ABC | Volume 113, Nº1, July 2019

Original Article Association of Dietary Patterns with Excess Weight and Body Adiposity in Brazilian Children: The Pase-Brasil Study Naruna Pereira Roch a, Luana Cupertino Milagre s, Mariana De Santis Filgueira s, Lara Gomes Suhet t, Mariane Alves Silv a, Fernanda Martins de Albuquerqu e, A ndréia Queiroz Ribeir o, Sarah Aparecida Vieir a, Juliana Farias de Novae s Departamento de Nutrição e Saúde - Universidade Federal de Viçosa, Viçosa, MG – Brazil Mailing Address: Naruna Rocha • Rua Doutor Milton Bandeira, 240. Postal Code 36570-172, Centro, Viçosa, MG – Brazil E-mail: narunarocha@hotmail.com, narunarocha@gmail.com Manuscript received February 27, 2018, revised manuscript April 04, 2018, accepted November 14, 2018 DOI: 10.5935/abc.20190113 Abstract Background: Obesity is a multifactorial disease and a serious public health problem. Some of the associated factors are modifiable and, among them, the diet is highlighted. Objective: To evaluate the association of dietary patterns of schoolchildren with obesity and body adiposity. Methods: A cross-sectional study was carried out with 378 children aged 8 and 9 years, enrolled in urban schools in the city of Viçosa, Minas Gerais, Brazil. A semi-structured questionnaire was applied to the children and their caregivers on sociodemographic characteristics and life habits. Three 24‑hour food recalls were used to identify dietary patterns; the Principal Component Analysis was employed. Weight and height were measured for the calculation of the body mass index (BMI) of the children and their mothers, waist circumference and neck circumference. Body composition was also evaluated through dual-energy X-ray absorptiometry (DXA). For all performed tests, the level of significance was set at 5%. Results: Five dietary patterns (DP) were identified: “unhealthy”, “snacks”, “traditional”, “industrialized” and “healthy”. There was an association between excess weight (prevalence ratio [PR]: 1.38, 95% confidence interval [95%CI]: 1.02 to 1.87) and body fat (PR: 1.32, 95%CI : 1.07 to 1.64) with industrialized DP. There was an association between excess body fat (PR: 1.31, 95%CI: 1.01 to 1.74) and lower adherence to traditional DP. The other patterns were not associated with obesity and body adiposity. Conclusion: Children with excess weight and body adiposity showed greater adherence to the industrialized DP and lower adherence to the traditional DP. We suggest that early assessments of dietary habits should be undertaken for monitoring and modifying these habits when necessary. (Arq Bras Cardiol. 2019; 113(1):52-59) Keywords: Child; Obesity; Adiposity; Hyperphagia; Feeding Behavior; Factor Analysis, Statistical; Epidemiology Introduction Childhood obesity is considered a serious public health problem.¹ According to the World Health Organization (WHO, 2016),² approximately 41 million children worldwide under five years of age have excess weight or obesity. In Brazil, the prevalence of obesity is increasing, and data related to childhood excess weight show that it is increasing in children from five to nine years of age more rapidly than in other age groups. 3 Obesity can be considered a multifactorial disease due to genetic predisposition, sedentary lifestyle, availability of food inside and outside the home environment, inadequate and structural food patterns, such as food production and distribution systems, all of which play important roles in the etiology of this alteration. 4,5 Among the several risk factors for obesity, the diet constitutes a modifiable factor and has been related to the onset of chronic diseases and cardiometabolic alterations. 6,7 Several studies have shown that energetically dense, fiber‑poor and refined carbohydrate-rich diets are associated with obesity in adults. 8,9 In children, most of the results are based on the analysis of isolated foods or nutrients, and studies on dietary patterns are scarce. 10,11 The analysis of dietary patterns allows the evaluation of the diet from a global perspective, favoring the implementation of strategies to promote healthy eating habits and prevention of nutrient-related diseases and conditions. 12 As childhood is a period of formation of eating habits, 13 initiatives that allow identifying inappropriate dietary practices and associating them with excess body weight and adiposity could help to prevent chronic diseases, as well as to reduce short and long-term health damage by encouraging and adopting healthy habits. 14 Considering the above, the aim of this study was to evaluate the association of eating patterns of schoolchildren with obesity and body adiposity. Our hypothesis is that unhealthy eating patterns are associated with excess weight and body adiposity in Brazilian children. 52