Abstract
To evaluate the association of dietary patterns (DP) at 4 years with adiposity and cardiometabolic risk factors at 10 years, considering sex-heterogeneity. This prospective analysis included 3823 children enrolled in the population-based birth cohort, Generation XXI (Porto-Portugal, 2005–2006). Diet at 4 years was assessed by FFQ, with three DP being identified: high in energy-dense foods (EDF), intermediate in snacks (snacking), and healthier (reference). BMI at 10 years was considered as the Z-score according to the WHO. Other adiposity indicators—fat mass percentage (FM%), fat mass index (FMI), and waist-to-height ratio (WHtR)—were converted to z-scores using the sample’s sex-specific means and standard deviations, as were the cardiometabolic risk factors (systolic and diastolic blood pressure, lipid profile, and insulin resistance). The associations of DP at 4 years with later adiposity or cardiometabolic factors were estimated by linear regression or by multinomial logistic regression models. In fully adjusted models, the EDF DP was significantly positively associated with the BMI (EDF vs. healthier: β = 0.139; 95% CI: 0.031, 0.246, P-interaction = 0.042) and obesity (OR = 2.68; 95% CI 1.55, 4.63, P-interaction = 0.005) only in girls, among whom, it increased insulin (β = 0.165; 95% CI: 0.020, 0.311) and HOMA-IR (β = 0.159; 95% CI: 0.013, 0.306) at 10 years. An EDF DP at 4 years is associated with later adiposity, insulin, and HOMA-IR in girls.
Highlights
The prevalence of obesity in children, despite reports of plateauing in some highincome countries, remains high, and is a crucial public health problem, as reflected by global numbers, with 50 million girls and 74 million boys suffering from obesity in 2016 [1]
After adjustment for mothers’ and children’s characteristics (Table 2, Model 2), following an energydense foods (EDF) dietary pattern at 4 years of age, when compared to following a healthier pattern, was significantly positively associated with BMI (β = 0.139; 95% confidence intervals (95% CI): 0.031, 0.246), FM% (β = 0.099; 95% CI: 0.002, 0.196), fat mass index (FMI) (β = 0.129; 95% CI: 0.037, 0.221), and waist-to-height ratio (WHtR) (β = 0.155; 95% CI: 0.055, 0.255) six years later only in girls (P-Interaction: 0.042; 0.113; 0.048; and 0.033, respectively)
When considering obesity (Table 3, Model 2), girls practicing the EDF dietary pattern at 4 years were significantly more likely to have obesity six years later (EDF vs. healthier: odds ratios (OR) = 2.68; 95% CI: 1.55, 4.63)
Summary
The prevalence of obesity in children, despite reports of plateauing in some highincome countries, remains high, and is a crucial public health problem, as reflected by global numbers, with 50 million girls and 74 million boys suffering from obesity in 2016 [1]. According to the WHO European Childhood Obesity Surveillance Initiative (COSI), data from the fourth round (2015–2017) found a prevalence of overweight of 32% in girls and 29% in boys at the ages of 6–9 years, with southern European countries showing a higher prevalence, a significant decrease in the prevalence of both overweight and obesity was observed in the last 10 years in Greece, Italy, Slovenia, and Portugal [3]. As such, considering that both overweight [6] and other cardiometabolic risk factors [7] show tracking into adulthood, prevention at early stages is crucial
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