Association between diet quality index and cardiometabolic risk factors among adolescents: ERICA study

Abstract Objective : To evaluate the association between diet quality, assessed by the Diet Quality Index for Adolescents adapted for Brazilians (DQIA-BR), and cardiometabolic markers in adolescents. Research Methods : DQIA-BR and cardiometabolic markers were assessed in 36,956 Brazilian adolescents (12–17 years old) enrolled in The Study of Cardiovascular Risks in Adolescents (ERICA), a national school-based cross-sectional multicenter study in Brazil. For analyses, the sample was stratified by sex and nutritional status. Multiple linear regressions were used to investigate the association between DQIA-BR and cardiometabolic markers (total cholesterol, HDL-c, LDL-c, triglycerides, fasting glucose, HbA1c and HOMA-IR). Adjusted models were constructed with two input levels of covariates. The first model was adjusted for sex, age and socioeconomic status; in the second model, total energy intake, physical activity and sedentary behavior were included. Results : Higher DQIA-BR score was associated with better cardiometabolic profile among girls with normal weight; however, no association was observed among those with overweight/obesity. Among boys with overweight/obesity, a better quality of diet was associated with lower concentrations of total cholesterol (β = −0.338, 95%CI: −0.611; −0.066) and LDL-c (β = −0.227, 95%CI: −0.448; −0.005); but only LDL-c remained significant among those with normal weight (β = −0.115, 95%CI: −0.224; 0.005). Conclusion : The effects of diet quality on cardiometabolic risk factors differ according to sex and the presence of overweight/obesity. Overall, DQIA-BR is a suitable tool to evaluate the association between diet quality and cardiometabolic markers among normal weight adolescents, but not for adolescents with overweight/obesity, especially girls.