Diet quality in childhood: the Generation R Study.

PURPOSE
We aimed to evaluate diet quality of 8-year-old children in the Netherlands, to identify sociodemographic and lifestyle correlates of child diet quality, and to examine tracking of diet quality from early to mid-childhood.

METHODS
For 4733 children participating in a population-based cohort, we assessed dietary intake using a validated food-frequency questionnaire at a median age of 8.1 years (interquartile range 8.0-8.2) (2011-2014). Based on dietary guidelines, we developed and validated a food-based diet quality score for children consisting of ten components (score 0-10): sufficient intake of vegetables; fruit; whole grains; fish; legumes; nuts; dairy; oils and soft fats; and low intake of sugar-containing-beverages; and high-fat and processed meat.

RESULTS
We observed a mean (± SD) diet quality score of 4.5 (± 1.2) out of a maximum of 10. On average, intake of legumes, nuts, and oils or soft fats was below recommendations, whereas intake of sugar-containing beverages and high-fat or processed meat was higher than recommended. The main factors associated with higher diet quality were higher maternal educational level (β = 0.29, 95% CI 0.21, 0.37 versus low education), higher household income (β = 0.15, 95% CI 0.05, 0.25 versus low income), no maternal smoking (β = 0.13, 95% CI 0.02, 0.25 versus current smoking), and less screen time (β = 0.31, 95% CI 0.24, 0.38)-all independent of each other. For children with available dietary data at age 1 year (n = 2608), we observed only weak tracking of diet quality from early to mid-childhood (Pearson's r = 0.19, k = 0.11 for extreme quartiles).

CONCLUSION
Overall diet quality of 8-year-old children did not conform to dietary guidelines, especially for children having more screen time, children of lower educated or smoking mothers, or from lower-income households.