Association between Overweight and Diet Diversity Score: A Cross-Sectional Study Conducted among Tunisian Children
Abstarct
1. Introduction
2. Methodology
2.1. Population
2.2. Dietary Intake Assessment
2.3. Diet Diversity Score
2.4. Anthropometric Measures
2.5. Demographic and Socio-Economic Characteristics
2.6. Data Analysis
3. Results
3.1. Demographics
3.2. Overweight Prevalence by Socio-Economic Characteristics
3.3. Analysis of Energy and Nutrient Intakes
3.4. Diet Diversity Score by Age and Overweight Status
3.5. Individual-Level Association between Overweight Status, Diet Diversity Score and Socio-Economic Characteristics
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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n | Age Group | p-Value | ||
---|---|---|---|---|
<6 Years | ≥6 Years | |||
Sex, female, % | 51.8 a | 47.9 | 0.19 | |
Father education level, % | ||||
No formal education | 10 | 0.3 | 0.9 | 0.0005 |
Primary schooling | 268 | 18.1 | 27.9 | |
Secondary schooling | 463 | 40.7 | 39.2 | |
University level | 409 | 40.5 | 32.0 | |
Mother education level, % | ||||
No formal education | 33 | 1.5 | 3.9 | <0.0001 |
Primary schooling | 250 | 14.2 | 27.7 | |
Secondary schooling | 421 | 35.2 | 36.9 | |
University level | 455 | 49.1 | 31.5 | |
Household head occupation | ||||
Not working | 15 | 1.2 | 1.3 | 0.022 |
Worker/employee | 674 | 55.1 | 62.3 | |
Middle executive | 211 | 22.6 | 15.8 | |
Upper executive | 230 | 21.1 | 20.3 | |
Household economic level | ||||
Low | 366 | 28.8 | 36.7 | 0.012 |
Medium | 375 | 37.4 | 30.8 | |
High | 362 | 33.7 | 32.5 |
Age Group | ||||
---|---|---|---|---|
<6 Years | ≥6 Years | |||
% | 95% C.I. | % | 95% C.I. | |
Sex, % | pa =0.54 | |||
pb = 0.99 | pc = 0.99 | |||
Boys | 21.7 | 17.2–27.0 | 29.3 | 24.4–34.7 |
Girls | 21.7 | 17.0–27.3 | 31.8 | 27.4–37.1 |
Father education level, % | p = 0.39 | |||
p = 0.19 | p = 0.042 | |||
No formal education | 47.6 | 10.9–87.1 | 17.8 | 2.4–65.3 |
Primary schooling | 18.5 | 11.9–27.7 | 24.4 | 18.6–31.3 |
Secondary schooling | 25.2 | 19.8–31.4 | 30.2 | 24.8–36.3 |
University level | 18.6 | 13.8–24.6 | 37.6 | 31.2–44.5 |
Mother education level, % | p = 0.28 | |||
p = 0.010 | p = 0.15 | |||
No formal education | 67.0 | 31.8–89.9 | 23.2 | 10.7–24.5 |
Primary schooling | 21.4 | 13.6–31.9 | 24.5 | 18.7–31.5 |
