Dietary patterns in toddlers with excess weight. The 2016 pitnuts study
Article Category: Therapeutics strategies/strategie postępowania profilaktyczno-leczniczego
Pubblicato online: 28 ott 2017
Pagine: 272 - 285
Ricevuto: 28 giu 2017
Accettato: 25 lug 2017
DOI: https://doi.org/10.34763/devperiodmed.20172103.272285
© 2017 Halina Weker, Marta Barańska, Agnieszka Riahi, Małgorzata Strucińska, Małgorzata Więch, Grażyna Rowicka, Hanna Dyląg, Witold Klemarczyk, Agnieszka Bzikowska, Piotr Socha, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Appropriate diet determines a child’s its optimal development, reduces the risk of childhood and diet-dependent diseases, including obesity in adulthood [1, 2, 3, 4]. In recent years, research proved that childhood obesity reflects interactions of genetic and environmental factors, including dietary ones, and that excessive weight in toddlers is a predictor of obesity at preschool and school age [1, 5, 6, 7]. It also increases the risk of chronic non-infectious diseases, such as type 2 diabetes or cardiovascular diseases. In obesity prevention, the basis for an appropriate diet is provided by safe nutrition models for toddlers, including recommendations for nutritional practices, choice of food in the diet, as well as nutrient profiles compliant with the standards [8, 9]. Therefore, dietary patterns of children, defined by the consumption of foods from various product groups and nutrient profiles, should be similar to the recommendations of the safe nutrition model.
To analyse the dietary patterns of with excess weight children aged 1-3 years in comparison with the main components of the safe nutrition model including organization of meals (frequency of meals), selection of products (food intake), energy and nutritional value of children’s diets.
The PITNUTS study was carried out in 2016 on a representative nationwide sample of children aged 5-36 months (n=1059). The analysis of dietary patterns covered 173 overweight and obese children aged 13-36 months (BMI-z-score>1SD and more). Their nutritional status was evaluated based on measurements of body weight and height, calculation of their BMI and its standardisation according to the WHO reference child growth standards for children aged 0-5 years (BMI z-score) in line with the applicable methodology [10]. The diets were assessed using 3-day dietary records of children prepared by their parents. The records were used for the estimation of daily food rations (food consumption) and the nutritional value of the rations was calculated using the Dieta 5.0 nutritional programme [11, 12, 13]. The data from the questionnaire on environmental and family conditions of the children who were analysed were also taken into account.
The dietary patterns of the children with excess weight analysed were determined using the cluster analysis (k-means method), incorporating 11 variables on average daily consumption of milk and dairy products (including cow’s milk, follow-up formula and fermented milk beverages), cereal products (bread, groats and rice, breakfast cereals), as well as fruits, cold meats, fats, sugar and sweets, nectars and juices.
In the clusters of children with various dietary patterns that were obtained, differences were analysed in terms of environmental variables (parents’ education, place of residence, socio-economic status and parents’ BMI) and nutritional variables (meeting dietary standards for energy, macronutrients, calcium and vitamin D, nutritional practices and consumption of recommended food rations, i.e. appropriate consumption of products from various food groups).
The statistical analysis of the results obtained was performed using the Statistica 12 PL statistical package.
The analyses were performed using the chi-square test (variables on a nominal scale) and the Kruskal-Wallis Anova rank test (variables on an ordinal or higher scale). The statistical significance level of p<0.05 was adopted.
The cluster analysis using the k-means method made it possible to distinguish three clusters of children with different dietary patterns.
The first cluster comprised 58 children in the second year of life (age median 19.9 months). The other two clusters included children in the third year of life (age median: 26.0 and 26.6 months).
The diet of the children from the first cluster (n=58) was based primarily on junior formula and ready-to-serve foods for infants and toddlers. This dietary pattern was defined as the “baby food diet”.
The second cluster comprised 33 children whose diets were characterised by a substantial share of cow’s milk and dairy products, as well as cereal products, including bread, groats, rice and breakfast cereals. The children from that group also ate a lot of cold meats and products containig sugar, including sweets. This dietary pattern was defined as the “milk and cereals diet”.
The third cluster consisted of 82 children whose dietary pattern was characterised by high consumption of bread, cold meats and fats, as well as a significant amount of products being a source of simple sugars and disaccharides (sweets, juices, fruit). The consumption of cow’s milk was reduced and partly replaced by sweet dairy products, including fruit yoghurts and milk desserts. The dietary pattern of the children from that cluster was defined as the “sandwich and sugar diet”.
