHD while many efforts have been devoted to the prevention of childhood obesity in mentally normal people. Hence the purpose of this study was to explore the nutritional status and life habits of children and adolescents with ADHD (n = 76) based on degree of obesity by utilizing the Korean National Health and Nutrition Examination Survey (KNHANES) data from 2005–2013. As results the levels of blood pressure, total triglycerides and the fat intake relative to total energy intake in overweight ADHD group were higher than those in normal weight group. Interestingly, overweight ADHD subjects consumed significantly less amount of iron compared to normal weight ADHD subjects and the level of serum ferritin was lower in the overweight ADHD group (59.0 ng/mL) than in the normal weight ADHD group (47.9 ng/mL). After adjusting total energy intake, total vegetable consumption was 14.3% lower in overweight group compared to the consumption in normal weight group. These results indicate a plausible relationship of iron status and obesity in ADHD subjects but this relationship may not be specific to ADHD. A future study with case-control design is necessary to investigate the association of obesity, nutrient intake, and cognitive/mental status of ADHD.

Dietary factors associated with metabolic syndrome and its components in overweight and obese Brazilian schoolchildren: a cross-sectional study

BACKGROUND

The metabolic syndrome (MS) has been assessed since childhood mainly because of the nutritional and epidemiological transition that has occurred worldwide. Our objectives were to explore the MS and its components according to anthropometric and demographic factors and to assess the relationship among MS components and dietary characteristics in overweight and obese schoolchildren.

METHODS

This was a cross-sectional study which included 147 schoolchildren (aged 6-10 years) from three elementary schools, with body mass index (BMI) higher than the 85th percentile. Sexual maturation stages, anthropometric measures (weight, height, skinfold thickness and waist circumference), biochemical data (glucose, HDL-C and triacylglycerol), blood pressure and dietary intake were assessed. The metabolic syndrome was diagnosed if three or more of the following components were presented: waist circumference ≥90th age and sex-specific cut-off, blood pressure ≥90th age, sex and height-specific cut-off, glucose ≥100 mg/dL, HDL-C ≥ 40 mg/dL and triacylglycerols ≥ 110 mg/dL. The dietary intake was assessed by three non-consecutive 24-h recalls. The T test, Kruskal-Wallis and multiple linear regression analysis were applied to assess MS components and dietary intake.

RESULTS

The MS percentage was 10.2 % and it was higher in obese children and ones with high body fat percentage. The waist circumference was the main altered component of MS and 62 % of overweight schoolchildren showed at least one altered component of MS. The components of metabolic syndrome associated with dietary intake were triacylglycerol (positive association with saturated and monounsaturated fat, whole-milk products and processed foods and negative associated with legumes and polyunsaturated fat), glycemia (positive association with processed foods and negative with cereals), HDL-C (positive association with vegetables and greens) and waist circumference was negative associated with protein.

CONCLUSIONS

The frequency of MS was higher in obese than overweight schoolchildren and the frequency of at least one MS component was high in more than half of our subjects. The waist circumference was the most frequent among all other components. The triacylglycerol and glycemia were the most frequent MS components associated with dietary intake. Unprocessed food was considered a protective dietary factor for MS metabolic components and processed food with high percentage of sugar and saturated fat was a risk factor for MS metabolic components.

Cross-sectional and longitudinal associations between energy intake and BMI z-score in European children

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.

Protein Intake as a Risk Factor of Overweight/Obesity in 8- to 12-Year-Old Children

Several studies investigating the relationship between body mass index (BMI), waist circumference (WC), and/or body fat (BF) with macronutrient composition of the diet have suggested that dietary composition may play an important role to overweight/obesity in childhood, but its relation remains inconclusive. The aim was to assess the association between energy intake (EI) and macronutrient diet composition with overweight/obesity among children.Nonrandomized cohort study including 396 Italian children and preadolescents (9-13 years old), 200 overweight/obese and 196 normal-weight. The children's weight, height, WC, and food intake were measured.Reported EI was higher in overweight/obese than in nonoverweight children; however, after body weight was considered, the overweight/obese children had less EI than their leaner counterparts. Percentages of EI from proteins, SFA, MUFA and PUFA (in males), and dietary fiber (g/1000 kcal) were higher in the overweight/obese children than in the leaner ones. EI from carbohydrates and fats was lower in overweight/obese males and females, respectively. Positive correlations between BMI and waist-to-height ratio with EI from proteins were found in males (r = 0.296, P < 0.01 and r = 0.326, P < 0.01; respectively) and females (r = 0.374, P < 0.01 and r = 0.405, P < 0.01; respectively), but negative correlations with fats were found in females (r = -0.240, P < 0.01 and r = -0.188, P < 0.05; respectively). Using binary logistic regression, the highest EI from proteins were associated with higher odds ratio for overweight/obesity, while the lowest EI from carbohydrates was associated with higher odds ratio for overweight/obesity in males.Reported EI of overweight/obese children was higher than nonoverweight peers. Overweight/obese children had higher intakes of proteins compared with nonoverweight ones. Overweight/obese males and females showed lower EI from carbohydrates and fats, respectively, than their leaner counterparts.

