Background
Methods
Data collection
Application of the HCST to dietary recalls
Foods recommended in the EWCFG
Foods not recommended in the EWCFG
Definition of compliance to the HCST tier system
Identification of implausible reporters
Statistical analyses
Results
Quantity of foods consumed
2–3 years (boys and girls) | 4–8 years (boys and girls) | 9–13 years (boys) | 9–13 years (girls) | 14–18 years (boys) | 14–18 years (girls) | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Number of servings/day | Mean | SEM | Mean | SEM | Mean | SEM | Mean | SEM | Mean | SEM | Mean | SEM |
Vegetables and Fruits | ||||||||||||
Tiers 1–3 | 4.95 | 0.16c
| 4.53 | 0.17c
| 4.10 | 0.21d
| 4.59 | 0.22d
| 3.94 | 0.23e
| 4.58 | 0.20e
|
Tiers 1–4 | 5.16 | 0.16c
| 4.76 | 0.17c
| 4.43 | 0.21d
| 4.87 | 0.22d
| 4.33 | 0.23e
| 4.91 | 0.20e
|
EWCFG Recommendation | 4 | 5 | 6 | 6 | 8 | 7 | ||||||
Grain Products | ||||||||||||
Tiers 1–3 | 4.85 | 0.14c
| 5.56 | 0.1c
| 5.69 | 0.20 | 5.50 | 0.17d
| 5.73 | 0.21e
| 5.43 | 0.17e
|
Tiers 1–4 | 5.90 | 0.15c
| 6.80 | 0.17c
| 6.82 | 0.22 | 6.76 | 0.18d
| 6.60 | 0.24e
| 6.53 | 0.19e
|
EWCFG Recommendation | 3 | 4 | 6 | 6 | 7 | 6 | ||||||
Milk and Alternatives | ||||||||||||
Tiers 1–3 | 3.09 | 0.09c
| 2.64 | 0.09c
| 2.35 | 0.11 | 2.26 | 0.10 | 1.86 | 0.13 | 1.94 | 0.10 |
Tiers 1–4 | 3.30 | 0.09c
| 2.83 | 0.09c
| 2.55 | 0.12 | 2.46 | 0.10 | 2.10 | 0.13 | 2.15 | 0.10 |
EWCFG Recommendation | 2 | 2 | 3–4 | 3–4 | 3–4 | 3–4 | ||||||
Meat and Alternatives | ||||||||||||
Tiers 1–3 | 1.28 | 0.08 | 1.34 | 0.09 | 1.57 | 0.12 | 1.39 | 0.10d
| 1.89 | 0.12e
| 1.52 | 0.10e
|
Tiers 1–4 | 1.61 | 0.07 | 1.68 | 0.08 | 1.92 | 0.11 | 1.71 | 0.09d
| 2.20 | 0.11e
| 1.76 | 0.10e
|
EWCFG Recommendation | 1 | 1 | 1–2 | 1–2 | 3 | 2 |
2–3 years (boys and girls) | 4–8 years (boys and girls) | 9–13 years (boys) | 9–13 years (girls) | 14–18 years (boys) | 14–18 years (girls) | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Variable (kcal/day) | Mean | SEM | Mean | SEM | Mean | SEM | Mean | SEM | Mean | SEM | Mean | SEM |
Tiers 1 + 2 + 3b
| 999 | 16 | 1142 | 14 | 1395 | 24 | 1160 | 19 | 1621 | 26 | 1144 | 19 |
Tier 4c
| 165 | 8 | 239 | 7 | 33 | 14 | 262 | 12 | 356 | 14 | 240 | 11 |
Other Foods | ||||||||||||
Alcoholic beveragesd
| 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 36 | 11 | 15 | 2 |
Beverages, higher calorie (≥40 kcal/100 g)e
| 60 | 4 | 90 | 4 | 149 | 6 | 126 | 5 | 227 | 9 | 144 | 7 |
Beverages, lower calorie (<40 kcal/100 g)f
| 7 | 1 | 12 | 1 | 22 | 2 | 18 | 2 | 33 | 3 | 25 | 3 |
