Relative validity and reproducibility of a brief-type self-administered diet history questionnaire for Japanese children aged 3-6 years: application of a questionnaire established for adults in preschool children

A scoping review of dietary assessment questionnaires potentially suitable for assessing habitual dietary intake in the National Health and Nutrition Survey, Japan

This scoping review aimed to identify questionnaire-based dietary assessment methods for use in the National Health and Nutrition Survey (NHNS) in Japan. The search was conducted in three databases (PubMed, Web of Science, and Ichushi) to identify questionnaire such as food frequency questionnaire and dietary history questionnaire validated against dietary recalls or food records for the intakes of both food groups and nutrients among Japanese adults. Study quality was assessed based on previously developed criteria. We extracted the questionnaire characteristics and the design and results of the validation studies. We identified 11 questionnaires, with the number of food items ranging from 40 to 196, from 32 articles of good quality. In the validation studies, participants were aged 30-76 years and 90% of the articles used ≥3 d dietary records as reference. The number of nutrients and food groups with a group-level intake difference within 20% against the reference method ranged from 1 to 30 and 1 to 11, respectively. The range of mean correlation coefficients between questionnaire and reference methods were 0.35-0.57 for nutrients and 0.28-0.52 for food groups. When selecting a survey instrument in the NHNS from the 11 existing questionnaires identified in this study, it is important to select one with high group-level comparison and correlation coefficient values on the intended assessment items after scrutinizing the design and results of the validation study. This review may serve as a reference for future studies that explore dietary assessment tools used for assessing dietary intake in specific representative populations.

Longitudinal relationship between screen-based sedentary behavior and nutrient intake in Japanese children: an observational epidemiological cohort study

BACKGROUND

Concerns regarding the impact of screen-based sedentary behavior on health have been increasing. Therefore, the present study investigated the longitudinal relationship between multiple screen time and nutrient intake in children and adolescents.

METHODS

The present study was conducted utilizing 3 years longitudinal data. Study subjects were 740 Japanese children aged between 6 and 12 years at baseline and between 9 and 15 years in the follow-up. Screen-based sedentary behavior was assessed using screen time, including television (TV) viewing, personal computer (PC) use, and mobile phone (MP) use. The main outcomes were the intakes of nutrients. Mixed effect multivariate linear regression analyses were used to examine the longitudinal relationship between screen-based sedentary time and nutrient intake. Covariates included in the multivariable analysis consisted of sex, age, solitary eating, skipping breakfast, staying up late, and body weight status, as confounders, and physical inactivity, as mediator.

RESULTS

In boys, a longer total screen time longitudinally correlated with higher intake of energy and lower intakes of protein, dietary fiber, minerals, and vitamins. In girls, longer total screen time longitudinally associated with higher intake of sucrose and lower intakes of protein, minerals, and vitamins. In boys, a longer TV viewing time was associated with higher intake of sucrose and lower intakes of protein, minerals, and vitamins. In girls, a longer TV viewing time was associated with higher intake of carbohydrates and lower intakes of protein, fat, minerals, and vitamins. In boys, relationships were observed between a longer PC use time and higher intakes of energy as well as lower intakes of protein, minerals, and vitamins. Relationship was observed between longer PC use time and lower intakes of minerals in girls. An increased MP use time was associated with higher intakes of energy, and lower intakes of protein, sucrose, dietary fiber, minerals, and vitamins in boys. A longer MP use time was associated with higher intakes of fat, and salt as well as lower intakes of carbohydrates, protein, minerals, and vitamins in girls.

CONCLUSIONS

The present results revealed that longer screen-based sedentary behaviors were longitudinally associated with nutrient intake in children and adolescents. Future study is needed to elucidate these relationships.

