The eating scene in recent decades points to an increase in the consumption of ultra-processed foods, which are high in energy, fat, sugar, and salt, opposed to the consumption of fruits and vegetables and, therefore, a reduction in vitamins, minerals, and fibers ^{[1][2][3][4][5][6][7]}[1,2,3,4,5,6,7]. These facts contributed to the increase in childhood overweight and obesity, which are early risk factors for the development of cardiometabolic complications, diabetes, and cancer [8]. It is estimated worldwide that 11% of children aged 5 to 9 years have obesity, which corresponds to 72 million children [9]. In Brazil, 14.37% of children aged 7 to 10 years are overweight for their age [10].

The assessment of food consumption in childhood is essential to help to understand the effect of food choices on health in the short term and even during adult life, as eating habits acquired in childhood can last in the long term [11]. This evaluation can be carried out using knowledge of dietary patterns, which were highlighted in recent years. Dietary patterns are defined as the set or group of foods consumed by a certain population obtained through statistical methods of aggregation or reduction in components. They can provide a global vision of the diet and that helps with the early identification of dietary deviations and the use of appropriate interventions ^[12][13][12,13].

Studies from the last decade with different populations identified several dietary patterns, such as the “Western”, “Mediterranean”, “traditional”, and the “healthy” one, referring to the consumption of food groups from each country or region. Each of these patterns presents specific associations with lifestyle characteristics, thus presenting diverse health effects ^[14][15][14,15].

2. General Characteristics of Dietary Patterns of the Included Studies

The number of dietary patterns obtained in each study varied. The majority of the studies (seven studies) found three patterns ^{[16][17][18][19][20][21][22]}[22,23,24,26,30,32,34], four identified four patterns ^{[23][24][25][26]}[20,27,28,33], three studies found five patterns ^[27][28][29][21,25,35], and two identified two patterns ^[30][31][29,31]. The majority (93.75%) identified a dietary pattern considered as “predominantly unhealthy”, that is, patterns that are made up predominantly of unhealthy foods, being called “snacks (n = 4), “junk convenient” (n = 2), “unhealthy” (n = 1),” less healthy” (n = 1), “industrialized” (n = 1),” saturated fat” (n = 1), “junk food” (n = 1), “fast food and fried food” (n = 1), “obesogenic” (n = 1), “snacks” (n = 1), “soft drinks” (n = 1), “canned soups and meals” (n = 1), “sweetened drinks” (n = 1), “modern” (n = 1), “milk and chocolates” (n = 1), “high fat” (n = 1), “high sugar” (n = 1), “Western” (n = 1), “diet” (n = 1), “refined cereals and animal organs” (n = 1). In contrast, dietary patterns classified as “predominantly healthy” (75%) were identified in the studies as “typical food” (n = 4), “healthy” (n = 3), “Mediterranean” (n = 1), “vegetables” (n = 1) and other “diverse” (n = 1), “legumes, whole grains and red meat” (n = 1), “fruit, milk and egg” (n = 1), “shellfish, mushroom and eggs” (n = 1), “beverages, fish and low-fat milk” (n = 1).

3. Factors Associated with Dietary Patterns

Table 1 represents the number of associations found in the articles, between all dietary patterns and associated factors found in each study in a broad but objective way. Associations were demonstrated directly or inversely, with patterns that were classified as healthy or unhealthy. In each study, it was possible to find more than one association between dietary pattern and associated factor.

	Patterns
	Healthy		Unhealthy
Associated Factors	Direct	Inverse	Direct	Inverse
Economic situation	3			1
Parents’ education		1	1	3
Per capita income	1	1	1	1
Maternal occupation			2
Parents’ overweight			2
Child’s age			1
Child’s gender	3		2
Obesity/Adiposity of the child		1	3
Screen time			3
Habit of eating breakfast and variety in food	1
Missing meals from the child	1		1
Bone mineral density	1			1

