Association of Dietary Glycemic Index and Glycemic Load with Overweight and Obesity in Lebanese Preschool Children : A cross-Sectional Study

Abstract

Children's obesity is increasingly recognized as a global public health issue. The worldwide increase in the prevalence of pediatric obesity is documented as early as the preschool years. Identifying modifiable lifestyle and diet-related factors that may have an impact on adiposity in children is crucial for the development of effective preventive strategies. Dietary glycemic index (GI) and glycemic load (GL), have been recently suggested to modulate obesity risk, although evidence amongst young children is scarce and controversial. It is in this context that this study was undertaken, with the main aim of investigating the association of dietary GI and GL with overweight and obesity in Lebanese preschool children (2-5 years).

This study is based on the cross-sectional national survey titled “Early Life Nutrition and health, ELNAHL” that was conducted amongst under five children and their mothers in 2012/2013. For the purpose of this study, data pertinent to preschool-aged 2-5 years are considered (n=531). Survey data includes demographic, socioeconomic, parental characteristics, anthropometric measurements, as well as dietary intakes. Anthropometric measurements were performed and the prevalence of overweight and obesity amongst preschoolers was assessed using the WHO-2006 criteria based on sex and age specific BMI-z scores. Dietary intakes of preschool children were assessed by a 24-hour recall that was administered to the mother. The Nutri Pro software was used to perform analysis of the 24-h dietary recall.

GI values were assigned to the food items consumed by preschoolers in Lebanon (543 food items and mixed dishes) based on the International table of GI values by Foster-Powell and colleagues as well as other pertinent literature. Daily dietary GI (DGI) for each subject was calculated as the weighted average of the GI values of the foods consumed, with the weights being based on the proportion of available carbohydrate contributed by each food item (g/day) divided by the total daily available CHO. Daily dietary GL (DGL) was calculated by multiplying the overall dietary GI by the total daily intake of available carbohydrates. Several regression models were applied to investigate the association of DGI and DGL with preschool overweight/obesity.

Among children participating in the study, 9.5% were either overweight or obese. Average DGI was estimated at 56.1 ± 6.7 and DGL at 99.2 ± 41.6. DGI was not significantly associated with overweight/obesity in the crude model. After adjustment for socio economic factors in model 1, the results showed that a higher dietary GI was significantly associated with higher odds of overweight/obesity amongst preschoolers (OR: 1.066, 95% CI: 1.008-1.127).The association remained significant after further adjustment for dietary energy intake in model 2 (OR: 1.066, 95% CI: 1.008-1.127), and additional adjustment for fat, protein and fiber in model 3(OR: 1.075, 95% CI: 1.010-1.145). As for GL, no significant association was observed with overweight/obesity in all models.

This study is the first from the Eastern Mediterranean Region to report dietary GI and GL amongst preschool-aged children and examine their association with overweight/obesity. The study showed that higher dietary GI was significantly associated with higher odds of overweight/obesity amongst preschoolers after adjusting for a variety of confounding factors. This highlights the need for public health interventions aimed at improving overall dietary quality and promoting lower GI, healthful components in young children’s diets. More studies (prospective and intervention trials ) are warranted to further confirm the association between DGI, and obesity risk in this age group .