Although a high intake of fat, particularly SFA, is a well-known risk factor for CVD, fat intake in Japan has attracted relatively little attention from health professionals to date due to the low intake in the Japanese population. However, recent surveys have shown an increase in fat intake in younger Japanese populations. Here, we described the fat intake and dietary sources of SFA in Japanese schoolchildren. Also, we experimentally exchanged a high-SFA food with a low-SFA substitute in the data, and calculated the resulting changes in nutrient intakes.

The study was conducted nationwide under a cross-sectional design. A non-consecutive, three-day diet record was performed on two school days and a non-school day.

Fourteen elementary and thirteen junior high schools.

Elementary-school children (n 629) and junior high-school children (n 281).

Prevalence of excess fat intake was 35·4 % in boys and 45·0 % in girls. Excess SFA intake was suspected in 97·7 % of boys and 99·4 % of girls when the dietary reference intake values for adults were applied. Major dietary sources of SFA were meat (26·4 % of total SFA intake), dairy products (25·7 %) and confectioneries (11·3 %).

Since one-third to nearly one-half of our Japanese schoolchildren consumed excess fat, careful monitoring of fat intake in the Japanese population should be continued. Adoption of low-fat milk and/or lean meat in daily meals might be a suitable means of reducing fat, particularly SFA intake, in schoolchildren.

To assess the relative validity of the latest version of the Scottish Collaborative Group (SCG) FFQ (version 6.6) in adults living in Scotland.

A cross-sectional validation study. Participants completed the self-administered, 169-item SCG FFQ followed by a 7 d, non-weighed food diary. Energy and energy-adjusted macronutrients and micronutrients were examined for relative validity through Spearman’s correlation, the percentage of classification into thirds of intake, Cohen’s weighted kappa (κw) and Bland–Altman analysis.

General population living in Scotland.

Ninety-six adults aged 18–65 years.

Spearman’s correlation coefficients ranged from 0·21 (retinol) to 0·71 (Mg). A median of 52 % of adults were correctly classified into thirds of intake (range: 42 % (PUFA, MUFA and Fe) to 64 % (percentage energy from carbohydrates)) and 8 % were grossly misclassified into opposite thirds of intake (range: 3 % (carbohydrates, percentage energy from carbohydrates) to 19 % (thiamin)). Values of κw ranged between 0·20 (PUFA, β-carotene) to 0·55 (percentage energy from carbohydrates). In the Bland–Altman analysis, the smallest limits of agreement, when expressed as a percentage of the mean intake from the FFQ and food diary, were seen for the main macronutrients carbohydrates, fat and protein.

As in the previous validation study more than 10 years ago, the FFQ gave higher estimates of energy and most nutrients than the food diary, but after adjustment for energy intake the FFQ could be used in place of non-weighed food diaries for most macronutrients and many micronutrients in large-scale epidemiological studies.

Although dietary supplement use is increasing in Europe and the USA, little research involving adults’ beliefs regarding dietary supplements has been conducted. Therefore, the present study aimed to explore and compare users’ and non-users’ beliefs towards dietary supplements.

Thirteen focus group discussions were conducted of which seven groups were dietary supplement users and six groups were non-users. Based on the socio-cognitive factors of the Integrated Change Model, a semi-structured topic guide was set up. The discussions were audio-recorded and subjected to qualitative content analysis, applying the framework approach.

Data were collected in Maastricht, the Netherlands, in 2014 and 2015.

In total fifty-six individuals participated in the study, of whom twenty-eight were dietary supplement users and twenty-eight non-users. The average age of participants was 42·9 years.

Dietary supplement users’ attitude beliefs were mainly related to mental and physical health enhancement, illness prevention and curative health benefits. Users were critical of the nutritional knowledge of health professionals and of the quality of food products. Non-users were convinced that the human body does not need any support and that regular food is enough to cover one’s nutritional needs. Users and non-users held comparable beliefs regarding the definition and risks of dietary supplements, and perceived social influences.

In their decision about dietary supplement use, both groups were guided by their own convictions to a great extent. Both groups would benefit from improved understanding of the health effects of dietary supplements to improve informed decision making.

To investigate the association between maternal employment and childhood overweight in low- and middle-income countries (LMIC).