4. Socioeconomic Characteristics

Galvan-Portilho et al., evaluated 857 Mexican children and adolescents aged 5 to 15 years and identified that the higher level of parental education showed a lower probability of adherence to the “high sugar” standard (grain products with more fat and sugar, sweetened beverages and dairy products high in fat and sugar, few fruits and vegetables) ^[16][22]. Li et al., found among 283 pairs of Chinese twins, aged 7 to 15 years, that higher levels of maternal education were associated with greater heritability for consumption of “fast food and fried foods” (Western fast food and Chinese fried foods) and lower heritability for the pattern “vegetables” (vegetables, beans, and fruits) ^[28][25]. In comparison, the study conducted by Oellingrath et al., with 924 Norwegian children aged 9 to 10 years identified that the low maternal educational level was associated with higher scores of the “snack” pattern (snacks and sweetened drinks consumed between meals, low frequency of breakfast and dinner, and low consumption of water, vegetables, and whole grain bread) ^[26][33]. In a study with 1.136 Brazilian children aged 7 to 14 years, Silva et al., observed that the lowest maternal educational level was negatively associated with the “obesogenic” pattern (foods source of fats in general and saturated fats and high glycemic index) [31]. The study by O’Brien et al., carried out with 483 Irish children aged 7 to 13 years, found an association between families with a high socioeconomic level (compared to low and medium levels) and a “healthier” pattern (higher intake of food groups: “rice, pasta, starches, and grains”, “wholemeal bread and pastries”, “breakfast cereals”, “skimmed milk”, “potatoes”, “vegetables”, “fruits”, “fish and fish products” and “poultry and poultry preparations”) ^[30][29]. Rodrigues et al., in their study with 1.063 Portuguese children aged 6 to 8 years, observed an association between higher socioeconomic status (parental education and occupation) with the pattern “Portuguese diet” (rice, pasta, meat, and potatoes) and “Mediterranean diet” (vegetables, fruits, and fish), and negative association with the pattern “saturated fat diet” (fast food, eggs, and butter) ^[19][26]. Regarding income, Silva et al., reported an inverse association between maternal income and the percentiles of the distribution of the “obesogenic” pattern [31]. Li et al., in a study with twins, detected an association between higher family income and adherence to the “meat”, “fast food and fried foods” pattern ^[28][25]. In the study by Galvan-Portilho et al., it was observed that instability in the mother’s occupation (unemployed or informal work) was associated with a greater probability of following the “high fat” pattern (processed and high-fat foods, refined grains, processed meats, red meats, whole grain products, processed dairy products, Mexican dishes) ^[16][22]. There were no consensual results when comparing sexes. Rodrigues et al., found that males were associated with a higher consumption of the “Portuguese diet” pattern, configured as a healthy diet ^[19][26]. Similarly, Wall et al., identified an association between the male gender with the “traditional” pattern (cauliflower, peas, vegetable mix, potatoes, pumpkin, and meat as the main dish) among 591 New Zealand children aged 7 years ^[20][30]. Oellingrath et al., observed that boys had higher scores for the patterns “snack” and “junk/convenient” (fast food processed with high fat and sugar content, such as French fries, industrialized pizza, processed meats, sweets, ice cream, and soft drinks) ^[26][33]. In the study by Lee et al., with 154 Korean children at 7 and at 9 years of age, there was an association between the “animal source” pattern (meat and fish), considered healthy, and being female ^[17][23].

5. Screen Time

Screen time was associated with the “predominant unhealthy” pattern among schoolchildren in the included studies. Lee et al., observed that having more TV time was associated with the consumption of the “snacks” pattern (sweets, soft drinks, and bread) ^[17][23]. Similarly, Rodrigues et al., identified an association between the habit of watching TV with the “diet based on saturated fat” pattern ^[19][26]. In the study by Galvan-Portilho et al., it was found that screen time higher than 1.25 h/day was associated with a higher probability of the child having a “high sugar” dietary pattern ^[16][22].

6. Nutritional Status

The included studies showed an association between nutritional status and the dietary pattern, and they showed higher weight gain/BMI or adiposity in schoolchildren with higher adherence to unhealthy dietary patterns. In 2751 Mexican schoolchildren (aged 5 to 11 years), the “modern” pattern (pies and sandwiches, and breakfast cereal with sugary groups) was associated with obesity ^[23][20]. Shroff et al., observed, in their study with 961 Colombian children aged 5 to 12 years, that those in the highest quartile of adherence to the “snacks” pattern (foods with high energy density and low nutrient density: sweets, ice cream, fried snacks, soft drinks, and sweetened drinks with fruit flavor) had a greater gain in BMI/year and the ratio of subscapular and tricipital skinfolds compared to children in the lower quartile ^[25][28]. In contrast, Zamora-Gasga et al., evaluated 724 Mexican children aged 9 to 12 years and observed a negative association between the pattern classified as “traditional” (large intake of legumes, vegetables, snacks, sauces, and seasoning) and weight and body mass index ^[18][24]. Meanwhile, in a study with 9 and 10-year-olds who had a “varied Norwegian” or “dieting” dietary pattern, the schoolchildren were much more likely to be overweight ^[26][33].

7. Other Factors

The habit of breakfast and the regularity of a varied diet were associated with greater adherence to the predominant “healthy” dietary pattern in the study by Lee et al. ^[23][20] conducted with 154 children aged 7 to 9 years. A study with children aged 2 to 8 years ^[22][34] found an association between meal skipping and adherence to the pattern “fast/convenient” considered mostly unhealthy. The nutritional status of the parents was mentioned as associated with the dietary pattern of the schoolchild. Oellingrath et al., found that paternal and maternal overweight were associated with higher “diet” pattern scores and maternal overweight with higher “snack” scores ^[26][33]. Regarding bone development, Liao X et al., associated the “fruit–milk–eggs” pattern, which is considered a healthy pattern, with better bone density. In contrast, the pattern “refined cereals and animals’ organs”, considered unhealthy, was associated with low bone density ^[29][35].