Article

Energy-dense, low-fiber, high-fat dietary pattern is associated with increased fatness in childhood

Medical Research Council Human Nutrition Research, Cambridge, United Kingdom.
American Journal of Clinical Nutrition (Impact Factor: 6.92). 05/2008; 87(4):846-54.
Source: PubMed

ABSTRACT Evidence for the dietary determinants of obesity in children is limited.
The objective was to identify a dietary pattern that explained dietary energy density (DED), fiber density (FD), and percentage of energy intake from fat and analyze its relation to fatness in children.
The subjects were 521 (at ages 5 and 9 y) and 682 (at ages 7 and 9 y) children participating in the Avon Longitudinal Study of Parents and Children. Diet was assessed with the use of 3-d diet diaries at ages 5 and 7 y. Reduced rank regression derived a dietary pattern with the use of DED, fiber, and fat intake as intermediate variables. Fat mass was measured at age 9 y with the use of dual-energy X-ray absorptiometry. Fat mass index (FMI) was calculated, and excess adiposity was defined (as the top quintile of logFMI).
Pattern score at ages 5 and 7 y was correlated with DED (r = 0.8), FD (r = -0.7), and percentage of energy intake from fat (r = 0.5). An increase of 1 SD of pattern score at ages 5 and 7 y, respectively, was associated with a 0.15-kg (95% CI: -0.1, 0.45 kg) and a 0.28-kg (95% CI: 0.05, 0.53 kg) higher fat mass at age 9 y, after controlling for confounders. The adjusted odds of excess adiposity at age 9 y for children in quintile 5 compared with quintile 1 of dietary pattern score at ages 5 and 7 y, respectively, were 2.52 (95% CI: 1.13, 6.08) and 4.18 (95% CI: 2.07, 9.38).
An energy-dense, low-fiber, high-fat diet is associated with higher fat mass and greater odds of excess adiposity in childhood.

