Dietary patterns of Australian children at three and five years of age and their changes over time: A latent class and latent transition analysis
Introduction
Consuming a healthy diet characterised by a variety of nutritious foods is essential for promoting and maintaining health and wellbeing (National Health and Medical Research Council, 2013). Particularly during the early childhood years, fostering optimal growth as well as cognitive, behavioural and social-emotional development through good nutrition is of utmost importance (Bryan et al., 2004; Nicklas, Johnson, & American Dietetic, 2004). However, the diets of Australian children continue to fall well short of national healthy eating recommendations (Australian Bureau of Statistics, 2015). Consequently inadequate dietary habits can hinder opportunities for enhancing child development across a broad range of outcomes (Kleinman et al., 1998; Nicklas et al., 2004) and increase the risk of diet-related chronic conditions including overweight and obesity, Type 2 diabetes and cardiovascular disease (National Health and Medical Research Council, 2013). Dietary intake is a highly modifiable determinant of health and development (Australian Institute of Health and Welfare, 2012) and remains a global public health priority (World Health Organisation, 2013).
Children's eating behaviour is influenced by an array of socio-ecological determinants and there is well-established evidence identifying socio-economic variations in eating behaviours and dietary intake (Zarnowiecki, Dollman, Parletta, 2014). Children of lower socio-economic position (SEP) are more likely to have poorer quality diets, characterised by lower quantities of fruit and vegetables and higher quantities of ultra-processed energy dense-nutrient poor foods and are at greater risk of overweight and obesity, compared to children of higher socio-economic position (Zarnowiecki et al., 2014, Zarnowiecki, Parletta, Dollman, 2014). Whilst the effect of SEP occurs at multiple levels, familial and individual level factors appear to be important predictors of dietary intake (Patrick & Nicklas, 2005), particularly in early childhood and more so than area level measures of SEP (Ranjit et al., 2015). Maternal level of education and employment status are consistently investigated as determinants of children's diets (Hidaka et al., 2016; Okubo et al., 2014). The association between paternal characteristics such as Body Mass Index (BMI) and level of education have also been considered regarding their influence on children's dietary intake (Kiefte-de Jong et al., 2013; Walsh et al., 2015), however, other factors remain less widely explored, including indicators of family structure.
Dietary patterns analysis is an approach to examining the quality of a person's overall diet and therefore acknowledges that consumption of individual food or nutrients does not occur in isolation, which has been the focus of earlier diet-related nutritional epidemiological research (Hu, 2002; Kant, 2004). Analysis of patterns of dietary intake has several public health benefits including developing and tailoring nutrition policies and guidelines, monitoring population food consumption with reference to nutrition recommendations and identifying links between diet and disease outcomes (Hu, 2002). A review by Smithers and Colleagues (Smithers et al., 2011) surmised that dietary patterns analyses fairly consistently identified “healthy” and “unhealthy” patterns of dietary intake in children and this is also reflected in research published in more recent years (Kiefte-de Jong et al., 2013; Leventakou et al., 2016; Wall et al., 2013). Healthier patterns of dietary intake were often associated with higher maternal age (Wall et al., 2013) and educational status, and less healthy patterns with a greater number of siblings (Kiefte-de Jong et al., 2013), whilst there appears to be mixed outcomes for the effect of household income (Kiefte-de Jong et al., 2013) and employment status (Smithers et al., 2011).
Factor Analysis (FA) and Cluster Analysis (CA) are some of the most widely used methods for deriving dietary patterns (Smithers et al., 2011). Whilst the available research using these techniques is extensive, Latent Class Analysis (LCA) and Latent Transition Analysis (LTA) are relatively underutilised statistical methods for deriving dietary patterns cross-sectionally (Harrington et al., 2014; Sotres-Alvarez, Herring, & Siega-Riz, 2010; Torgersen et al., 2015) and over time (Sotres-Alvarez, Herring, & Siega-Riz, 2013), respectively, despite their increased application to health-related data more generally. Additionally, LCA and LTA offers several advantages over these other techniques including the ability to model complex categorical data; allowing for partial class membership, rather than classifying people in to clusters on an all-or-none basis (Vermunt and Magidson, 2002); and being a person-centred approach in which sub-groups of people are identified based on similar patterns of individual characteristics (Collins & Lanza, 2010).
