title: Association of Dietary Variety and Diversity With Body Mass Index in US Preschool Children.
abstract: OBJECTIVE
  Dietary variety and diversity are recommended in dietary guidelines, but their association with BMI in US preschool-aged children is unknown. This study examined predictors of dietary variety and diversity and their association with child BMI z score (BMIz).
  
  
  METHODS
  Primary caregivers responded to a food frequency questionnaire. Child anthropometry was obtained concurrently (n = 340) and prospectively (n = 264). Dietary variety scores and dietary diversity scores were computed. Multivariable linear regression was used to model predictors of these scores and their association with BMIz concurrently and BMIz change per year prospectively.
  
  
  RESULTS
  The sample was 49.4% boys; 69.4% of the primary caregivers were non-Hispanic white and 46.2% had a high school education or less. Girls and older children had greater Fruit and Vegetable Variety (gender: P = .03, age: P < .001), Healthy Foods Variety (P = .02, P < .001), and Dietary Diversity (P = .04, P = .03) scores. Older children also had greater scores for Overall Variety (P < .001) and Moderation Foods (eg, high-fat, high-sugar foods recommended to be consumed in moderation) (P < .001). Having a non-Hispanic white primary caregiver (versus not) was associated with lower Dietary Diversity (P = .01). Greater Healthy Variety, Overall Variety, and Dietary Diversity were associated with greater annual increases in BMIz prospectively (β[SE] = 0.009 [0.004], P = .04; β[SE] = 0.007 [0.003], P = .02; β[SE] = 0.003 [0.001], P = .02, respectively), adjusted for energy intake.
  
  
  CONCLUSIONS
  Greater dietary variety and diversity were prospectively associated with higher BMIz. Targeting dietary variety and diversity as an obesity prevention strategy in children requires careful consideration.
authors.affiliation: Departments of Epidemiology.
authors.forename: Carmen
authors.initials: C
authors.lastname: Fernandez
authors.affiliation: Nutritional Sciences, and University of Colorado Pediatric Nutrition Section and Rocky Mountain Prevention Research Center, Denver, Colorado;
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Kasper
authors.affiliation: Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan; Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan;
authors.forename: Alison L
authors.initials: AL
authors.lastname: Miller
authors.affiliation: Nutritional Sciences, and Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan; and.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Lumeng
authors.affiliation: Nutritional Sciences, and Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan; Departments of Nutrition and Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts karenep@umich.edu.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Peterson
mesh_terms: D015992:Body Mass Index; D002675:Child, Preschool; D002149:Energy Intake / Q000502:physiology*; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008824:Michigan / Q000453:epidemiology; D009749:Nutrition Surveys / Q000379:methods*; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D013997:Time Factors