Associations between the trajectories of free sugar intake and cardiometabolic risk markers during childhood: generation XXI birth cohort

Free sugar (FS) intake is linked to obesity, but most evidence is cross-sectional. Few studies have explored early-life FS intake trajectories with later cardiometabolic risk markers (CRM). To estimate associations between the trajectories of FS intake and CRM during childhood using a longitudinal and cross-sectional analysis and two dietary assessment methods. Participants are from the G21 cohort evaluated at 4, 7, 10, and 13y. Dietary intake was assessed through food diaries and food frequency questionnaries (FFQ). FS was measured using a 10-step adapted methodology based on the WHO definition. CRM analyzed included BMI, waist circumference (WC), HOMA-IR, HDL, triglycerides, and systolic blood pressure. Linear mixed-effect models were used to estimate cross-sectional and longitudinal associations between FS trajectories, and CRM. Two regression models were considered: model 1 (crude) and model 2 (adjusted for parity, mothers’ education, mothers’ weight pre-pregnancy, breastfeeding, physical activity, weight for gestational age, and energy intake). Considering data from food diaries and after adjustment, the longitudinal analysis presented positive significant associations between FS intake(/10 g) and CRM, particularly within adiposity variables: BMI (β = 0.044, 95%CI = 0.000;0.088), WC (β = 0.240 95%CI = 0.093;0.386) and HOMA (β = 0.015, 95%CI = 0.003;0.028). In contrast, cross-sectional analyses showed negative associations for the same variables. When using data from FFQ similar results were observed as in diaries. A sensitivity analysis only in plausible reporters supported the previous results in both epidemiological approaches. This study supports the adverse effects of FS on CRM during childhood, independently of the dietary assessment method. Longitudinal approaches are relevant to obtaining accurate associations.