High fat and/or sugar foodsg
| 93 | 10 | 122 | 4 | 195 | 11 | 165 | 9 | 191 | 10 | 168 | 12 |
Meal replacementsh
| 1 | 0 | 1 | 1 | 2 | 1 | 1 | 0 | 7 | 3 | 2 | 1 |
Saturated and/or trans fats and oilsi
| 31 | 2 | 44 | 2 | 60 | 4 | 47 | 3 | 78 | 5 | 52 | 3 |
Supplementsj
| 1 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 1 | 0 | 1 | 0 |
Uncategorized ingredients, seasonings and unprepared foodsk
| 7 | 1 | 8 | 1 | 13 | 1 | 14 | 2 | 19 | 2 | 15 | 1 |
Unsaturated fats and oilsl
| 23 | 2 | 33 | 2 | 51 | 4 | 39 | 3 | 72 | 4 | 61 | 4 |
Total energy from Tier 4 and “other” foods (kcal/day)m
| 363 | 14 | 515 | 10 | 770 | 20 | 632 | 17 | 940 | 27 | 659 | 19 |
Total (% of total Tier 4 and “other” foods)n
| 23 | 1 | 27 | 0 | 31 | 1 | 30 | 1 | 31 | 1 | 31 | 1 |
Quality of food consumed
Association between percentage of energy from tier 4 and “other” foods and obesity
Compliers (Q1)c
| Intermediates (Q2)d
| Intermediates (Q3)d
| Non-compliers (Q4)e
| ||||||
---|---|---|---|---|---|---|---|---|---|
≤22.29 % Energy | 22-29-33.83 % Energy | 33.83-47.48 % Energy | >47.48 % Energy | ||||||
Characteristics | Mean | SEM | Mean | SEM | Mean | SEM | Mean | SEM | P-Trend |
Age (years) | 6.55 | 0.23 | 7.09 | 0.28 | 7.31 | 0.30 | 7.61 | 0.29 | <.0001 |
Sex | |||||||||
Males (%) | 49.60 | 2.81 | 53.55 | 3.16 | 52.21 | 2.55 | 48.12 | 2.57 | |
Females (%) | 50.40 | 2.81 | 46.45 | 3.16 | 47.79 | 2.55 | 51.88 | 2.57 | 0.3034 |
BMI (kg/m2) | 17.64 | 0.17 | 17.78 | 0.16 | 17.55 | 0.15 | 17.41 | 0.12 | 0.3100 |
Misreporting Status | |||||||||
Under Reporters (%) | 11.72 | 1.88 | 9.89 | 1.65 | 5.80 | 1.00 | 6.48 | 1.13 | |
Plausible Reporters (%) | 56.60 | 2.73 | 52.64 | 2.79 | 54.19 | 2.51 | 49.79 | 2.94 | |
Over Reporters (%) | 31.69 | 2.45 | 37.47 | 2.62 | 40.01 | 2.47 | 43.73 | 3.04 | 0.0015 |
Physical Activity (%)f
| |||||||||
(60 min, 0 days/wk) | 3.18 | 1.46 | 0.76 | 0.43 | 1.75 | 0.84 | 1.75 | 0.93 | |
(60 min, 1 day/wk) | 1.60 | 0.87 | 2.05 | 1.26 | 2.75 | 0.98 | 2.88 | 1.06 | |
(60 min, 2–3 days/wk) | 18.09 | 3.17 | 15.31 | 3.16 | 17.03 | 2.67 | 13.42 | 2.30 | |
(60 min, 4+ days/wk) | 77.13 | 3.37 | 81.88 | 3.23 | 78.47 | 2.81 | 81.95 | 2.54 | 0.3849 |
Association between the percentage of energy from tier 4 foods and “other” foods and overall dietary nutrient density
Compliers (Q1)e
| Intermediates (Q2)f
| Intermediates (Q3)f
| Non-compliers (Q4)g
| |||||||
---|---|---|---|---|---|---|---|---|---|---|
≤22.29 % Energy | 22-29-33.83 % Energy | 33.83-47.48 % Energy | >47.48 % Energy | |||||||