Relationship between Maternal Mood Disorders and Dietary Intake of 3-Year-Olds

Maternal depression affects parenting and children's early development, but its effect on dietary intake is unknown. While husbands' involvement in parenting and having friends to talk to may reduce childcare stress, this has not been thoroughly studied. In this study, mothers were stratified by the presence or absence of mood disorders, and the effects of support from their husbands and friends on the dietary intake of their 3-year-old children were examined. This cross-sectional analysis included 920 mother-child pairs examined at the National Center for Child Health and Development in Japan. Dietary intake was assessed using a brief dietary history questionnaire, and physical measurements were taken when the children were 3 years old. The Kessler Psychological Distress Scale was used to screen for maternal mood disorders, 3 years after delivery. The presence or absence of the husband's assistance with housework and childcare, mental support, and friends was obtained from a self-administered questionnaire when the child was 3 years old. Differences in the children's physical measurements, energy, and food intake with the presence or absence of support for subjects with or without mood disorders were compared. Mothers with support from husbands or friends had significantly fewer mood disorders. Support from friends and family did not affect the children's physical development and whether or not mothers had mood disorder symptoms. However, children's vegetable intake was higher if mothers were supported. Children of mothers with mood disorders had a significantly higher vegetable intake and fruit intake, depending on the support from friends (P=0.046,  P=0.037); thus, such support may increase children's vegetable and fruit intake. The results of this study revealed the importance of supportive friends and family regarding childcare.

The Association between Milk Intake and Nutrient Intake Adequacy among Japanese Female Junior High School Students: A Cross-Sectional Study

The consumption of dairy products, including milk, may be important for improving the overall quality of a diet. The aim of this study was to examine the relationship between milk intake and nutritional adequacy among Japanese female junior high school students. The participants of this study were Japanese female junior high school students aged between 12 and 15 years. Dietary habits over the past month were assessed by a brief self-administered diet history questionnaire. The adequacy of each nutrient intake was determined based on the Dietary Reference Intakes for Japanese 2020, with two goals: the estimated average requirement for fourteen nutrients and tentative dietary goals for preventing lifestyle-related diseases for six nutrients. The participants were classified into five groups according to milk intake (Q1 (lowest) to Q5 (highest)) by quintile. The adequacy of vitamin B₂, calcium, magnesium, and potassium were higher among students with a higher milk consumption than among those with a lower milk consumption. However, the intake of saturated fatty acids was in excess among higher milk consumers. The present study suggests that milk intake was related to an adequate intake of some vitamins and minerals and an inadequate intake of saturated fatty acids among Japanese female junior high school students.

Necessity of salt intake reduction education beginning in youth: a cross-sectional survey of sodium-to-potassium ratios in mothers and their preschool children

Urinary sodium-to-potassium ratios are known to be high in preschoolers, but there are no reports comparing these ratios with those of the children's mothers. The aim of this study was to investigate the association between the urinary sodium-to-potassium ratios of mothers and their preschool children under the hypothesis that the ratio is equivalent between the two. We evaluated 297 preschoolers aged four to five attending six kindergartens (four in northern Japan, two in southern Japan), and we also evaluated the children's mothers. We asked the participants to take morning first urine samples for 2 consecutive days in the spring and autumn of the same year (four samples per participant) and to fill out a dietary questionnaire. There was a correlation between the urinary sodium-to-potassium ratios of preschoolers and those of their mothers. However, in a comparison between the preschoolers and their mothers overall, higher values were found in the preschoolers [preschoolers: 4.6 (3.5-6.3) mmol/L/g·Cr; mothers: 4.3 (3.9-4.7) mmol/L/g·Cr, p = 0.003]. These results correlated with the urinary sodium-to-potassium ratios estimated from the dietary questionnaire. The preschoolers showed high sodium and low potassium intake consumption compared to the mothers. Interestingly, these were found to differ by region and gender. In conclusion, the urinary sodium-to-potassium ratio in Japanese preschoolers is related to and higher than that of their mothers. It is important to educate children, their parents, childcare professionals, and society as a whole about proper salt restriction and potassium supplementation, as well as to improve the food environment.

