title: Free Sugars and Total Fat Are Important Characteristics of a Dietary Pattern Associated with Adiposity across Childhood and Adolescence.
abstract: BACKGROUND
  The importance of dietary sugar compared with fat in the development of obesity is currently a topic of debate.
  
  
  OBJECTIVE
  We aimed to identify dietary patterns (DPs) characterized by high sugar content, high fat content, or both and their longitudinal associations with adiposity during childhood and adolescence.
  
  
  METHODS
  Participants were 6722 children from the ALSPAC (Avon Longitudinal Study of Parents and Children) who were born in 1991-1992. DPs were characterized by percentage of total energy intake (%E) from free sugars, %E from total fat, and dietary energy density (DED) and fiber density by using reduced rank regression at 7, 10, and 13 y of age. Total body fat mass was measured at 11, 13, and 15 y of age. Regression analyses were used to adjust for dietary misreporting, physical activity, and maternal social class.
  
  
  RESULTS
  Two major DPs were identified: higher z scores for DP1 were associated with greater DED, greater %E from free sugars and total fat, and lower fiber density; higher z scores for DP2 were associated with greater %E from free sugars but lower %E from total fat and DED. A 1-SD increase in z score for DP1 was associated with a mean increase in the fat mass index z score of 0.04 SD units (95% CI: 0.01, 0.07; P = 0.017) and greater odds of excess adiposity (OR: 1.12; 95% CI: 1.0, 1.25; P = 0.038). DP2 was not associated with adiposity.
  
  
  CONCLUSIONS
  An energy-dense DP high in %E from total fat and free sugars is associated with greater adiposity in childhood and adolescence. This appears to confirm the role of both fat and sugar and provides a basis for food-based dietary guidelines to prevent obesity in children.
authors.affiliation: School of Population Health, The University of Western Australia, Perth, Australia.|Medical Research Council Human Nutrition Research, Cambridge, United Kingdom.
authors.forename: Gina L
authors.initials: GL
authors.lastname: Ambrosini
authors.affiliation: Medical Research Council Human Nutrition Research, Cambridge, United Kingdom.|Public Health Directorate, National Health Service Lincolnshire, Lincoln, United Kingdom.
authors.forename: David J
authors.initials: DJ
authors.lastname: Johns
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: Kate
authors.initials: K
authors.lastname: Northstone
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: Pauline M
authors.initials: PM
authors.lastname: Emmett
authors.affiliation: Medical Research Council Human Nutrition Research, Cambridge, United Kingdom.|Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Jebb
keywords: ALSPAC; adiposity; adolescents; children; diet; dietary patterns; energy density; fat; obesity; sugar