Changing Landscape from Nutrients to Dietary Patterns: Implications to Child Health
The last several decades have seen a major shift in how diet is viewed: from a purely nutritional function to a platform to mitigate and safe- guard against chronic diseases. A healthy diet defined by the WHO as one that helps to protect against malnutrition in all its forms (undernutri- tion, overnutrition, or micronutrient deficiency), and noncommunicable diseases (NCDs) like diabetes, heart disease, stroke, and cancer, has now become the ultimate goal [1].
For infants and young children, the aim is for optimal nutrition in the first 2 years of life to achieve enhanced growth and development as well as reduce the risk of becoming overweight or obese and developing NCDs later in life [1].
The emphasis on the diet-disease relationship has acquired a new dimension recently, from a focus on single nutrients to dietary patterns. It is difficult to attribute health effects to a single dietary component as individual dietary components interact with each other in the form of food synergy. From a narrow perspective involving micronutrients then macronutrients to foods and food groups, the view has become wider in scope. It changed the nutrition landscape to involve dietary patterns and how they affect dietary quality, which in the long-term can relate to health and disease outcomes.
Dietary patterns are quantities, proportions, variety, or combina- tion of different foods, drinks, and nutrients in diets and the frequency by which they are habitually consumed [2]. A healthy dietary pattern is composed of nutrient-dense foods and beverages across all food groups in recommended amounts based on age and physiologic status and within calorie limits. It should support present and future health, be established early, and be maintained throughout life course to minimize the risks of diet-related chronic diseases. Conversely, consuming unhealthy dietary patterns throughout life can increase the risks of chronic diseases like car- diovascular diseases, obesity, diabetes, and some forms of cancer.
Dietary patterns are used to assess diet quality. Two methods are used to derive dietary patterns: the index-based (a priori or hypothesis-oriented) approach and the data-driven (a posteriori or exploratory) approach. The index-based approach relies on previ- ous scientific knowledge on the effects of diet on health and disease, calculated as the dietary quality score, and measures how intake of diet components conforms to standards or guidelines. Examples are the Healthy Eating Index, Mediterranean Diet Score, and the DASH score. The data-driven approach is purely mathematical and popu- lation specific and relies on statistical modeling, where food com- ponents are reduced in number as principal components, factors, or clusters based on how they account for the greatest variation in the data set. Examples are arbitrary and descriptive: “western,” ”pru- dent,” and “healthy” diets.
The effects of dietary patterns on health outcomes are more stud- ied in adults. Figure 1 shows a summary of some studies regarding these in children. Recently, the emphasis of pediatric studies is on tracking the dietary patterns from early childhood to later life stages coming from large longitudinal studies. These have unraveled a common conclusion that dietary patterns, whether healthy or unhealthy, can develop early in life and may persist throughout childhood and beyond. Two major out- comes studied are cardiometabolic markers and adiposity. These may have an impact on later risks for diseases such that early intervention may be warranted to foster a healthy eating pattern geared toward better future health outcomes.
References
- World Health Organization. Healthy diet. 2020 April 26 [cited 2022 May 1]. Available from: https://www.who.int/news-room/fact-sheets/detail/healthy-diet
- US Department of Agriculture, Center for Nutrition Policy and Promotion, Nutrition Evidence Library, Dietary Patterns Technical Expert Collaborative. A series of system- atic reviews on the relationship between dietary patterns and health outcomes. 2014 [cited 2022 May 1]. Available from: https://nesr.usda.gov/sites/default/files/2019-06/ DietaryPatternsReport-FullFinal2.pdf.