Evaluating the effect of energy dense foods on children’s weight status using a cross-lagged panel design

Abstract

C Durao, A Oliveira, P Moreira, M Severo, A Guerra, H Barros, C Lopes Institute of Public Health, University of Porto, Porto, Portugal Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal Faculty of Nutrition Sciences, University of Porto, Portugal Department of Pediatrics, University of Porto Medical School, Porto, Portugal Contact: kdurao@netcabo.pt Background Energy dense foods (EDF) have been suggested as risk factors for childhood overweight, but evidence to clarify their importance and longitudinal research are still warranted. Our objective was to study the temporal associations between consumption of EDF and weight status in children from 2 to 4 years of age. Methods The present study involved 453 children evaluated at 2 and 4 years of age, enrolled in the Portuguese birth cohort – Generation XXI. Socio-demographic characteristics of children and mothers were evaluated in face-to-face interviews. Children’s weight status was assessed through BMI z-scores according to the WHO Child Growth Standards. Consumption of EDF (snacks, soft drinks, sweets and cakes) was assessed by Food Frequency Questionnaire. Linear regression and structural equation models with cross-lagged design were used to estimate the temporal associations between consumption of EDF and BMI z-scores. Results After adjustment for maternal preconception BMI and education, frequency of consumption of EDF at 4 years was significantly predicted by frequency of consumption of these foods at 2 years ( = 0.707, p < 0.001), and children’s BMI zscores at 4 years were predicted by their BMI z-scores at 2 years ( = 0.737, p < 0.001). In the cross-sectional analysis, consumption of EDF at 2 years was significantly associated with BMI z-scores at the same age ( = 0.163, p = 0.014) but, after adjustment, the association was on the threshold of statistical significance ( = 0.129, p = 0.054). At 4 years, consumption of EDF was not significantly associated with current BMI ( = 0.009, p = 0.800). Regarding the cross-lagged effect of EDF consumption at 2 years on BMI at 4 years, after adjustment for maternal characteristics and BMI z-score at 2 years, no significant association was observed ( = -0.017, p = 0.752), as well as between BMI z-scores at 2 years and EDF consumption at 4 years ( = 0.027, p = 0.659). Conclusions Consumption of EDF at 2 years was associated with later consumption of these foods. The effect of consumption on BMI at 4 years seems to be indirect, related with the association between consumption and BMI at 2 years of age. Key messages Dietary habits acquired early in life track into later ages. Therefore, early dietary modifications may prevent posterior inadequate dietary habits such as the high consumption of EDF. In addition to other environmental factors, intervention programs focused at overweight prevention may have to include a special focus on EDF since early ages.