ABC | Volume 113, Nº1, July 2019

Original Article Rocha et al Dietary patterns and adiposity in children Arq Bras Cardiol. 2019; 113(1):52-59 Table 1 – Sample characterization according to socioeconomic, behavioral variables and maternal nutritional status of the children. Viçosa, MG, Brazil, 2015 Variable N % Age 8 years 183 48.4 9 years 195 51.6 Gender Female 197 52.1 Male 181 47.9 Child Ethnicity /skin color White 119 31.5 Non-white 259 68.5 Type of School Public 268 70.9 Private 110 29.1 Maternal schooling > 9 years 234 62.2 = 9 years 142 37.8 per capita income tertiles = 1500.0 133 35.2 > 1599.0 to 2340.98 117 31.0 > 2340.98 128 33.8 Screen time < 2 hours/day 95 25.1 = 2 hours/day 283 74.9 Maternal excess weight No 127 43.1 Yes 168 56.9 Breakfast omission No 303 80.2 Yes 75 19.8 Discussion In the present study, five dietary patterns were identified: unhealthy, snacks, traditional, industrialized and healthy. Children with excess weight and body adiposity showed greater adherence to the industrialized DP. Moreover, children with lower adherence to the traditional DP had higher adiposity prevalence. The comparison of dietary patterns from different studies is difficult to make due to cultural, geographical and methodological differences. 5 However, despite the complexity, the dietary patterns identified in this study are similar to those found in other national and international studies. 30,31 Among Brazilian children aged 8 and 9 years, Villa et al. (2015) 31 identified five food patterns: traditional pattern, consisting of rice, beans, roots and tubers and beef; DP of sweetened beverages and snacks, characterized by ultra-processed foods with high fat content and refined sugars; monotonous pattern, consisting of whole milk and chocolate; healthy pattern, characterized by the consumption of fibers and white meats; and the ovo‑lacto pattern, characterized by the consumption of eggs, cheeses and sweetened milk-based beverages. Ambrosini et al. (2012) 10 identified an energetically dense, high-fat, low‑fiber DP in children and adolescents from 7 to 13 years of age. Durão et al. (2017) 30 identified three patterns at 4 years of age, named energetically dense, snacks and healthy. Overall, industrialized DPs, rich in fats and refined carbohydrates, predominate in this population. It is worth noting that the unhealthy pattern includes the participation of whole dairy products, foods that are recommended in childhood to guarantee the adequate supply of calcium and high biological value protein, essential for adequate growth in childhood. 32 However, in the assessed population, milk consumption is attained with the addition of chocolate-flavored powder and simple sugars. This habit is common in childhood, but may lead to the consumption of a hypercaloric diet, predisposing to the risk of obesity and cardiometabolic alterations. 32,33 The industrialized DP identified in this study consists of processed and ultra-processed foods, rich in simple sugars and fats, nutrients that favor lipogenesis, excess weight and an increase in metabolic complications in childhood. 10,34 In this study, the prevalence of excess of body weight and adiposity were higher in the children with higher consumption of the industrialized DP. Studies have reported that low fruit and vegetable intake, associated with increased intake of fats and processed foods may increase the risk of obesity. 6,30 A possible explanation for this association is that the usual consumption of a high-fat diet tends to impair appetite control, leading to hyperphagia due to the greater palatability of fatty foods, resulting in higher energy consumption. 35 The higher consumption of fat, simple sugars and sweetened beverages by individuals with excess weight may also be explained by their lower effect on satiety when compared to other macronutrients. 35 Children with excess body fat showed lower adherence to the traditional DP. The traditional pattern identified in this study is characterized by the consumption of rice and beans, as well as other carbohydrates. Beans are a legume source of soluble and insoluble proteins, minerals, vitamins, and soluble and insoluble fibers, which, when routinely consumed, may be associated with a reduced risk of cardiovascular diseases. 36 Kupek et al. (2016), 37 when evaluating dietary patterns in schoolchildren aged 7 to 10 years, concluded that children who consumed rice and beans had a lower risk of obesity. Some studies evaluating the association between dietary patterns and body composition in children found similar results to ours. Durão et al. (2017) 30 observed that girls with the highest adherence to the high-energy density diet, consisting mainly of sweets, soft drinks, pastries and processed meats, had higher values of BMI, WHtR and body fat. Zhang et al. (2015), 38 assessing Chinese children and adolescents, found that the modern dietary pattern of northern China was associated with an increased risk of obesity. Shang et al. (2012) 7 observed that obesity was more prevalent in children who adopted the western dietary pattern, when compared to those who consumed the traditional healthy pattern. 55