The Journal of Nutrition

Nutritional Epidemiology

Higher Intakes of Energy and Grain Products at

4 Years of Age Are Associated with Being
Overweight at 6 Years of Age1,2
Lise Dubois,3,4* Megan A. Carter,4 Anna Farmer,4 Manon Girard,4 Daniel Burnier,4
Fabiola Tatone-Tokuda,4 and Marion Porcherie4
3
Department of Epidemiology and Community Medicine, Faculty of Medicine, and 4Institute of Population Health, University of
Ottawa, Ottawa, Ontario, Canada

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Abstract
This study examined dietary factors associated with overweight in a population-based sample of 6-y-old children. Analyses
of data from the Québec Longitudinal Study of Child Development (QLSCD) included a representative sample (n = 1014) of
children born in 1998 in the province of Québec, Canada. Dietary intake was measured by using a 24-h dietary recall
administered at 4 y of age. Weight and height were measured using a standard protocol at 6 y. Using logistic regression,
higher daily energy intake at 4 y was significantly related to overweight at 6 y. After adjustment for confounding and
overweight at 4 y, the relationship remained significant among girls (P = 0.04) but became marginally significant among
boys (P = 0.07). Additionally, boys who consumed $5 servings of grain products/d at 4 y were more likely to be overweight
at 6 y compared to those who did not [adjusted OR = 3.20 (95% CI): 1.72–5.97]. The association attenuated somewhat
after adjustment for overweight at 4 y [OR = 1.82 (95% CI): 0.894–3.71; P = 0.09]. The findings provide support for the
revisions made in the Canadian dietary guidelines for young children, which now recommend 4–7 servings of grain
products daily for children aged 4–8 y rather than the excessive 5–12 servings of previous recommendations. J. Nutr.
141: 2024–2029, 2011.

Introduction
Childhood overweight and obesity are well recognized as a global
epidemic (1). Recent evidence highlights that changing lifestyles
and dietary habits, such as a high consumption of energy-dense
foods and fluids (2), eating out at fast-food restaurants (3), larger
portion sizes (4,5), and the consumption of reduced-fat, energy-
dense products (6) are implicated as considerable contributors to
this epidemic in children, infants, and toddlers. However, current
population-based data on the association between food or nutrient
intakes and BMI in early childhood are limited. Moreover, the role
of dietary fat and carbohydrates in propagating the obesity
epidemic in young children is a source of considerable controversy,
because study findings on this subject are inconclusive (7,8). Studies
on the role of major food groups (vegetables and fruits, grain
products, milk products, and meat and alternatives) in childhood
obesity have also yielded inconsistent results (7).
1
Supported by the Canada Research Chair Program (2003–2008). L. Dubois’
research was partly financed by the Canadian Institute of Health Information,
Population Health Initiative, and by the Canadian Institute of Health Research.
The analyses were performed using data from the Québec Longitudinal Study of
Child Development (1998–2002), conducted by Santé Québec, a division of the
Institut de la Statistique du Québec, and funded by the Ministry of Health and
Social Services of Québec.
2
Author disclosures: L. Dubois, M. A. Carter, A. Farmer, M. Girard, D. Burnier, F.
Tatone-Tokuda, and M. Porcherie, no conflicts of interest.
* To whom correspondence should be addressed. E-mail: ldubois@uottawa.ca.
The 2004 Canadian Community Health Survey (9), the most
recent and first national survey of dietary habits in Canada since the
1970s, revealed that Canadian children and adolescents consume
macronutrients within an acceptable range with respect to the
guidelines set by the Institute of Medicine; children aged 4–18 y
should consume between 45 and 65% of energy from carbohy-
drates, 25 and 35% from fat, and 10 and 30% from protein (10).
However, with respect to food groups, Canadian children are not
consuming a balanced diet; they consume fewer vegetables, fruits,
and milk products than recommended, too few or too many servings
of grain products, and too many foods from the “other” food group
category. In fact, this other food group provided the second highest
percentage of daily calories (22%) next to grain products (31%) (9).
These dietary practices have been well summarized and compared to
American values in a recent review (11). Alongside these trends, the
prevalence of childhood overweight and obesity in Canada continues
to increase, more than doubling over the past 3 decades (12–14). For
this reason, this study aims to conduct a population-based analysis of
the prospective association among dietary factors, including energy
intake, macronutrient, and food group consumption levels, and
overweight at 6 y of age in a Canadian cohort of children.
Methods
The analyses were performed using data from the Québec Longitudinal
Study of Child Development (QLSCD), a study conducted by Santé

ã 2011 American Society for Nutrition.