Association between dietary intake and serum biomarkers of long-chain PUFA in Japanese preschool children

OBJECTIVE

Recent research supports the importance of PUFA intake in children, particularly of EPA and DHA; however, few verified methods to assess whether PUFA intake is adequate are available.

DESIGN

We assessed the correlation between serum PUFA and lipid concentrations with seafood and PUFA intake measured using a brief-type self-administered diet history questionnaire for Japanese preschool children (BDHQ3y).

SETTING

Single centre birth cohort in Japan.

PARTICIPANTS

A total of 152 36-month-old Japanese children.

RESULTS

Average dietary intake of daily seafood, EPA and DHA was 13·83 (sd 10·36) g, 49·4 (sd 43·5) mg and 98·3 (sd 64·6) mg, respectively. Significant weak-to-moderate correlations were observed between dietary intake and serum EPA (Spearman rho = 0·41, P < 0·001; Pearson r = 0·44, P < 0·001); DHA (Spearman rho = 0·40, P < 0·001; Pearson r = 0·42, P < 0·001) and AA (arachidonic acid) (Spearman rho = 0·33, P < 0·001; Pearson r = 0·32, P < 0·001), whereas no significant correlation was observed for dihomo-γ-linolenic acid (DGLA) (Spearman rho = 0·06, P = 0·484; Pearson r = 0·07, P = 0·387). Correlations between seafood intake and serum EPA and DHA were also moderate (0·39-0·43). A negative correlation between serum TAGs and serum EPA, as well as positive correlations between serum cholesterol (total cholesterol, LDL and HDL) with serum EPA and DHA were observed, whereas no significant correlations between seafood intake and serum lipid profiles. Based on this model, we estimated 61-98 g/week of seafood intake is required to meet current EPA/DHA intake recommendations by the WHO (100-150 mg/d).

CONCLUSIONS

For children of 2-4 years of age, weekly intake of 61-98 g of seafood is required to meet WHO recommendations of EPA/DHA intake.

Eating Vegetables First at Start of Meal and Food Intake among Preschool Children in Japan

Eating behavior is an important aspect for dietary quality and long-term health. This study examined associations between eating vegetables first at a meal and food intakes among preschool children in Tokyo, Japan. We used cross-sectional data of 135 preschool children from seven nursery schools in Adachi City, Tokyo, Japan. Caregivers completed a survey on child’s eating behaviors and a diet questionnaire. Linear regression was used to examine frequency of eating vegetables first at a meal and food intakes; percent difference and the corresponding 95% confidence interval (95% CI) were presented. Overall, 25.2% of children reported eating vegetables first at a meal every time, 52.6% sometimes, and 22.2% not often or never. In the multivariate analysis, higher vegetable intake remained significant after adjusting for other covariates (compared with the group of eating vegetables first not often or never, the group reported sometimes: 27%, 95% CI: 0–63%; the group reported every time: 93%, 95% CI: 43–159%). No significant difference in intake by frequency categories of eating vegetables first was observed for other food groups, including fruits, meat, fish, cereals, and sweets. Children eating vegetables first at a meal more was associated with higher total intake of vegetables compared with children who did not eat vegetables first, among Japanese preschool children.

Change in Growth and Diet Quality Among Preschool Children in Tokyo, Japan

Dietary intake of adequate quality and quantity in early life is essential for healthy growth and development. This study aimed to examine the association between one-year change in growth and diet quality in preschool children in Adachi City, Tokyo, Japan. A total of 110 participants (49% boys, four to five years old at baseline) were included in this analysis. Body mass index for age z-score (BAZ) and height for age z-score (HAZ) were calculated in accordance with WHO reference. Dietary intakes were assessed using the brief-type self-administered diet history questionnaire for children (BDHQ3y), and daily quality score was calculated based on the Japanese Food Guide Spinning Top (JFGST score). Regression analyses found no significant association between one-year change in growth and diet quality (compared to a low JFGST score, BAZ: β = 0.16, 95% CI: −0.29 to 0.60 for a middle JFGST score, β = −0.14, 95% CI: −0.61 to 0.33 for a high JFGST score, HAZ: β = −0.15, 95% CI: −0.50 to 0.21 for a middle JFGST score, β = −0.06, 95% CI: −0.43 to 0.30 for a high JFGST score). Further studies are needed to develop an appropriate diet quality index for healthy growth in Japanese preschool children.