Secondary schooling | 23.8 | 18.2–30.4 | 32.4 | 26.6–38.7 |
University level | 18.8 | 14.4–24.1 | 34.3 | 28.0–41.2 |
Household head occupation, % | p = 0.99 | |||
p = 0.49 | p = 0.31 | |||
Not working | 31.9 | 8.3–70.9 | 12.7 | 1.8–54.4 |
Worker/employee | 22.9 | 18.4–28.2 | 29.0 | 24.7–33.8 |
Middle executive | 21.0 | 14.4–29.7 | 32.7 | 24.2–42.7 |
Upper executive | 16.4 | 10.4–24.8 | 36.0 | 28.0–44.8 |
Household economic level, % | p = 0.038 | |||
p = 0.73 | p = 0.0003 | |||
Low | 18.5 | 13.1–25.6 | 18.5 | 13.9–24.2 |
Medium | 20.6 | 15.3–27.1 | 30.6 | 24.3–37.6 |
High | 17.3 | 12.2–24.0 | 36.0 | 29.6–43.1 |
Total | <6 Years | ≥6 Years | p-Value | |
---|---|---|---|---|
Energy (kcal) | 1510 ± 7.9 a | 1446.3 ± 10.7 | 1581.0 ± 11.0 | <0.0001 |
Proteins (g/d) | 55.3 ± 0.4 | 54.1 ± 0.7 | 56.6 ± 0.6 | 0.005 |
Energy from proteins (%) | 14.8 ± 0.1 | 15.1 ± 0.2 | 14.4 ± 0.1 | 0.002 |
Carbohydrates (g/d) | 218.9 ± 1.4 | 208.7 ± 1.9 | 230.0 ± 1.9 | <0.0001 |
Energy from carbohydrates (%) | 58.1 ± 0.3 | 58.0 ± 0.5 | 58.3 ± 0.3 | 0.62 |
Total sugar (g/d) | 86.6 ± 1.0 | 91.9 ± 1.4 | 90.9 ± 1.4 | <0.0001 |
Energy from sugars (%) | 23.1 ± 0.3 | 25.5 ± 0.4 | 20.4 ± 0.3 | <0.0001 |
Dietary fibers (g/d) | 14.8 ± 0.2 | 14.1 ± 0.3 | 15.4 ± 0.2 | <0.0001 |
Fats (g/d) | 49.7 ± 0.5 | 47.8 ± 0.7 | 51.7 ± 0.6 | <0.0001 |
Energy from fats (%) | 29.6 ± 0.3 | 29.8 ± 0.6 | 29.3 ± 0.3 | 0.42 |
SFA b (mg/d) | 19.2 ± 0.2 | 18.8 ± 0.3 | 19.7 ± 0.3 | 0.058 |
Energy from SFA (%) | 11.4 ± 0.1 | 11.6 ± 0.2 | 11.1 ± 0.1 | 0.008 |
MUFA c (mg/d) | 17.2 ± 0.2 | 16.4 ± 0.3 | 18.1 ± 0.2 | <0.0001 |
Energy from MUFA (%) | 10.2 ± 0.1 | 10.2 ± 0.1 | 10.3 ± 0.1 | 0.46 |
PUFA d (mg/d) | 11.4 ± 0.2 | 10.6 ± 0.2 | 12.2 ± 0.2 | <0.0001 |
Energy from PUFA (%) | 6.78 ± 0.08 | 6.6 ± 0.1 | 7.0 ± 0.1 | 0.008 |
Vitamin A—RAE e (µg/d) | 511.2 ± 25.8 | 566.2 ± 47.2 | 451.1 ± 15.4 | 0.021 |
Vitamin E (alpha tocopherol) mg/d | 6.54 ± 0.15 | 6.4 ± 0.2 | 6.7 ± 0.2 | 0.36 |
Vitamin C (mg/d) | 76.4 ± 2.3 | 77.6 ± 3.4 | 75.1 ± 3.1 | 0.57 |
Vitamin B1 (mg/d) | 1.47 ± 0.02 | 1.34 ± 0.02 | 1.61 ± 0.02 | <0.0001 |
Vitamin B2 (mg/d) | 1.80 ± 0.02 | 1.80 ± 0.04 | 1.82 ± 0.02 | 0.54 |
Vitamin B3 (mg/d) | 14.1 ± 0.2 | 12.7 ± 0.2 | 15.5 ± 0.2 | <0.0001 |
Vitamin B5 (mg/d) | 4.11 ± 0.04 | 4.22 ± 0.07 | 3.99 ± 0.04 | 0.005 |
Vitamin B6 (mg/d) | 1.86 ± 0.03 | 2.00 ± 0.05 | 1.72 ± 0.04 | <0.0001 |