We utilized cross-sectional data from forty-five Demographic and Health Surveys from 2010 to 2016 (n 268 763). Mothers were categorized as formally employed, informally employed or non-employed. We used country-specific logistic regression models to investigate the association between maternal employment and childhood overweight (BMI Z-score>2) and assessed heterogeneity in the association by maternal education with the inclusion of an interaction term. We used meta-analysis to pool the associations across countries. Sensitivity analyses included modelling BMI Z-score and normal weight (weight-for-age Z-score≥−2 to <2) as outcomes.

Participants included children 0–5 years old and their mothers (aged 18–49 years).

In most countries, neither formal nor informal employment was associated with childhood overweight. However, children of employed mothers, compared with children of non-employed mothers, had higher BMI Z-score and higher odds of normal weight. In countries where the association varied by education, children of formally employed women with high education, compared with children of non-employed women with high education, had higher odds of overweight (pooled OR=1·2; 95 % CI 1·0, 1·4).

We find no clear association between employment and child overweight. However, maternal employment is associated with a modestly higher BMI Z-score and normal weight, suggesting that employment is currently associated with beneficial effects on children’s weight status in most LMIC.

Sufficient vitamin D status during infancy is important for child health and development. Several initiatives for improving vitamin D status among immigrant children have been implemented in Norway. The present study aimed to evaluate the vitamin D status and its determinants in children of immigrant background in Oslo.

Cross-sectional study.

Child health clinics in Oslo.

Healthy children with immigrant background (n 102) aged 9–16 months were recruited at the routine one-year check-up from two child health clinics with high proportions of immigrant clients. Blood samples were collected using the dried blood spot technique and analysed for serum 25-hydroxyvitamin D (s-25(OH)D) concentration using LC–MS/MS.

Mean s-25(OH)D was 52·3 (sd 16·7) nmol/l, with only three children below 25 nmol/l and none below 12·5 nmol/l. There was no significant gender, ethnic or seasonal variation in s-25(OH)D. However, compared with breast-fed children, s-25(OH)D concentration was significantly higher among children who were about 1 year of age and not breast-fed. About 38 % of the children were anaemic, but there was no significant correlation between s-25(OH)D and Hb (Pearson correlation, r=0·1, P=0·33).

Few children in the study had vitamin D deficiency, but about 47 % of the children in the study population were under the recommended s-25(OH)D sufficiency level of ≥50 nmol/l.

Using the Healthy Eating Index-2010 (HEI-2010), the present study aimed to examine diet quality and the impact of overall diet quality and its components on central obesity among Mexican-American men and women.

Cross-sectional data from NHANES 1999–2012 were used. The HEI-2010 data, including twelve components for a total score of 100, were collected with a 24 h recall interview. Central obesity was defined as a waist circumference of ≥88 cm for women and ≥102 cm for men. Weighted logistic regressions were performed to assess associations between HEI-2010 scores and central obesity.

National Health and Nutrition Examination Survey (NHANES) 1999–2012.

A total of 6847 Mexican Americans aged ≥20 years with reliable dietary recall status and non-pregnancy status.

Higher HEI-2010 total score was associated with lower odds of central obesity in Mexican-American men (OR; 95 % CI=0·98; 0·98, 1·00). Among all Mexican Americans, one-unit higher score of total fruit and sodium (i.e. lower level of intake) was associated with 4 % (0·96; 0·93, 0·99) and 2 % (0·98; 0·96, 0·99) lower odds of central obesity, respectively. However, a higher total proteins score was associated with higher odds of central obesity (1·08; 1·00, 1·16). In gender-specific analyses, a higher whole fruit or sodium score was inversely associated with central obesity in men but not in women.

HEI-2010 scores of total fruit and sodium were inversely associated with central obesity among all Mexican Americans. However, total proteins score and central obesity was positively associated. In Mexican-American men, HEI-2010 total and whole fruit scores were inversely associated with central obesity.

Dietary Ca is now being recognized to play an important role not only in skeletal integrity, but also in the regulation of energy and metabolism. The aim of the present study was to estimate the relationship of dairy Ca intake with BMI and blood pressure (BP) in a sample derived from the Polish population.

Ca intake was calculated from an interviewer-administered semi-quantitative FFQ. BMI was calculated from measured weight and height, and BP was measured by a physician.

Cross-sectional epidemiological study on osteoporosis risk factors in Poland.

Randomly selected healthy adult persons (n 1259; 750 women and 509 men).

