Dietary patterns in school-aged children are associated with the risk of overweight/obesity in Hainan Island: the largest free-trade zone in Southern China.
5 affiliations
- 1Hainan Women and children's Medical Center, School of Pediatrics, Hainan Medical University, Hainan Academy of Medical Sciences, Haikou, 571199,, China.
- 2School of Pediatrics, Hainan Medical University, Haikou, China.
- 3School of Public Health, Hainan Medical University, Haikou, China.
- 4Hainan Women and children's Medical Center, School of Pediatrics, Hainan Medical University, Hainan Academy of Medical Sciences, Haikou, 571199,, China. [email protected].
- 5School of Pediatrics, Hainan Medical University, Haikou, China. [email protected].
Abstract
Background
Childhood overweight/obesity stems from complex interactions among genetic, environmental, and behavioral factors, with diet being a key modifiable determinant. However, evidence on the association between dietary patterns and overweight/obesity remains inconclusive.Methods
We conducted a cross-sectional study to investigate the association between dietary patterns and overweight/obesity among 13,312 school-aged children (6-12 years) in Hainan Province, China, from January 2021 to June 2022. We recorded the height and weight of each child and calculated their body mass index (BMI). The z-score for BMI for age was calculated using the WHO-recommended AnthroPlus software, and diagnoses of overweight and obesity were determined according to the WHO criteria. Dietary information on school-age children was collected by a validated food frequency questionnaire, which covered the most common foods consumed in Hainan, China. Factor analysis was conducted using principal component analysis and varimax rotation to group food items with factor loadings >0.5. Subsequently, K-means clustering was applied to classify children into five dietary pattern clusters. Logistic regression was used to explore the relationship between dietary patterns and overweight/obesity in school-aged children.Results
The study identified five distinct dietary patterns among school-aged children in Hainan Province. Traditional (n = 2,039, 15.32%): Dominated by staple foods, meat, eggs, and fruits. High-fat and high-protein (n = 3,469, 26.06%): Characterized by high consumption of nuts, beans, aquatic products, and dairy products. Balanced (n = 5,560, 41.77%): Marked by a balanced intake of staple foods, meat, eggs, fruits, vegetables, nuts, beans, aquatic products, and dairy products. Dried fruits (n = 676, 5.08%): Primarily consisting of dried fruits. Snacks (n = 1,568, 11.77%): Mainly composed of sugary drinks, puffed foods, fried foods, and dried fruits. Balanced dietary pattern is the main dietary pattern for school-age children in Hainan Province. Compared to the balanced dietary pattern, the traditional pattern (OR = 0.88, 95%CI : 0.75-1.03) and dried fruit dietary pattern (OR = 1.13, 95%CI : 0.91-1.40) showed no significant association with overweight/obesity after multivariable adjustment. To avoid clinically trivial effects in this large sample, we applied a conservative effect size threshold (OR ≥ 1.2). Only the snack-based dietary pattern showed a clinically meaningful association with overweight/obesity after multivariable adjustment (OR = 1.22, 95%CI : 1.04-1.43). The high-fat, high-protein pattern showed a statistically significant but clinically negligible association (OR = 1.15, 95%CI : 1.03-1.30), which did not meet the predefined clinical relevance criterion.Conclusion
School - aged children with snack - type dietary pattern had a higher likelihood of overweight/obesity than those with balanced dietary patterns.
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BibTeX
@article{wu2026dietary,
title = {{Dietary patterns in school-aged children are associated with the risk of overweight/obesity in Hainan Island: the largest free-trade zone in Southern China.}},
author = {Weijia Wu and Xuelu Lei and Pinghao Chen and Zhenning Huang and Chen Wang and Chunhui Zhang and Ping Wang and Chuican Huang and Qing Luo and Lichun Fan},
journal = {BMC pediatrics},
year = {2026},
month = aug,
doi = {10.1186/s12887-026-07452-8},
url = {https://europepmc.org/article/MED/42968082},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Dietary patterns in school-aged children are associated with the risk of overweight/obesity in Hainan Island: the largest free-trade zone in Southern China.
AU - Weijia Wu
AU - Xuelu Lei
AU - Pinghao Chen
AU - Zhenning Huang
AU - Chen Wang
AU - Chunhui Zhang
AU - Ping Wang
AU - Chuican Huang
AU - Qing Luo
AU - Lichun Fan
PY - 2026
DA - 2026/08/03
JO - BMC pediatrics
DO - 10.1186/s12887-026-07452-8
UR - https://europepmc.org/article/MED/42968082
AB - Background Childhood overweight/obesity stems from complex interactions among genetic, environmental, and behavioral factors, with diet being a key modifiable determinant. However, evidence on the association between dietary patterns and overweight/obesity remains inconclusive.Methods We conducted a cross-sectional study to investigate the association between dietary patterns and overweight/obesity among 13,312 school-aged children (6-12 years) in Hainan Province, China, from January 2021 to June 2022. We recorded the height and weight of each child and calculated their body mass index (BMI). The z-score for BMI for age was calculated using the WHO-recommended AnthroPlus software, and diagnoses of overweight and obesity were determined according to the WHO criteria. Dietary information on school-age children was collected by a validated food frequency questionnaire, which covered the most common foods consumed in Hainan, China. Factor analysis was conducted using principal component analysis and varimax rotation to group food items with factor loadings >0.5. Subsequently, K-means clustering was applied to classify children into five dietary pattern clusters. Logistic regression was used to explore the relationship between dietary patterns and overweight/obesity in school-aged children.Results The study identified five distinct dietary patterns among school-aged children in Hainan Province. Traditional (n = 2,039, 15.32%): Dominated by staple foods, meat, eggs, and fruits. High-fat and high-protein (n = 3,469, 26.06%): Characterized by high consumption of nuts, beans, aquatic products, and dairy products. Balanced (n = 5,560, 41.77%): Marked by a balanced intake of staple foods, meat, eggs, fruits, vegetables, nuts, beans, aquatic products, and dairy products. Dried fruits (n = 676, 5.08%): Primarily consisting of dried fruits. Snacks (n = 1,568, 11.77%): Mainly composed of sugary drinks, puffed foods, fried foods, and dried fruits. Balanced dietary pattern is the main dietary pattern for school-age children in Hainan Province. Compared to the balanced dietary pattern, the traditional pattern (OR = 0.88, 95%CI : 0.75-1.03) and dried fruit dietary pattern (OR = 1.13, 95%CI : 0.91-1.40) showed no significant association with overweight/obesity after multivariable adjustment. To avoid clinically trivial effects in this large sample, we applied a conservative effect size threshold (OR ≥ 1.2). Only the snack-based dietary pattern showed a clinically meaningful association with overweight/obesity after multivariable adjustment (OR = 1.22, 95%CI : 1.04-1.43). The high-fat, high-protein pattern showed a statistically significant but clinically negligible association (OR = 1.15, 95%CI : 1.03-1.30), which did not meet the predefined clinical relevance criterion.Conclusion School - aged children with snack - type dietary pattern had a higher likelihood of overweight/obesity than those with balanced dietary patterns.
SN - 1471-2431
ER -