2024 Manuscript received April 20, 2011. Initial review completed May 26, 2011. Revision accepted August 15, 2011.
First published online September 14, 2011; doi:10.3945/jn.111.143347.
Québec, a division of the Institut de la Statistique du Québec in Canada
(15,16). Ethical approval from the Ministry of Health Ethics Committee
and the consent of participants was obtained. The QLSCD, established
to examine the role of familial and social factors in children’s health and
cognitive and behavioral development, follows a representative sample
(n = 2120) of children born in 1998 in the Canadian province of Québec
(total population over 7 million, with ~70,000 newborns/y). To ensure
geographic representation and minimize the effect of seasonality,
participants were chosen through a random selection of children born
throughout the year in each public health geographic area of the
province. Children selected were first seen at 5 mo of age (gestational age
adjusted for preterm birth) and then once each year thereafter. Twins and
children with major diseases or handicaps at birth were excluded from
the QLSCD cohort. Standardized, questionnaire-based, face-to-face
interviews and self-administered questionnaires with children’s mothers
and fathers were conducted at each data collection cycle. To obtain
information on the child, the person deemed most knowledgeable about
the child, generally the mother, was interviewed. Data were also
obtained from children’s medical birth records.
Of the 2120 infants included in the first cycle of the study, 1944 were
followed to the age of 4 y (in 2002) and 1240 to 6 y (in 2004). In 2002,
1549 children with a mean age of 49 mo (6 3.12 mo; range = 44–56 mo)
participated in a nutrition substudy. Previous analyses indicated that
these children remained longitudinally representative of infants born in
1998 who were enrolled in the cohort at the start of the study and also of
same-aged children (4 y) in the Québec population.
Dietary methodology. Information on energy, macronutrient, and
food consumption was obtained by means of a 24-h, multiple-pass,
dietary recall interview conducted in the home by trained nutritionists
(17). The 24-h recalls were administered evenly across all days in a week.
Mothers were asked to indicate the foods (e.g. type, quantities, recipes)
their child had eaten during the 24-h period preceding the interview, with
the aid of volume food models to determine portion sizes and the
verification of nutrition labels to ensure accuracy. If children were
attending a daycare (n = 390), the daycare attendant was responsible for
documenting the child’s beverage and food intake (e.g. time, meal,
quantity) for the determined 24-h period. A 30-min visit with the
daycare attendant by a trained nutritionist allowed for the revision of all
the nutrition information collected and the completion of the 24-h
questionnaire. To increase the level of accuracy in this process, daycare
centers also underwent a double sampling procedure, whereby the
daycare attendant set aside a portion of all beverages and foods
consumed by the child throughout the 24-h period. A second 24-h recall
was conducted with one-half (n = 696) of the sample included in the
nutrition substudy to calculate intra- and inter-child variability for
energy and macronutrient (carbohydrates, fats, and proteins) intakes,
ensuring representative data on patterns of usual food consumption (18).
Final consumption and serving estimates were adjusted to minimize
within-child variability (17). All dietary information was managed using
a validated nutrient analysis software (Micro Gesta, version 73),
developed specifically for Canadian nutritional studies. The 24-h recall
procedure is considered appropriate for studying energy and nutrient
intakes in large samples of children and is used in nutrition surveys in
several countries (19). In fact, validation studies of dietary assessment
methods indicate that food recalls show a higher congruence with
validation standards compared to FFQ and they are considered to
provide reasonably accurate group mean estimates of food intakes while
also being less invasive and burdensome than food diaries (20,21).
Usual energy and macronutrient consumption per day were calcu-
lated according to the Canadian Nutrient File (22,23) and the USDA
recipe file (23). Categorization of food groups was based on Canada’s
Food Guide to Healthy Eating (1992–2007) in use at the time of the
study. Canada’s Food Guide classifies foods into 4 food groups: 1) grain
products, which include breads, pastas, cereals, rice, and other grains
(excluding cakes and foods high in fat, sugar, or salt); 2) vegetables and
fruit (e.g. fresh, frozen, canned, or dried vegetables and fruit, or 100%
pure juices); 3) milk products (e.g. milk, yogurt, cheese, and fortified soy
beverages); and 4) meat and alternatives (e.g. beef, pork, fish, eggs,
lentils, tofu, and peanut butter).
Physical activity. The degree of children’s involvement in physical
activities was measured through a survey question that asked mothers:
“In your opinion, is your child’s level of physical activity less than or
more than children of the same age and sex?” Mothers were asked to
choose from one of the following responses on a Likert-type scale:
“much higher,” “slightly higher,” “equal,” “slightly lower,” and “much
lower.” To facilitate analysis, this was dichotomized into “higher” vs.
“equal or lower.”
Outcome: overweight. Children’s heights and weights were measured
by a trained interviewer following a standardized protocol using a
measuring tape, ruler, and scale (17). The children were weighed without
shoes, wearing light clothing. Children’s anthropometric measures were
used to derive their BMI [weight (kg)/ height(m)2]. BMI was categorized
according to the percentiles on the sex- and age-specific U.S. CDC
Growth Charts: underweight (,10th percentile), normal weight (10–
84.9th percentile), and overweight (including obese, $85th percentile)
(24). The outcome used in the main analysis was overweight (including
obese) compared to not overweight at 6 y of age.
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Statistical analysis. Analyses were conducted using SAS (version 8.2;
SAS Institute) and an a of 0.05 and were stratified by sex. Data were
weighted by a factor based on the inverse of the selection probability, the
probability of nonresponse, and the poststratification and attrition rates
to ensure data were longitudinally representative of infants born in 1998
in the population (25). The weights provided by the Institut de la
Statistique du Québec were also used to correct for nonresponse.
Statistical analyses were based on individuals with no missing values.
This was ~65% of those children who completed the nutrition substudy
(n = 1014/1549). Weighted data, which adjusted for within-child
variability based on usual food consumption patterns (not only on the
single day recall), were used in the analyses. ANOVA and chi-square tests
were used to explore bivariate associations between the diet and weight
status variables. Energy and macronutrients were analyzed as continu-
ous variables and food groups were dichotomized based on recommen-
dations made by Canada’s Food Guide to Healthy Eating (1992–2007).
Logistic regression modeling was used to examine the association
between the diet variables and odds of being overweight (including
obesity) at age 6 y. Energy was also analyzed by quintiles to identify
groups of children with similar consumption patterns. Birth weight
(from medical records), level of physical activity, mother’s smoking
status during pregnancy, annual household income, the number of
overweight/obese parents (from reported weight and height), and total
intake of dietary fiber were added to regression models to adjust for
potential confounding. An ad-hoc analysis was conducted to determine if
the association changed after controlling for overweight at baseline (4 y
of age). The impact of missing data were evaluated through with-and-
without analyses by first including the missing values as separate
categories and then repeating the analyses by excluding children with
missing values. Given that missing observations did not significantly
affect the results, children with missing data were excluded from the final
analyses.
Results
In this representative sample, 20% of children were overweight
($85th percentile) at 6 y (Table 1). In bivariate analysis, energy
intake, percentage of energy consumed from the different
macronutrients (with the exception of proteins), and percentage
meeting recommendations for grains were associated with BMI
percentile group at 6 y among boys (Tables 2 and 3). Only
energy intake was significantly associated among girls. Overall,
children were most likely to reach or exceed the recommended
intakes for dairy products and meat and alternatives compared
to the other food groups (Table 3).
In crude logistic regression analysis, energy was positively
related to overweight among both boys and girls (P-trend #
0.01), with the highest quintiles of energy intake increasing the
Intake of energy and grains and later overweight 2025
TABLE 1 Characteristics of the sample (n = 1014)1 5.57). This attenuated slightly but remained significant after
adjustment for potential confounders. After additional adjust-
Characteristic % ment for overweight at 4 y, this attenuated further, but remained
Sex
marginally significant [OR = 1.82 (95% CI): 0.894–3.71; P =
Girl 49
0.09]. This same association was not found among girls.
Boy 51
Birth weight
,2500 g 4.4
Discussion
2500–4000 g 84.8
.4000 g 10.8 Given that dietary patterns formed in early childhood often
Physical activity level at 4 y of age persist through adolescence and adulthood (26,27), it is vital that
Much higher than other children 7.3 current and representative information about children’s food
Higher than other children 21.1 intakes be gathered and examined in relation to overweight to
Same as other children 68.7 progress in our knowledge of how to combat this global epidemic.
Lower and much lower than other children 2.9 Food portion sizes have grown, particularly for grain products
Mother smoked during pregnancy such as pastas, muffins, and bagels, and have become completely
No 74.9 disconnected from recommended serving sizes (28,29). It is there-
Yes 25.1 fore not surprising that children have difficulty identifying health-
ful portion sizes (30).

