A prospective analysis of dietary energy density at age 5 and 7 years and fatness at 9 years among UK children

Abstract

Objective: To analyse whether high dietary energy density (DED) is associated with increased fat mass and risk of excess adiposity in free-living children. Design: Longitudinal, observational cohort study. Subjects: Six hundred and eighty-two healthy children from the Avon Longitudinal Study of Parents and Children. Measurements: Diet was assessed at age 5 and 7 years using 3-day diet diaries, and DED (kJ g À1 ) was calculated excluding drinks. Fat mass was estimated at age 9 years using Dual-Energy X-ray Absorptiometry. To adjust for body size, fat mass index (FMI) was calculated by dividing fat mass (kg) by height (m 5.8 ). Excess adiposity was defined as the top quintile of logFMI. Results: Mean DED at age 5 years was higher among children with excess adiposity at age 9 years compared to the remaining sample (8.870.16 vs 8.570.07 kJ g À1 ), but there was no evidence of an association with excess adiposity at age 9 years (odds ratio (OR) ¼ 1.14, 95% confidence interval (CI) 0.90-1.44) after controlling for potential confounders. Mean DED at age 7 years was higher among children with excess adiposity compared to the remaining sample (9.170.12 vs 8.870.06 kJ g À1 ) and a 1 kJ g À1 rise in DED increased the odds of excess adiposity at 9 years by 36% (OR ¼ 1.36, 95% CI 1.09-1.69) after controlling for potential confounders. Conclusion: Higher DED at age 7 years, but not age 5 years, is a risk factor for excess adiposity at age 9 years, perhaps reflecting deterioration in the ability to compensate for extra calories in an energy-dense diet. DED tracks strongly from age 5 to 7 years suggesting intervention to alter dietary habits need to commence at younger ages to prevent the formation of preferences for energy dense foods.

Dietary energy density as a marker of dietary quality in Swedish children and adolescents: the European Youth Heart Study

“…These foods may reflect home cooking as well as fast food consumption and hence the association with diet quality may not be as straightforward. The mean energy density values in our study are slightly lower than those published by Johnson et al (2008a) and McCaffrey et al (2008), but their dietary assessment methods differed from ours and their subjects were younger. Mendoza et al (2006) reported much lower values but did not exclude all beverages in their calculations.…”

“…To the best of our knowledge, no other studies comprehensively describing dietary quality and energy density in children under free-living conditions have been published, although Johnson et al (2008a) did report a relationship between dietary energy density and percent energy from total fat (positive) and fibre (negative) in a sample of UK children. A cross-sectional association between energy density and selected predictors of obesity (Mendoza et al, 2006), and a longitudinal association with overweight (McCaffrey et al, 2008;Johnson et al, 2008a), have also been reported in children.…”

“…A cross-sectional association between energy density and selected predictors of obesity (Mendoza et al, 2006), and a longitudinal association with overweight (McCaffrey et al, 2008;Johnson et al, 2008a), have also been reported in children. In adults, low-energy-density diets have been associated with higher diet quality (based on micronutrient, macronutrient and food intakes) in two large US cohorts: the NHANES III (Third National Health and Nutrition Examination Survey) and the CSFII (Continuing Survey of Food Intakes by Individuals) 1994-1996 surveys (Kant and Graubard, 2005b;Ledikwe et al, 2006b).…”

Influencing and modifying children's energy intake: the role of portion size and energy density

“…The evidence for the association in young people was based on four methodologically rigorous longitudinal studies, whose key strengths were: (1) use of objective measures of adiposity (including dual-energy X-ray absorptiometry or doubly-labelled water) rather than reliance on proxy measures such as BMI; (2) mis-reporting of dietary EI was appropriately adjusted for; (3) ED was calculated by recommended methods that excluded all or most beverages, to avoid attenuation of results (62)(63)(64)(65) . The latter issue is of critical importance in evaluating associations between ED and adiposity (65) .…”

Dietary assessment in the Avon Longitudinal Study of Parents and Children

“…It is important to make adjustments for possible misreporting of intakes when using dietary data. In ALSPAC, several methods of assessment of misreporting and subsequent adjustment have been used Johnson et al, 2007).…”