The Cross-Sectional Association of Energy Intake and Dietary Energy Density with Body Composition of Children in Southwest China

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.

Association between behavioural factors and BMI-for-age among early adolescents in Hulu Langat district, Selangor, Malaysia

OBJECTIVE

This paper investigates the association between behavioural factors and BMI-for-age among early adolescents (10-11 years old) in Hulu Langat district, Selangor.

METHODS

This cross-sectional study was conducted among 333 primary school students. Body weight and height of the students were measured and their BMI-for-age was calculated. Eating behaviours, energy intake, energy expenditure, physical activity, and screen time were assessed using the Eating Behaviours Questionnaire and a 2-day dietary and physical activity recall, respectively. Data were analysed using multiple linear regression analysis.

RESULTS

The prevalence of overweight and obesity (28.2%) was about twice the prevalence of thinness (11.1%). The mean energy intake and energy expenditure of the students was 1772±441kcal/day and 1705±331kcal/day, respectively. Three in five of the students (60.1%) skipped at least one meal and 98.2% snacked between meals daily. A majority of them (55.3%) were sedentary. Low energy intake (p<0.05) and low energy expenditure (p<0.05) were associated with high BMI-for-age. Energy expenditure (β=-0.033) and energy intake (β=-0.090) significantly explained 65.1% of the variances in BMI-for-age (F=119.170, p<0.05).

CONCLUSION

These findings suggested that promoting healthy eating and active lifestyle should be targeted in the prevention and management of obesity among early adolescents.

Is there an association between food portion size and BMI among British adolescents?

The prevalence of obesity has increased simultaneously with the increase in the consumption of large food portion sizes (FPS). Studies investigating this association among adolescents are limited; fewer have addressed energy-dense foods as a potential risk factor. In the present study, the association between the portion size of the most energy-dense foods and BMI was investigated. A representative sample of 636 British adolescents (11–18 years) was used from the 2008–2011 UK National Diet and Nutrition Survey. FPS were estimated for the most energy-dense foods (those containing above 10·5 kJ/g (2·5 kcal/g)). Regression models with BMI as the outcome variable were adjusted for age, sex and misreporting energy intake (EI). A positive association was observed between total EI and BMI. For each 418 kJ (100 kcal) increase in EI, BMI increased by 0·19 kg/m2(95 % CI 0·10, 0·28;P< 0·001) for the whole sample. This association remained significant after stratifying the sample by misreporting. The portion sizes of a limited number of high-energy-dense foods (high-fibre breakfast cereals, cream and high-energy soft drinks (carbonated)) were found to be positively associated with a higher BMI among all adolescents after adjusting for misreporting. When eliminating the effect of under-reporting, larger portion sizes of a number of high-energy-dense foods (biscuits, cheese, cream and cakes) were found to be positively associated with BMI among normal reporters. The portion sizes of only high-fibre breakfast cereals and high-energy soft drinks (carbonated) were found to be positively associated with BMI among under-reporters. These findings emphasise the importance of considering under-reporting when analysing adolescents' dietary intake data. Also, there is a need to address adolescents' awareness of portion sizes of energy-dense foods to improve their food choice and future health outcomes.

High fat diets are associated with higher abdominal adiposity regardless of physical activity in adolescents; the HELENA study

BACKGROUND & AIMS

Failure to attain fat balance may contribute to obesity development even without excessive energy intake. The objective of this study was to examine the associations of dietary macronutrient distribution with abdominal adiposity in adolescents and to evaluate whether these relationships were attenuated by physical activity.

METHODS

A total of 224 Spanish adolescents (51% females, 14.9 ± 1.2 years) were included in the study. Abdominal adiposity in three regions, truncal and total body fat mass (FM) and lean mass (LM) were measured by dual-energy X-ray absorptiometry and thereafter FM index (FMI = FM/height(2)) and FMI/LMI ratio were calculated. The energy derived from fat intake was assessed by two non-consecutive 24 h recalls. Total physical activity (PA) and time spent in moderate-to-vigorous PA (MVPA) and vigorous PA were objectively measured by accelerometry.

RESULTS

We observed that the percent of energy derived from fat intake was significantly associated with FMI and FMI/LMI ratio (Ps = 0.001) and greater amounts of truncal (P = 0.001) and abdominal adiposity in the three regions regardless of age, sex and height (all P ≤ 0.005). The strength of the relationships was not substantially altered by further adjustment for PA, vigorous PA or moderate-to-vigorous PA (Ps ≤ 0.005).

