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. 2020 Aug 21;12(9):2536.
doi: 10.3390/nu12092536.

Clustering of Dietary Patterns and Lifestyles Among Spanish Children in the EsNuPI Study †

Julio Plaza-Díaz  1   2   3 , Esther Molina-Montes  2   3   4 , María José Soto-Méndez  5 , Casandra Madrigal  4   5 , Ángela Hernández-Ruiz  5 , Teresa Valero  6 , Federico Lara Villoslada  7 , Rosaura Leis  8   9   10 , Emilio Martínez de Victoria  2   11 , José Manuel Moreno  12 , Rosa M Ortega  13 , María Dolores Ruiz-López  2   4   5 , Gregorio Varela-Moreiras  6   14 , Ángel Gil  1   2   3   5   10
Affiliations

Clustering of Dietary Patterns and Lifestyles Among Spanish Children in the EsNuPI Study †

Julio Plaza-Díaz et al. Nutrients. .

Abstract

Dietary patterns (DPs) are known to be tied to lifestyle behaviors. Understanding DPs and their relationships with lifestyle factors can help to prevent children from engaging in unhealthy dietary practices. We aimed to describe DPs in Spanish children aged 1 to <10 years and to examine their associations with sociodemographic and lifestyle variables. The consumption of toddler and young children milk formulas, enriched and fortified milk within the Spanish pediatric population is increasing, and there is a lack of evidence whether the consumption of this type of milk is causing an impact on nutrient intakes and if they are helping to reach the nutrient recommendations. Within the Nutritional Study in the Spanish Pediatric Population (EsNuPI), we considered two study cohorts and three different age groups in three year-intervals in each of them. The study cohort included 740 children in a representative sample of the urban non-vegan Spanish population and 772 children in a convenience cohort of adapted milk consumers (AMS) (including follow-on formula, toddler's milk, growing up milk, and fortified and enriched milks) who provided information about sociodemographics, lifestyle, and dietary habits; a food frequency questionnaire was used for the latter. Principal component analysis was performed to identify DPs from 18 food groups. Food groups and sociodemographic/lifestyle variables were combined through a hierarchical cluster algorithm. Three DPs predominated in every age group and study sample: a palatable energy-dense food dietary pattern, and two Mediterranean-like DPs. However, children from the AMS showed a predominant dietary pattern markedly related to the Mediterranean diet, with high consumption of cereals, fruits and vegetables, as well as milk and dairy products. The age of children and certain lifestyle factors, namely level of physical activity, parental education, and household income, correlated closely with the dietary clusters. Thus, the findings provide insight into designing lifestyle interventions that could reverse the appearance of unhealthy DPs in the Spanish child population.

Keywords: children; cluster analysis; dietary patterns; physical activity; sedentary behavior.

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Conflict of interest statement

The funding sponsor had no role in the design of the study; in the collection, analyses, or interpretation of the data; in the writing of the manuscript, and in the decision to publish the results. The authors declare no conflict of interest, with the exception of Federico Lara who is a member of the IPN.

Figures

Figure 1
Figure 1
Dietary patterns extracted from principal component analysis of 18 major food groups in a representative cohort (SRS) of the EsNuPI (n = 740). (A). Children from 1 to <3 years (n = 169), (B). children from 3 to <6 years (n = 256), and (C). children from 6 to <10 years (n = 315).
Figure 2
Figure 2
Dietary patterns extracted from the principal component analysis of 18 major food groups in a sample of adapted milk consumers cohort (AMS) for the EsNuPI (n = 772): (A). Children from 1 to <3 years (n = 302), (B). children from 3 to <6 years (n = 277), and (C). children from 6 to <10 years (n = 193).
Figure 3
Figure 3
Clusters of subjects and dietary and lifestyle variables identified via hierarchical clustering in SRS by age groups ((A) 1–3 years, (B) 3–6 years, (C) 6 to <10 years) in the Nutritional Study in Spanish Pediatric Population (EsNuPI) (n = 740). The clusters are visually separated by longitudinal marks on vertical and horizontal faces (clusters of subjects or dietary/lifestyle variables, respectively). The vertical and horizontal dendrograms denote the relationship between the clusters, i.e., similar observations. The color bar refers to levels above (red) or below (blue) the mean intake of the dietary variable or mean scores of lifestyle variables. Increased color intensities indicate larger differences around the mean. Abbreviations: EE MVPA, energy expenditure moderate and vigorous physical activity; PAL, physical activity level; Z-BMI-for-age, body mass index for age z-score.
Figure 4
Figure 4
Clusters of subjects and dietary/lifestyle variables identified via hierarchical clustering in the AMS by age group ((A) 1–3 years, (B) 3–6 years, (C) 6 to <10 years) in the Nutritional Study in Spanish Pediatric Population (EsNuPI) (n = 772). The clusters are visually separated by longitudinal marks on vertical and horizontal faces (clusters of subjects or dietary/lifestyle variables, respectively). The vertical and horizontal dendrograms denote the relationship between the clusters, i.e., similar observations. The color bar refers to levels above (red) or below (blue) the mean intake of dietary variable or mean scores of lifestyle variables. Increased color intensities indicate larger differences around the mean. Abbreviations: EE MVPA, energy expenditure moderate and vigorous physical activity; PAL, physical activity level; Z-BMI-for-age, body mass index for age z-score.
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