Table I presents the characteristics of children in individual clusters in terms of their family background. Statistically significant differences in the parents’ education of the children from the analysed clusters were found (mothers p=0.09, fathers p=0.02). The parents of the children from the second cluster were the least educated. The analysed groups of children did not vary in terms of place of residence or subjective assessment of their financial situation. The BMIs of the parents of children from various clusters did not show statistically significant differences, either.
Baseline characteristics.
Tabela I. Charakterystyka badanych dzieci.
| Variables |
All children |
Cluster 1 |
Cluster 2 |
Cluster 3 |
P value | ||||
|---|---|---|---|---|---|---|---|---|---|
| Age [months] |
23.5 (17.8-28.8) | 19.9 (15.4-24.4) | 26.6 (20.0-28.8) | 26.0 (19.0-30.1) | <0.0001 StatisticaIly significant differences between three clusters of children |
||||
| Children's BMI z-score |
1.6 (1.3-2.3) | 1.6 (1.2-2.1) | 1.8 (1.3-2.7) | 1.6 (1.3-2.3) | 0.5 | ||||
| Mothers' BMI z-score |
23.4 (21.3-26.5) | 22.9 (21.0-26.0) | 22.9 (21.8-29.9) | 23.8 (21.3-26.0) | 0.7 | ||||
| Fathers' BMI z-score |
26.6 (24.7-28.9) | 26.8 (24.5-29.4) | 26.9 (24.6-29.4) | 26.4 (24.7-28.0) | 0.8 | ||||
| Parents' education |
Mothers [%] |
Fathers [%] |
Mothers [%] |
Fathers [%] |
Mothers [%] |
Fathers [%] |
Mothers [%] |
Fathers [%] |
0.09 (Mothers) 0.02 StatisticaIly significant differences between three clusters of children |
| Primary |
18.6 | 31.4 | 15.5 | 34.3 | 53.5 | 14.7 | 29.3 | ||
| Secondary |
36.0 | 37.2 | 34.5 | 39.6 | 31.3 | 28.6 | 39.0 | 38.7 | |
| University |
45.4 | 31.4 | 50.0 | 37.7 | 34.4 | 17.9 | 46.3 | 32.0 | |
| Place of residence [%] |
|||||||||
| Urban agglomerations |
20.8 | 25.9 | 21.2 | 17.1 | 0.3 | ||||
| Mid-sized cities |
30.6 | 20.7 | 42.4 | 32.9 | |||||
| Countryside |
48.6 | 53.4 | 36.4 | 50.0 | |||||
| Economic status [%] |
|||||||||
| Poor |
0.6 | 1.7 | 0.0 | 0.0 | 0.6 | ||||
| Average |
41.6 | 41.4 | 45.4 | 40.2 | |||||
| Good |
57.8 | 59.6 | 54.6 | 59.8 | |||||
Median
Table II presents the comparison of average daily food rations of children with different dietary patterns with respect to the recommended food ration for children aged 13-36 months [9].
Comparison of the average daily food rations of children with excess weight aged 1-3 years with different dietary patterns with regard to model food rations.
Tabela II. Porównanie przeciętnej całodziennej racji pokarmowej dzieci w wieku 1-3 lata z nadmiarem masy ciała różniɋcych się wzorami żywienia w odniesieniu do zalecanej racji pokarmowej.
