International Journal of Food Sciences and Nutrition

ISSN: 0963-7486 (Print) 1465-3478 (Online) Journal homepage: https://www.tandfonline.com/loi/iijf20

Lack of association between dietary fibres intake

and childhood obesity: an epidemiological study
among preadolescents in Greece

Venetia Notara, Marina Legkou, Aikaterini Kanellopoulou, George

Antonogeorgos, Andrea Paola Rojas-Gil, Ekaterina N. Kornilaki, Eleni
Konstantinou, Areti Lagiou & Demosthenes B. Panagiotakos

To cite this article: Venetia Notara, Marina Legkou, Aikaterini Kanellopoulou, George
Antonogeorgos, Andrea Paola Rojas-Gil, Ekaterina N. Kornilaki, Eleni Konstantinou, Areti Lagiou
& Demosthenes B. Panagiotakos (2020): Lack of association between dietary fibres intake and
childhood obesity: an epidemiological study among preadolescents in Greece, International Journal
of Food Sciences and Nutrition

To link to this article: https://doi.org/10.1080/09637486.2020.1712681

Published online: 13 Jan 2020.

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INTERNATIONAL JOURNAL OF FOOD SCIENCES AND NUTRITION
https://doi.org/10.1080/09637486.2020.1712681

ARTICLE

Lack of association between dietary fibres intake and childhood obesity: an

epidemiological study among preadolescents in Greece
Venetia Notaraa,b, Marina Legkoub, Aikaterini Kanellopouloub, George Antonogeorgosb,
Andrea Paola Rojas-Gilc , Ekaterina N. Kornilakid , Eleni Konstantinoua, Areti Lagioua and
Demosthenes B. Panagiotakosb,e
a
Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece; bDepartment of
Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; cDepartment of Nursing,
Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Greece; dDepartment of Preschool
Education, School of Education, University of Crete, Crete, Greece; eFaculty of Health, University of Canberra, Canberra, Australia

ABSTRACT ARTICLE HISTORY

The aim of this study was to evaluate whether dietary fibres intake is associated with childhood Received 29 September 2019
obesity. From 2014 to 2016, a sample of 1728 Greek boys and girls students, 10–12 years and Revised 1 January 2020
their parents were enrolled in the study. Dietary fibres intake was assessed through food ques- Accepted 5 January 2020
tionnaires and child’s body mass status was defined according to the International Obesity Task
KEYWORDS
Force (IOTF)’s criteria. Prevalence of combined overweight/obesity was 26.7%, with boys having Dietary fibres; overweight;
significantly higher prevalence than girls (31.5 versus 24.7%, p < 0.001). Logistic regression ana- obesity; children; diet
lysis, after various adjustments were made, revealed no association between dietary fibres intake
and obesity/overweight (Odds Ratio ¼ 0.76; 95% CI 0.48, 1.19). The lack of an association
between dietary fibres intake and overweight/obesity status among pre-adolescents could be
attributed to various reasons such as, methodological issues reflecting the study’s design, the
measurement of exposure or due to true absence of a relationship. Nevertheless, fibres con-
sumption should not be prevented, but, promoted under the context of a balanced diet,
because of their numerous pleiotropic health effects.

