Review Article
Is dietary intake able to explain differences in body fatness in children and adolescents?

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Abstract

Obesity is the result of an imbalance between energy intake and energy expenditure. Controversial information exists about what are the strongest energy balance aspects influencing body fatness. This article is focused on food consumption facts that could be related to the risk of being obese in children and adolescents. It reviews whether energy intake, macronutrient composition of diet, eating patterns or other dietary intake factors are able to explain differences in body composition when obesity has been already developed or even in subjects at risk to become obese. There is not enough evidence to clarify the importance of diet on overweight children and adolescents, and conclusions derived are somewhat controversial. Cross-sectional and longitudinal studies do not show clear relationships between energy intake or food composition and body fatness. To find relations between dietary factors and childhood obesity perhaps eating patterns or different types of foods must be considered: meal patterns and meal frequency, snacking and beverage consumption, fast food intake, portion sizes, etc. There is no clear association between different aspects of dietary intake and the development of obesity in children and adolescents. Longitudinal and experimental studies are needed in the future.

Introduction

Obesity is the most frequent type of malnutrition in developed countries. Excess body fat prevalence has increased enormously over the last few years both in children and in adults. This dramatic rise has reached the grade of ‘epidemic phenomenon’ in almost all regions of Europe, North America and Australia. Depending on the demographic origin, population characteristics and criteria definition, epidemiological data show that the prevalence of overweight/obesity in children and adolescents ranges between 15% and 25%. Furthermore, the risk of becoming obese seems to be on the increase nowadays [1], [2].

Obesity is more than an excessive deposition of fat in the body. Even in children and adolescents, excess body fat is associated with adverse metabolic complications, as well as with significant short- and long-term physical and psychosocial problems, that must all be included in the same concept [3], [4]. Therefore, to prevent undesirable human health effects and excessive economic costs, a good knowledge of obesity etiology and its underlying factors is needed.

Childhood and adolescence are decisive periods in human life. Body composition and psycho-sociological changes determine nutritional requirements as well as eating and physical activity behavior variability [5]. Sometimes characteristic behavior patterns that originate during these periods produce energy balance and nutritional status disturbances. Obesity and its related metabolic abnormalities (dyslipidemia, hypertension, insulin resistance, hyperinsulinemia and impaired glucose tolerance) commonly appear during adolescence and persist frequently into adulthood, increasing the risk of cardiovascular diseases [6], [7], [8] (Fig. 1).

It is obvious that energy imbalance is the cause of overweight in susceptible children and adolescents. Although both genetic and environmental factors determine the risk of overweight in a subject, the latter are more important in relation to the increase of population obesity prevalence. Excessive energy intake, food composition, eating habits and/or low energy expenditure may be the main determinants of this phenomenon because the human genotype has not changed over the last decades. Obese phenotype, as a final disease expression in predisposed subjects, is the result of gene–environmental interactions throughout life (Fig. 1).

Nowadays, controversial information exists regarding the strongest energy balance aspects influencing body fatness. This article is focused on food consumption facts that could be related to the risk of children and adolescents becoming obese. We review whether energy intake, macronutrient composition of diet, eating patterns or other dietary intake factors are able to explain differences in body composition when obesity has already developed or, on the other hand, in children and adolescents at risk of becoming obese. Existing cross-sectional and retrospective studies have been reviewed in the former case and longitudinal studies in the latter.

