Web of Causation between Dietary Patterns and Childhood Obesity: Applying Hill's Criteria

Open access


Since their publication in 1965, the Bradford Hill criteria for causality have been largely used as a framework for causal inference in epidemiology. We aim at employing this classical approach to shed new light onto the web of causation of childhood obesity. Although the fundamental cause of obesity is the long-term imbalance between energetic need and intake, this medical condition is multifactorial in its origin, influenced by genetic, behavioral, socioeconomic, and environmental factors. This imbalance leads to accumulation of excessive adipose tissue. Observational studies tend to mostly quantify association between dietary factors and accumulation of adipose tissue. On the other hand, multivariate analysis proved some of these associations to be spurious, therefore prospective trials are needed to demonstrate causality. Short term experimental studies have been conducted to identify unique dietary pattern changes on specific outcomes, but long term, community-based studies would offer more comprehensive answers on dietary pattern effects. We conducted a literature review on PubMed, Scopus, Web of Science, and Google Scholar. From a total of 323 papers identified at first stage, we further discuss the applicability of Bradford Hill criteria for 31 articles, by examples of dietary patterns and accumulation of excess body fat as exposure-response associations. We also put forward and analyzed the evidence prospective studies would bring, as foundation for future interventions.

1. Hill AB. The Environment and Disease: Association or Causation? Proc R Soc Med 58(5): 295- 300, 1965

2. Rothman KJ, Greenland S. Causation and causal inference in epidemiology. Amn J Public Health 95(SUPPL. 1): S144-50, 2005.

3. Coughlin SS. Causal Inference and Scientific Paradigms In Epidemiology. Bentham ebooks (ed.), 2012.

4. Ng M, Flemint T, Robinson M et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 384(9945): 766-781, 2014.

5. Austin GL, Ogden LG, Hill JO. Trends in carbohydrate, fat, and protein intakes and association with energy intake in normal-weight, overweight, and obese individuals: 1971-2006. Am J Clin Nutr 93(4): 836-843, 2011.

6. Poti JM, Popkin BM. Trends in Energy Intake among US Children by Eating Location and Food Source, 1977-2006. J Am Diet Assoc 111(8): 1156-1164, 2011.

7. Church TS, Thomas DM, Tudor-Locke C et al. Trends over 5 decades in U.S. occupation-related physical activity and their associations with obesity. PLoS One 6(5): e19657, 2011.

8. Hallal PC, Andersen LB, Bull FC et al. Global physical activity levels: Surveillance progress, pitfalls, and prospects. Lancet 380(9838): 247-257, 2012.

9. Alonso-Blanco C, Palacios-Ceña D, Hernández-Barrera V, Carrasco-Garrido P, Jiménez-García R, Fernández-de-las-Peñas C. Trends in leisure time and work-related physical activity in the Spanish working population, 1987-2006. Gac Sanit 26(3): 223- 230, 2012.

10. Juneau CE, Potvin L. Trends in leisure-, transport-, and work-related physical activity in Canada 1994-2005. Prev Med (Baltim) 51(5): 384-386, 2010.

11. Salmon J, Timperio A, Cleland V, Venn A. Trends in children’s physical activity and weight status in high and low socio-economic status areas of Melbourne, Victoria, 1985-2001. Aust N Z Public Health 29(4): 337-342, 2005.

12. Dollman J, Norton K, Norton L. Evidence for secular trends in children’s physical activity behavior. Br J Sports Med 39(12): 892-7, 2005.

13. Hruby A, Hu FB. The Epidemiology of Obesity: A Big Picture. PharmacoEconomics 33(7): 673-689, 2015.

14. Schulze MB, Manson JE, Ludwig DS et al. Sugar-Sweetened Beverages, Weight Gain, and Incidence of Type 2 Diabetes in Young and Middle-Aged Women. JAMA 292(8): 927, 2004.

15. DeBoer MD, Scharf RJ, Demmer RT. Sugar- Sweetened Beverages and Weight Gain in 2- to 5-Year- Old Children. Pediatrics 132(3): 413-420, 2013.

16. Johnson L, Mander AP, Jones LR, Emmett PM, Jebb SA. A prospective analysis of dietary energy density at age 5 and 7 years and fatness at 9 years among UK children. Int J Obes 32(4): 586-593, 2008.

17. Malik VS, Willett WC, Hu FB. Sugar-sweetened beverages and BMI in children and adolescents: reanalyzes of a meta-analysis Am J Clin Nutr 7: 438-439, 2008.

18. Astrup A, Christensen B, Buemann P, Western S, Toubro A, Raben N. Obesity as an adaptation to a high-fat diet: evidence from a cross-sectional study. Am J Clin Nutr 59(2): 350-355, 1994.

19. Crume TL, Brinton JT, Shapiro A et al. Maternal dietary intake during pregnancy and offspring body composition: The Healthy Start Study. Am J Obstet Gynecol 215(5): 609.e1-609.e8, 2006.

20. Ribaroff GA, Wastnedge E, Drake AJ, Sharpe RM, Chambers TJG. Animal models of maternal high fat diet exposure and effects on metabolism in offspring: a meta-regression analysis. Obesity Reviews 18(6): 673-686, 2017.

21. Ullah R, Su Y, Shen Y et al. Postnatal feeding with high-fat diet induces obesity and precocious puberty in C57BL/6J mouse pups: a novel model of obesity an puberty. Front Med 11(2): 266-276, 2017.