| Groups of food Products [g] |
Recommended food ration for children aged 13-36 months |
Daily food ration |
Children [%] with consumption of food exceeding recommendations |
|||||||
|---|---|---|---|---|---|---|---|---|---|---|
| All children |
Cluster 1 |
Cluster 2 |
Cluster 3 |
All children |
Cluster 1 |
Cluster 2 |
Cluster 3 |
|||
| 1. | Cereal products and potatoes |
|||||||||
| Bread Statistically significant differences in consumption of food products between the three clusters of children (KruskaI-Wallis rank Anova; Statistically significant differences in the odds of children from different clusters with consumption of food exceeding recommendations (chi2 test; |
20 | 46.7 (26.7-63.3) | 29.6 (11.7-50.0) | 53.3 (43.3-65.0) | 50.3 (30.0-70.0) | 83.2 | 65.5 | 97.0 | 90.2 | |
| Flour and pasta |
25 | 19.7 (12.2-29.5) | 17.7 (10.3-28.2) | 21.6 (15.3-28.4) | 20.6 (12.5-34.6) | 34.7 | 31.0 | 36.4 | 36.6 | |
| Groats, rice, breakfast cereals Statistically significant differences in consumption of food products between the three clusters of children (KruskaI-Wallis rank Anova; Statistically significant differences in the odds of children from different clusters with consumption of food exceeding recommendations (chi2 test; |
30 | 16.5 (8.0-32.2) | 11.2 (3.7-28.9) | 33.5 (10.8-49.5) | 16.6 (9.3-27.3) | 27.7 | 20.7 | 54.6 | 22.0 | |
| 1A. | Potatoes |
100 | 76.0 (42.1-123.7) | 68.9 (27.0-109.2) | 81.9 (54.2-149.5) | 81.7 (46.3-127.3) | 37.6 | 34.5 | 42.4 | 37.8 |
| 2. | Vegetables and fruits Statistically significant differences in consumption of food products between the three clusters of children (KruskaI-Wallis rank Anova; Statistically significant differences in the odds of children from different clusters with consumption of food exceeding recommendations (chi2 test; |
450 | 271.6 (198.4-374.0) | 259.3 (168.6-381.7) | 225.4 (149.1-325.6) | 295.0 (234.6-443.6) | 15.0 | 10.3 | 3.0 | 23.2 |
| vegetables |
200 | 111.1 (69.6-159.2) | 99.0 (71.7-139.9) | 100.2 (60.2-139.0) | 121.7 (76.2-173.6) | 10.4 | 8.6 | 3.0 | 14.6 | |
| fruits Statistically significant differences in consumption of food products between the three clusters of children (KruskaI-Wallis rank Anova; |
250 | 154.7 (93.3-226.7) | 134.6 (90.4-225.7) | 120.8 (68.8-197.9) | 183.1 (119.0-259.3) | 20.2 | 17.2 | 9.1 | 26.8 | |
| 3. | Milk and dairy products |
|||||||||
| milk and fermented milk beverages Statistically significant differences in consumption of food products between the three clusters of children (KruskaI-Wallis rank Anova; Statistically significant differences in the odds of children from different clusters with consumption of food exceeding recommendations (chi2 test; |
550 | 467.0 (343.4-666.3) | 555.2 (418.4-699.9) | 719.0 (592.3-867.1) | 348.0 (227.5-467.0) | 38.2 | 51.7 | 75.8 | 13.4 | |
| incl. liquid milk Statistically significant differences in consumption of food products between the three clusters of children (KruskaI-Wallis rank Anova; Statistically significant differences in the odds of children from different clusters with consumption of food exceeding recommendations (chi2 test; |
450 | 297.9 (15.8-446.7) | 429.8 (321.7-492.6) | 469.7 (377.5-584.5) | 142.6 (66.4-232.9) | 24.9 | 39.7 | 60.6 | 0.0 | |
| cow's milk Statistically significant differences in consumption of food products between the three clusters of children (KruskaI-Wallis rank Anova; |
-- | 111.2 (42.3-257.0) | 38.6 (12.6-84.9) | 468.6 (377.5-528.2) | 118.7 (58.8-208.8) | -- | -- | -- | -- | |
| baby formula Statistically significant differences in consumption of food products between the three clusters of children (KruskaI-Wallis rank Anova; |
-- | 0.0 (0.0-278.3) | 360.0 (278.3-450.0) | 0.0 (0.0-0.0) | 0.0 (0.0-0.0) | -- | -- | -- | -- | |
| fermented milk beverages |
