A prospective analysis of dietary energy density at age 5 and 7 years and fatness at 9 years among UK children

Objective: To analyse whether high dietary energy density ( DED) is associated with increased fat mass and risk of excess adiposity in free- living children. Design: Longitudinal, observational cohort study. Subjects: Six hundred and eighty- two healthy children from the Avon Longitudinal Study of Parents and Children. Measurements: Diet was assessed at age 5 and 7 years using 3- day diet diaries, and DED ( kJ g(-1)) was calculated excluding drinks. Fat mass was estimated at age 9 years using Dual- Energy X- ray Absorptiometry. To adjust for body size, fat mass index ( FMI) was calculated by dividing fat mass ( kg) by height ( m(5.8)). Excess adiposity was defined as the top quintile of logFMI. Results: Mean DED at age 5 years was higher among children with excess adiposity at age 9 years compared to the remaining sample ( 8.8 +/- 70.16 vs 8.5 +/- 70.07 kJ g(-1)), but there was no evidence of an association with excess adiposity at age 9 years ( odds ratio ( OR) = 1.14, 95% confidence interval ( CI) 0.90 - 1.44) after controlling for potential confounders. Mean DED at age 7 years was higher among children with excess adiposity compared to the remaining sample ( 9.1 +/- 0.12 vs 8.8 +/- 0.06 kJ g(-1)) and a 1kJ g(-1) rise in DED increased the odds of excess adiposity at 9 years by 36% ( OR = 1.36, 95% CI 1.09 - 1.69) after controlling for potential confounders. Conclusion: Higher DED at age 7 years, but not age 5 years, is a risk factor for excess adiposity at age 9 years, perhaps reflecting deterioration in the ability to compensate for extra calories in an energy- dense diet. DED tracks strongly from age 5 to 7 years suggesting intervention to alter dietary habits need to commence at younger ages to prevent the formation of preferences for energy dense foods.