Vitamin B9 (mg/d) | 342.0 ± 4.4 | 304.3 ± 5.7 | 382.9 ± 6.2 | <0.0001 |
Vitamin B12 (µg/d) | 3.34 ± 0.29 | 3.81 ± 0.53 | 2.86 ± 0.15 | 0.089 |
Sodium (mg/d) | 2087 ± 19 | 1889 ± 24 | 2304 ± 25 | <0.0001 |
Potassium (mg/d) | 1944 ± 17 | 2022 ± 25 | 1859 ± 23 | <0.0001 |
Phosphorus (mg/d) | 1115 ± 8 | 1134 ± 12 | 1095 ± 11 | 0.018 |
Calcium (mg/d) | 916.9 ± 8.2 | 955.0 ± 13.0 | 875.3 ± 12.1 | <0.0001 |
Copper (mg/d) | 1.00 ± 0.03 | 0.97 ± 0.05 | 1.01 ± 0.02 | 0.47 |
Iron (mg/d) | 9.32 ± 0.09 | 8.55 ± 0.13 | 10.2 ± 0.10 | <0.0001 |
Magnesium (mg/d) | 422.9 ± 4.2 | 411.5 ± 5.9 | 435.4 ± 5.9 | 0.004 |
Zinc (mg/d) | 7.11 ± 0.06 | 7.10 ± 0.08 | 7.13 ± 0.07 | 0.74 |
<6 years (n = 532) | ≥6 years (n = 632) | |||||
---|---|---|---|---|---|---|
Non-Overweight | Overweight | p-Value | Non-Overweight | Overweight | p-Value | |
DDS score | 6.87 ± 0.07 a | 6.04 ± 0.26 | 0.002 | 6.82 ± 0.07 | 6.21 ± 0.18 | 0.002 |
All starch staples score | 0.98 ± 0.01 | 0.83 ± 0.03 | <0.001 | 0.98 ± 0.01 | 0.87 ± 0.02 | <0.0001 |
Vitamin A-rich vegetables and fruit score | 0.89 ± 0.02 | 0.77 ± 0.04 | 0.004 | 0.91 ± 0.01 | 0.83 ± 0.02 | 0.014 |
All other fruits score | 0.24 ± 0.02 | 0.24 ± 0.04 | 0.90 | 0.19 ± 0.02 | 0.17 ± 0.03 | 0.44 |
All other vegetables score | 0.86 ± 0.02 | 0.77 ± 0.04 | 0.023 | 0.86 ± 0.02 | 0.80 ± 0.03 | 0.061 |
All legumes and nuts score | 0.80 ± 0.02 | 0.71 ± 0.04 | 0.052 | 0.78 ± 0.02 | 0.68 ± 0.03 | 0.013 |
Oil and fat score | 0.81 ± 0.02 | 0.72 ± 0.04 | 0.034 | 0.82 ± 0.02 | 0.79 ± 0.03 | 0.38 |
Meat, poultry, fish score | 0.96 ± 0.01 | 0.81 ± 0.03 | <0.0001 | 0.96 ± 0.01 | 0.87 ± 0.02 | <0.0001 |
All dairy score | 0.98 ± 0.01 | 0.82 ± 0.03 | <0.0001 | 0.93 ± 0.01 | 0.82 ± 0.03 | <0.0001 |
Eggs score | 0.33 ± 0.02 | 0.37 ± 0.04 | 0.56 | 0.36 ± 0.02 | 0.36 ± 0.03 | 0.95 |
<6 Years | ≥6 Years | |||||||
---|---|---|---|---|---|---|---|---|
Crude Analysis | Adjusted Analysis | Crude Analysis | Adjusted Analysis | |||||
OR a | 95% C.I. b | OR a | 95% C.I. b | OR a | 95% C.I. b | OR a | 95% C.I. b | |
pc < 0.0001 | pc = 0.030 | pc < 0.0001 | pc = 0.093 | |||||
DDS | 0.81 | 0.72–0.89 | 1.37 | 1.03–1.82 | 0.84 | 0.77–0.91 | 1.15 | 0.97–1.35 |
Sex | pc = 0.99 | pc = 0.74 | pc = 0.48 | pc = 0.27 | ||||
Boys | 1 | 1 | 1 | 1 | ||||
Girls | 1.00 | 0.65–1.52 | 1.08 | 0.67–1.75 | 1.12 | 0.80–1.58 | 1.23 | 0.84–1.79 |