100 | 25.0 (0.0-56.9) | 18.3 (0.0-53.3) | 20.0 (0.0-50.0) | 33.3 (0.0-76.7) | 12.1 | 8.6 | 9.1 | 15.9 | |
| curd cheese |
10-15 | 13.1 (1.2-45.7) | 9.6 (0.0-33.3) | 22.0 (1.7-50.0) | 12.4 (2.9-50.0) | 46.2 | 39.7 | 57.6 | 46.3 | |
| rennet cheese |
2 | 0.0 (0.0-5.7) | 0.0 (0.0-5.0) | 0.3 (0.0-8.3) | 0.0 (0.0-6.7) | 40.5 | 31.0 | 48.5 | 43.9 | |
| 4. | Meat, cold meats, fish and eggs |
|||||||||
| meat, poultry, cold meats Statistically significant differences in consumption of food products between the three clusters of children (KruskaI-Wallis rank Anova; |
20 | (54.480.4 -114.6) | (48.3 70.3 - 100.2) | (66.086.4 -121.8) | (58.083.8 - 127.3) | 94.8 | 93.1 | 93.9 | 96.3 | |
| fish |
10 | 0.0 (0.0-4.7) | 0.0 (0.0-0.0) | 0.0 (0.0-19.2) | 0.0 (0.0-9.3) | 21.4 | 13.8 | 27.3 | 24.4 | |
| 4A. | Eggs Statistically significant differences in consumption of food products between the three clusters of children (KruskaI-Wallis rank Anova; Statistically significant differences in the odds of children from different clusters with consumption of food exceeding recommendations (chi2 test; |
25 | 26.4 (9.3-42.1) | 19.7 (7.9-33.3) | 24.7 (8.8-42.1) | 35.9 (11.8-46.3) | 51.4 | 36.2 | 48.5 | 63.4 |
| 5. | Fats Statistically significant differences in consumption of food products between the three clusters of children (KruskaI-Wallis rank Anova; Statistically significant differences in the odds of children from different clusters with consumption of food exceeding recommendations (chi2 test; |
16 | 15.6 (9.1-23.1) | 10.5 (6.1-16.7) | 21.3 (13.9-28.8) | 17.2 (12.4-24.6) | 47.4 | 25.9 | 63.6 | 56.1 |
| 6. | Sugar and sweets Statistically significant differences in consumption of food products between the three clusters of children (KruskaI-Wallis rank Anova; Statistically significant differences in the odds of children from different clusters with consumption of food exceeding recommendations (chi2 test; |
20 | 25.3 (13.8-36.9) | 19.3 (10.6-26.5) | 34.8 (24.5-49.5) | 29.0 (14.8-39.0) | 61.3 | 48.3 | 78.9 | 63.4 |
Median (1Q-3Q)/med/ono
The identified dietary patterns of children with excess weight were not compliant with the recommended daily food rations. Almost every child from the second and third cluster ate over twice as much bread and several times more meat and meat products as compared to the recommended daily food ration. The consumption of pasta and potatoes exceeding recommendations was observed in the diets of more than 30% of the children. About 50% of the subjects ate too many dairy products (cheese), eggs and fats. The quantity of sugar and sweets in the diets of 48.3-78.9% of the children exceeded daily limits. The odds of the children not following the sugar and sweet consumption limitations is increasing with the children’s age. The average intake of vegetables and fruits in all the clusters of children with excess weight was significantly lower than the recommended amounts.
Table III presents the energy and nutritional value of the identified dietary patterns of the children analysed in comparison with dietary standards [11]. The majority of diets of the children (in all clusters) exceeded the EAR standard for protein (100% of children) and digestible carbohydrates (86.2% children in the first cluster, 97.0% children in the second cluster, 87.8% children in the third cluster). A higher than recommended share of energy from saccharose was identified in the diets of 63.8-79.3% of the subjects.
Comparison of an average energy and nutrient intake in diets of children with excess weight aged 1-3 years with different dietary patterns with regard to nutritional recommendations.
Tabela III. Porównanie przeciętnej wartości energetycznej i odżywczej diet dzieci w wieku 1-3 lata z nadmiarem masy ciała różniɋcych się wzorami żywienia w odniesieniu do zaleceń żywienia.
