Associations between dietary patterns and biomarkers of nutrient status and cardiovascular risk factors among adolescents in Germany: results of the German Health Interview and Examination Survey for Children and Adolescents in Germany (KiGGS)

Dietary patterns among children and adolescents in Germany consuming vegetarian, vegan or omnivore diets: results of the VeChi Youth Study

PURPOSE

To identify dietary patterns of vegetarian, vegan and omnivore children and adolescents in Germany and to examine associations with nutrient intake.

METHODS

First, three principal component analyses based on 17-22 food groups were used to identify dietary patterns among vegetarians (n = 145, 3-day weighed dietary records), vegans (n = 110) and omnivores (n = 135) from the cross-sectional Vegetarian and Vegan Children and Youth (VeChi Youth) Study (2017-2019, 6-18 years, 57% girls). Secondly, these patterns were correlated (Spearman correlations) with energy and nutrient intakes.

RESULTS

Among vegetarians, 3 dietary patterns were identified ("Animal foods", "Vegetables and fruits", "Meat alternatives and potatoes") accounting for 32.7% of the variance in food group intake. In the vegan group, 4 patterns were identified ("Vegetables and legumes", "Refined carbohydrates", "Meat alternatives and juices", "Fruits and convenience foods") accounting for 43.2% of the variance. Among omnivores, 5 ("Flexitarian", "Vegetables and fruits", "Dairy Products", "meat and convenience foods", "Refined grains and juices") patterns accounting for 43.0% of the variance could be identified. Regardless of diet group, both more favorable dietary patterns ("Vegetables and fruits", "Meat alternatives and potatoes", "Vegetables and legumes", "Fruits and convenience food", "Flexitarian") correlated with higher micronutrient density and less favorable dietary patterns ("Animal foods", "Refined carbohydrates", "Meat alternatives and juices", "Dairy products", "Meat and convenience food", "Refined grains and juices") with unfavorable nutrient profiles were found.

CONCLUSION

Various dietary patterns exist within omnivore, vegetarian, and vegan diets of children and adolescents, which differ in their contribution to nutrient intake. It is therefore necessary to distinguish between different dietary patterns, also within the vegetarian and vegan diet.

Development of a short food frequency questionnaire to assess diet quality in UK adolescents using the National Diet and Nutrition Survey

BACKGROUND

UK adolescents consume fewer fruits and vegetables and more free sugars than any other age group. Established techniques to understand diet quality can be difficult to use with adolescents because of high participant burden. This study aimed to identify key foods that indicate variation in diet quality in UK adolescents for inclusion in a short food frequency questionnaire (FFQ) and to investigate the associations between adolescent diet quality, nutritional biomarkers and socio-demographic factors.

METHODS

Dietary, demographic and biomarker data from waves 1-8 of the National Diet and Nutrition Survey rolling programme were used (n=2587; aged 11-18 years; 50% boys; n=≤997 biomarker data). Principal component analysis (PCA) was applied to 139 food groups to identify the key patterns within the data. Two diet quality scores, a 139-group and 20-group, were calculated using the PCA coefficients for each food group and multiplying by their standardised reported frequency of consumption and then summing across foods. The foods with the 10 strongest positive and 10 strongest negative coefficients from the PCA results were used for the 20-group score. Scores were standardised to have a zero mean and standard deviation of one.

RESULTS

The first PCA component explained 3.0% of variance in the dietary data and described a dietary pattern broadly aligned with UK dietary recommendations. A correlation of 0.87 was observed between the 139-group and 20-group scores. Bland-Altman mean difference was 0.00 and 95% limits of agreement were - 0.98 to 0.98 SDs. Correlations, in the expected direction, were seen between each nutritional biomarker and both scores; results attenuated slightly for the 20-group score compared to the 139-group score. Better diet quality was observed among girls, non-white populations and in those from higher socio-economic backgrounds for both scores.

CONCLUSIONS

The diet quality score based on 20 food groups showed reasonable agreement with the 139-group score. Both scores were correlated with nutritional biomarkers. A short 20-item FFQ can provide a meaningful and easy-to-implement tool to assess diet quality in large scale observational and intervention studies with adolescents.

Changes in Dietary Patterns among German Adolescents between 2003–2006 and 2014–2017: Results of KiGGS

Empirically derived dietary patterns are useful to describe food consumption habits within population groups. The aim of the study was to analyse dietary patterns as well as changes of these patterns within the last decade among German adolescents.