Breakfast skipping is related to inadequacy of vitamin and mineral intakes among Japanese female junior high school students: a cross-sectional study

Breakfast skipping is a public health issue which affects nutrient intake among adolescents worldwide. However, there have been few reports comparing intake and reference values to assess the deficiency of nutrient intake between breakfast consumers and skippers. Therefore, the present study aimed to examine the relationship between breakfast skipping and adequacy of total habitual nutrient intake among junior high school female students. The participants were 516 Japanese female junior high school students. Dietary habits during the preceding month were assessed using a brief self-administered diet history questionnaire. Inadequacy of each nutrient intake was assessed by the cut-point method, based on the estimated average requirement for fourteen nutrients and on dietary goal values for five nutrients. The overall nutritional inadequacy in participants was assessed by the number of consumed nutrients which did not meet the requirements as per the dietary reference intakes for Japanese, 2015 version. The participants were classified into two groups according to the frequency of breakfast eating: breakfast consumers (seven times/week) and breakfast skippers (0-6 times/week). Adequacy of vitamin A, vitamin B1, vitamin B2, vitamin C, Ca, Fe, Zn and K was higher among breakfast consumers than among skippers. Breakfast consumers had more intakes of fruits, vegetables and dairy products. Our findings suggest that breakfast skipping was related to deficiencies in vitamin and mineral intakes, and to an unfavourable dietary pattern, among Japanese female junior high school students.

The Hekinan Children's Study: Design and Profile of Participants at Baseline

BACKGROUND

The early life environment is now recognized as a key factor contributing to susceptibility to certain diseases in later life.

METHODS

We initiated a cohort study among school children in 2011 to primarily investigate the associations between lifestyle and environmental factors and some surrogate markers of chronic diseases, such as cardiometabolic risk factors (ie, obesity, high blood pressure, high blood glucose, insulin, or lipids) and cancer risk factors (ie, height and age at menarche). A baseline questionnaire asked for information, including demographic variables, medical history and use of medication, dietary habits, physical activity, sleep habits, and behavioral and emotional problems of children. Follow-up surveys are planned for the fourth grade of elementary school and the first grade of junior high school. At these follow-up surveys, fasting blood samples will be obtained to measure cardiometabolic markers. We also checked the validity of a food frequency questionnaire, which was originally created for 6-year-olds but was modified for use in older children.

RESULTS

A total of 3,141 first-year students at elementary schools in Hekinan City, Aichi Prefecture, participated in the study. The response rate was 87.4%. The means of age and body mass index were 6.99 (standard deviation, 0.28) years and 15.3 (standard deviation, 1.7) kg/m2, respectively, in the 3,067 Japanese children (1,639 boys and 1,428 girls).

CONCLUSIONS

This cohort will reveal determinants of cardiometabolic risk factors and cancer risk factors during childhood.