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    • "However, little is currently known about the dietary patterns of children in India. Studies in European children have looked at the associations between diet patterns and body composition and found that 'snacking' and 'energy dense' patterns are associated with overweight (Lioret et al. 2008) and higher fat mass (Johnson et al. 2008). South Asian children tend to have a higher body fat percentage compared with Western children (Yajnik et al. 2003; Krishnaveni et al. 2005), but to our knowledge diet patterns and their relationships with body composition have not been studied among South Asian children. "
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    • "Research has shown a number of correlations between general dietary patterns and specific dietary behaviors with children's weight. Correlations with increased body fat were found for consumption of an energy dense, low-fiber, high-fat diet among children (Johnson et al., 2008). Conversely, correlations with lower BMI or obesity rates have been demonstrated with increased milk consumption (Barba, Troiano, Russo, Venezia, & Siani, 2005), higher fruit and vegetable intake (Lin & Morrison, 2002; Rockett, Berkey, Field, & Colditz, 2001), eating school breakfast (P. "
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Globalement, les résultats n’ont pas montré de différences significatives dans l’alimentation des participants selon les catégories d’IMC en considérant les indicateurs reliés à la quantité et à la qualité de l’alimentation comme l’apport énergétique total, l’apport énergétique en provenance des lipides, les fibres alimentaires, la densité énergétique et la diversité alimentaire. Par contre, les résultats de la nouvelle méthode fondée sur la sélection des items alimentaires fréquemment consommés par au moins 10 % des participants ont révélé que les enfants de Kahnawake à risque d’excès de poids consommaient plus fréquemment de croustilles (p=0.001) et moins fréquemment de craquelins que les enfants avec excès de poids ou ceux ayant un poids normal (p=0.015). Ensuite, en prenant la catégorie de poids normal comme référence, le rapport de côte (Odds ratio : OR) d’être à risque d’excès de poids était de 2.16 (95 % IC : 1.14 - 4.09) fois plus élevé chez les enfants de Kahnawake qui consommaient plus fréquemment de croustilles comparativement aux non-consommateurs de croustilles, et ce, après ajustement pour l’âge. Par contre, le rapport de côte d’être à risque d’excès de poids diminuait de 79 % (OR = 0.21; 95 % IC : 0.06 – 0.72) chez les enfants consommateurs de craquelins comparativement à leurs homologues non-consommateurs. Après avoir corrigé les quantités pour l’âge, on note que les enfants avec excès de poids consommaient plus de frites que les enfants à risque d’excès de poids ou ceux ayant un poids normal (p = 0.027). Chez les femmes cries, les résultats de la nouvelle méthode ont montré que le colorant à café était associé à un risque élevé d’obésité (OR = 4.64, 95 % IC : 1.04 - 0.54); alors que le lait faible en matières grasses était associé à un moindre risque d’embonpoint (OR = 0.38, 95 % IC : 0.17 - 0.82), après ajustement pour l’âge. Quant aux hommes cris, le lait entier était associé à un moindre risque d’avoir de l’embonpoint (OR ajusté pour l’âge = 0.38, 95 % IC : 0.20 - 0.71) et, en termes de quantité corrigée pour l’âge, les hommes obèses buvaient plus de boissons sucrées aux fruits comparativement aux hommes de poids normal ou ceux ayant de l’embonpoint (p=0.015). Selon les résultats de cette méthode appliquée aux données de l’enquête ESCC 2.2, les garçons à risque d’excès de poids ou avec excès de poids consommaient moins fréquemment de pain blanc que ceux de poids normal (p=0.048). En termes de quantité toutefois, ils consommaient plus de pain blanc (p=0.040), utilisaient plus de farine de blé (p=0.006) et de levure (p=0.002). Après avoir ajusté les quantités consommées pour l’âge et l’indice d’activité physique, les femmes avec embonpoint ou obèses utilisaient plus de farine de blé (p< 0.001) que leurs homologues de poids normal. Chez les hommes, il n'y avait pas de différences ni dans les fréquences de consommation ni dans les quantités consommées. Concernant les filles, leurs apports alimentaires n'étaient pas valides (facteur d'activité de Goldberg < 1.2 dans la catégorie embonpoint / obèse). Les résultats de cette méthode innovatrice pourraient d’une part, permettre d’axer la sensibilisation sur des aliments particuliers en plus des recommandations générales du Guide Alimentaire Canadien. D’autre part, ils nous renvoient aux données biologiques de laboratoire afin d’identifier les composantes des items susceptibles de contribuer au développement de l’obésité. Obesity is a public health problem in Canada, particularly among Aboriginal populations where the highest prevalences have been reported. In the literature, several methods have been tried to study the relationship between diet and obesity, but results are inconsistent. The objective of this thesis is to identify differences in selected dimensions of diet quality and quantity across body mass index (BMI) categories for Aboriginal children and adults in Canada. To achieve this goal, we developed a new method by using data from Mohawk children in Kahnawake. The same method was then applied to two other datasets (James Bay Cree adults and off-reserve adults and children from CCHS 2.2). Overall, in each dataset, the results showed no differences in the diets of participants considering indicators such as energy intake, percent fat, fiber intake, energy density and dietary diversity. On the contrary, using the new method based on the most-frequently consumed food items by at least 10% of participants, we found that Mohawk children “at risk of overweight” consume potato chips more frequently (p=0.001) and crackers less frequently (p = 0.015), compared to normal-weight or overweight children. Compared to normal-weight, and after adjusting for age, Mohawk children who consumed more frequently chips increased their probability of being at risk of overweight (Odds ratio : OR = 2.16, 95 % CI : 1.14 - 4.09), while those who consumed crackers more frequently decreased their risk (OR = 0.21; 95 % CI : 0.06 – 0.72). In terms of quantity, and after adjusting for age, overweight children consumed larger portions of french fries (p = 0.027).Among the Cree women (compared to normal-weight, and after adjusting for age), we found out that nondairy creamer was associated to increase risk of being obese (OR = 4.64, 95 % CI : 1.04 - 20.54) while low-fat milk was associated to lower risk of overweight (OR = 0.38, 95 % CI : 0.17 - 0.82). Among Cree men, (after adjusting for age), whole milk was associated to a high risk of the men being overweight (OR = 0.38, 95 % CI : 0.20 - 0.71). Finally, in terms of quantity (after adjusting for age), obese men drank more sweetened fruit drinks compared to men of normal weight or those with overweight (p = 0.015). In the third dataset CCHS2.2, results of the new method show that boys at “risk of overweight” or overweight consumed white bread less frequently (p = 0,048) but in greater quantity when they do so (p = 0,040). They also used more flour (p = 0.006) and yeast (p = 0.002). After adjusting the quantities consumed for age and physical activity, women with overweight or obese used more flour (p < 0.001) than those of normal weight. No differences were found in terms of frequency and quantity for men. The data were not analysed for girls since their Goldberg activity factor was less than 1.2 with greater body weight. The results of this new method could, on one hand, allow us to focus awareness on foods in addition to general recommendations of the Canadian Food Guide. On the other hand, they refer us back to laboratory data to identify components of items that may contribute to the development of obesity.
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