| Energy and nutrients |
Nutritional recommendations EAR / Al+ |
Nutritional value of children's diets |
Children [%] with energy and nutrient intake below EAR/AI |
||||||
|---|---|---|---|---|---|---|---|---|---|
| All children |
Cluster 1 |
Cluster 2 |
Cluster 3 |
All children |
Cluster 1 |
Cluster 2 |
Cluster 3 / |
||
| Energy [kJ] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
4885.6 (3979.7-5928.5) | 4449.9 (3625.7-5117.6) | 5854.1 (5076.2-6683.6) | 4725.8 (3826.4-5804.5) | -- | -- | -- | -- | |
| Energy [kcal] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; Statistically significant differences in the odds of children from different clusters with consumption of food exceeding recommendations (chi2 test; |
1000 | 1168.5 (951.2-1414.3) | 1063.2 (866.4-1222.9) | 1391.2 (1210.6-1596.0) | 1128.2 (914.1-1385.1) | 31.2 | 41.4 | 6.1 | 34.2 |
| Protein [g] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
12 | 43.0 (34.8-52.3) | 37.2 (28.8-46.6) | 56.7 (47.7-61.1) | 43.0 (35.1-52.0) | 0.0 | 0.0 | 0.0 | 0.0 |
| Fat [g] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; Statistically significant differences in the odds of children from different clusters with consumption of food exceeding recommendations (chi2 test; |
39 | 39.3 (30.9-51.7) | 33.5 (29.7-43.4) | 52.2 (42.0-57.2) | 39.9 (30.3-46.3) | 49.1 | 63.8 | 24.2 | 48.8 |
| LCPUFA [g] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
0.25+ | 0.0 (0.0-0.1) | 0.0 (0.0-0.1) | 0.1 (0.0-0.1) | 0.0 (0.0-0.1) | 91.9 | 98.3 | 87.9 | 89.0 |
| Carbohydrates [g] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
-- | 170.9 (131.4-197.3) | 158.8 (125.3-186.1) | 182.8 (166.0-219.4) | 167.7 (127.2-196.9) | -- | -- | -- | -- |
| Digestible carbohydrates [g] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
100 | 162.6 (123.6-187.4) | 151.3 (117.7-178.2) | 174.6 (154.6-209.2) | 158.8 (119.4-183.4) | 11.0 | 13.8 | 3.0 | 12.2 |
| Saccharose [g] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
-- | 38.8 (25.8-53.3) | 30.9 (21.8-40.0) | 48.3 (36.3-66.1) | 41.3 (28.5-55.5) | -- | -- | -- | -- |
| Lactose [g] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
-- | 17.7 (9.7-27.6) | 28.1 (21.2-35.5) | 25.6 (22.1-32.4) | 9.8 (7.0-14.0) | -- | -- | -- | -- |
| Starch [g] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
-- | 56.0 (44.7-79.2) | 47.2 (33.8-62.7) | 67.6 (49.9-84.6) | 63.2 (48.4-83.1) | -- | -- | -- | -- |
| Fiber [g] |
10+ | 9.4 (7.5-12.1) | 9.4 (7.5-11.7) | 8.7 (7.6-10.2) | 9.9 (7.5-12.7) | 56.1 | 55.2 | 72.7 | 50.0 |
| Energy from protein [%] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
-- | 14.9 (13.3-16.7) | 13.9 (12.8-15.2) | 16.0 (14.8-17.2) | 15.3 (13.3-17.3) | -- | -- | -- | -- |
| Energy from fat [%] |
-- | 30.8 (27.1-33.7) | 30.1 (27.1-33.0) | 31.9 (29.6-35.0) | 30.4 (26.3-33.3) | -- | -- | -- | -- |
| Energy from carbohydrates [%] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
-- | 54.1 (50.6-58.6) | 56.6 (52.6-59.5) | 51.2 (48.6-54.5) | 53.9 (50.3-57.8) | -- | -- | -- | -- |
| Energy from Saccharose [%] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
<10 | 13.5 (10.0-16.9) | 11.4 (8.9-13.9) | 13.9 (10.3-16.1) | 14.7 (11.0-18.6) | 26.0 | 36.2 | 21.2 | 20.7 |
| Sodium [mg] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; Statistically significant differences in the odds of children from different clusters with consumption of food exceeding recommendations (chi2 test; |
750+ | 1611.4 (1206.3-2072.3) | 1280.9 (886.2-1639.5) | 1851.8 (1669.0-2167.7) | 1762.9 (1347.1-2170.3) | 6.4 | 15.5 | 0.0 | 2.4 |
| Potassium [mg] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; Statistically significant differences in the odds of children from different clusters with consumption of food exceeding recommendations (chi2 test; |
2400+ | 1811.5 (1430.3-2163.4) | 1561.3 (1329.9-2002.3) | 2127.6 (1941.7-2393.9) | 1810.5 (1446.9-2258.8) | 85.5 | 96.6 | 75.8 | 81.7 |
| Calcium [mg] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; Statistically significant differences in the odds of children from different clusters with consumption of food exceeding recommendations (chi2 test; |
500 | 561.1 (421.6-746.8) | 568.7 (488.8-726.4) | 855.9 (783.9-974.9) | 451.5 (362.0-572.2) | 38.7 | 29.3 | 3.0 | 59.8 |
