Abstract
Background:Poor diet quality in early childhood is inconsistently linked to obesity risk. Understanding may be limited by the use of cross-sectional data and the use of body mass index (BMI) to define adiposity in childhood.Objective:The objective of this study is to examine the effects of continued exposure to diets of varying quality across early childhood in relation to adiposity at 6 years.Methods:One thousand and eighteen children from a prospective UK birth cohort were studied. Diet was assessed using food frequency questionnaires when the children were aged 6 and 12 months, and 3 and 6 years; diet quality was determined according to scores for a principal component analysis-defined dietary pattern at each age (characterized by frequent consumption of fruits, vegetables and fish). At each age, children were allocated a value of 0/1/2 according to third of the distribution (bottom/middle/top) their diet quality score was in; values were summed to calculate an overall diet quality index (DQI) for early childhood (range 0–8). Obesity outcomes considered at 6 years were dual-energy X-ray absorptiometry-assessed fat mass and BMI.Results:One hundred and seven (11%) children had a DQI=0, indicating a consistently low diet quality, 339 (33%) had a DQI=1–3, 378 (37%) had a DQI=4–6 and 194 (19%) had a DQI=7–8. There was a strong association between lower DQI and higher fat mass z-score at 6 years that was robust to adjustment for confounders (fat mass s.d. per 1-unit DQI increase: β=−0.05 (95% confidence interval (CI): −0.09, −0.01), P=0.01). In comparison with children who had the highest diet quality (DQI=7–8), this amounted to a difference in fat mass of 14% (95% CI: 2%, 28%) at 6 years for children with the poorest diets (DQI=0). In contrast, no independent associations were observed between DQI and BMI.Conclusions:Continued exposure to diets of low quality across early childhood is linked to adiposity at the age of 6 years.
Highlights
The prevalence of overweight and obesity in children is increasing rapidly and now is one of the most serious public health challenges worldwide.[1]
In this study we describe the relations of diet quality at four ages from infancy to early childhood, with body composition and obesity risk at 6 years, among 1018 children who participated in a prospective birth cohort, the Southampton Women’s Survey (SWS)
There were no differences in gestational age, child’s birthweight, maternal prepregnancy body mass index (BMI), maternal serum 25-hydroxyvitamin D concentration, plasma n-6 polyunsaturated fatty acid concentration in late pregnancy or Institute of Medicine weight-gain categories between mother–child pairs studied and the remaining pairs
Summary
The prevalence of overweight and obesity in children is increasing rapidly and now is one of the most serious public health challenges worldwide.[1]. Recent systematic reviews have explored associations between diet quality in early life and health-related outcomes.[6,7,8,12] Weight status and risk of overweight/obesity were the most commonly assessed health-related outcomes, but surprisingly, findings in relation to diet quality and childhood obesity are not consistent across studies.[8] One possibility is that much of the evidence is based on cross-sectional comparisons, whereas longitudinal data are needed to address the cumulative effects of exposure to diets of poor quality Another issue may be the limitation of using body mass index (BMI) as an indicator of adiposity in children.[13]. CONCLUSIONS: Continued exposure to diets of low quality across early childhood is linked to adiposity at the age of 6 years
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