Free Sugars and Total Fat Are Important Characteristics of a Dietary Pattern Associated with Adiposity across Childhood and Adolescence

Abstract

Background: The importance of dietary sugar compared with fat in the development of obesity is currently a topic of debate.

Objective: We aimed to identify dietary patterns (DPs) characterized by high sugar content, high fat content, or both and their longitudinal associations with adiposity during childhood and adolescence.

Methods: Participants were 6722 children from the ALSPAC (Avon Longitudinal Study of Parents and Children) who were born in 1991-1992. DPs were characterized by percentage of total energy intake (%E) from free sugars, %E from total fat, and dietary energy density (DED) and fiber density by using reduced rank regression at 7, 10, and 13 y of age. Total body fat mass was measured at 11, 13, and 15 y of age. Regression analyses were used to adjust for dietary misreporting, physical activity, and maternal social class.

Results: Two major DPs were identified: higher z scores for DP1 were associated with greater DED, greater %E from free sugars and total fat, and lower fiber density; higher z scores for DP2 were associated with greater %E from free sugars but lower %E from total fat and DED. A 1-SD increase in z score for DP1 was associated with a mean increase in the fat mass index z score of 0.04 SD units (95% CI: 0.01, 0.07; P = 0.017) and greater odds of excess adiposity (OR: 1.12; 95% CI: 1.0, 1.25; P = 0.038). DP2 was not associated with adiposity.

Conclusions: An energy-dense DP high in %E from total fat and free sugars is associated with greater adiposity in childhood and adolescence. This appears to confirm the role of both fat and sugar and provides a basis for food-based dietary guidelines to prevent obesity in children.

Keywords: ALSPAC; adiposity; adolescents; children; diet; dietary patterns; energy density; fat; obesity; sugar.

FIGURE 1

Intakes of response variables by quintile of DP z scores characterized by %E from free sugars, %E from total fat, DED (in MJ · g⁻¹ · d⁻¹), and fiber density (in g · MJ⁻¹ · d⁻¹) at 7 y of age in the ALSPAC cohort for DP1 (A) and DP2 (B). Values are means, n = 1457 in each quintile. ALSPAC, Avon Longitudinal Study of Parents and Children; DED, dietary energy density; DP, dietary pattern; DP1, energy-dense, high %E from free sugars, high %E from total fat, low fiber dietary pattern; DP2, non–energy dense, high %E from free sugars, and low %E from total fat dietary pattern; Q, quintile; %E, proportion of total energy intake.

FIGURE 2

Factor loadings for dietary patterns characterized by %E from free sugars, %E from total fat, dietary energy density, and fiber density calculated by using reduced rank regression at 7 y of age in the ALSPAC cohort for DP1 (A) and DP2 (B). ALSPAC, Avon Longitudinal Study of Parents and Children; DP1, energy-dense, high %E from free sugars, high %E from total fat, low-fiber dietary pattern; DP2, non–energy dense, high %E from free sugars, and low %E from total fat dietary pattern; %E, proportion of total energy intake.

FIGURE 3

Quintiles of DP1 and DP2 z scores in relation to FMI z score (A, B) and odds of excess adiposity (C, D) between 7 and 15 y of age in the ALSPAC cohort. (A, B) Plotted values (diamonds) represent the mean increase in FMI z score (β-coefficients and 95% CIs) associated with a quintile increase in DP z score between follow-ups, relative to the lowest quintile, adjusted for age, sex, dietary misreporting, physical activity, and maternal social class. (C, D) Plotted values (circles) represent the odds of excess adiposity (ORs and 95% CIs) associated with a quintile increase in DP z score between follow-ups, relative to the lowest quintile, adjusted for age, sex, dietary misreporting, physical activity, and maternal social class. P-trend values were derived from modelling DP quintiles as continuous variables. DP1 median z score in each quintile: −1.37 (Q1), −0.47 (Q2), 0.06 (Q3), 0.56 (Q4), and 1.28 (Q5); DP2 median z scores in each quintile: −1.07 (Q1), −0.47 (Q2), −0.05 (Q3), 0.39 (Q4), and 1.14 (Q5). ALSPAC, Avon Longitudinal Study of Parents and Children; DP, dietary pattern; DP1, energy-dense, high %E from free sugars, high %E from total fat, and low-fiber dietary pattern; DP2, non–energy dense, high %E from free sugars, and low %E from total fat dietary pattern; FMI, fat mass index; Q, quintile; %E, proportion of total energy intake.