Abstract
To describe dietary patterns by applying cluster analysis and to describe the cluster memberships of European children over time and their association with body composition changes. The analyses included k-means clustering based on the similarities between the relative frequencies of consumption of forty-three food items and regression models were fitted to assess the association between dietary patterns and body composition changes. Primary schools and pre-schools of selected regions in Italy, Estonia, Cyprus, Belgium, Sweden, Hungary, Germany and Spain. Participants (n 8341) in the baseline (2-9 years old) and follow-up (4-11 years old) surveys of the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS) study. Three persistent clusters were obtained at baseline and follow-up. Children consistently allocated to the 'processed' cluster presented increased BMI (β=0·050; 95 % CI 0·006, 0·093), increased waist circumference (β=0·071; 95 % CI 0·001, 0·141) and increased fat mass gain (β=0·052; 95 % CI 0·014, 0·090) over time v. children allocated to the 'healthy' cluster. Being in the 'processed'-'sweet' cluster combination was also linked to increased BMI (β=0·079; 95 % CI 0·015, 0·143), increased waist circumference (β=0·172; 95 % CI 0·069, 0·275) and increased fat mass gain (β=0·076; 95 % CI 0·019, 0·133) over time v. the 'healthy' cluster. Children consistently showing a processed dietary pattern or changing from a processed pattern to a sweet pattern presented the most unfavourable changes in fat mass and abdominal fat. These findings support the need to promote overall healthy dietary habits in obesity prevention and health promotion programmes targeting children.
Highlights
Cyprus, Belgium, Sweden, Hungary, Germany and Spain
The present study aims to investigate the associations of dietary patterns obtained by applying cluster analysis to children participating in the baseline and follow-up surveys of the IDEFICS study with changes in body composition including BMI, waist circumference (WC), fat mass index (FMI) and fat-free mass index (FFMI)
The present study describes associations between dietary patterns and body composition changes in European children applying cross-sectional and prospective models
Summary
The IDEFICS study is a large multi-centre populationbased study of children aged 2–9 years in selected regions of eight European countries (Belgium, Cyprus, Estonia, Germany, Hungary, Italy, Spain and Sweden) including an embedded intervention[20,21]. Z-scores of WC and of WC change over the 2-year follow up were determined according to ageand gender specific reference standards of the International Obesity Task Force[27]. Statistical methods In a previous IDEFICS report, k-means cluster analysis was performed to identify clusters of children with similar dietary patterns at baseline and follow-up. To assess the changes in dietary patterns over time, children’s cluster memberships at baseline and follow-up were cross-tabulated, showing the proportion of children being allocated to the same or different clusters. The associations of body composition changes with dietary patterns at baseline (T0) and follow-up (T1) were estimated based on mixed models with random effects for country and setting (school) to account for the clustered study design. The analyses were performed using the statistical software package IBM SPSS Statistics version 20.0
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