Dairy Ca intake was significantly lower in individuals with overweight/obesity (BMI≥25·00 kg/m2) and/or with elevated BP (systolic/diastolic ≥140/≥90 mmHg) than in those with normal body mass and BP, respectively. Ca intake was negatively correlated with BMI (r=−0·12, P<0·001), systolic BP (r=−0·11, P<0·001) and diastolic BP (r=−0·08, P<0·01). Daily dairy Ca intake below 1000 mg was a predictor for BMI≥25·0 kg/m2 (OR=1·44, P<0·005). This relationship was stronger in women, particularly premenopausal women.

The obtained results indicate the role of low dairy Ca intake in the development of obesity and hypertension, notably in premenopausal women.

To find out how the consumption of organic food during pregnancy is associated with consumer characteristics, dietary patterns and macro- and micronutrient intakes.

Cross-sectional description of consumer characteristics, dietary patterns and macro- and micronutrient intakes associated with consumption of organic food during pregnancy.

Healthy, pregnant women recruited to a prospective cohort study at midwives’ practices in the southern part of the Netherlands; to enrich the study with participants adhering to alternative lifestyles, pregnant women were recruited through various specific channels.

Participants who filled in questionnaires on food frequency in gestational week 34 (n 2786). Participant groups were defined based on the share of organic products within various food types.

Consumers of organic food more often adhere to specific lifestyle rules, such as vegetarianism or anthroposophy, than do participants who consume conventional food only (reference group). Consumption of organic food is associated with food patterns comprising more products of vegetable origin (soya/vegetarian products, vegetables, cereal products, bread, fruits, and legumes) and fewer animal products (milk and meat), sugar and potatoes than consumed in conventional diets. These differences translate into distinct intakes of macro- and micronutrients, including higher retinol, carotene, tocopherol and folate intakes, lower intakes of vitamin D and B12 and specific types of trans-fatty acids in the organic groups. These differences are seen even in groups with low consumption of organic food.

Various consumer characteristics, specific dietary patterns and types of food intake are associated with the consumption of organic food during pregnancy.

The current study investigates potential pathways from socio-economic status (SES) to BMI in the adult population, considering psychological domains of eating behaviour (restrained eating, uncontrolled eating, emotional eating) as potential mediators stratified for sex.

Data were derived from the population-based cross-sectional LIFE-Adult-Study. Parallel-mediation models were conducted to obtain the total, direct and indirect effects of psychological eating behaviour domains on the association between SES and BMI for men and for women.

Leipzig, Germany.

We studied 5935 participants aged 18 to 79 years.

Uncontrolled eating mediated the association between SES and BMI in men only and restrained eating in both men and women. Emotional eating did not act as mediator in this relationship. The total effect of eating behaviour domains on the association between SES and BMI was estimated as β=−0·03 (se 0·02; 95 % CI −0·062, −0·003) in men and β=−0·18 (se 0·02; 95 % CI −0·217, −0·138) in women.

Our findings do not indicate a strong overall mediation effect of the eating behaviour domains restrained eating, uncontrolled eating and emotional eating on the association between SES and BMI. Further research on other pathways of this association is strongly recommended. Importantly, our findings indicate that, independent from one’s social position, focusing on psychological aspects in weight reduction might be a promising approach.

Dairy products contain essential nutrients to ensure healthy growth and bone development in children. However, a significant proportion of children in developed countries fail to consume the daily recommended intake of dairy products. Parents are the gatekeepers of familial nutritional intake and represent a potential vehicle through which to increase dairy consumption in children. As such, formative research was conducted to gain insight into parents’ perceived barriers to and benefits of purchasing and consuming dairy products and to develop innovative message content that could be utilized in future public health campaigns.

Seven in-depth group interviews were conducted in two phases between February and May 2015.

Interviews were conducted in local recreational centres and libraries in British Columbia, Canada.

Mothers (n 21, mean age 38 (sd 5) years) and fathers (n 9, mean age 38 (sd 3) years) of children aged 4–10 years.

Parents perceived both positive and negative physical outcomes associated with consuming dairy. Lack of trustworthy information was a frequently discussed barrier theme to purchasing and consuming dairy products. Mothers were concerned about the cost of dairy products. Differences in purchasing and consumption strategies were reported between parents of children who consumed adequate dairy and those who did not. Parents believed the most appropriate communication channel was through print material.

Messages targeting parents, as a means of increasing dairy consumption in children, should address barriers identified by parents. In addition, practical tips should be provided to promote purchasing and consumption of dairy products.

