Socioeconomic determinants of the adherence to an obesogenic dietary pattern 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
There is a paucity of data on adolescents’ dietary factors and how dietary patterns change during this stage of life, as well as its association with sociodemographic variables.

Purpose
This study aims to identify longitudinal dietary obesogenic patterns in a large cohort of adolescents aged 12 to 16 years and to explore their association with sociodemographic variables.

Methods
This study collected data at approximately 12, 14 and 16 years of age from 600 adolescents attending 24 secondary schools enrolled in the SI! Program for Secondary Schools trial in Spain. Caregivers filled a validated 157-item semi-quantitative food frequency questionnaire excluding alcohol intake and a survey with sociodemographic information at the three different time-points. An obesogenic pattern was determined by grouping food intake into forty categories based on usage or variations in energy density, fat, and fibre contents, and subsequently a Reduced Rank Regression approach was applied using percentage of energy intake from fat, fibre density (FD), and dietary energy density (DED) as intermediate variables. The trajectories of adherence to an obesogenic pattern were identified using latent class trajectory modeling with the Stata command traj. Next, individuals were assigned to the trajectory group they were most likely to belong based on the posterior predictive probabilities of group membership.

Results
Among 600 adolescents, with a baseline mean (SD) age of 12.5 (0.4) years and 48.8% girls, an obesogenic pattern was derived. This pattern was highly positively correlated with DED, moderately correlated with the percentage of energy from fat, and inversely correlated with FD. The dietary obesogenic pattern explained ∼50% of the variation in all three response (intermediate) variables. This energy-dense, high-fat and low-fibre DP identified at three different time-points was characterized by higher factor loadings for margarine and vegetable oils, cheese, processed meat, nuts and seeds, biscuits and cakes, and meat mixed dishes and lower factor loadings for fresh fruit, vegetables, and legumes (Figure 1). Four stable distinct trajectory groups, ranging from less obesogenic (Trajectory 1) to more obesogenic (Trajectory 4), were identified based on changes in adherence to the pattern during adolescence. No associations were found at baseline with parental educational level and household income. However, girls and individuals from families with a migrant background tended to have a healthier diet over adolescence (Figure 2).

Conclusions
In a large cohort of adolescents, an obesogenic (energy-dense, high-fat and low-fibre) pattern was identified, and the adherence to this pattern was stable over adolescence, with differences in sociodemographic characteristics. This information may help tailoring health promotion programs for adolescents focusing on the key food groups in these populations.