Abstract
BackgroundIdentifying leading dietary determinants for cardiometabolic risk (CMR) factors is urgent for prioritizing interventions in children. We aimed to identify leading dietary determinants for the change in CMR and create a healthy diet score (HDS) to predict CMR in children.MethodsWe included 5676 children aged 6–13 years in the final analysis with physical examinations, blood tests, and diets assessed at baseline and one year later. CMR score (CMRS) was computed by summing Z-scores of waist circumference, an average of systolic and diastolic blood pressure (SBP and DBP), fasting glucose, high-density lipoprotein cholesterol (HDL-C, multiplying by − 1), and triglycerides. Machine learning was used to identify leading dietary determinants for CMR and an HDS was then computed.ResultsThe nine leading predictors for CMRS were refined grains, seafood, fried foods, sugar-sweetened beverages, wheat, red meat other than pork, rice, fungi and algae, and roots and tubers with the contribution ranging from 3.9 to 19.6% of the total variance. Diets high in seafood, rice, and red meat other than pork but low in other six food groups were associated with a favorable change in CMRS. The HDS was computed based on these nine dietary factors. Children with HDS ≥8 had a higher decrease in CMRS (β (95% CI): − 1.02 (− 1.31, − 0.73)), BMI (− 0.08 (− 0.16, − 0.00)), SBP (− 0.46 (− 0.58, − 0.34)), DBP (− 0.46 (− 0.58, − 0.34)), mean arterial pressure (− 0.50 (− 0.62, − 0.38)), fasting glucose (− 0.22 (− 0.32, − 0.11)), insulin (− 0.52 (− 0.71, − 0.32)), and HOMA-IR (− 0.55 (− 0.73, − 0.36)) compared to those with HDS ≦3. Improved HDS during follow-up was associated with favorable changes in CMRS, BMI, percent body fat, SBP, DBP, mean arterial pressure, HDL-C, fasting glucose, insulin, and HOMA-IR.ConclusionDiets high in seafood, rice, and red meat other than pork and low in refined grains, fried foods, sugar-sweetened beverages, and wheat are leading healthy dietary factors for metabolic health in children. HDS is strongly predictive of CMR factors.
Highlights
The pandemic and increasing trend of obesity-related cardiometabolic risk (CMR) factors are a public health challenge globally [1, 2]
Data from the China Health and Nutrition Survey (CHNS) in 2009 showed that there was a high prevalence of CMR factors in both children and adults [3], which imposes a tremendous burden on health care systems
Dietary patterns have been well linked to CMR factors in children in some countries [15,16,17], they cannot be applied to other populations given that a healthy diet pattern in one study can be hardly derived from other studies
Summary
The pandemic and increasing trend of obesity-related cardiometabolic risk (CMR) factors are a public health challenge globally [1, 2]. Strong evidence from adults has shown that diets low in processed food, sugar-sweetened beverages (SSBs), and carbohydrate, and high in dairy and fish are associated with lower risks of cardiometabolic disorders including obesity, cardiovascular disease, diabetes, dyslipidemia, and hypertension [12, 13]. A recent systematic review has shown that significant associations between dietary intakes and obesity-related CMR factors were observed in 19% of the 81 included studies in children [14]. It is important to create a healthy diet score (HDS) to predict CMR factors in children. Identifying leading dietary determinants for cardiometabolic risk (CMR) factors is urgent for prioritizing interventions in children. We aimed to identify leading dietary determinants for the change in CMR and create a healthy diet score (HDS) to predict CMR in children
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