We conducted a content analysis of public comments to understand the key framing approaches used by private industry v. public health sector, with the goal of informing future public health messaging, framing and advocacy in the context of policy making.

Comments to the proposed menu-labelling policy were extracted from Regulations.gov and analysed. A framing matrix was used to organize and code key devices and themes. Documents were analysed using content analysis with Dedoose software.

Recent national nutrition-labelling regulations in the USA provide a timely opportunity to understand message framing in relation to obesity prevention and policy.

We examined a total of ninety-seven documents submitted on behalf of organizations (private industry, n 64; public health, n 33).

Public health focused on positive health consequences of the policy, used a social justice frame and supported its arguments with academic data. Industry was more critical of the policy; it used a market justice frame that emphasized minimal regulation, depicted its members as small, family-run businesses, and illustrated points with humanizing examples.

Public health framing should counter and consider engaging directly with non-health-related arguments made by industry. Public health should include more powerful framing devices to convey their messages, including metaphors and humanizing examples.

To identify the relationship between perceptions of Ca and vitamin D consumption and actual intakes to inform the design of osteoporosis prevention education.

An FFQ was used to approximate usual monthly Ca and vitamin D intakes among a group of young Canadians. Qualitative interviews and a food card pile sort activity explored individuals’ perceptions of nutrient intakes. The FFQ was used to assess nutrient adequacy for individual participants and the qualitative interviews and pile sort were analysed using thematic content analysis.

Hamilton, Canada.

Sixty participants aged 17–30 years, representing varying levels of educational attainment.

Seventy-eight per cent of young adults who consumed inadequate vitamin D perceived their intake as adequate, compared with 57 % for Ca. Thematic analysis revealed three major themes that contributed to young adults’ understandings of intake: belief their diet was correct, absence of symptoms and confusion over nutrient sources.

The majority of participants perceived themselves as consuming adequate amounts of Ca and vitamin D, when they were actually consuming inadequate amounts according to FFQ findings. These perceptions were related to low engagement in prevention activities. Prevention education must motivate young adults to question the adequacy of their micronutrient intakes and design tailored programmes that are geared to a young adult audience.

We aimed to assess dietary profiles of adults from the NutriNet-Santé cohort according to different levels of organic food consumption using detailed self-reported data on organic food intakes.

Food intakes were obtained using an organic food frequency questionnaire (Org-FFQ). The participants were ranked into five groups (quintiles, Q) according to the proportion of organic foods in their diet. To determine diet quality, two scores were computed reflecting adherence to food-based recommendations (mPNNS-GS) and the probability of adequate nutrient intake (PANDiet). Relationships between levels of organic food consumption and dietary characteristics were assessed using multivariable-adjusted ANCOVA models.

The NutriNet-Santé Study.

French adults from the NutriNet-Santé Study (n 28 245).

Intakes of foods of plant origin increased along with the contribution of organic foods to the diet while a reverse trend was identified for dairy products, cookies and soda (P-trend<0·0001). The diet quality scores increased from Q1 (mPNNS-GS, 7·89 (se 0·02); PANDiet: 63·04 (se 0·11)) to Q5 (mPNNS-GS, 8·78 (se 0·02); PANDiet, 69·37 (se 0·10)). Overall, high organic food consumers exhibited better diet quality, although intermediate organic food consumers showed better adherence to specific nutritional recommendations related to animal products.

The study provides new insights into the understanding of organic food consumption as a part of a healthy diet and sheds some light on the dietary profiles of different categories of organic food consumers. These results underline strong dietary behaviour correlates associated with organic food consumption that should be controlled for in future aetiological studies on organic foods and health.

To identify the magnitude of anaemia and deficiencies of Fe (ID) and vitamin A (VAD) and their associated factors among rural women and children.

Cross-sectional, comprising a household, health and nutrition survey and determination of Hb, biochemical (serum concentrations of ferritin, retinol, C-reactive protein and α1-acid glycoprotein) and anthropometric parameters. Multivariate logistic regression examined associations of various factors with anaemia and micronutrient deficiencies.

Kalalé district, northern Benin.

Mother–child pairs (n 767): non-pregnant women of reproductive age (15–49 years) and children 6–59 months old.