Introduction management and consequently minimize the potential

The increased childhood obesity consists a worldwide
concern and its escalating prevalence poses adverse
health implications during the lifespan. In the 2000’s
report of World Health Organization (WHO), obesity
is defined as a growth in fat mass tissue that can lead
to non-communicable diseases and may have negative
impacts on wellbeing (World Health Organization
[WHO] 2000). It is well established that obese chil-
dren are at higher risk of developing comorbidities
such as diabetes mellitus, dyslipidaemia, hypertension,
obstructive sleep apnoea, non-alcoholic fatty liver dis-
ease and other detrimental health consequences (Han
et al. 2010). Late childhood and early adolescence
appear to be a crucial period in obesity development.
This period is accompanied by physiologic changes
associated with puberty, which may increase the risk
of acquiring and “tracking” obesity into adulthood
(Whitaker et al. 1997; Maynard et al. 2001; OECD
2014; Kumar and Kelly 2017). Thus, it’s of outmost
importance to detect strategies for weight
risks of developing obesity. Among the most effective
means for reducing obesity is healthy nutrition.
Several food behaviours, dietary patterns, foods and
nutrients have been associated with the development
of obesity. A high value nutrient, which triggered
great interest in the past years is dietary fibres. The
American Dietetic Association reported that fibres
seem to have a protective effect in the management of
cardiovascular risk and childhood appendicitis, are
beneficial for gastrointestinal health, can be proved
helpful for glycemic control and cancer prevention,
along with many more positive effects in various
health aspects (Adamidis et al. 2000; Slavin 2008;
Gianfredi et al. 2018). Fibres are also considered as a
safeguard to body weight control and consequently as
a protective factor against obesity development
(Gropper and Acosta 1987; Samuel et al. 2003; Slavin
2008). The proposed pathophysiological mechanisms
through which fibres may reduce fat accumulation
and obesity have not been well studied and

CONTACT Demosthenes B. Panagiotakos dbpanag@hua.gr Department of Nutrition and Dietetics, School of Health Science and Education,
Harokopio University, Athens 176 71, Greece
ß 2020 Taylor & Francis Group, LLC
2 V. NOTARA ET AL.
understood; it has been suggested that dietary fibres
may lead to the reduction of the adsorption capacity
of the small intestine, the nutrient displacement of
energy-dense foods and the induced satiety by fibre-
rich foods (Slavin 2005). Several previous studies have
examined the role of fibres consumption on weight
control, adiposity shrinkage and obesity risk reduction
among children and adolescences, with conflict-
ing results.
Therefore, the purpose of this study was to exam-
ine the association between dietary fibres intake and
overweight, obesity prevalence, among children
10–12 years old children, and to further explore
potential mediating factors.
Methodology
Participants and sampling procedures
The study was conducted in the greater metropolitan
Athens area, in Heraklion, the capital City of the
Island of Crete, and in three main counties of the
Peloponnese peninsula, during the school years
2014–2015 and 2015–2016. Schools were selected
using random sampling from a list of schools pro-
vided by the Greek Ministry of Education. In total, 47
schools were chosen (32 from Athens, 5 from
Heraklion, Crete, 3 from Pyrgos, 2 from Kalamata
and 5 from Sparta, Peloponnese). Participation rate
ranged from 95 to 100% between schools, without any
significant differences between the studied areas. A
total of 1728 students (795 or 46% boys), aged
10–12 years, attending the 5th and 6th grade of pri-
mary school, were enrolled in the study; however,
information for body mass was available from 1659
children (due to lack of weight or and height meas-
urements) and this consisted the working sample of
the present analysis. Children’s parents were also
invited to participate, with 68.9% response rate being
achieved (n ¼ 1190). The sample size was adequate
to evaluate effect size measures’ differences of 20% at
<5% level of significance, achieving 85% statis-
tical power.
Bioethics
The study was approved by the Institute of
Educational Policy of the Ministry of Education and
Religious Affairs (code of approval F15/396/72005/C1)
and was carried out in accordance with the
Declaration of Helsinki (1989). The school principals,
teachers, parents and students were informed about
the aims and procedures of the study. A signed
parental consent was obtained before the completion
of the questionnaires.
Measurements
Each child was asked by the study’s investigators or
the schoolteacher to complete an anonymous ques-
tionnaire. To increase the accuracy of responses
obtained, study’s investigators assisted giving practical
examples. The children’s questionnaire included a var-
iety of questions regarding basic socio-demographic
characteristics (age, gender), daily activities and habits
(i.e. physical and sedentary activities, outdoor activ-
ities, dietary habits and smoking). Specifically, dietary
habits were evaluated using a validated semi-quantita-
tive Food Frequency Questionnaire (FFQ)
(Antonogeorgos et al. 2013) that included all foods
and beverages consumed by the general child popula-
tion, as well as dietary behaviours (i.e. breakfast con-
sumption, number of meals per day, etc.). Physical
and sedentary activities were also recorded through a
validated questionnaire that has been developed for
children and adolescents (Argiropoulou et al. 2004).
In order to evaluate children’s daily activities, daily
computer use and TV watching time were also meas-
ured. Parental questionnaire was completed by any of
the parents at home and they were asked to return
the completed questionnaire at the school setting. In
most cases, questionnaires were completed by one
parent, usually by the mother (75%). Parental ques-
tionnaire consisted of questions on family demo-
graphic characteristics (place of residence, nationality),
anthropometric self-reported data, various family
characteristics, i.e. socioeconomic status (SES)—mater-
nal and paternal educational level and current occupa-
tional status. Parental educational status was classified
into (i) lower secondary or less, including all individu-
als having completed <9 years of schooling, (ii) higher
secondary education, for those having completed
12 years of mandatory education, (iii) post-secondary
education for those with a Bachelor degree and (iv)
higher third level education for those with postgradu-
ate studies. For this study, participants were classified
into three educational levels: (i) Primary Education,
(ii) Secondary and (iii) University.
Dietary intake assessment
As mentioned above, dietary habits of children were
evaluated from self-reported semi quantitative FFQ, in
which various food items and beverages were recorded
(Antonogeorgos et al. 2013). The FFQ included 63
questions regarding the frequency of consumption