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Parental overweight
None 37.6 In the present study, a positive association was observed
Only one parent 46.9 between daily energy intake at age 4 y and overweight at age 6 y for
Both parents 15.5 both boys and girls, even after adjustment for other potential
Household annual income confounders. The association may be stronger in girls, because
,$20,000 11.1 significance was retained after controlling for overweight at 4 y.
$20,000–39,999 22.4 Although this finding is not surprising, given the fundamental
$40,000–59,999 26.7 knowledge that energy intake is a crucial component of the energy
$$60,000 39.8 balance equation, it differs from a previous study that used the
BMI percentiles at 6 y of age NHANES III. This study found only small differences in energy
Underweight (,10th percentile) 10.7 intake between overweight and nonoverweight children and
Normal weight (10–84.9th percentile) 69.2 adolescents (31). Similarly, 2 small intervention studies in older
Overweight ($85th percentile) 20.1 children found that overweight children tend to have lower or
1
similar energy intakes compared to nonoverweight children
Values are weighted percentages.
(32,33). Dietary under-reporting (34), inconsistency or absence of
measurement for level of physical activity (35), and small sample
odds of overweight approximately 3-fold (Tables 4 and 5). sizes may explain why studies report only small differences.
These associations did not change after adjustment for potential Interestingly, consuming $5 servings of grain products/d at
confounders but attenuated somewhat when controlling for age 4 y increased the odds of being overweight at age 6 y among
overweight at 4 y. Among boys, the association became boys compared to those who consumed ,5 servings; this
marginally significant (P-trend = 0.07) but remained significant association was found to be independent of energy and total
among girls (P-trend = 0.04). None of the macronutrients, dietary fiber intake, which have been shown to act as con-
adjusted for energy, were related to overweight among both boys founders (36). Again, the relationship attenuated after adjust-
and girls. The only food group significantly related to over- ment for overweight at 4 y but remained marginally significant
weight was grains. Meeting or exceeding the recommended (P = 0.09). This suggests that a high intake of grain products may
number of servings per day of grain products increased the odds precede and even lead to overweight in young boys but does not
for overweight among boys, by almost 3.5-fold (95% CI: 2.15– appear to be relevant among girls.