Dietary patterns were analyzed for 12 to 17 years old participants of two waves of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Baseline (2003–2006) N = 5.197 and KiGGS Wave 2 (2014–2017) N = 5.199). KiGGS is part of the nationwide health monitoring in Germany. Food consumption was assessed by a semi-quantitative food frequency questionnaire. Based on this information, dietary patterns were derived using principal component analysis in a former analysis for KiGGS Baseline(1) and in this new analysis for KiGGS Wave 2. In KiGGS Baseline three major dietary patterns were identified (‘western’, ‘traditional’, and ‘healthy’) among boys and two among girls (‘western/traditional’, and ‘healthy’).

In KiGGS wave 2 the ‘traditional’ pattern could not be identified anymore among boys and a new pattern, the ‘sandwich’ pattern was identified among girls and boys. The ‘sandwich’ pattern was positively correlated with the intake of bread, processed meat, cheese, butter/margarine, jam, cake/cookies, and among boys also confectionary. Compared to the former ‘traditional’ dietary pattern among boys, the new ‘sandwich‘ pattern shows similarities (bread, processed meat and butter/margarine) but the former warm meal components are missing (meat and potatoes).There were only slight differences in the food groups associated with the ‘western’, ‘western/traditional’ or ‘healthy’ pattern between both surveys.

Within the past decade dietary patterns changed among German adolescents. In 2014–2017 a new ‘sandwich’ pattern was identified among boys and girls, and the ‘traditional’ dietary pattern was not found any more among boys. This change could be associated with more frequent food consumption out of home among adolescents. Within the past decade, the school system in many German federal states was restructured from half-day schools towards whole-day schools and the utilization of meal supply within schools almost doubled among adolescents. These changes may have influenced the food consumption habits among adolescents.

Do dietary patterns determine levels of vitamin B6, folate, and vitamin B12 intake and corresponding biomarkers in European adolescents? The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study

OBJECTIVES

To determine dietary patterns (DPs) and explain the highest variance of vitamin B6, folate, and B12 intake and related concentrations among European adolescents.

METHODS

A total of 2173 adolescents who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence study met the eligibility criteria for the vitamin B intake analysis (46% boys) and 586 adolescents for the biomarkers analysis (47% boys). Two non-consecutive, 24-h, dietary recalls were used to assess the mean intakes. Concentrations were measured by chromatography and immunoassay testing. A reduced rank regression was applied to elucidate the combined effect of food intake of vitamin B and related concentrations.

RESULTS

The identified DPs (one per vitamin B intake and biomarker and by sex) explained a variability between 34.2% and 23.7% of the vitamin B intake and between 17.2% and 7% of the biomarkers. In the reduced rank regression models, fish, eggs, cheese, whole milk and buttermilk intakes were loaded positively for vitamin B intake in both sexes; however, soft drinks and chocolate were loaded negatively. For the biomarkers, a higher variability was observed in the patterns in terms of food loads such as alcoholic drinks, sugars, and soft drinks. Some food items were loaded differently between intakes and biomarkers such as fish products, which was loaded positively for intakes but negatively for plasma folate in girls.

CONCLUSIONS

The identified DPs explained up to 34.2% and 17.2% of the variability of the vitamin B intake and plasma concentrations, respectively, in European adolescents. Further studies are needed to elucidate the factors that determine such patterns.

Association of dietary patterns with continuous metabolic syndrome in children and adolescents; a nationwide propensity score-matched analysis: the CASPIAN-V study

OBJECTIVE

This study aims to determine the association of dietary patterns with metabolic syndrome (MetS) and its components in children and adolescents.

METHODS

This nationwide study was conducted in 2015 among 4200 students aged 7-18 years, who lived in 30 provinces in Iran. The analysis was conducted based on the propensity score using a matched case-control study design. Three dietary patterns were obtained conducting a principal component analysis with a varimax rotation on 16 dietary groups. Continuous MetS score was computed by standardizing the residuals (z-scores) of MetS components by regressing them according to age and sex. The gold standard diagnosis of MetS was considered based on the International Diabetes Federation criteria. Moreover, for the purpose of data analysis, matched logistics analysis was used.

RESULTS

The study participants consisted of 3843 children and adolescents (response rate 91.5%) with mean (SD) age of 12.45 (3.04) years. Totally 49.4% of students were girls and 71.4% lived in urban areas. Three dietary patterns were obtained: Healthy, Western, and Sweet. Prevalence of MetS was 5% (boy 5.5 and girl 4.5%). Results of multivariate analysis show that students with Sweet dietary patterns were at higher risk for abdominal obesity (OR 1.29; 95% CI 1.01-1.66), elevated blood pressure (OR 1.35; 95% CI 1.01-1.81) and MetS (OR 1.33; 95% CI 1.02-1.74). The two other dietary patterns were not associated with MetS and its components.

CONCLUSION

Sweet dietary pattern increase the risk of MetS and some its components in Iranian children and adolescents. This finding provides valuable information for effective preventive strategies of MetS based on diet rather than medication to maintain healthy lifestyle habits.