Usefulness of a salt check sheet for elementary school and junior high school children

There are no known methods to easily evaluate the dietary salt intake of children. We hypothesized that the salt check sheet, for which validity has been confirmed in both hypertensive outpatients and in the general population, can be used to assess dietary salt intake in children. We enrolled 188 healthy schoolchildren (mean age 11.2 ± 1.1 years, 53.2% boys) and asked them to answer both the salt check sheet and a brief self-administered dietary history questionnaire for Japanese schoolchildren aged 6-18 years (BDHQ15y). The mean total salt check-sheet score was 12.7 ± 4.0 points (range: 4-24 points), and the estimated daily salt intake from the BDHQ15y was 12.1 ± 3.7 g (range: 4.7-27.2 g). The total check-sheet score was significantly positively correlated with the estimated daily salt intake from the BDHQ15y (r = 0.408, P < 0.001). Thirty-one study participants were assigned to the "low" salt group (total score on the salt check sheet was 0-8 points), 78 participants to the "medium" salt group (9-13 points), and 79 participants to the "high and very high" salt group (≥14 points), and a comparison estimating daily salt intake from the BDHQ15y among the three groups was performed. Daily salt-intake levels tended to increase as the group of total check-sheet scores increased: "low" vs "medium" vs "high and very high" salt group levels were 9.5 ± 3.1 vs 11.6 vs 13.5 ± 3.9, respectively (P < 0.001). This demonstrates that the salt check sheet is a useful tool to easily assess dietary salt intake in children.

Association Between Caregiver's Perception of "Good" Dietary Habits and Food Group Intake Among Preschool Children in Tokyo, Japan

Given that parents are mainly responsible for a preschooler's dietary management, they need to understand a child's diet. However, few studies have examined the association between parental perception of a preschool child's "good" dietary habits and actual food intake. We conducted a cross-sectional study investigating whether a child's food intake would differ depending on the caregiver's perception of their child's dietary habits among 4-year-old nursery school children at Adachi City, Tokyo, Japan. Children's dietary data were collected using the brief-type self-administered diet history questionnaire for children Aged 3-6 Years (BDHQ3y), while caregivers' perceptions of their child's dietary habits (good, normal, and poor) were inquired (N = 136). The percentage of caregivers who perceived their child's dietary habit as good, normal, and poor was 41.2, 40.4, and 18.4%, respectively. Multiple linear regression analysis revealed that children whose caregivers perceived their diet as poor showed lower intakes of vegetables [β = -48.7, 95% confidence interval (CI): -86.1 to -11.2], beans (β = -13.2, 95% CI: -26.1 to -0.3), and fish and shellfish (β = -9.2, 95% CI: -17.5 to -1.0) and higher intakes of fat and oil (β = 1.7, 95% CI: 0.4 to 3.1), confectionaries (β = 11.9, 95% CI: 3.6 to 20.3), and soft drinks (β = 31.2, 95% CI: 3.5 to 59.0) compared to children whose caregivers perceived their diet as good (all measures are in g/1,000 kcal per day). No significant difference was observed in other food groups, such as dairy products, an important source of protein and calcium for children. The current study may therefore guide future nutritional education programs for parents of preschool children.

The Relationship of Eating Rate and Degree of Chewing to Body Weight Status among Preschool Children in Japan: A Nationwide Cross-Sectional Study

There is growing recognition that eating slowly is associated with a lower risk of obesity, and chewing well might be an effective way to reduce the eating rate. However, little is known about these relationships among children. We therefore investigated the associations of eating rate and chewing degree with weight status among 4451 Japanese children aged 5⁻6 years. Information on eating rate (slow, medium, or fast), degree of chewing (not well, medium, or well), and nutrient intake of children were collected from guardians using a diet history questionnaire. Weight status was defined using the International Obesity Task Force cut-offs based on BMI calculated from guardian-reported height and weight. The prevalence of overweight and thinness was 10.4% and 14.3%, respectively. A higher eating rate and a lower degree of chewing were associated with being overweight (both p < 0.001). Eating slowly was associated with being thin (p < 0.001), but no association was observed between chewing degree and thinness. These associations were still evident after controlling for potential confounders including parental educational attainment, weight status, and the child's nutrient intake. In conclusion, this cross-sectional study suggested that chewing well, rather than eating slowly, might be a more effective way for healthy weight management among Japanese preschool children.