TABLE 2 Daily energy and macronutrient intake at 4 y of age in boys and girls by BMI
percentiles at 6 y1

Underweight Normal weight Overweight

Total ,10th percentile 10–84.9th percentile $85th percentile

Boys
Energy,2 kcal/d 1640 6 224 1590 6 215 1630 6 206 1710 6 273
Carbohydrates,2 % energy/d 53.8 6 4.0 51.6 6 3.6 54.0 6 4.0 54.5 6 4.2
Total fats,2 % energy/d 31.3 6 2.6 33.2 6 2.7 31.2 6 2.6 30.9 6 2.6
Proteins, % energy/d 14.5 6 1.6 14.5 6 1.4 14.5 6 1.9 14.4 6 1.9
Girls
Energy,2 kcal/d 1520 6 286 1460 6 234 1500 6 279 1620 6 316
Carbohydrates, % energy/d 53.8 6 2.9 53.3 6 3.0 53.9 6 2.8 54.1 6 3.3
Total fats, % energy/d 31.4 6 2.3 31.8 6 2.2 31.3 6 2.2 31.2 6 2.6
Proteins, % energy/d 14.5 6 2.1 14.5 6 2.1 14.5 6 2.0 14.4 6 1.8
1
Values are weighted mean 6 SD.
2
BMI categories differ, P # 0.05.

2026 Dubois et al.

 TABLE 3 Percentage of boys and girls consuming recommended servings of specific foods
by BMI percentile group1

Underweight Normal weight Overweight

Total ,10th percentile 10–84.9th percentile $85th percentile

Boys
Vegetables and fruits, $5 servings/d 17.6 16.2 18.1 16.7
Grain products,2 $5 servings/d 23.9 15.5 19.1 42.6
Milk products, $2 servings/d 49.6 55.0 47.5 53.2
Meats and alternatives, $2 servings/d 46.8 44.3 46.5 49.0
Girls
Vegetables and fruits, $5 servings/d 14.2 13.4 14.4 13.9
Grain products,3 $5 servings/d 5.9 1.9 5.9 8.2
Milk products, $2 servings/d 46.4 40.3 44.8 56.2
Meats and alternatives, $2 servings/d 26.0 23.8 25.2 30.5
1
Values are weighted percentages.
2
BMI categories differ, P # 0.05.
3
Cell counts were too low to conduct chi-square analysis.