Nutrients | Mean | SEM | Mean | SEM | Mean | SEM | Mean | SEM | P-Trend | |
Energy (kcal/day) | c | 1863 | 42 | 1996 | 36 | 2026 | 30 | 2116 | 49 | 0.00 |
d | 1732.13 | 24.75 | 1799.65 | 21.80 | 1774.36 | 23.62 | 1834.42 | 27.44 | 0.05 | |
Fat (%Energy) | c | 28.14 | 0.38 | 30.39 | 0.36 | 30.93 | 0.35 | 33.07 | 0.44 | <.0001 |
d | 27.59 | 0.37 | 29.67 | 0.38 | 30.04 | 0.36 | 32.13 | 0.44 | <.0001 | |
Saturated fat (%Energy) | c | 10.55 | 0.19 | 11.08 | 0.21 | 11.10 | 0.16 | 11.68 | 0.21 | 0.00 |
d | 10.35 | 0.20 | 10.83 | 0.22 | 10.79 | 0.19 | 11.35 | 0.22 | 0.00 | |
Monounsaturated fat (%Energy) | c | 10.28 | 0.18) | 11.56 | 0.17 | 11.97 | 0.18 | 12.95 | 0.21 | <.0001 |
d | 10.06 | 0.17 | 11.27 | 0.19 | 11.61 | 0.18 | 12.57 | 0.21 | <.0001 | |
Polyunsaturated fat (%Energy) | c | 4.35 | 0.13 | 4.64 | 0.08 | 4.94 | 0.09 | 5.37 | 0.15 | <.0001 |
d | 4.26 | 0.13 | 4.52 | 0.10 | 4.80 | 0.09 | 5.23 | 0.14 | <.0001 | |
Carbohydrates (%Energy) | c | 55.58 | 0.49 | 54.46 | 0.40 | 55.71 | 0.44 | 55.19 | 0.51 | 0.15 |
d | 56.28 | 0.49 | 55.33 | 0.43 | 54.78 | 0.46 | 56.31 | 0.52 | 0.08 | |
Added sugar (%Energy) | c | 10.81 | 0.38 | 12.24 | 0.42 | 14.79 | 0.50 | 17.20 | 0.59 | <.0001 |
d | 10.84 | 0.43 | 12.28 | 0.47 | 14.84 | 0.58 | 17.26 | 0.66 | <.0001 | |
Dietary fiber (g/1000 kcal) | c | 8.19 | 0.17 | 7.36 | 0.15 | 6.90 | 0.15 | 6.01 | 0.12 | <.0001 |
d | 8.30 | 0.19 | 7.50 | 0.18 | 7.08 | 0.18 | 6.21 | 0.16 | <.0001 | |
Protein (%Energy) | c | 16.28 | 0.21 | 15.09 | 0.21 | 13.35 | 0.17 | 11.71 | 0.16 | <.0001 |
d | 16.13 | 0.22 | 14.94 | 0.21 | 13.17 | 0.19 | 11.55 | 0.17 | <.0001 | |
Alcohol (%Energy) | c | 0.00 | 0.00 | 0.06 | 0.04 | 0.01 | 0.00 | 0.02 | 0.01 | 0.11 |
d | 0.00 | 0.00 | 0.06 | 0.04 | 0.01 | 0.00 | 0.02 | 0.01 | 0.14 | |
Vitamin A (RE/1000 kcal) | c | 348.98 | 9.25 | 334.97 | 10.17 | 296.11 | 7.47 | 259.22 | 7.56 | <.0001 |
d | 348.61 | 9.67 | 335.92 | 11.47 | 297.65 | 8.40 | 261.61 | 8.15 | <.0001 | |
Vitamin D (ug/1000 kcal) | c | 3.62 | 0.11 | 3.36 | 0.11 | 2.92 | 0.09 | 2.45 | 0.08 | <.0001 |
d | 3.67 | 0.14 | 3.42 | 0.12 | 3.00 | 0.11 | 2.53 | 0.10 | <.0001 | |
Thiamin (mg/1000 kcal) | c | 0.99 | 0.02 | 0.89 | 0.02 | 0.79 | 0.01 | 0.68 | 0.01 | <.0001 |
d | 1.00 | 0.02 | 0.90 | 0.02 | 0.80 | 0.02 | 0.69 | 0.02 | <.0001 | |
Riboflavin (mg/1000 kcal) | c | 1.15 | 0.01 | 1.08 | 0.02 | 1.00 | 0.02 | 0.93 | 0.03 | <.0001 |
d | 1.16 | 0.02 | 1.10 | 0.02 | 1.03 | 0.02 | 0.95 | 0.04 | <.0001 | |
Niacin (NE/1000 kcal) | c | 17.77 | 0.27 | 16.52 | 0.21 | 15.05 | 0.18 | 13.24 | 0.17 | <.0001 |
