Free Sugars and Total Fat Are Important Characteristics of a Dietary Pattern Associated with Adiposity across Childhood and Adolescence(1)(2)(3)

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.