Dietary Patterns and Risk of Overweight/Obesity in Children and Adolescents in Western Countries: A Systematic Review and Meta-Analysis of Longitudinal Studies With at Least 1 Year of Follow-Up

CONTEXT: Childhood overweight/obesity (Ov/Ob), and its association with metabolic complications, known as metabolically unhealthy obesity (MUO), is a major public health problem. Diet is an important modifiable determinant of weight status, but the relationship between dietary patterns and Ov/Ob or MUO in children/adolescents in Western countries remains poorly studied. OBJECTIVE: This systematic review and meta-analysis aimed to explore associations between adherence to dietary patterns and Ov/Ob or MUO risk in children/adolescents aged 2-19 years. DATA SOURCES: The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to identify prospective epidemiological studies and randomized controlled trials (RCTs), with ≥12 months of follow-up for both study designs, from PUBMED and Scopus published between January 2013 and November 2024. DATA EXTRACTION: Thirty-two prospective studies were included, all of which reported on Ov/Ob risk. No studies addressing MUO risk were identified. Nineteen studies were included in the meta-analysis. The dietary patterns were categorized as healthy or unhealthy. DATA ANALYSIS: Healthy dietary patterns had a positive effect, whereas unhealthy dietary patterns had a negative impact on various anthropometric parameters in children and adolescents. A higher level of adherence to a healthy dietary pattern was associated with lower odds of childhood Ov/Ob (odds ratio [OR], 0.86; 95% CI, 0.77-0.96 [adjusted model]) and with a decrease in the longitudinal change of the body mass index (β, -.10; 95% CI, -.0.16 to -.0.05 kg/m2 [adjusted model]) while a higher level of adherence to an unhealthy dietary pattern was associated with higher odds of childhood Ov/Ob (OR, 1.22; 95% CI, 1.08-1.37 [adjusted model]) compared to a lower level of adherence. CONCLUSION: In children and adolescents, a preventive effect against Ov/Ob is exhibited with higher adherence to healthy dietary patterns, while unhealthy dietary patterns contribute to an increased risk of Ov/Ob. The observed associations were modest in magnitude, and the absence of RCTs limits the strength of the evidence. No studies were identified relative to MUO, highlighting a significant research gap. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration No. [CRD42023477613].