| Phosphorus [mg] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
380 | 745.2 (591.8-897.6) | 650.4 (542.6-815.6) | 1012.6 (874.1-1118.1) | 693.1 (556.0-832.0) | 4.0 | 5.2 | 0.0 | 4.9 |
| Magnesium [mg] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
65 | 159.0 (123.4-197.7) | 135.1 (109.5-170.9) | 195.8 (176.3-209.4) | 157.6 (127.0-197.1) | 1.7 | 1.7 | 0.0 | 2.4 |
| Iron [mg] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
3 | 7.0 (5.6-9.0) | 9.0 (7.7-10.6) | 6.0 (5.0-6.9) | 6.2 (4.9-7.8) | 0.6 | 0.0 | 0.0 | 1.2 |
| Zinc [mg] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
2.5 | 5.9 (4.9-6.9) | 6.4 (5.6-8.1) | 6.2 (5.3-6.8) | 5.1 (4.1-6.4) | 1.2 | 0.0 | 0.0 | 2.4 |
| Copper [mg] |
0.25 | 0.6 (0.5-0.7) | 0.6 (0.5-0.7) | 0.6 (0.5-0.7) | 0.6 (0.5-0.7) | 0.0 | 0.0 | 0.0 | 0.0 |
| Manganese [mg] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
-- | 1.7 (1.2-2.3) | 1.3 (0.9-1.8) | 1.9 (1.5-2.1) | 1.8 (1.3-2.5) | -- | -- | -- | -- |
| lodine [µg] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; Statistically significant differences in the odds of children from different clusters with consumption of food exceeding recommendations (chi2 test; |
65 | 91.3 (68.9-114.9) | 114.6 (94.3-135.5) | 80.6 (67.3-100.1) | 80.5 (59.8-99.5) | 19.7 | 3.4 | 18.2 | 31.7 |
| Vitamin A [µg] |
280 | 875.9 (583.7-1183.7) | 923.9 (685.4-1191.4) | 959.4 (688.5-1130.5) | 805.1 (516.1-1173.8) | 1.7 | 0.0 | 0.0 | 3.7 |
| Vitamin E [mg] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; Statistically significant differences in the odds of children from different clusters with consumption of food exceeding recommendations (chi2 test; |
6+ | 5.6 (4.0-7.6) | 7.6 (6.6-9.3) | 4.5 (3.8-6.0) | 4.6 (3.5-5.9) | 55.5 | 17.2 | 72.7 | 75.6 |
| Thiamine [mg] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
0.4 | 0.8 (0.6-1.0) | 0.9 (0.7-1.2) | 0.9 (0.7-1.1) | 0.7 (0.5-0.9) | 3.5 | 3.4 | 0.0 | 4.9 |
| Riboflavin [mg] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
0.4 | 1.2 (1.0-1.5) | 1.2 (0.9-1.4) | 1.7 (1.5-2.1) | 1.0 (0.8-1.4) | 0.0 | 0.0 | 0.0 | 0.0 |
| Niacin [mg] |
5 | 9.4 (7.4-11.8) | 9.8 (7.2-11.6) | 9.5 (7.7-12.6) | 9.0 (7.5-11.4) | 6.4 | 6.9 | 0.0 | 8.5 |
| Vitamin B6 [mg] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
0.4 | 1.2 (0.9-1.4) | 1.0 (0.8-1.3) | 1.3 (1.0-1.7) | 1.2 (0.9-1.4) | 0.6 | 0.0 | 0.0 | 1.2 |
| Vitamin B12 [µg] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
0.7 | 2.2 (1.5-2.8) | 1.8 (1.3 2.1) | 3.3 (2.8-4.2) | 2.2 (1.5-2.7) | 1.2 | 0.0 | 0.0 | 2.4 |
| Vitamin D [µg] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; Statistically significant differences in the odds of children from different clusters with consumption of food exceeding recommendations (chi2 test; |
10 | 3.5 (1.6-6.2) | 6.7 (5.6-8.9) | 2.2 (1.2-3.8) | 1.9 (1.2-3.1) | 93.1 | 81.0 | 100.0 | 98.8 |
| Vitamin C [mg] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
30 | 81.4 (56.1-112.6) | 100.6 (77.3-124.6) | 66.5 (51.4-86.8) | 72.8 (44.4-109.5) | 4.0 | 0.0 | 6.1 | 6.1 |
| Folate [µg] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
120 | 162.6 (132.8-199.9) | 182.5 (156.3-219.5) | 144.7 (128.6-180.8) | 155.1 (126.9-186.1) | 15.6 | 6.9 | 18.2 | 20.7 |
| Folic acid [µg] Statistical significant differences in consumption of food products between the three clusters of children (Kruskal-Wallis rank Anova; |
-- | 3.9 (0.0-38.6) | 42.3 (27.7-59.5) | 0.0 (0.0-9.3) | 0.0 (0.0-10.6) | -- | -- | -- | -- |
Median (1Q-3Q)/mecf/ono
EAR - Estimated Average Requirement/
The fulfilment of the requirement for energy (EER) and fat (EAR) in the diets of children with different dietary patterns varied significantly. In the second cluster (“milk and cereals diet”) 93.9% of the toddlers exceeded the
Dietary patterns in toddlers with excess weight 275 requirement for energy (compared to 58.6% in the first cluster and 65.6% in the third cluster), 75.8% exceeded the requirement for fat (compared to 36.2% in the first cluster and 51.2% in the third cluster). Children from the second cluster did not fulfil the requirement for dietary fibre with significantly higher frequency than children from other clusters.