Most dietary patterns research has come from analysis of cross-sectional data and as such, few studies have investigated how patterns of dietary intake evolve longitudinally within the childhood years (Camara et al., 2015; Northstone & Emmett, 2008; Northstone et al., 2013). Whilst there is a relatively limited contribution from Australian research in terms of identifying dietary patterns in childhood; especially in the early childhood years (Bell et al., 2013; Grieger, Scott, & Cobiac, 2011; Lioret et al., 2013), there appear to be no studies investigating patterns of dietary intake in Australian children using LCA or LTA techniques, and only one Australian study investigating changes in childhood dietary patterns over time (Gasser et al., 2017). Research utilising the aforementioned methods for deriving patterns of dietary intake in early childhood in the Australian context will strengthen the available evidence-base regarding dietary patterns analysis.
It is evident the association between socio-economic factors and dietary intake is complex, multifaceted and still not fully understood (Zarnowiecki et al., 2014c, 2016). Given that eating habits tend to be established early in life and track throughout the adult years (Birch & Fisher, 1998) it is crucial to further our understanding regarding factors that influence eating behaviours during early childhood. The aim of the present study is to: 1) identify patterns of dietary intake in Australian children at three and five years of age using LCA and investigate associations between early childhood dietary patterns and demographic and socio-economic indicators; and 2) identify if there are changes in children's dietary patterns from three to five years of age using LTA.
Section snippets
Materials and methods
The current research is a secondary analysis of longitudinal birth cohort data.
Participants
Sample characteristics at baseline, three years and five years follow-up can be seen in Table 1. At three-years follow-up, retention was significantly higher among participants with mothers who were older (OR = 1.07, p < 0.001), had a university degree (OR = 3.62, p < 0.001), were in the highest quintile of income, (OR = 3.21, p < 0.001), lived in a two-carer household (OR = 2.63, p < 0.001), had working mothers (OR = 1.33, p = 0.001) and fathers who were older (OR = 1.06, p < 0.001). Retention
Discussion
The purpose of this study was to identify patterns of dietary intake in Australian children at three and five years of age and investigate their associations with socio-economic and demographic predictors and BMI, as well as to explore changes in early childhood dietary patterns between three and five years of age. To our knowledge, no other research has investigated cross-sectional and longitudinal dietary patterns in Australian children using latent class or latent transition analysis
Conclusion
The current research has identified patterns of dietary intake within early childhood, specifically at three and five years of age and has provided further exploration of familial and individual demographic and socio-economic factors that influence early childhood dietary intake. Not only are the diets of young children suboptimal, but a proportion of children appear to transition to a less healthy pattern of dietary intake over time. Although there are important individual and familial
Funding
E.P. was supported by a Griffith University Postgraduate Research Scholarship.
Author contributions
E.P. led the conceptual design of the research, undertook data analysis and interpretation of results and wrote the manuscript. C.C and T.C contributed to the design of the research and technical expertise on the dataset. D. G and L. T. contributed discipline knowledge and expertise and consulted on the design of the research. S. N. and A. F. guided the statistical analysis and interpretation of results. All authors contributed to editing and approved the final manuscript.
Acknowledgements
The research reported in this publication is part of the Griffith Study of Population Health: Environments for Healthy Living (EFHL) (Australian and New Zealand Clinical Trials Registry: ACTRN12610000931077). Core funding to support EFHL is provided by Griffith University. The EFHL project was conceived by Professor Rod McClure, Dr Cate Cameron, Professor Judy Searle, and Professor Ronan Lyons. We are thankful for the contributions of the Project Manager, Rani Scott, and the current and past
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