Clustering of Dietary Patterns and Lifestyles Among Spanish Children in the EsNuPI Study †

Abstract

Dietary patterns (DPs) are known to be tied to lifestyle behaviors. Understanding DPs and their relationships with lifestyle factors can help to prevent children from engaging in unhealthy dietary practices. We aimed to describe DPs in Spanish children aged 1 to <10 years and to examine their associations with sociodemographic and lifestyle variables. The consumption of toddler and young children milk formulas, enriched and fortified milk within the Spanish pediatric population is increasing, and there is a lack of evidence whether the consumption of this type of milk is causing an impact on nutrient intakes and if they are helping to reach the nutrient recommendations. Within the Nutritional Study in the Spanish Pediatric Population (EsNuPI), we considered two study cohorts and three different age groups in three year-intervals in each of them. The study cohort included 740 children in a representative sample of the urban non-vegan Spanish population and 772 children in a convenience cohort of adapted milk consumers (AMS) (including follow-on formula, toddler’s milk, growing up milk, and fortified and enriched milks) who provided information about sociodemographics, lifestyle, and dietary habits; a food frequency questionnaire was used for the latter. Principal component analysis was performed to identify DPs from 18 food groups. Food groups and sociodemographic/lifestyle variables were combined through a hierarchical cluster algorithm. Three DPs predominated in every age group and study sample: a palatable energy-dense food dietary pattern, and two Mediterranean-like DPs. However, children from the AMS showed a predominant dietary pattern markedly related to the Mediterranean diet, with high consumption of cereals, fruits and vegetables, as well as milk and dairy products. The age of children and certain lifestyle factors, namely level of physical activity, parental education, and household income, correlated closely with the dietary clusters. Thus, the findings provide insight into designing lifestyle interventions that could reverse the appearance of unhealthy DPs in the Spanish child population.

Screen Time and Parents’ Education Level Are Associated with Poor Adherence to the Mediterranean Diet in Spanish Children and Adolescents: The PASOS Study

“…They show that nearly half of children and adolescents whose parents had a university education had high adherence to the Mediterranean diet, whereas the percentage was much lower among children whose parents had a low or medium education level. Outcomes that are consistent with ours in this respect have been observed in studies conducted in various countries [66][67][68][69]. Yañez et al have shown that low family educational level is associated with low adherence to the Mediterranean diet in adolescents [70].…”

Dietary Patterns and Their Association with Body Composition and Cardiometabolic Markers in Children and Adolescents: Genobox Cohort

“…ANIBES [14,31,32] and enKID [13,30] found a negative association, EsNuPi [13] found different associations according to age, and SI! [15] found a positive association, as did we. Indeed, we found that the HC cluster included a higher proportion of children with obesity (51.1% vs. 46.1%) and overweight (29.0% vs. 19.7%), and a lower proportion with normal weight (19.9% vs. 36.2%) than the SP cluster.…”

“…Specifically, in Spain, there have been four previous studies including large samples of children or adolescents, which also found healthy dietary patterns in their study populations by using different approaches, labeling them as "healthy" (enKID [13,30] and SI! [16]), or "Mediterranean-like" (ANIBES [14,31,32] and EsNuPi [15]), including a high intake of vegetables, fruits and fish, similar to our HC.…”

“…The World Health Organization (WHO) stated that the prevalence of overweight and obesity has risen dramatically worldwide from 1975 to 2016, as it has nearly triplicated among adults, and even more among children and adolescents (aged [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], increasing from 4% to 18% [1]. WHO also highlighted Spain among the European countries with the highest prevalence [1], and although national studies suggested that it has stabilized in the last few years, it continues to be high in this country, at over 40% (for children seven and eight years old) [2].…”

“…Additionally, there is still scarce literature on these populations regarding the associations between dietary patterns and other variables of body composition beyond BMI, and metabolic indicators, especially biochemical ones related to oxidative stress, inflammation or endothelial damage [11,12]. Indeed, in Spain the enKid [13], the ANIBES [14], the EsNuPi [15], and the SI! [16] studies had large sample sizes (n > 400), and all considered BMI exclusively as an obesity phenotype indicator in relation to dietary patterns (except SI!…”