d | 17.64 | 0.29 | 16.40 | 0.21 | 14.90 | 0.21 | 13.10 | 0.19 | <.0001 | |
Vitamin B6 (ug/1000 kcal) | c | 0.94 | 0.02 | 0.83 | 0.02 | 0.73 | 0.01 | 0.61 | 0.01 | <.0001 |
d | 0.94 | 0.02 | 0.83 | 0.02 | 0.73 | 0.01 | 0.62 | 0.01 | <.0001 | |
Folate (ug/1000 kcal) | c | 108.16 | 2.86 | 96.56 | 2.56 | 84.59 | 2.21 | 74.28 | 2.19 | <.0001 |
d | 109.22 | 3.31 | 98.12 | 2.84 | 86.58 | 2.60 | 76.48 | 2.80 | <.0001 | |
Vitamin B12 (ug/1000 kcal) | c | 2.17 | 0.09 | 2.10 | 0.10 | 1.86 | 0.11 | 1.44 | 0.04 | <.0001 |
d | 2.13 | 0.09 | 2.06 | 0.10 | 1.82 | 0.11 | 1.40 | 0.05 | <.0001 | |
Vitamin C (mg/1000 kcal) | c | 86.23 | 3.76 | 76.90 | 2.98 | 71.93 | 2.39 | 65.23 | 2.73 | <.0001 |
d | 86.96 | 4.56 | 78.32 | 3.49 | 73.81 | 3.04 | 67.48 | 3.37 | 0.00 | |
Calcium (mg/1000 kcal) | c | 610.13 | 12.76 | 571.64 | 10.27 | 505.19 | 10.13 | 427.65 | 8.15 | <.0001 |
d | 614.92 | 13.74 | 578.60 | 11.48 | 514.03 | 11.73 | 437.46 | 10.04 | <.0001 | |
Phosphorous (mg/1000 kcal) | c | 740.25 | 9.42 | 693.36 | 8.84 | 620.76 | 8.43 | 543.90 | 7.80 | <.0001 |
d | 742.69 | 10.05 | 697.08 | 9.68 | 625.53 | 9.72 | 549.29 | 9.00 | <.0001 | |
Potassium (mg/1000 kcal) | c | 1580.91 | 24.20 | 1438.47 | 20.67 | 1299.15 | 18.56 | 1099.98 | 19.08 | <.0001 |
d | 1592.29 | 24.48 | 1455.85 | 22.21 | 1321.45 | 20.19 | 1125.10 | 20.13 | <.0001 | |
Sodium (mg/1000 kcal) | c | 1446.79 | 38.66 | 1438.80 | 30.64 | 1477.03 | 27.64 | 1358.75 | 19.94 | 0.00 |
d | 1440.79 | 38.37 | 1433.99 | 33.88 | 1471.81 | 30.13 | 1354.73 | 23.75 | 0.00 | |
Magnesium (mg/1000 kcal) | c | 156.20 | 2.02 | 139.59 | 1.88 | 127.66 | 1.47 | 110.43 | 1.51 | <.0001 |
d | 157.58 | 2.20 | 141.52 | 2.07 | 130.10 | 1.86 | 113.10 | 1.76 | <.0001 | |
Iron (mg/1000 kcal) | c | 7.47 | 0.13 | 6.95 | 0.11 | 6.48 | 0.10 | 5.78 | 0.08 | <.0001 |
d | 7.53 | 0.14 | 7.02 | 0.12 | 6.56 | 0.11 | 5.86 | 0.10 | <.0001 | |
Zinc (mg/1000 kcal) | c | 5.52 | 0.09 | 5.38 | 0.17 | 4.87 | 0.25 | 4.02 | 0.07 | <.0001 |
d | 5.47 | 0.09 | 5.31 | 0.17 | 4.78 | 0.25 | 3.92 | 0.08 | <.0001 | |
Glycemic Index | c | 52.42 | 0.32 | 53.96 | 0.33 | 56.14 | 0.31 | 57.85 | 0.31 | <.0001 |
d | 52.38 | 0.32 | 53.91 | 0.34 | 56.07 | 0.33 | 57.77 | 0.34 | <.0001 | |
Glycemic Load | c | 135.93 | 2.93 | 148.16 | 2.82 | 160.79 | 3.27 | 171.85 | 3.94 | <.0001 |
d | 126.67 | 2.02 | 134.26 | 1.99 | 143.01 | 2.75 | 151.92 | 2.71 | <.0001 | |
Energy Density (kcal/g) | c | 1.80 | 0.03 | 1.92 | 0.03 | 2.05 | 0.03 | 2.33 | 0.04 | <.0001 |
d | 1.79 | 0.04 | 1.90 | 0.03 | 2.03 | 0.03 | 2.30 | 0.04 | <.0001 |