Managing obesity in children remains challenging. In addition to body mass index (BMI), incorporating body composition into evaluations of post-obesity interventions would help assess changes in adiposity. This study aimed to identify the relationship between dietary intake, physical activity, and changes in BMI z-scores and adiposity among children with obesity. Children aged 7-15 years with obesity received monthly dietary and physical activity instructions for 6 months. Three-day dietary records and physical activity questionnaires were collected at 0, 3, and 6 months. Body composition was measured using bioelectrical impedance analysis. These relationships were analyzed using uni- and multivariate linear regression analyses. A total of 155 children with obesity completed the 6-month study. A higher total protein intake per ideal weight for height was significantly correlated with a decrease in BMI z-score and trunk fat mass index (trunk fat mass [FM] in kg/height in m2). Mean dietary fiber intake was negatively correlated with BMI z-score, FM, FM index (FMI, FM in kg/height in m2), and visceral fat area (VFA) at 6 months. Each 1 g/kg/day increase in protein intake and additional 1 g/day of dietary fiber intake led to a 0.191 kg/m2 (95% confidence interval [CI], -0.309 to -0.072) and 0.028 kg/m2 (-0.05 to -0.005) reduction in BMI z-score. Each 1 g/day increase in protein intake led to a reduction of 0.009 kg/m² in trunk FMI (-0.016 to -0.002) and 0.21 cm² in VFA (-0.418 to -0.002). The outcomes observed at 6 months were consistent with the overall 6-month findings, reinforcing the efficacy of the intervention. Our study showed beneficial effects of high dietary protein and fiber intakes on BMI z-scores and adiposity of children with obesity. Fine-tuning dietary interventions that emphasize appropriate protein and fiber intakes may be more practical for managing childhood obesity.
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