Section snippets

Energy intake and macronutrient composition of diet in obese children and adolescents

First of all, this section of the article must answer the question: ‘Is there any difference in the amount of energy intake between non-obese and obese children and adolescents?’ It is often assumed that overweight subjects eat more than non-overweight counterparts but, surprisingly, this assumption has been rarely demonstrated. To serve as an example, a study performed with a cross-sectional design in 181 Canadian subjects, aged 4–16 years, showed a positive relation between juvenile obesity

Energy intake and macronutrient composition as risk factors for the development of obesity in children and adolescents

Energy balance homeostasis is regulated by a complex matrix of neurohormonal and metabolic processes. Variations in any component or physiological determinant of this balance are compensated with other changes that modify energy expenditure or energy intake in order to reestablish energy equilibrium. There is a strong inertia to conserve the individual body composition status, and it is difficult to modify it with short-term energy expenditure or energy intake variations. On the other hand,

Eating patterns and obesity in children and adolescents

Compared with past times, nowadays there is a diet ‘revolution’ due to environmental, socioeconomic, affective and marketing factors. In children and adolescents, eating behaviors and the type of foods consumed are influenced by various and concomitant aspects: eating away from home, food advertising and promotion, time limitations with respect to eating and meal preparation, and families in which both parents work. The food industry has responded to this social demand by increasing convenience

Conclusions

Obesity is the result of an imbalance between energy intake and energy expenditure. Many controversial data have been obtained after reviewing whether energy intakes, macronutrient composition of diet, eating patterns or other dietary intake factors are able to explain differences in body composition when obesity has already developed or even in subjects at risk of becoming obese. There is not enough evidence to clarify the importance of diet on childhood and adolescence overweight but,

References (57)

  • B.J. Rolls et al.

    Serving portion size influences 5-year-old but not 3-year-old children's food intakes

    J Am Diet Assoc

    (2000)
  • S.M. Krebs-Smith et al.

    The effects of variety in food choices on dietary quality

    J Am Diet Assoc

    (1987)
  • M.A. McCrory et al.

    Dietary variety within food groups: association with energy intake and body fatness in men and women

    Am J Clin Nutr

    (1999)
  • L.A. Moreno et al.

    Overweight, obesity and body fat composition in Spanish adolescents

    Ann Nutr Metab

    (2005)
  • L.A. Moreno et al.

    Trends in body mass index and overweight prevalence among children and adolescents in the region of Aragon (Spain) from 1985 to 1995

    Int J Obes

    (2000)
  • C.E. Flodmark et al.

    New insights into the field of children and adolescents' obesity: the European perspective

    Int J Obes

    (2004)
  • World Health Organisation

    Obesity. Preventing and managing the global epidemic. Report of a WHO consultation on obesity

    (1998)
  • G. Rodriguez et al.

    Body composition in adolescents: measurements and metabolic aspects

    Int J Obes

    (2004)
  • L.A. Moreno et al.

    Waist circumference for the screening of the metabolic syndrome in children

    Acta Paediatr

    (2002)
  • L.A. Moreno et al.

    Leptin and the metabolic syndrome in obese and non-obese children

    Horm Metab Res

    (2002)
  • G. Csabi et al.

    Presence of metabolic cardiovascular syndrome in obese children

    Eur J Pediatr

    (2000)
  • L.J. Gillis et al.

    Relationship between juvenile obesity, dietary energy and fat intake and physical activity

    In J Obes

    (2002)
  • M. Guillaume et al.

    Obesity and nutrition in children. The Belgian Luxembourg child study IV

    Eur J Clin Nutr

    (1998)
  • A.F. McGloin et al.

    Energy and fat intake in obese and lean children at varying risk of obesity

    In J Obes

    (2002)
  • J.M. Gazanniga et al.

    Relationship between diet composition and body fatness, with adjustment for resting energy expenditure and physical activity, in preadolescent children

    Am J Clin Nutr

    (1993)
  • C. Maffeis et al.

    Fat intake and adiposity in 8 to 11-year-old obese children

    Int J Obes

    (1996)
  • G. Maillard et al.

    Macronutrient energy intake and adiposity in non obese prepubertal children aged 5–11 years (the Fleurbaix Laventie Ville Sante Study)

    Int J Obes

    (2000)
  • C. Maffeis et al.

    Distribution of food intake as a risk factor for childhood obesity

    Int J Obes

    (2000)
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