Diet Quality and Mortality, Stunting and Wasting in Children Aged 6–59 Months: An Ecological Analysis from the Global Dietary Database

Abstract

Objectives Empirical evidence on the relationship between diet quality metrics and child growth outcomes is sparse. We investigated the associations between the Infant and Young Child Minimum Dietary Diversity (IYCMDD) and Dietary Approaches to Stop Hypertension (DASH) scores, and under-5 mortality and disability-adjusted life years (DALYs) due to stunting, wasting, underweight and overweight/obesity in children aged 6–59 months. Methods The Global Dietary Database (GDD) uses Bayesian hierarchical modeling methods to combine individual-level dietary intake from national and sub-nationally representative surveys with other country-level data to estimate mean national intakes for 55 dietary factors. Dietary data for children from 185 countries was obtained from the GDD. Data on under-5 mortality rates and disease specific DALYs were obtained from the World Bank's World Development Indicators and the Global Burden of Diseases study, respectively. We assessed country- and sex-stratum level cross-sectional associations between the IYCMDD and DASH scores, and mortality and DALYs using Poisson regression models, adjusting for individual and national-level confounders (sex, education, urbanicity, unemployment rate, poverty rate, income, and geographic region). Results In 2015, a higher IYCMDD score was associated with a lower risk of under-5 mortality (odds ratio [OR] 0.88, 95% CI 0.86–0.90, P-value < 0.001 for a 1-unit increase) and DALYs linked to stunting (0.67, 0.67–0.68, P-value < 0.001), wasting (0.70, 0.69–0.70, P-value < 0.001), and underweight (0.70, 0.70–0.71, P-value < 0.001). No significant association with overweight/obesity (0.99, 0.97–1.01, P-value = 0.479) was observed. A higher DASH score was associated with a decreased risk of DALYs linked to under-5 mortality (0.94, 95% 0.93–0.95, P-value < 0.001), stunting (0.87, 0.87–0.88, P-value < 0.001), wasting (0.89, 0.88–0.89, P-value < 0.001), and underweight (0.88, 0.87–0.89, P-value < 0.001), and an increased risk of overweight/obesity (1.02, 1.01–1.02, P-value < 0.01). Conclusions Higher IYCMDD and DASH scores were protective against the risk of death and stunting and wasting in children, but not overweight/obesity. Our findings suggest a need to prioritize appropriate metrics relevant to the double burden of malnutrition. Funding Sources Gates Foundation.

Developmental origins of health and disease knowledge is associated with diet quality in preconception young adult men and women

“…12 SSB and, to a lesser extent, confectionary consumption showed the opposite pattern. The cross-sectional DQS findings in the present study do not reflect the low DQS of about 32/100 observed by Miller et al 31 for the same age group in high-income countries. Regardless of this discrepancy, the total DQS in this study was still suboptimal, which is strongly in line with all the aforementioned studies.…”

“…The mean total DQS in the present study of 60/100 points indicates a higher diet quality than for the studies above but is comparable to the findings of Patetta et al 34 from 2011 to 2014. Moreover, our observations of higher DQS among women compared to men are in line with global trends 31 and among UK adolescents and young adults. 32 Looking into the individual DQS components in this study, modest to high scores for fruit (6/10) and vegetables (8/10) were observed, which is better than what other studies have found.…”

“…There seems to be a J-or U-shaped relationship between diet quality and age, and diet quality has been observed to worsen especially in adolescence. Miller et al 31 observed this relationship for most regions worldwide, and Lipsky et al 33 as a modest improvement in diet quality during the transition from adolescence to emerging adulthood. This relationship has also been observed in Norway.…”

Flavonoids, gut microbiota, and host lipid metabolism

“…In recent decades, with the improvement in living standards, most people's dietary structure and habits have undergone significant changes with the high intake of high sugar, high fat and refined processed foods, sedentary work, and lack of exercise. The physiological processes associated with lipid metabolism encompass the dysregulated synthesis and metabolism of fatty acids and cholesterol [1][2][3]. Diseases, including, obesity, type 2 diabetes, hyperlipidemia, hyperglycemia, atherosclerosis, nonalcoholic fatty liver disease, asthma, and osteoarthritis arise from disorders in lipid metabolism [4,5].…”

Rising tide of NAFLD in youth: A warning bell and call to action

“…With increased commercialization and globalization of the world's food supply, rapid transitions to diets higher in ultraprocessed foods are likely one of the primary contributing factors to the global rise in NAFLD in children. [6] Another ascendant theory includes increased exposure to endocrine-modifying chemical exposures, now ubiquitously found in food, water, textiles, electronic, and building components, to which children are more susceptible due to their smaller size, greater hand-and object-to-mouth exposure, and immature physiology. [7] The consistently higher prevalence of NAFLD in male adolescents (on average 2% higher than females) may also point to sex-specific differences in susceptibility to these chemical exposures, some of which have estrogen-like effects or associate with reduced testosterone levels.…”