Serum 25-hydroxyvitamin D levels showed strong seasonality but lacked association with vitamin D intake in 3-year-old Japanese children

Current guidelines provide a universal recommendation on vitamin D intake to prevent insufficiency. However, the relative influence of food, UVB and other factors on serum 25-hydroxyvitamin D (25(OH)D) insufficiency has been poorly investigated in preschool children. We assessed serum 25(OH)D quantities and their association with vitamin D intake using a brief-type self-administered diet history questionnaire for children aged 3-6 years (BDHQ3y), outdoor playing time and background UVB radiation level among 574 36-month-old Japanese children living at latitude 35°N. The average serum 25(OH)D concentration was 23·5 (sd 6·1) ng/ml, and 170 (29·6 %) children had vitamin D insufficiency (<20 ng/ml) despite high consumption of fish. Multiple logistic regression adjusting for social factors showed that when background UVB radiation level was <15 kJ/m2 (monthly average), there was a 1·89 (95 % CI 1·31, 2·74) times higher risk of vitamin D insufficiency, to which vitamin D intake nor time spent outdoors were significantly associated. ANOVA showed that the contribution of the variability in vitamin D intake on the variability of serum 25(OH)D level was 1·8 % of that of UVB exposure. The correlation between vitamin D intake and serum 25(OH)D level was not stronger when limited to measurements in winter. We found that nearly 30 % of 3-year-old Japanese children had vitamin D insufficiency despite high consumption of fish and living at relatively low latitude. We failed to observe an association between vitamin D intake and the risk of vitamin D insufficiency. This may be due to the extremely limited access to vitamin D-fortified food and supplements for children in Japan.

Relationship between screen time and nutrient intake in Japanese children and adolescents: a cross-sectional observational study

Background

Sedentary behaviors have recently become an important public health issue. We aimed to investigate the relationship between screen time and nutrient intake in children and adolescents.

Methods

The present study was conducted in 2013. Data were collected from children and adolescents aged between 6 and 15 years old in Shika town. Questionnaires were distributed to 1459 subjects, 1414 of whom participated in the study (96.9%). Sedentary behaviors were assessed based on participants’ screen behaviors (television (TV) viewing, personal computer (PC) use, and mobile phone (MP) use). The main outcomes were the intake of nutrients from a validated food frequency questionnaire. Analysis of covariance (ANCOVA) was used to examine the significance of differences in nutrient intake estimates. Multivariate linear regression analyses, adjusting for age, BMI, and physical activity, were used to provide parameter estimates (β) and 95% CI for the relationship between screen time and nutrient intake.

Results

In boys, longer TV viewing times correlated or tended to correlate with a lower intake of protein, potassium, calcium, iron, vitamin K, vitamin B-2, and total dietary fiber. In girls, longer TV viewing times correlated with a lower intake of protein, sodium, calcium, vitamin D, and vitamin B-2. Longer TV viewing times correlated with a higher intake of n-6 fatty acids in girls. PC use was related or tended to be related to a lower intake of potassium, iron, vitamin K, and folic acid in boys, but not in girls. A relationship was observed between MP use and a lower intake of vitamin K in boys, and MP use and a higher intake of vitamin D in girls.

Conclusions

The present results revealed that longer TV viewing times are associated with less protein, minerals, vitamins, and total dietary fiber intake in children and adolescents. It was also revealed that boys with PC use have less minerals and vitamins. These results support the need to design intervention programs that focus on decreasing TV viewing time in both sexes and PC use in boys while encouraging adherence to dietary guidelines among children and adolescents.

Prevalence of Functional Constipation and Relationship with Dietary Habits in 3- to 8-Year-Old Children in Japan

Objectives

To determine the prevalence and effect of dietary habits on functional constipation in preschool and early elementary school children in Japan.