(weekly or daily) of the main food groups and bever-
ages typically consumed in Greece, and the eating
habits of children. The FFQ has been validated on a
sample of children aged 10–12 years living in urban
areas in Greece. The reported frequencies of intake
varied from never/rare to daily consumed. Moreover,
portions of foods and beverages consumed were also
recorded. Breakfast consumption was also assessed
and categorized into never or rarely consumed to
everyday intake; type of breakfast was also recorded.
Children’s adherence to the Mediterranean diet was
evaluated through a Mediterranean diet quality index,
the KIDMED score, for children and adolescents
(Serra-Majem et al. 2004). This can be regarded as a
measure of an overall healthy diet. The higher the
KIDMED score is, the greater the adherence to the
Mediterranean diet is. Dietary fibres consumption was
calculated through the United States Department of
Agriculture food composition tables, as well as local
food composition tables (US Department of
Agriculture, Agricultural Research Service [USDA]
2019; Trichopoulou and Georga 2004). Quartiles of
dietary fibres were calculated in units of g/1000 kcal
and were classified into four categories according to
the portions of fibres consumed from all food catego-
ries in the FFQ. Dietary fibres were then classified
into: (i) 1st quartile, “very low consumption” (0–5 g/
1000 kcal per day), (ii) 2nd quartile, “low con-
sumption” (6–10 g/1000 kcal per day), (iii) 3rd quar-
tile, “medium consumption” (11–15 g/1000 kcal per
day) and (iv) 4th quartile, “high consumption”
(>16 g/1000 kcal per day). This categorical approach
was preferred to evaluate fibres intake since several
outliers were observed that could influence the analy-
ses followed on.
Children and parents body weight categorization
Body mass index (BMI) was calculated as weight (in
kilograms) divided by height (in meters) squared. For
children, weight status was categorized using the age-
and gender-specific International Obesity Task Force
(IOTF) BMI cut-off criteria (Cole et al. 2000) where
child’s BMI is related to the relevant adult’s BMI,
according to age in months and gender. Children
were, therefore, also categorized as underweight, nor-
mal weight, overweight and obese. Under- and nor-
mal-weight categories were combined in both cases
(for parents and children) since the sample that was
underweight was small. All associations were eval-
uated using underweight/normal BMI as the reference
category. Weight status, however, was calculated by
INTERNATIONAL JOURNAL OF FOOD SCIENCES AND NUTRITION 3
taking the mean value (for males and females), from
the IOTF tables, for each weight category. Parental
weight status was defined based on the WHO cut-
offs: underweight: <18.5 kg/m2, normal weight:
18.5–24.9 kg/m2, overweight: 25–29.9 kg/m2 and obese:
>30 kg/m2.
Statistical analysis
Group mean differences between BMI categories were
tested using the analysis of variance (ANOVA), for
the normally distributed variables, after controlling for
equality of variances using Levene’s test. Pearson’s
chi-squared test was used to examine associations
between BMI categories and categorical variables.
Logistic regression analysis was applied to evaluate the
association between fibres intake (as a categorical
independent variable) and BMI status of the children.
Variables found to be statistically associated with
children’s BMI status were also included in the logistic
regression models. Moreover, some other factors (i.e.
breakfast consumption, daily walking time) were also
used as confounding factors (although not significant
in the univariate analyses) due to a-prior evidence of
potential association with children’s weight status.
Collinearity between the independent variables used
to fit logistic regression models was tested using the
correlation of b-coefficients. Two-sided hypothesis
tests were considered with the level of significance set
at 5%. All analyses were conducted using STATA 14.0
(StataCorp LP, College Station, Texas).
Results
Prevalence of combined overweight/obesity was 26.7%
(21.7% overweight and 5.0% obese), with prevalence
being significantly higher in boys (31.5% compared to
24.7%, p < 0.001). In Tables 1 and 2, children’s and
parent’s characteristics, respectively, including
anthropometric measurements, dietary habits, daily
activities and socioeconomic factors in association
with children’s body weight status were evaluated.
Among obese children approximately 52.9% were
boys and 47.1% were girls (p ¼ 0.01). Most of the chil-
dren who were classified as obese and overweight
were more likely to have very “low” dietary fibres
intake (38.2 and 28.7%, respectively) compared to
22.5% of the normal body weight children who
reported the same amount of fibres consumption;
however, fibres intake and child body weight did not
reach statistical significance (p ¼ 0.14). Factors that
displayed the strongest relationship with children’s
4 V. NOTARA ET AL.