The diets of the majority of the children did not have any iron deficiencies or any deficiency of phosphorus, magnesium, zinc, copper and vitamin A, vitamins from the B group and vitamin C.
Nutrient profiles of the diets of children from all clusters exhibited significant deficiencies of LCPUFA and vitamin D. A deficiency of vitamin E was found in 72.7% and 75.6% of the children (cluster two and three), and potassium deficiency was observed in all the clusters (81.7-96.6%).
The requirement for calcium was fulfilled in 97.0% of the children in the second cluster, in 70.7% - in the first cluster and 40.2% of the children in the third cluster. Calcium deficiency was observed in 29.3% and 59.8% of the children (first and third cluster, respectively). Iodine intake was lower than the recommended level in 18.2% of the children from the second cluster and in 31.7% of the children from the third cluster.
Excessive sodium intake was found in the diets of all the children from the second and third cluster and in 85% of the children from the first cluster.
Nutritional practices in all the children analysed differ from the safe nutrition model – 79.3-89.0% of the children received snacks between meals every day or at least 2-4 times a week, had meals before bedtime (69.7% in the second cluster, 56.9% in the first cluster and 48.8% in the third cluster; p=0.06) and ate or drank during night time (46.3% in the third cluster, 39.4% in the second cluster and 37.9% in the first cluster; p=0.03). Children from the first cluster significantly more frequently received foodstu$s intended for infants and toddlers (junior formula, baby cereals and gruels) (p<0.05). The odds of breastfed toddlers were significantly higher in the third cluster (p=0.005) (Table IV ).
Nutritional practices in children (overweight and obese) aged 1-3 years with different dietary patterns.
Tabela IV. Organizacja żywienia dzieci w wieku 1-3 lata z nadmiarem masy ciała różniących się wzorami żywienia.
| Nutritional practices |
Toddlers with excess weight [%] consuming various types of foods everyday or at least 2-4 times a week |
P value |
|||
|---|---|---|---|---|---|
| All children |
Cluster 1 |
Cluster 2 Grupa 2 MILK AND CEREALS DIET (N=33) | Cluster 3 |
||
| Breastfeeding |
10.4 | 3.5 | 3.0 | 18.3 | 0.005 Statistically significant differences between three clusters of children (p<0.05)/Sstatystycznie istotne różnice pomiędzy trzema grupami dzieci. |
| Breakfast |
99.4 | 100.0 | 100.0 | 98.8 | 0.1 |
| Second breakfast |
93.6 | 98.3 | 87.9 | 92.7 | 0.4 |
| Soup |
96.0 | 96.6 | 93.9 | 96.3 | 0.9 |
| Main course dish |
92.5 | 93.1 | 90.9 | 92.7 | 0.9 |
| Afternoon snack |
93.6 | 94.8 | 93.9 | 92.7 | 0.6 |
| Supper |
99.4 | 98.3 | 100.0 | 100.0 | 0.7 |
| Bedtime meal |
55.5 | 56.9 | 69.7 | 48.8 | 0.06 |
| Eating/drinking during the night |
42.2 | 37.9 | 39.4 | 46.3 | 0.03 Statistically significant differences between three clusters of children (p<0.05)/Sstatystycznie istotne różnice pomiędzy trzema grupami dzieci. |
| Snacking |
85.5 | 79.3 | 87.9 | 89.0 | 0.2 |
| Family meals |
86.7 | 81.0 | 87.9 | 90.2 | 0.5 |
| Separate meals prepared for the child |
25.4 | 34.5 | 18.2 | 22.0 | 0.6 |
| Meals based on baby food |
|||||
| follow-on/junior formula |
40.4 | 87.9 | 21.2 | 14.6 | <0.0001 Statistically significant differences between three clusters of children (p<0.05)/Sstatystycznie istotne różnice pomiędzy trzema grupami dzieci. |
| vegetable purees, soups |
15.6 | 24.1 | 12.1 | 11.0 | 0.06 |
| baby cereals |
36.4 | 46.6 | 33.3 | 30.5 | 0.01 Statistically significant differences between three clusters of children (p<0.05)/Sstatystycznie istotne różnice pomiędzy trzema grupami dzieci. |
| fruit purees |
22.0 | 25.9 | 15.2 | 22.0 | 0.3 |
| juices |
30.1 | 36.2 | 30.3 | 25.6 | 0.8 |
| baby teas |
19.1 | 29.3 | 15.2 | 13.4 | 0.3 |
| Ready-to-serve meals |
9.2 | 5.2 | 0.0 | 3.7 | 0.8 |
