Eating Frequency and Relative Weight in Children and Adolescents.
Evans, Erin Whitney.
Identifying points of intervention to reduce the burden of childhood obesity is
critical. Despite concurrent trends of increased childhood obesity prevalence and
increased eating frequency, the role of eating frequency in excess childhood weight gain
is not well understood. To clarify this relationship, we examined the cross-sectional
and prospective relationships of eating frequency ... read morewith relative weight in children using
data from the National Health and Nutrition Examination Survey (NHANES) 2005-2010 and
the Daily D diet sub-study. We also explored the relationships of eating frequency with
total energy intake, diet quality, and television (TV) viewing as possible pathways by
which the eating frequency may affect relative weight in children. In cross-sectional
analyses using data from 9,713 children, ages 2-18 years, who participated in NHANES
2005-2010, we observed that the relationships of eating frequency with weight status,
total energy intake and diet quality differed among pediatric life stage groups.
Unexpectedly, we found that eating frequency was associated with lower odds of being
obese in both elementary school-age (6-11 years) and adolescent (12-18 years)
participants, despite the observed positive association between eating frequency and
total energy intake. Also inconsistent with our hypothesis, we found that eating
frequency was associated with better diet quality, as measured by the Healthy Eating
Index-2005 (HEI-2005), in both older age groups. Using prospective data from the Daily D
study, a low-income, racially and ethnically diverse sample of 176 school-age children,
ages 9-15 years, we were able to compare the cross-sectional and prospective
relationships of eating frequency with relative weight. At baseline, we observed a
statistically significant and inverse cross-sectional association between eating
frequency and BMI z-score (BMIz); however, the association between eating frequency and
6-month change in BMIz was statistically significant and positive. Similar to our
findings in NHANES, eating frequency was statistically significantly and positively
associated with total energy intake. With respect to diet quality, snacking behavior was
positively associated with diet quality in elementary school-age participants and
inversely associated with diet quality in adolescents. Finally, in a cross-sectional
analysis of the relationship between TV viewing and eating frequency in children ages
6-11 years who participated in NHANES, 2005-2010, each additional reported hour of daily
TV viewing was statistically significantly associated with increased odds of being
overweight or obese and lower total diet quality. The relationships of TV viewing with
eating frequency and with total energy intake, in separate models, however, were not
statistically significant. The observed inverse cross-sectional relationship of eating
frequency with relative weight and positive association with total energy intake is
paradoxical. However, when considered along with the observed positive prospective
association between eating frequency change in BMIz, we conclude that the inverse
association between eating frequency with relative weight is likely an artifact of the
cross-sectional study design. More specifically, the prospective findings support that
residual confounding, reverse causation, and/or biased dietary recall may account for
the inverse cross-sectional relationship. The present research highlights the need for
further prospective work to assess the relationship between usual eating frequency and
long-term weight gain in children.
Thesis (Ph.D.)--Tufts University, 2013.
Submitted to the Dept. of Nutritional Epidemiology.
Advisor: Aviva Must.
Committee: Gerard Dallal, Paul Jacques, and Jennifer Sacheck.
Keywords: Nutrition, and Epidemiology.read less