Table 1. Children characteristics by weight status .
Underweight /normal Overweight Obese Total
(n ¼ 1197) (n ¼ 375) (n ¼ 87) (n ¼ 1659) p
Children characteristics
Age (years), mean ± SD 11.2 ± 0.7 11.2 ± 0.7 11.2 ± 0.6 11.2 ± 0.7 0.64
Gender (%) 0.01
Boys 523 (43.7%) 195 (52.0%) 46 (52.9%) 764 (46.1%)
Girls 674 (56.3%) 180 (48.0%) 41 (47.1%) 895 (53.9%)
Children’s dietary habits and activities
Dietary fibres intake per day (g/1000 kcal) 0.14
Very low consumption (0–5 g/1000 kcal) 128 (22.5%) 52 (28.7%) 13 (38.2%) 193 (24.6%)
Low consumption (5–10 g/1000 kcal) 144 (25.3%) 45 (24.9%) 10 (29.4%) 199 (25.4%)
Medium consumption (10–15 g/1000 kcal) 143 (25.1%) 46 (25.4%) 6 (17.6%) 195 (24.8%)
High consumption (>15 g/1000 kcal) 155 (27.2%) 38 (21.0%) 5 (14.7%) 198 (25.2%)
Breakfast consumption (times/week) 0.84
Never/almost never 69 (5.8%) 23 (6.2%) 5 (5.7%) 97 (5.9%)
1–2 times/week 168 (14.1%) 52 (14.1%) 9 (10.3%) 229 (13.9%)
3–4 times/week 112 (9.4%) 41 (11.1%) 9 (10.3%) 162 (9.8%)
5–6 times/week 86 (7.2%) 25 (6.8%) 3 (3.4%) 114 (6.9%)
Everyday 754 (63.4%) 229 (61.9) 61 (70.1%) 1044 (63.4%)
Computer use on daily basis (hours/day) 0.002
0–1 h/day 771 (69.3) 224 (63.3%) 51 (61.4%) 1046 (67.5%)
1–2 h/day 221 (19.9) 88 (24.9%) 27 (32.5%) 336 (21.7%)
2–3 h/day 90 (8.1) 26 (7.3%) 0 (0.0%) 116 (7.5%)
3–5 h/day 20 (1.8) 14 (4.0%) 4 (4.8%) 38 (2.5%)
>5 h/day 11 (1.0) 2 (0.6%) 1 (1.2%) 14 (0.9%)
Walking (min/day) 0.69
<15 min/day 326 (28.0%) 107 (29.6%) 28 (33.3%) 461 (28.6%)
15–30 min/day 405 (34.8%) 127 (35.1%) 33 (39.3%) 565 (35.1%)
31–45 min/day 144 (12.4%) 49 (13.5%) 10 (11.9%) 203 (12.6%)
46–60 min/day 112 (9.6%) 30 (8.3%) 4 (4.8%) 146 (9.1%)
>60 min/day 178 (15.3%) 49 (13.5%) 9 (10.7%) 236 (14.4%)
KidMed score (4 to 12), mean ± SD 4.7 ± 2.3 4.4 ± 2.3 4.3 ± 2.5 4.6 ± 2.3 0.05
Age is presented as mean ± SD and categorical variables as frequencies (%), level of significance set at p < 0.05; tested via ANOVA for age, and chi-square
test for all other categorical variables.
IOTF: International obesity task force; SD: standard deviation.
Weight status is defined based on IOTF cut-off criteria for children.