The study evaluated the diets of overweight and obese children from a representative nationwide group and identified three dietary patterns with varying energy and nutritional value. The “baby food diet” in younger children was the most balanced one when compared with the safe nutrition model. Rose et al proved that the dietary patterns of children in infancy had an impact on their diet and risk of obesity at preschool age [14]. Infants whose diet was higher in fruit and vegetables at 9 months had higher fruit and vegetable intake also at 6 years of age. Similarly, infants with a dietary pattern characterized by foods high in energy density (French fries, sweet desserts) continued to have higher consumption of these foods at 6 years old, and had a higher prevalence of overweight (43%). Formula-fed infants had higher sugar-sweetened beverage intake and fewer fruit and vegetable intake at 6 years than breastfed infants. Another study which aimed at identifying the dietary patterns of infants in the first year of life showed that the main determinants of their variability were not only the mother’s education and age, but also the place of residence [15]. Our results confirm the influence of the educational level of not only the mothers, but of both parents, on the dietary patterns of children in post-infancy.
The results of many studies proved that widespread prevalence of excess body weight even in the early period of life is correlated with the intake of food with high energy density [2, 3, 7, 16].
It is supposed that lower quality diets, high in energy-dense, high-fat products and low in dietary fibre consumed in childhood and adolescence are associated with the risk of obesity, as they undermine innate appetite control, which may lead to greater energy consumption [17]. Such a dietary pattern was found in overweight and obese children in the third year of life (cluster 2 and 3).
Inappropriate food choices and portion sizes and a diet which is well-balanced in terms of nutrient profile may be related with an increased risk of obesity [18, 19, 20].
In the study conducted the most frequently used food products were identified in the diets of children with excess weight. In toddlers in their second year of life (cluster 1) the main products were foods for special nutritional purposes, intended for young children, such as junior formula, baby cereals and gruels. In children in the third year of life (cluster 2 and 3) the diet base was cow’s milk, breakfast cereals, groats and bread. All the overweight and obese children consumed excessive quantities of meat and meat products, as well as foods being sources of sugar (dairy desserts, sweet beverages and juices).
Research conducted in recent years indicates that food choices following the safe nutrition model guidelines ensure the proper energy and nutritional value of a child’s diet and decrease the risk of developing eating disorders and obesity [7, 21, 22, 23].
The assessment of diets of children residing in different countries, including the European Union, showed that excessive energy and nutrient intake (i.e. excess of protein) is a risk factor for developing childhood obesity [2, 24]. It was also found that the adequate intake of macronutrients, calcium, fibre, vitamin D is negatively correlated with the risk of childhood obesity. On the contrary, the increased intake of B vitamins (B1, B2, niacin, which may enhance fat synthesis), excessive consumption of sweet beverages being sources of mono- and disaccharides contribute to developing obesity [7]. In our study we observed an excessive intake of energy, protein, sodium, B vitamins and saccharose and an insufficient supply of calcium, fibre, vitamin D, vitamin E, LCPUFA, iodine and potassium in children’s diet in reference to nutritional recommendations.
The analysis of nutrient profiles in the diets of the overweight children pointed to the need to popularise the model of food rations among the parents of young children.
The identified dietary patterns of overweight toddlers differ from the safe nutrition model in terms of product selection and nutrient profile.
Younger children with excess weight, with separate dietary patterns, require fast nutritional intervention to introduce proper food choices in their diets.
Nutritional education is required for parents or caregivers of overweight toddlers, with a particular focus on the group with a significantly lower level of education.