Father education level | pc = 0.21 | pc = 0.47 | pc = 0.045 | pc = 0.74 | ||||
No formal education | 1 | 1 | 1 | 1 | ||||
Primary schooling | 0.25 | 0.03–2.00 | 0.49 | 0.04–5.52 | 1.49 | 0.16–13.29 | 0.95 | 0.10–8.96 |
Secondary schooling | 0.37 | 0.05–2.81 | 0.97 | 0.10–9.68 | 2.00 | 0.22–17.69 | 0.99 | 0.10–9.20 |
University level | 0.25 | 0.03–1.92 | 0.95 | 0.10–10.5 | 2.78 | 0.32–24.7 | 1.39 | 0.13–13.91 |
Mother education level | pc = 0.033 | pc = 0.084 | pc = 0.15 | pc = 0.62 | ||||
No formal education | 1 | 1 | 1 | 1 | ||||
Primary schooling | 0.13 | 0.02–0.64 | 0.12 | 0.01–0.85 | 1.08 | 0.40–2.89 | 1.26 | 0.37–4.22 |
Secondary schooling | 0.15 | 0.03–0.69 | 0.10 | 0.02–0.62 | 1.58 | 0.60–4.15 | 1.31 | 0.39–4.36 |
University level | 0.11 | 0.02–0.51 | 0.09 | 0.01–0.57 | 1.72 | 0.65–4.55 | 0.93 | 0.26–3.31 |
Household head occupation | pc = 0.50 | pc = 0.42 | pc = 0.34 | pc = 0.96 | ||||
Not working | 1 | 1 | 1 | 1 | ||||
Worker/employee | 0.63 | 0.12–3.37 | 0.36 | 0.07–2.00 | 2.80 | 0.33–23.3 | 1.51 | 0.19–11.71 |
Middle executive | 0.56 | 0.10–3.14 | 0.35 | 0.06–2.16 | 3.33 | 0.39–28.5 | 1.34 | 0.15–11.41 |
Upper executive | 0.42 | 0.07–2.34 | 0.22 | 0.03–1.51 | 3.85 | 0.45–32.55 | 1.37 | 0.16–11.50 |
Household economic level | pc = 0.73 | pc = 0.54 | pc = 0.0004 | pc = 0.030 | ||||
Low | 1 | 1 | 1 | 1 | ||||
Medium | 1.13 | 0.65–1.97 | 1.45 | 0.74–2.85 | 1.93 | 1.21–3.08 | 1.81 | 1.04–3.15 |
High | 0.91 | 0.51–1.64 | 1.31 | 0.59–2.89 | 2.47 | 1.58–3.88 | 2.30 | 1.22–4.33 |
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Dogui, D.; Doggui, R.; El Ati, J.; El Ati-Hellal, M. Association between Overweight and Diet Diversity Score: A Cross-Sectional Study Conducted among Tunisian Children. Children 2021, 8, 536. https://doi.org/10.3390/children8070536
Dogui D, Doggui R, El Ati J, El Ati-Hellal M. Association between Overweight and Diet Diversity Score: A Cross-Sectional Study Conducted among Tunisian Children. Children. 2021; 8(7):536. https://doi.org/10.3390/children8070536
Chicago/Turabian StyleDogui, Darine, Radhouene Doggui, Jalila El Ati, and Myriam El Ati-Hellal. 2021. "Association between Overweight and Diet Diversity Score: A Cross-Sectional Study Conducted among Tunisian Children" Children 8, no. 7: 536. https://doi.org/10.3390/children8070536