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In contrast to the findings of this study, a study on low-
income children aged 2–5 y uncovered a significant negative
association between consumption of bread and grain products
and body weight (37). Similarly, another study reported that
children aged 4–12 y with higher intakes of ready-to-eat cereals
had a lower mean BMI (38). However, findings from a study on
adolescents aged 11–18 y concur with the findings here; intakes
of bread, rice, and pasta were positively associated with BMI
(39).
Intake of grain products has increased dramatically in recent
decades: among 6- to 11-y-old children, grain product intakes
were one-fifth to one-third higher in 1994–1998 than in 1977–

TABLE 4 Crude and adjusted OR for overweight in boys at 6 y of age according to daily energy,
macronutrient, and food group intakes at 4 y of age1

Additional adjustment for overweight at

Variable Crude OR (95% CI)2 Adjusted OR (95% CI)3 4 y: OR (95% CI)

Model 1: energy4
1st Quintile (ref) 1 1 1
2nd Quintile 0.773 (0.364–1.64) 0.830 (0.381–1.81) 0.666 (0.276–1.61)
3rd Quintile 1.14 (0.544–2.38) 1.28 (0.594–2.75) 1.18 (0.502–2.76)
4th Quintile 1.06 (0.511–2.18) 1.25 (0.584–2.66) 0.968 (0.413–2.27)
5th Quintile 3.15 (1.58–6.27) 3.21 (1.55–6.63) 1.97 (0.851–4.57)
P-trend 0.0007 0.001 0.07
Model 2: macronutrients5
Carbohydrate 1.26 (0.846–1.87) 1.30 (0.847–2.00) 1.07 (0.658–1.75)
Total fat 1.23 (0.756 – 2.00) 1.31 (0.776–2.23) 1.04 (0.571–1.89)
Protein 1.25 (0.820–1.91) 1.30 (0.814–2.07) 1.02 (0.595–1.74)
Model 3: food groups6
Vegetables and fruits
,5 servings (ref) 1 1 1
$5 servings 0.948 (0.520–1.73) 0.984 (0.486–1.99) 0.895 (0.406–1.98)
Grain products
,5 servings (ref) 1 1 1
$5 servings 3.46 (2.15–5.57) 3.20 (1.72–5.97) 1.82 (0.894–3.71)
Milk products
,2 servings (ref) 1 1 1
$2 servings 1.17 (0.742–1.85) 1.26 (0.748–2.11) 1.36 (0.758–2.45)
Meat and alternatives
,2 servings (ref) 1 1 1
$2 servings 1.20 (0.759–1.91) 1.16 (0.676–2.00) 0.940 (0.513–1.72)
1
Odds ratios are weighted.
2
Within each model, dietary variables are measured together, not separately.
3
Each model is adjusted for birth weight, level of physical activity, mother’s smoking status during pregnancy, annual household income,
and number of overweight/obese parents. Model 2 additionally adjusts for total intake of dietary fiber and the other macronutrients. Model 3
additionally adjusts for total intake of dietary fiber, energy intake, and intakes of the other food groups.
4
Values are OR and 95% CI for energy quintiles 2, 3, 4, and 5, measured in kcal/d, compared to the lowest quintile.
5
Values are OR and 95% CI for a one percentage increase in percentage of energy/d from each of the three macronutrients.
6
Values are OR and 95% CI for meeting or exceeding food group recommendations/d as compared to not meeting recommendations.

Intake of energy and grains and later overweight 2027

 TABLE 5 Crude and adjusted OR for overweight in girls at 6 y of age according to daily energy,
macronutrients, and food group intakes at 4 y of age1

Crude OR2 Adjusted OR3 Additional adjustment for overweight at

Variable (95% CI) (95% CI) 4 y: OR (95% CI)