Table 2. Parental characteristics of the sample by weight status.

Child’s body weight status
Underweight/normal Overweight Obese Total
(n ¼ 1197) (n ¼ 375) (n ¼ 87) (n ¼ 1659) p
Parent’s characteristics
Mother’s weight status <0.0001
Lean 100 (12.5%) 24 (10.0%) 3 (6.8%) 127 (11.7%)
Normal 447 (55.9%) 113 (47.3%) 11 (25.0%) 571 (52.7%)
Overweight 180 (22.9%) 73 (30.5%) 17 (38.6%) 270 (24.9%)
Obese 73 (9.1%) 29 (12.1%) 13 (29.5%) 115 (10.6%)
Father’s weight status 0.003
Lean 15 (2.0%) 3 (1.4%) 1 (2.3%) 19 (1.9%)
Normal 235 (30.8%) 38 (17.2%) 13 (29.5%) 286 (27.8%)
Overweight 361 (47.4%) 118 (53.4%) 18 (40.9%) 497 (48.4%)
Obese 151 (19.8%) 62 (28.1%) 12 (27.3%) 225 (21.9%)
Socio-economic status
Educational level of mother (years of school) 0.16
Primary 89 (10.8%) 24 (10.0%) 7 (14.9%) 120 (10.8%)
Secondary 344 (41.8%) 119 (49.6%) 23 (48.9%) 486 (43.8%)
University 389 (47.3%) 97 (40.4%) 17 (36.2%) 503 (45.4%)
Educational level of father (years of school) 0.065
Primary 129 (15.8%) 41 (17.2%) 12 (24.5%) 182 (16.5%)
Secondary 340 (41.7%) 111 (46.4%) 25 (51.0%) 476 (43.1%)
University 347 (42.5%) 87 (36.4%) 12 (24.5%) 446 (40.4%)
Parent’s dietary habits
Dietary fibres intake (g/1000 kcal) 0.58
Very low consumption 66 (26.0%) 17 (21.3%) 4 (33.3 %) 57 (25.1%)
Low consumption 70 (27.6%) 16 (20.0%) 3 (25.0%) 89 (25.7%)
Medium consumption 60 (23.6%) 22 (27.5%) 3 (25.0%) 85 (24.6%)
High consumption 58 (22.8%) 25 (31.3%) 2 (16.7%) 85 (24.6%)
Categorical variables as frequencies (%), level of significance set at p < 0.05; tested via ANOVA for age, and chi-square test for all other categor-
ical variables.
BMI: body mass index; SD: standard deviation.
Weight status is defined based on BMI cut-offs for adults.
 INTERNATIONAL JOURNAL OF FOOD SCIENCES AND NUTRITION 5