In women, the overall prevalence of anaemia, ID, Fe-deficiency anaemia (IDA) and VAD was 47·7, 18·3, 11·3 and 17·7 %, respectively. A similar pattern for anaemia (82·4 %), ID (23·6 %) and IDA (21·2 %) was observed among children, while VAD was greater at 33·6 %. Greater risk of anaemia, ID and VAD was found for low maternal education, maternal farming activity, maternal health status, low food diversity, lack of fruits and vegetables consumption, low protein foods consumption, high infection, anthropometric deficits, large family size, poor sanitary conditions and low socio-economic status. Strong differences were also observed by ethnicity, women’s group participation and source of information. Finally, age had a significant effect in children, with those aged 6–23 months having the highest risk for anaemia and those aged 12–23 months at risk for ID and IDA.

Anaemia, ID and VAD were high among rural women and their children in northern Benin, although ID accounted for a small proportion of anaemia. Multicentre studies in various parts of the country are needed to substantiate the present results, so that appropriate and beneficial strategies for micronutrient supplementation and interventions to improve food diversity and quality can be planned.

To determine if the association between soda consumption and obesity is uniform among Asian-American population subgroups.

We conducted multivariate logistic regression analyses on odds of being obese among seven Asian subgroups and by place of birth using data from the 2009 California Health Interview Survey.

An omnibus population-based health survey.

Non-institutionalized adults, aged 18 years or over, residing in California (n 36 271).

Despite low levels of soda consumption in several Asian-American ethnic groups, soda consumption increased the odds of being obese among Chinese, Koreans and Other Asians but not for Whites. Obesity risk varied across Asian subgroups and by place of birth within these subgroups.

More public health efforts addressing soda consumption in Asian-American communities are needed as a strategy for not only preventing chronic diseases but also disparities, considering the varying levels of soda intake across subgroups. Results support the growing body of literature critiquing acculturation theory in immigrant health research by documenting inconsistent findings by place of birth. Future research should take into account the heterogeneity among Asian Americans to advance our understanding of health outcomes and disparities.

The purpose of the present study was to examine the influence of maternal pre-pregnancy BMI and gestational weight gain (GWG) on initiation and duration of infant breast-feeding in a prospective birth cohort study.

Breast-feeding information was collected at 1, 3, 6 and 12 months postpartum. The association of pre-pregnancy BMI and GWG with delayed lactogenesis II and termination of exclusive breast-feeding was assessed with logistic regression analysis. The risk of early termination of any breast-feeding during the first year postpartum was assessed with Cox proportional hazards models.

Urban city in China.

Women with infants from the Ma’anshan Birth Cohort Study (n 3196).

The median duration of any breast-feeding in this cohort was 7·0 months. Pre-pregnancy obese women had higher risks of delayed lactogenesis II (risk ratio=1·89; 95 % CI 1·04, 3·43) and early termination of any breast-feeding (hazard ratio=1·38; 95 % CI 1·09, 1·75) adjusted for potential maternal and infant confounders, when compared with normal-weight women. No differences in breast-feeding initiation or duration of exclusive breast-feeding according to pre-pregnancy BMI were found. Moreover, GWG was not associated with any poor breast-feeding outcomes.

The present study indicated that pre-pregnancy obesity increases the risks of delayed lactogenesis II and early termination of any breast-feeding in Chinese women.

To: (i) determine the prevalence of self-reported eating less and eating down during early and late pregnancy and postpartum, and explore risk factors associated with eating less; (ii) examine the association between eating less and diet quality; and (iii) determine the association between eating less and weight gain during pregnancy.

Data were collected longitudinally from a cohort of women participating in a community health programme. Diet was assessed at three time points (≤20 weeks’ gestation, 36 weeks’ gestation, 6 months’ postpartum), body weight was measured during study enrolment (≤20 weeks’ gestation) and at 36 weeks’ gestation, and information about the woman and her household was collected at enrolment.

The Rang-Din Nutrition Study in the Rangpur and Dinajpur districts of Bangladesh.

Women (n 4011).

The prevalence of self-reported eating less differed by time point (75·9 % in early pregnancy, 38·8 % in late pregnancy, 7·4 % postpartum; P<0·001). The most common reason for eating less across all time periods was food aversion or loss of appetite. Women who reported eating less in late pregnancy had consumed animal-source foods less frequently in the preceding week than women who reported eating more (mean (sd): 11·7 (7·4) v. 14·8 (9·2) times/week; P<0·001) and had lower weekly weight gain than women who reported eating more (mean (se): 0·27 (0·004) v. 0·33 (0·004) kg/week; P<0·001).

Eating less has negative implications with respect to diet quality and pregnancy weight gain in this context.

