Three-year change in diet quality and associated changes in BMI among schoolchildren living in socio-economically disadvantaged neighbourhoods.

Findings from research that has assessed the influence of dietary factors on child obesity have been equivocal. In the present study, we aimed to test the hypothesis that a positive change in diet quality is associated with favourable changes in BMI z-scores (zBMI) in schoolchildren from low socio-economic backgrounds and to examine whether this effect is modified by BMI category at baseline. The present study utilised data from a subsample (n 216) of the Resilience for Eating and Activity Despite Inequality study, a longitudinal cohort study with data collected in 2007-8 (T1) and 2010-11 (T2) in socio-economically disadvantaged women and children (5-12 years at T1). Dietary data were collected using a FFQ and diet quality index (DQI) scores derived at both time points. The objective measures of weight, height and physical activity (accelerometers) were included. The other variables were reported in the questionnaires. We examined the association between change in DQI and change in zBMI, using linear regression analyses adjusted for physical activity, screen sedentary behaviour and maternal education level both in the whole sample and in the sample stratified by overweight status at baseline. After accounting for potential covariates, change in diet quality was found to be inversely associated with change in zBMI only in children who were overweight at baseline (P= 0.035), thus supporting the hypothesis that improvement in diet quality is associated with a concurrent improvement in zBMI among already overweight children, but not among those with a normal BMI status. The identification of modifiable behaviours such as diet quality that affect zBMI longitudinally is valuable to inform future weight gain prevention interventions in vulnerable groups.