Table 3. Results from multiple logistic regression models (odds ratios, 95% confidence intervals) on children’s likelihood of being
overweight/obese compared to their quartiles of dietary fibres consumption (highest, medium, low versus very low quartile, i.e.
>15 g/1000 kcal, 11–15 g/1000 kcal, 6–10 versus 0–5 g/1000 kcal).
Odds ratio 95% (confidence interval)
Low versus very low Medium versus very low Highest versus very low Adjusted for
Model 1 0.79 (0.52, 1.19) 0.84 (0.55, 1.27) 0.81 (0.53, 1.22) —
Model 2 0.77 (0.49, 1.23) 0.81 (0.50, 1.22) 0.79 (0.52, 1.20) Age, gender
Model 3 0.75 (0.46, 1.22) 0.78 (0.52, 1.19) 0.77 (0.51, 1.17) Model 2 plus breakfast consumption
Model 4 0.80 (0.44, 1.27) 0.77 (0.47, 1.20) 0.76 (0.48, 1.19) Model 3 plus daily walking time, computer use
Model 5 0.83 (0.44, 1.54) 0.88 (0.41, 1.58) 0.83 (0.45, 1.53) Model 4 plus parental education level
Model 6 1.00 (0.51, 1.98) 0.98 (0.49, 1.95) 0.99 (0.50, 1.94) Model 5 plus parental BMI
Model 7 0.87 (0.46, 2.10) 0.82 (0.41, 2.05) 0.88 (0.48, 2.00) Model 6 plus KIDMED index
Model 1 examines the crude likelihood of children being obese/overweight considering fibres consumption (high, medium, low versus very low intake);
Model 2 is adjusted for gender and age of the children; Model 3 is adjusted for gender, age and breakfast consumption, as part of their dietary habits;
Model 4 is adjusted for age, gender, breakfast consumption, computer use and daily walking time, as a part of their daily activities; Model 5 is adjusted
for age, gender, breakfast consumption, computer use, daily walking time and parental educational level, as a part of their socioeconomic status; Model
6 is adjusted for age, gender, breakfast consumption, computer use, daily walking time and parental educational level and parental BMI status (as part
from parental influence on children’s body weight), Model 7 is adjusted for age, gender, breakfast consumption, computer use, daily walking time, paren-
tal educational level, parental BMI status and KIDMED index.

