The role of Protein Intake (PI) at preschool age on later adiposity is understudied, and prospective studies also examining Dietary Glycemic Load (GL) are lacking. The current study evaluated the association of PI and GL at 4 years with adiposity and Fasting Serum Insulin (FSI) 3 years later, and examined the possible interaction between PI and GL on these associations, by sex.
This prospective study included 1999 singleton children enrolled in the population-based birth cohort, Generation XXI (Porto, Portugal, 2005–2006). Diet at 4 years was assessed by 3-days food diaries. Energy-adjusted PI and GL (g per day) were converted into sex-specific tertiles (T). At 7 years, Body Mass Index (BMI) z-scores were defined according to the World Health Organization. Sample’s sex-specific z-scores were computed for Fat Mass Index (FMI), Waist-to-Height ratio (W/Ht) and FSI. Associations were estimated by linear regression coefficients (β) and 95% confidence intervals (95% CI).
After adjustment for confounders, PI was positively associated with BMI in girls (T2 vs T1: β=0.187; 95% CI: 0.015, 0.359) and boys (T3 vs T1: β=0.205; 95% CI: 0.003, 0.406), being associated with FSI only in boys (T3 vs T1: β=0.207; 95% CI: 0.011, 0.404; P-interaction=0.026). Also, GL was associated with BMI only in boys (T3 vs T1: β=0.362; 95% CI: 0.031, 0.693; P-interaction=0.006), in whom significant interactions between PI and GL were found on the association with FMI (P=0.019) and W/Ht (P=0.039). Boys within the third T of both PI and GL at 4 years had higher FMI (β=0.505; 95% CI: 0.085, 0.925) and W/Ht (β=0.428; 95% CI: 0.022, 0.834) at 7 years.
In both girls and boys, PI at preschool age is positively associated with later BMI, being positively associated with FSI only in boys. Dietary GL is associated with adiposity only in boys, in whom it seems to interact with PI enhancing increased adiposity.
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We gratefully acknowledge the families enrolled in Generation XXI for their kindness, all members of the research team (coordinated by Henrique Barros) for their enthusiasm and perseverance and the participating hospitals and their staff for their help and support. We would also like to acknowledge the work of António Raso and Bárbara Nogueira for their contribution to the process of assigning GI values to the database. Generation XXI was funded by Programa Operacional de Saúde (Regional Department of Ministry of Health). It was supported by the Portuguese Foundation for Science and Technology (FCT) and by the Calouste Gulbenkian Foundation. This study was supported through FEDER from the Operational Programme Factors of Competitiveness—COMPETE and through national funding from the FCT (Portuguese Ministry of Education and Science) within the project PTDC/SAU-EPI/121532/2010 (FCOMP-01-0124-FEDER-021177). The work of Catarina Durão was also supported by a FCT grant (SFRH/BD/81788/2011).
Catarina Durão performed statistical analyses and drafted the initial manuscript; Andreia Oliveira and Ana Cristina Santos contributed to the design of data collection instruments; Milton Severo carried out statistical analysis; António Guerra contributed to the interpretation of data and discussion of results; Henrique Barros contributed to the design of the study, and coordinated and supervised data collection; Carla Lopes contributed to the design of study, to the design of data collection instruments, and to the discussion of results. All authors contributed to the study’s conception, reviewed and revised the manuscript and approved the final manuscript as submitted.
The authors declare no conflict of interest.
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Durão, C., Oliveira, A., Santos, A. et al. Protein intake and dietary glycemic load of 4-year-olds and association with adiposity and serum insulin at 7 years of age: sex-nutrient and nutrient–nutrient interactions. Int J Obes 41, 533–541 (2017). https://doi.org/10.1038/ijo.2016.240
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