Adherence to an obesogenic dietary pattern and adiposity during adolescence
Authors: Martinez-Gomez J , Bodega P , Fernandez-Alvira J M , De Cos-Gandoy A , Moreno L A , Beneito-Dura M , De Miguel M , Ruiz-Leon A M , Tresserra-Rimbau A , Estruch R , Lamuela-Raventos R M , Santos-Beneit G , Fernandez-Jimenez R 
Published: June 2024

Abstract

Background
The longitudinal associations between dietary patterns and adiposity markers during adolescence remain poorly understood.

Purpose
This study aims to determine the association between the adherence to an obesogenic pattern over adolescence and adiposity markers.

Methods
Adolescents attending 24 secondary schools participating in the SI! Program for Secondary Schools trial in Spain were measured at approximately 12, 14 and 16 years of age. Caregivers provided information on dietary habits by completing a validated 157-item semi-quantitative food frequency questionnaire at the specified time points, excluding alcohol intake. An obesogenic pattern was identified by grouping food intake into forty food groups. Next, a Reduced Rank Regression (RRR) approach was applied using percentage of energy intake from fat, fibre density, and dietary energy density as intermediate variables. Trajectories of adherence to an obesogenic pattern were identified through latent class trajectory modeling with the Stata command traj. Individuals were assigned to the trajectory group they were most likely to belong based on the posterior predictive probabilities of group membership. Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and fat mass index (FMI) served as adiposity markers. Age- and sex-adjusted z-scores were calculated using validated cutoff points from the Centers for Disease Control (CDC) standards for BMI and from the Third National Health and Nutrition Examination Survey (NHANES III) for WC and WHtR. FMI-specific age- and gender-adjusted z-scores were calculated based on our sample. Associations between the adherence to the obesogenic pattern and the different adiposity outcomes at final follow-up were analyzed using generalized linear adjusted models.

Results
Among 600 adolescents, with a baseline mean (SD) age of 12.5 (0.4) years and 48.8% girls, an obesogenic pattern (energy-dense, high-fat and low-fibre) was derived at three different time-points. Based on the change in adherence to the obesogenic pattern during adolescence, four stable distinct trajectory groups were identified (Figure 1). Trajectory 1 had the lowest adherence to the obesogenic pattern over time, with 44 participants (7.3%), followed by Trajectory 2 with 180 participants (30.0%), Trajectory 3 with 292 participants (48.7%), and Trajectory 4 with 84 participants (14.0%). Trajectory 4, the one with highest adherence to the obesogenic pattern at three time-points, was associated with the unhealthiest adiposity profile at ∼16 years of age, especially for WC z-score (0.26; 95% CI: 0.00 to 0.51), with a statistically significant dose-response effect (Figure 2).

Conclusions
Greater adherence to an obesogenic pattern over adolescence is associated with higher WC at 16 years of age. These findings underscore the importance of maintaining a healthy diet in this stage of life for cardiometabolic health.