CONCLUSIONS

The percent of energy derived from dietary fat intake is strongly and linearly associated with total, truncal and abdominal adiposity independently of PA in adolescents. These observations implicate the amount of dietary fat intake as a specific risk factor in the excess of abdominal adiposity in adolescence.

Is overweight at 12 months associated with differences in eating behaviour or dietary intake among children selected for inappropriate bottle use?

Bottle feeding beyond the recommended weaning age of 12 months is a risk factor for childhood obesity. This paper describes a sample of toddlers at high risk for obesity: prolonged bottle users from a low-income multi-ethnic community. We report here baseline mealtime and feeding behaviour, 24 h dietary recall and bottle intake data for Feeding Young Children Study (FYCS) participants, by overweight (≥85% weight-for-length) status. FYCS enrolled 12-13-month-olds from urban nutrition programmes for low-income families in the United States who were consuming ≥2 bottles per day. Our sample was predominately Hispanic (62%), 44% of mothers were born outside of the United States and 48% were male. Overall, 35% were overweight. Overweight status was not associated with mealtime/feeding behaviours, bottle use or dietary intake. Most (90%) children ate enough, were easily satisfied and did not exhibit negative (e.g. crying, screaming) mealtime behaviours, per parent report. The sample's median consumption of 4 bottles per day accounted for 50% of their total calories; each bottle averaged 7 ounces and contained 120 calories. Mean daily energy intake, 1098.3 kcal day(-1) (standard deviation = 346.1), did not differ by weight status, nor did intake of fat, saturated fat, protein or carbohydrates. Whole milk intake, primarily consumed via bottles, did not differ by weight status. Thus, overweight 12-13-month-olds in FYCS were remarkably similar to their non-overweight peers in terms of several obesity risk factors. Findings lend support to the set-point theory and prior work finding that weight and intake patterns in the first year of life alter subsequent obesity risk.

How can we help people to develop lean and healthy bodies? A new perspective

The dominant metabolic theory of obesity is that it develops from excessive positive energy balance. However, preventive interventions based on this theory have often been ineffective. This article proffers a developmental theory, which is based on recent epidemiologic research and a new line of research dealing with differentiation of immature stem cells into mature tissues. This theory posits that the mechanical stimulation provided by vigorous physical activity (PA) causes immature stem cells to differentiate into lean tissue cells rather than into fat cells. If this new theory is confirmed by future research, it implies that interventions that involve adequate doses of vigorous PA, along with appropriate diet composition, may be especially effective in promoting development of healthy bodies.

Dietary factors associated with overweight and body adiposity in Finnish children aged 6-8 years: the PANIC Study

OBJECTIVES

To investigate the associations of dietary factors with overweight, body fat percentage (BF%), waist circumference (WC) and hip circumference (HC) among children.

DESIGN

Cross-sectional analysis of the Physical Activity and Nutrition in Children (PANIC) Study among 510 children (263 boys, 247 girls) aged 6-8 years from Kuopio, Finland.

METHODS

The children's weight, height, WC and HC were measured. Overweight was defined by International Obesity Task Force body mass index cutoffs. The BF% was measured by dual-energy X-ray absorptiometry, nutrient intakes and meal frequency by 4-day food records and eating behaviour by Children's Eating Behaviour Questionnaire.

RESULTS

Daily consumption of all the three main meals was inversely associated with overweight (odds ratio (OR) 0.37, 95% confidence interval (CI) 0.18-0.75), BF% (β -0.12, P = 0.012), WC (β -0.16, P = 0.002) and HC (β -0.15, P = 0.002). Enjoyment of food, food responsiveness and emotional overeating were directly associated with overweight (OR 1.57, 95% CI 1.04-2.35; OR 4.68, 95% CI 2.90-7.54; OR 2.60, 95% CI 1.52-4.45, respectively), BF% (β 0.13, P = 0.004; β 0.30, P<0.001; β 0.09, P = 0.035, respectively), WC (β 0.14, P = 0.003; β 0.40, P<0.001; β 0.19, P<0.001, respectively) and HC (β 0.15, P = 0.001; β 0.38, P<0.001; β 0.15, P = 0.001, respectively). Satiety responsiveness was inversely associated with overweight (OR 0.42, 95% CI 0.26-0.67), BF% (β -0.20, P<0.001), WC (β -0.26, P<0.001) and HC (β -0.26, P<0.001). Slowness in eating was inversely associated with overweight (OR 0.61, 95% CI 0.41-0.92), WC (β -0.16, P = 0.001) and HC (β -0.17, P<0.001). Protein intake was directly associated with BF% (β 0.11, P = 0.017), WC (β 0.11, P = 0.020) and HC (β 0.13, P = 0.008).

CONCLUSIONS

Promoting regular consumption of main meals and healthy eating behaviours should be emphasized in the prevention of overweight among children. More research is needed on the association of protein-rich foods with body adiposity in children.