22. Newby PK, Peterson KE, Berkey CS, Leppert J, Willett WC, Colditz GA. Beverage consumption is not associated with changes in weight and body mass index among low-income preschool children in North Dakota. J Am Diet Assoc 104(7): 1086-1094, 2004.

23. Te Morenga L, Mallard S, Mann J. Dietary sugars and body weight: systematic review and metaanalyses of randomized controlled trials and cohort studies. Bmj 346: 3-5, 2013.

24. Clayton-Smith J, Bochukova EG, Huang N et al. Large, rare chromosomal deletions associated with severe early-onset obesity. Nature 463(7281): 666-670, 2010.

25. Bachmann-Gagescu R, Mefford HC, Cwan C et al. Recurrent 200-kb deletions of 16p11.2 that include the SH2B1 gene are associated with developmental delay and obesity. Genet. Med 12(10): 641-647, 2010.

26. Cantoral A, Téllez-Rojo MM, Ettinger AS, Hu H, Hernández-Ávila M, Peterson K. Early introduction and cumulative consumption of sugar-sweetened beverages during the pre-school period and risk of obesity at 8-14 years of age. Pediatr Obes 11(1): 68-74, 2016.

27. De Ruyter JC, Olthof MR, Seidell JC, Katan MB. A trial of sugar-free or sugar-sweetened beverages and body weight in children. World Review of Nutrition and Dietetic 190: 4-5, 2014.

28. Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 70(1): 3-21, 2012.

29. Schulz M, Kroke A, Liese AD, Hoffmann K, Bergmann MM, Boeing H. Food groups as predictors for short-term weight changes in men and women of the EPIC-Potsdam cohort. J Nutr 132(6): 1335-1340, 2002.

30. Ambrosini GL, Emmett PM, Northstone K, Howe LD, Tilling K, Jebb SA. Identification of a dietary pattern prospectively associated with increased adiposity during childhood and adolescence. World Review of Nutrition and Dietetics 109: 13, 2014.

31. Malik VS, Pan A, Willett WC, Hu FB. Sugarsweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. Am Journal Clin Nutr 98(4): 1084-102, 2013.

32. Dimeglio D, Mattes R. Liquid versus solid carbohydrate: effects on food intake and body weight. Int J Obes 24: 794-800, 2000.

33. Pan A, Hu FB. Effects of carbohydrates on satiety: differences between liquid and solid food. Curr Opin Clin Nutr Metab Care 14(4): 385-390, 2011.

34. Bray GA, Nielsen SJ, Popkin BM. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr 79: 537-543, 2004.

35. Softic S, Cohen DE, Kahn CR. Role of Dietary Fructose and Hepatic De Novo Lipogenesis in Fatty Liver Disease. Digestive Diseases and Sciences 61(5): 1282- 1293, 2016.

36. Moore JB, Gunn PJ, Fielding BA. The role of dietary sugars and de novo lipogenesis in non-alcoholic fatty liver disease. Nutrients 6(12): 5679-5703, 2014.

37. Siervo M, Montagnese C, Mathers JC, Soroka KR, Stephan BC, Wells JC. Sugar consumption and global prevalence of obesity and hypertension: an ecological analysis. Public Health Nutr 17(3): 587-596, 2014.

38. Vos MB, Kimmons JE, Gillespie C, Welsh J, Blanck HM. Dietary fructose consumption among US children and adults: the Third National Health and Nutrition Examination Survey. Medscape J. Me 10(7): 160, 2008.

39. Marriott B, Cole N, Lee E. National estimates of dietary fructose intake increased from 1977 to 2004 in the United States. J Nutr 139(6): 1228S-1235S, 2009.

40. Hooper L, Abdelhamid A, Moore HJ, Douthwaite W, Skeaff CM, Summerbell CD. Effect of reducing total fat intake on body weight: systematic review and meta-analysis of randomized controlled trials and cohort studies. BMJ 345: 7666, 2012.

41. Mirza NM, Palmer MG, Simclair KB et al. Effects of a low glycemic load or a low-fat dietary intervention on body weight in obese Hispanic American children and adolescents: a randomized controlled trial. Am J Clin Nutr 97(2): 276-85, 2013.

42. Saris WH, Astrup A, Prentince AM et al. Randomized controlled trial of changes in dietary carbohydrate/fat ratio and simple vs complex carbohydrates on body weight and blood lipids: the CARMEN study. The Carbohydrate Ratio Management in European National diets. Int J Obes Relat Metab Disord 24(10): 1310-1318, 2000.

43. Lustig RH. Fructose: Metabolic, Hedonic, and Societal Parallels with Ethanol. J Am Diet Assoc 110(9): 1307-1321, 2010.

44. Lustig RH. Fructose: It’s ‘Alcohol Without the Buzz. Adv Nutr An Int Rev J 4(2): 226-235, 2013.

45. Alwahsh SM, Gebhardt R. Dietary fructose as a risk factor for non-alcoholic fatty liver disease (NAFLD). Arch. Toxicol 91(4): 1545-1563, 2017.

Romanian Journal of Diabetes Nutrition and Metabolic Diseases

The Journal of Romanian Society of Diabetes Nutrition and Metabolic Diseases

Journal Information

CiteScore 2018: 0.19

SCImago Journal Rank (SJR) 2018: 0.128
Source Normalized Impact per Paper (SNIP) 2018: 0.229


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 205 205 11
PDF Downloads 174 174 12