BMJ open: High frequency eating in children and adolescents is associated with low body mass index and is recommended for 5 meals per day.

Current trends in the body mass index (BMI) of children and adolescents indicate that the BMI of children and adolescents continues to grow rapidly in different low-/middle-income countries (LMICs).
In addition, some countries in Latin America have reported a rapid transition from underweight to overweight and obesity, where the median distribution of overweight among school-age children is estimated at 29.8 per cent, compared with 17.8 per cent among adolescents.
of changes in body mass index is the imbalance between food intake and energy consumption.
, differences in certain dietary characteristics, such as dietary quality or energy intake, may affect BMI changes.
sense, eating frequency is considered a potential risk factor for weight index gain, such as overweight and obesity.
, studies have shown that regular (i.e. more frequent) eating is associated with a lower risk of overweight and obesity.
addition, a recent systematic review and meta-analysis of 57 observational studies found a significant relationship between frequent diets and better nutritional outcomes, including lower BMI.
But this meta-analysis only includes reports from high-income countries, since most of the summarized studies are cross-sectional (only eight studies are vertical) and only one study comes from Latin America (Puerto Rico).
these longitudinal studies did not take into account changes in eating frequency and BMI over time.
therefore, it is not clear whether the relationship between eating frequency and BMI is established in Latin America.
, a study published in BMJ Open assessed the relationship between the frequency of children's diets in lower-income countries (Peru) and changes in BMI over time.
low- and middle-income countries, is the frequency of diet positively or negatively related to BMI? The study was divided into two groups of different age groups: the younger group registered 2,052 children aged 6 to 18 months, and the older group included 1,000 children between the ages of 7 and 8.
, the outpost sampling strategy is adopted, and the sentinel is multi-stage, clustered and random sampling techniques.
initial sample framework was carried out at the regional level, with 20 outposts selected from 1,818 available areas.
to sample poor areas, the sampling did not include the richest 5 per cent.
in the study, parents were asked seven questions related to their children's eating: Did the child eat breakfast in the previous 24 hours: Any food? Do you have breakfast? Do you have any food in the morning and noon? Do you have any meals? Do you have anything to eat at noon and evening? Do you have dinner? Do you have anything to eat after dinner? Simply add a "yes/no" answer to these seven questions to estimate the total number of times your child has ingested in the past 24 hours.
for analysis, variables are classified as 4, 4, 5, 6 and 7 times a day, 5 times, and intermediate categories (5 times a day) as reference categories.
Other variables are also included in the regression model as a potential mix of baseline assessments, including: gender (boys or girls), age (in years), three levels of wealth index assessment based on family assets (low, medium and high), environmental type (urban or rural), and maternal and child education years (7 years, 7 years, 11 years and 12 years).
: The study initially recruited 2,052 younger children.
103 (5.0 per cent) of them had lost their visits and 1 (0.1 per cent) had been excluded due to lack of data.
result, 1948 people were included in the baseline analysis, with an average age of 4.3 years and 49.6 per cent female.
baseline data show that these children ate an average of 4.9 times a day (standard deviation: 1.0, range: 2 7), 43.5 per cent five times a day, 11.0 per cent four times a day and 4.0 per cent seven times a day.
noted that the child's age, mother's and father's education, socioeconomic status, environmental type and mother's BMI were positively related to the frequency of diet.
population characteristics were also studied according to the classification of baseline dietary frequencies.
based on the multivarivariation model, lower feeding frequencies were associated with higher BMI and BMI-for-age z scores.
who ate four meals a day had an increased body mass index (BMI).
, changes in those who ate six or seven times a day showed no correlation.
food frequency and BMI over time (A) BMI and (B) BMI-for-age z-score over time.
, there was an association between the frequency of daily feeding in children and changes in body mass index over time.
Although the scale of the association was small, over time, low-frequency eating was associated with a greater increase in BMI: people who ate less than five times a day had larger BMI and BMI-for-age z-score measurements, while those who ate five times a day did not increase these results.
In addition, almost two thirds of the subjects ate five times a day during baseline examinations (i.e., children between the ages of 4 and 5), but that number decreased to less than half as children grew to between the ages of 14 and 15.
effects of food frequency on endocrine response and regulation could explain the findings.
increasing the frequency of eating may reduce post-meal metabolism and endocrine response to nutrient intake, which in turn may lead to reduced insulin secretion.
because there is more evidence that not eating, especially breakfast, increases the risk of overnutrition in children (i.e. overweight and obesity), regular eating patterns of at least five meals a day should be promoted.
, it is important to promote the quality and composition of meals to children, especially their parents, families and caregivers.
: Bernabe-Ortiz, A., and Carrillo-Larco, R. M. (2020). Longitudinal association between food frequency and changes in body mass index: a prospective cohort study. BMJ Open, 10 (9), e037057. doi:10.1136/bmjopen-2020-037057liangying Source: MedSci Originals !-- Content Presentation Ends -- !-- To Determine If Login Ends.