A Varied and Diverse Diet Can Lead to Increasing BMI for Poor Children.

In this month’s issue of Pediatrics, Fernandez et al1 invite us to consider that a diverse diet (DD) and varied diet should not be advocated to prevent obesity. They studied children and their primary caregivers who were enrolled in Head Start in southeastern Michigan to provide a window on US low-income, preschool-aged children of mixed race/ethnicity. They applied the Harvard Service Food Frequency Questionnaire to assess usual frequency of food consumed in low-income mothers and preschoolaged children and the Berry Index to develop a DD. The authors found that the mean BMI for the primary caregiver was 32.4. Girls and older children ate a more diverse diet. Whites had a lower mean DD and food-insecure households had a higher mean Moderation Foods Variety score. Moderation foods (fried, salty, highfat, and sweets) are foods that should be decreased in the diet. Healthy foods (grains, fruits, vegetables, dairy, and protein) are foods that should be increased. What compelled the investigators to reconsider increasing DD as a strategy to prevent obesity was their observation of no association between the scores and concurrent BMI z score (BMIz). In addition, the authors found that a greater healthy variety, overall variety, and DD each was associated with a larger annual increase in BMIz. When stratified by initial BMI, the obese group showed an association between Healthy Foods Variety and DD and an increased BMIz.