Study Design

A total of 3595 children aged 3 to 8 years from 28 nursery schools and 22 elementary schools in Yokohama City, Kanagawa Prefecture, Japan, were evaluated. The subjects were divided into a functional constipation group and a nonfunctional constipation group according to the Rome III criteria. Dietary intake data were collected using a brief-type, self-administered, diet-history questionnaire validated for Japanese preschool-aged children.

Results

Of the 3595 subjects evaluated, 718 (20.0%) had functional constipation. The association between functional constipation and gender was not statistically significant (p = 0.617). A decrease in bowel frequency was observed in 15.9% of those with functional constipation. There was no significant difference in the proportion of participants in the constipation group by age (p = 0.112). Binomial logistic regression analysis indicated that only fat per 100 kcal positively correlated with functional constipation [odds ratio = 1.216, 95% confidence interval: 1.0476–1.412].

Conclusions

Functional constipation is common among children in preschool and early elementary school in urban areas of Japan. Parents should pay attention to constipation-related symptoms other than defecation frequency. A high-fat diet should be avoided to prevent functional constipation.

Rate of eating in early life is positively associated with current and later body mass index among young Japanese children: the Osaka Maternal and Child Health Study

The possible effect of eating rate on promoting obesity has attracted considerable attention among various age groups, but little is known about these associations in an early stage of life. We investigated the hypothesis that eating rate in early childhood influences current and later body mass index (BMI) among young Japanese children. The study participants were 492 Japanese mother-child pairs from a prospective birth cohort study. Information on rate of eating (slow, medium, or fast), macronutrient intake (protein, fat, and carbohydrate), and dietary fiber intake were collected from the mothers using a diet history questionnaire when the children were aged 29 to 39 months. Height and weight as measured at 30 and 42 months of age were used to calculate BMI at each age. Multiple linear regression analyses were performed to examine the relationships between eating rate in early childhood and BMI at 30 and 42 months. There were strong positive associations between eating rate and BMI at 30 and 42 months of age that were robust to adjustment for confounders including maternal BMI, socioeconomic status, health behaviors, and child's nutrient intake. In comparison with children in the "slow" rate of eating group, the size of the difference in BMI (95% confidence interval) at 42 months of age was 0.49 (0.17-0.80) and 0.67 (0.24-1.10) kg/m² greater among children in the "medium" and "fast" groups, respectively. In conclusion, a higher rate of eating in early childhood was positively associated with not only current BMI but also BMI measured 1 year later in young Japanese children.

Early sugar-sweetened beverage consumption frequency is associated with poor quality of later food and nutrient intake patterns among Japanese young children: the Osaka Maternal and Child Health Study

Evidence from Western countries shows that higher consumption of sugar-sweetened beverages (SSBs) is associated with lower quality of young children's diets, but little is known about these relations in non-Western countries with relatively low consumption levels of SSBs. We hypothesized that SSB consumption in infancy would be associated with poor quality of later food and nutrient intake patterns among Japanese young children. The study subjects were 493 Japanese mother-child pairs from a prospective birth cohort study. Dietary data on children were collected from the mothers using self-administered questionnaires when the children were aged 16-24 months and 41-49 months. Multiple linear regression analyses were used to examine the relationships between SSB consumption frequency in infancy and later intake of foods and nutrients. At 16-24 months of age, more than half of the children (56.4%) consumed SSBs less than once a week, whereas 11.6% consumed SSBs at least once daily. More frequent consumption of SSBs in infancy was associated with higher intake of confectionaries and SSBs and lower intake of fruits and vegetables at 41-49 months of age. These associations were still evident after adjustment for maternal SSB consumption and socioeconomic status. At the nutrient level, SSB consumption frequency was positively associated with energy intake and inversely associated with intake of many nutrients, such as protein, dietary fiber, and most of the micronutrients examined. In conclusion, higher consumption frequency of SSBs at an early age is associated with poor quality of overall dietary intake among young Japanese children 1.5-2.5 years later.