body weight status were gender, as mentioned above, Discussion

computer use and parental body weight (p < 0.05).
Additionally, father’s educational status presented a
marginal relation to children’s body weight status
(p ¼ 0.06).
Obese children, seemed to have a significantly
lower level of computer use (p ¼ 0.00). Moreover,
obese children were more likely to have overweight/
obese parents, such as the prevalence of obese chil-
dren was higher among overweight (38.6%) and obese
mothers (29.5%) in comparison to normal (25.0%)
and underweight mothers (6.8%) (p < 0.00). Similarly,
the prevalence of obese children was higher among
overweight (40.9%) fathers instead of obese (27.3%),
normal and underweight fathers (29.5 and 2.3%,
respectively) (p ¼ 0.00).
Crude analysis revealed no association between
fibre intake and children overweight or obesity status.
However, residual confounding may exists, thus,
multi-adjusted logistic regression analysis was applied.
No association between dietary fibres’ intake and the
odds of children being overweight/obese was observed
(Table 3). The results remained similar and insignifi-
cant even after adjusting for age, sex, (Model 2),
breakfast consumption, daily walking time, computer
use and parental socio-economic level, as potential
confounders (Models 3, 4 and 5). Further adjustment
including father’s and mother’s BMI into the previous
model did not alter the aforementioned association
between dietary fibres consumption and childhood
obesity (Model 6). Similarly, when further adjustment
for overall quality of children’s dietary habits was per-
formed by KIDMED index, the results remained insig-
nificant (Model 7).
The association between dietary fibres intake and
obesity development, in a sample of primary school
age Greek children, was examined. In contrast to the
vast majority of other studies, dietary fibres intake
was not associated with childhood overweight and
obesity in our sample. Despite the limitations of this
cross-sectional study, the presented results are of con-
siderable importance, since they give a different view
of a controversial issue of fibres intake and childhood
obesity. It is widely adopted that to form a conclusion
based on research data, all available information, both
positive and negative, has to be included. But this
does not always happen. A number of scientists sup-
port that a large portion of research today is flawed,
which is particularly problematic and even dangerous
especially within the health sciences (Ioannidis 2005).
A solution to this problematic situation is meta-
research in which all information is included, both
positive and negative. Under this context, the pre-
sented findings could be a valuable source of informa-
tion when examining the topic of fibres intake and
obesity in children and adolescents.
The vast majority of previous studies have pointed
out the protective role of high dietary fibres intake in
obesity, mostly among adults, but also in children and
adolescents. For example, high dietary fibres intake
has shown a reduction in the body mass of 398 chil-
dren of 8–10 years old; however, this was evident only
when the consumption exceeded 10 g in fibres per day
(Kring and Heitmann 2008). In addition, the favour-
able effects of high fibres consumption on excessive
body weight management was also observed in
6 V. NOTARA ET AL.
another small-scale, observational study conducted in
the Obesity Unit of Huddinge University Hospital in
Sweden, between 2001 and 2002 (Vågstrand et al.
2007). More recently, using the NHANES 2003–2006
data, it was revealed that among 2–18 year old chil-
dren and adolescents, the risk for overweight/obesity
decreased by 17% from children in the medium tertile
of fibre intake compared to the lowest tertile and by
21% between the highest compared to the lowest ter-
tile (Brauchla et al. 2012). Adherence to fibres rich
diets was also related to healthier eating patterns and
higher engagement in physical activity among chil-
dren, which depicts a healthier lifestyle in general
(O’Neil et al. 2011; Choumenkovitch et al. 2013).
Apart from their beneficial effects on weight reduc-
tion, dietary fibres have shown significant changes in
body composition and especially in adiposity tissue
(Albertson et al. 2015), lower likelihood of early mor-
tality and cardiovascular diseases, through possible
mechanisms on glycaemic control, cholesterol lower-
ing effects and hypertension (Veronese at al. 2018;
Bozzetto et al. 2018). However, there are also studies
suggesting no association. In particular, no relation-
ships was observed between dietary fibre and visceral
adiposity among 120 overweight Latino children,
10–17 years old, with a family history of type 2 dia-
betes (Davis et al. 2007), whereas, in a longitudinal
study of German children, higher fibre intake was
associated with a higher risk for overweight or obesity
(Cheng et al. 2009).
The main mechanisms that have been proposed
regarding the role of dietary fibre on obesity include
reduced caloric density of the foods, a slower rate of
food ingestion and potential effects on satiety (Heaton
1973; Djukic et al. 2009; Clark and Slavin 2013).
Moreover, the physiological effects of fibre relate to
the physical properties of volume, viscosity and water-
holding capacity. Fibre directly influences a complex
array of microbiological and biochemical paths dir-
ectly through modification of the kinetics of digestion
and metabolism (Slavin 2005; Howarth et al. 2009).
Despite the accumulating level of evidence, it should
be acknowledged that most studies that have evaluated
the role of fibre in the treatment of obesity have been
somewhat limited by lack of comparison groups, inad-
equate sample sizes, short durations of the observa-
tions and some methodological issues, and
particularly, the sources of dietary fibres consumed
(i.e. breakfast cereals (sweetened or not), fruits and
vegetables, peas, beans and pulses, etc). A review of
44 studies on fibre treatments found that only viscous
fibres reduced food intake and led to weight loss
(Clark and Slavin 2013). Viscous fibres include gluco-
mannan, beta-glucans, pectins, guar gum and psyl-
lium, and can be found in legumes, asparagus,
Brussels sprouts, oats and flax seeds. Other types of
food sources of fibres have not shown promising
results as regards obesity, and particularly when fibres
are consumed through sweetened breakfast cereals
(Kosti et al. 2010). Therefore, the study by which diet-
ary fibres intake may prevent obesity in children and
adolescents needs further investigation and careful
studies’ settings and considerations.
Apart from their beneficial effects on obesity, diet-
ary fibres in last decades have emerged as remarkable
dietary components and reported many health bene-
fits, especially in the prevention and treatment of sev-
eral chronic diseases. High fibres intake has been
associated with lower cholesterol concentrations, lower
blood pressure and reduced C-Reactive Protein levels
(Brown et al. 1999; Ajani et al. 2004; Whelton et al.
2005). Dietary fibres have also proven helpful for gly-
cemic control, especially via mechanisms that include
slow digestion and absorption of nutrients which con-
sequently end up in long term diabetes treatment
(Chandalia et al. 2000). Extensive evidence support
that fibres may be protective to gut function, particu-
larly by increasing faecal weight and serving as pre-
biotic for bowel microflora (Tucker et al. 1981;
Roberfroid 2007). Additionally, in children it has been
reported to improve constipation and used as a thera-
peutic treatment tool (Maffei and Vicentini 2011).
Finally, a relationship between dietary fibres and can-
cer prevention, with a priority to colon and breast
cancer has been observed (Prentice 2000; Bingham
et al. 2003).
As regards the other findings of this work, parental
body weight status was associated with children’s
obesity. It has long been reported that parental obesity
is a strong predictor of children’s BMI levels
(Danielzik et al. 2004; Wardle et al. 2008; Beydoun
and Wang 2009; Svensson et al. 2011; Xu et al. 2019).
The finding from this study was consistent with the
previous observations displaying that obese children
were more likely to have overweight and obese
parents, and this relationship was spotted mainly
among overweight parents instead of obese. Regarding
gender differences, boys displayed higher BMI levels
compared to girls. A possible explanation relies on the
desire of girls to have thinner silhouette, whereas boys
at this age express a desire of larger and more muscu-
lar body (Ling et al. 2015). As it concerns father’s
educational status, it was revealed that there was a sig-
nificant relationship with children’s overweight and

