Child and family characteristics are associated with a dietary variety index in 4-year-old children from the generation XXI cohort

Abstract

This study aims to assess dietary variety and adequacy and their associated factors in 4-year-old children. The hypothesis under study is that poor early life characteristics and a deprived family background may be associated with lower dietary variety and adequacy at 4 years of age. The study participants were from a population-based birth cohort: Generation XXI (2005/2006, northern Portugal). Data were collected by trained interviewers at birth (eg, type of delivery, gestational age, birth weight, maternal age, education, smoking during pregnancy, and self-reported weight status before pregnancy) and at 4 years of age (behaviors, family background, and weight status). Diet was assessed by a food frequency questionnaire, and a Healthy Dietary Variety Index was calculated considering variety and adequacy within and among 5 food groups (starchy foods; fruit; vegetables; meat, fish and alternatives; and dairy foods) (score: 0 to 1). General linear models were run (β̂ coefficients and the respective 95% confidence intervals [CIs], adjusted for child's sex, maternal age, and education) (n = 3962). Lower dietary variety and adequacy at 4 years of age were associated with more screen time (≥120 vs <120 min/d: β̂ = -0.012, 95% CI: -0.019 to 0.004), no regular participation in sports (β̂ = -0.022, 95% CI: -0.029 to -0.014), underweight status (β̂ = -0.081, 95% CI: -0.130 to -0.032), shorter breastfeeding duration (<4 vs ≥6 months: β̂ = -0.012, 95% CI: -0.019 to -0.005), no siblings (0 vs ≥2: β̂ = -0.023, 95% CI: -0.034 to -0.011), and a 2-parent family structure (vs single-parent: β̂ = -0.010, 95% CI: -0.021 to -0.001). Children of less educated and less physically active mothers also had lower dietary variety and adequacy. In conclusion, several factors are associated with lower dietary variety and adequacy, including early life determinants, such as shorter breastfeeding duration, but also poor lifestyle choice and family characteristics appear to play a major role.