The study aimed to examine nutrition label use and dietary behaviours among ethnically diverse middle- and high-school students, in Texas, USA.

The School Physical Activity and Nutrition (SPAN) survey is a cross-sectional statewide study using a self-administered questionnaire to assess nutrition and physical activity behaviours. Height and weight measurements were used to determine BMI. Multivariable logistic regression was used to determine associations between nutrition label use and dietary behaviours, with gender, grade, ethnicity, BMI, parent education, socio-economic status and nutrition knowledge as covariates.

Participants from 283 schools, weighted to represent Texas youth.

SPAN 2009–2011 included 6716 8th and 11th graders (3465 girls and 3251 boys). The study population consisted of 39·83 % White/Other, 14·61 % African-American and 45·56 % Hispanic adolescents; with a mean age of 14·9 years, and 61·95 % at a healthy weight, 15·71 % having overweight and 22·34 % having obesity.

Adolescents who did not use nutrition labels had 1·69 times greater odds of consuming ≥1 sugary beverages/d (P<0·05). Adolescents who used nutrition labels had 2·13 times greater odds of consuming ≥1 fruits and vegetables/d (P<0·05). Adolescents who used nutrition labels had significantly higher healthy eating scores than those who did not (P<0·001). For every 1-point increase in nutrition knowledge, adolescents had 1·22 greater odds of using nutrition labels.

Nutrition label use is associated with healthier dietary behaviours in adolescents. Intervention strategies for youth should include efforts to teach adolescents to use labels to make healthy food choices.

To examine the association between breast-feeding duration and the risk of excess body weight (children >85th percentile, mothers BMI≥25·0 kg/m2) concurrently in mother–child pairs two years after delivery.

Prospective cohort study in Joinville, Brazil. Multivariable logistic regression was used to examine the independent relationship between breast-feeding duration and risk of excess body weight.

Brazilian public maternity hospital.

Three hundred and five mother–child pairs.

At 2-year follow-up, 23·6 % of mother–child pairs had excess body weight. Children breast-fed for <2 months were more likely to have excess body weight than children breast-fed for ≥6 months (OR=2·4; 95 % CI 1·1, 5·1). Breast-feeding for <2 months was also associated with a greater likelihood of maternal excess body weight compared with those who breast-fed for ≥6 months (OR=2·9; 95 % CI 1·1, 8·1). There was a progressive increase in the likelihood of mother–child pairs having excess body weight as breast-feeding duration decreased. In addition to breast-feeding duration, other independent determinants of excess body weight were pre-pregnancy weight, gestational weight gain and number of pregnancies in mothers, and birth weight in children.

Breast-feeding for a longer duration has a parallel protective effect on the risk of excess body weight in mother–child pairs two years after birth. Since members of the same family could be influenced by the same risk factors, continued promotion and support of breast-feeding may help to attenuate the rising prevalence of overweight in mother–child pairs.

To describe dietary patterns by applying cluster analysis and to describe the cluster memberships of European children over time and their association with body composition changes.

The analyses included k-means clustering based on the similarities between the relative frequencies of consumption of forty-three food items and regression models were fitted to assess the association between dietary patterns and body composition changes.

Primary schools and pre-schools of selected regions in Italy, Estonia, Cyprus, Belgium, Sweden, Hungary, Germany and Spain.

Participants (n 8341) in the baseline (2–9 years old) and follow-up (4–11 years old) surveys of the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS) study.

Three persistent clusters were obtained at baseline and follow-up. Children consistently allocated to the ‘processed’ cluster presented increased BMI (β=0·050; 95 % CI 0·006, 0·093), increased waist circumference (β=0·071; 95 % CI 0·001, 0·141) and increased fat mass gain (β=0·052; 95 % CI 0·014, 0·090) over time v. children allocated to the ‘healthy’ cluster. Being in the ‘processed’–‘sweet’ cluster combination was also linked to increased BMI (β=0·079; 95 % CI 0·015, 0·143), increased waist circumference (β=0·172; 95 % CI 0·069, 0·275) and increased fat mass gain (β=0·076; 95 % CI 0·019, 0·133) over time v. the ‘healthy’ cluster.

Children consistently showing a processed dietary pattern or changing from a processed pattern to a sweet pattern presented the most unfavourable changes in fat mass and abdominal fat. These findings support the need to promote overall healthy dietary habits in obesity prevention and health promotion programmes targeting children.