Associations between eating frequency, adiposity, diet, and activity in 9-10 year old healthy-weight and centrally obese children

Abstract

The rising prevalence of childhood obesity is a key public health issue worldwide. Increased eating frequency (EF) is one aspect of diet that has been beneficially associated with obesity, although the mechanisms are unclear. The aims of the current study were to determine whether increased EF was associated with improved adiposity in children, and if this was due to differences in dietary and activity behaviors. Cross-sectional data from 1,700 children aged 9-10 year were analyzed to examine the associations between EF, as estimated from diet diaries, measures of adiposity, and activity measured by accelerometer. Analyses were stratified by obesity status using waist-to-height ratio to define obesity as it has been shown to be a good predictor of adverse health outcomes. Mean EF was 4.3 occasions/day and after adjustment for underreporting, energy intake (EI), and activity significant relative mean differences of -2.4% for body weight (P = 0.001), -1.0% for BMI (P = 0.020), -33% for BMI z-score (P = 0.014), and -0.6% for waist circumference (P = 0.031) per increase in eating occasion were found in healthy-weight but not centrally obese children. Differences between the extreme quartiles of EF were observed for total fat intake at breakfast (-18%, P < 0.001), fruit and vegetables from snacks (201% healthy-weight and 209% centrally obese children, P < 0.01), and for healthy-weight children, vigorous activity (4%, P = 0.003). Increased EF was favorably associated with adiposity, diet quality, and activity behaviors in healthy-weight but not centrally obese children. Future obesity interventions should consider the mediating role of diet quality and activity in the relationship between EF and adiposity in children.

Figure 1

Distribution of eating frequency in 1700 9-10-year-old children

Figure 2

Mean percentage differences in dietary intake at specified meals and physical activity by eating frequency (*categories were plotted on the secondary axis). Comparisons were made between the 4^th and 1^st quintile (Healthy weight children n=269 for Q1 and 273 for Q4; centrally obese children n=191 for Q1 and 155 for Q4). Values were adjusted for gender, parental education, under-reporting, physical activity, and ^†energy intake. %ES = percentage of total energy from snacks; %EB = percentage of total energy from breakfast. ‡The difference between the 4^th and 1^st quintile was significantly different P <0.05 (ANCOVA) in healthy weight and centrally obese children, or in ^§healthy weight children only.