Model 1: energy4
1st Quintile (ref) 1 1 1
2nd Quintile 1.29 (0.542–3.06) 1.42 (0.584–3.47) 1.65 (0.64–4.25)
3rd Quintile 1.87 (0.814–4.32) 1.92 (0.816–4.50) 1.50 (0.60–3.77)
4th Quintile 2.45 (1.09–5.53) 2.39 (1.04–5.49) 2.21 (0.898–5.41)
5th Quintile 2.89 (1.31–6.38) 2.89 (1.28–6.51) 2.37 (0.986–5.70)
P-trend 0.002 0.004 0.04
Model 2: macronutrients5
Carbohydrate 1.60 (0.926–2.76) 1.34 (0.760–2.37) 1.04 (0.542–2.00)
Total fat 1.61 (0.896–2.90) 1.31 (0.715–2.42) 0.984 (0.490–1.98)
Protein 1.37 (0.908–2.08) 1.22 (0.788–1.88) 1.00 (0.609–1.65)
Model 3: food groups6
Vegetables and fruits
,5 servings (ref)

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1 1 1
$5 servings 0.842 (0.417–1.70) 0.855 (0.389–1.88) 0.876 (0.375–2.04)
Grain products
,5 servings (ref) 1 1 1
$5 servings 1.55 (0.608–3.92) 0.910 (0.319–2.59) 0.574 (0.179–1.85)
Milk products
,2 servings (ref) 1 1
$2 servings 1.45 (0.908–2.33) 1.08 (0.626–1.84) 0.999 (0.557–1.79)
Meat and alternatives
,2 servings (ref) 1 1 1
$2 servings 1.37 (0.811–2.30) 0.967 (0.529–1.77) 1.04 (0.539–2.01)
1
Odds ratios are weighted.
2
Within each model, dietary variables are measured together, not separately.
3
Each model is adjusted for birth weight, level of physical activity, mother’s smoking status during pregnancy, annual household income,
and number of overweight/obese parents. Model 2 additionally adjusts for total intake of dietary fiber and the other macronutrients. Model 3
additionally adjusts for total intake of dietary fiber, energy intake, and intakes of the other food groups.
4
Values are OR and 95% CI for energy quintiles 2, 3, 4, and 5, measured in kcal/d, compared to the lowest quintile.
5
Values are OR and 95% CI for a one percentage increase in percentage of energy/d from each of the three macronutrients.
6
Values are OR and 95% CI for meeting or exceeding food group recommendations/d as compared to not meeting recommendations.

1978 (40). After beverages, grain-based products such as pasta,
rice, and pizza are the particular foods in this food group of
which consumption has increased the most in 20 y. An
explanation for an association among boys and not girls may
be due to sex differences in carbohydrate metabolism and
adapting to different types of diets (41,42).
It is also difficult to know whether the significant associations
observed in this study, with respect to consumption of grain
products, would have remained if boys had higher intakes of
whole-grain products. Using data from the same sample of 4-y-
old children used in the present analyses, Desrosiers et al. (17)
reported that 22% of total energy intakes came from enriched
refined grain products and only 2% from whole-grain products.
Thus, further research is needed to decipher the role of grain
products in childhood obesity.
Canada’s Food Guide to Healthy Eating was recently revised,
now recommending that children aged 4–8 y consume 4–7
servings of grain products daily rather than the 5–12 previously
recommended (43,44). The present study provides evidence and
support for this change to promote healthy body weights in
young children.
A major strength of this study was the use of a population-
based, representative sample of children and its prospective
design. Additionally, BMI was based on direct measurement of
children’s heights and weights. Although the 24-h dietary recall
is often recognized as the best method to estimate dietary intake,
2028 Dubois et al.
some limitations include the reliance on participants’ memory,
how well selected days represent usual intakes, and the possi-
bility of under-reporting of food intakes (45). A number of
studies have shown that overweight or obese individuals tend to
under-report to a greater extent than lean individuals (46–48).
Likewise, parents may be under-reporting their children’s intake,
particularly for snacks rather than meals (49,50). Nonetheless,
the 24-h recall method is considered reasonably accurate for
providing group mean estimates of children’s intakes while
being less burdensome and invasive than food records (20).
Overall, the results of the present study indicate that higher
energy intakes in young children may increase the likelihood
of overweight at a later age and suggest an association with
change in overweight status, especially among girls. Among
boys, meeting or exceeding the recommended intake for grain
products was associated with later overweight and may also
explain a change in overweight status. These findings provide
support for the change in recommended number of grain
servings for children aged 4–8 y made recently to Canada’s
Food Guide to Healthy Eating.
Acknowledgments
L.D. designed the research; M.G. and M.A.C. analyzed the
data; A.F., D.B., F.T., and M.P. wrote the paper; M.A.C. edited
the paper; and L.D. had primary responsibility for final content.
All authors read and approved the final manuscript.
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Intake of energy and grains and later overweight 2029