Abstract
Previous studies of the relationship between energy intake and child weight have shown mixed results and have largely not described differences in diet quality or the impact of underreporting. The objective of this study was to investigate the relationship between dietary intake and childhood obesity by assessing energy intake and diet quality across BMI categories for 2–19-year-old children before and after excluding underreporters. Energy intake and the Healthy Eating Index 2010 (HEI) were studied for 2–19-year-old children using data from 2005–2014 NHANES. Underreporters were defined as children consuming <100% of their predicted resting energy expenditure (REE) and were excluded from some analyses. There were no statistically significant differences in HEI scores across weight categories; mean HEI total score was 47.1 (SE 0.23) out of a possible 100. When considering all 12–19-year-old children, those in the overweight, obesity, and severe obesity categories had a lower mean energy intake than children in the healthy weight category (p < 0.001). Excluding underreporters, 6–11-year-old children in the overweight, obesity, and severe obesity categories had a higher energy intake than healthy weight children (p < 0.001). In both analyses, children in the overweight, obesity, and severe obesity categories reported consuming a lower % REE than healthy weight children. Diet quality in all children is low, and the relationship between reported energy intake and BMI remains complex. Healthy eating messages should target all children.
Highlights
The prevalence of childhood obesity in the United States is currently 19.3% [1], and energy imbalance is widely accepted as a cause of obesity
Assessments that measure dietary intake in real time can alter the intake of participants, and assessments that occur at a time after intake rely on memory [2]
Underreporting of dietary intake is a common concern [4] and may be a reason why, to date, studies of the relationship between childhood obesity and energy intake have been mixed in their findings
Summary
The prevalence of childhood obesity in the United States is currently 19.3% [1], and energy imbalance is widely accepted as a cause of obesity. The limitations of dietary assessment make it difficult to test differences in ad libidum energy intake across weight categories. Underreporting of dietary intake is a common concern [4] and may be a reason why, to date, studies of the relationship between childhood obesity and energy intake have been mixed in their findings. A systematic review conducted by the Academy of Nutrition and Dietetics showed that, when examining the relationship between energy intake and adiposity in children, some studies found a positive relationship, some a negative relationship, and some found no relationship [5]
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