obesity. This outcome is in accordance with a recent
analysis in which a positive association between high
educational level of parents and the prevalence of
obesity was displayed. Parents with higher educational
level are challenged with time constraints and that
could be a barrier to direct their children to healthier
nutritional choices (Smith et al. 2018). Computer use
was also examined in relation to children’s body
weight status; a significant positive association
between overweight/obesity and computer use was
observed. This is a usual finding since children at this
age are massively exposed to technology advancements
through video games, a fact that negatively affect their
daily activities and, consequently, their body weight
status. Moreover, recent data have already revealed
that screening time is associated with sedentary activ-
ities and subsequently with exceed weight gain among
children (Carson et al. 2016).
Limitations
This was an observational study, therefore, some limi-
tations should be acknowledged. No temporal rela-
tionship and hence causal inferences can be made.
Another potential limitation may also be reporting
bias due to the self-reporting questionnaires.
However, the presence of a trained investigator
throughout the completion of the questionnaire for
addressing any potential misconceptions, increases the
validity of the given responses. It should be also stated
that dietary fibres consumption was calculated
through FFQ, which represent dietary habits rather
than the actual dietary intake of the participants.
Finally, given that energy intake was not measured we
cannot include it in the model, as it has been sug-
gested (Willett et al. 1997).
Conclusions
The lack of an association between dietary fibres
intake and overweight/obesity status among pre-ado-
lescents could be attribute to various reasons, includ-
ing, methodological issues reflecting the study’s
design, the measurement of exposure (i.e. sources of
dietary fibres) or due to true absence of a relationship.
Nevertheless, fibres consumption should not be pre-
vented, but, promoted under the context of a balanced
diet, because of their pleiotropic effects on
human health.
INTERNATIONAL JOURNAL OF FOOD SCIENCES AND NUTRITION 7
Acknowledgments
The authors would like to thank all the students and
parents who took part in the research. Also, they would like
to thank all the teachers and school principals who contrib-
uted to the sampling process and data collection. Moreover,
the authors would like to acknowledge and thank the field
investigators of the study: Marialena Kordoni, Anna
Velentza, Magdalini Mesimeri, Ilias Kokoris, Athina
Fregoglou, Vasiliki Maragou, Marina Mitrogiorgou, Rania
Baroucha, Dimitra Kroustalli for their support and assist-
ance with the data collection.
Disclosure statement
The authors report no conflict of interest.
ORCID
Andrea Paola Rojas-Gil http://orcid.org/0000-0002-
9812-2131
Ekaterina N. Kornilaki http://orcid.org/0000-0003-
1723-7453
Demosthenes B. Panagiotakos http://orcid.org/0000-
0001-8583-153X
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