This review looked at the effects of eating less fat on bodyweight and fatness in healthy children aged between two and 18 years, who were not aiming to lose weight. This relationship differs in children compared to adults, because children are still growing and developing. To try to better prevent people from being overweight and obese, we need to understand what the ideal amount of total fat in our diets should be, and particularly how this is related to bodyweight and fatness. What is the relationship between the amount of fat a child eats and their weight and body fat? However, heterogeneous methods and reporting across cohort studies, and predominantly very low‐quality evidence, made it difficult to draw firm conclusions and true relationships may be substantially different. Over half the cohort analyses that reported on primary outcomes suggested that as total fat intake increases, body fatness measures may move in the same direction. Lower versus usual or modified fat intake may make little or no difference to height over more than five years (MD ‐0.60 cm, 95% CI ‐2.06 to 0.86 1 RCT n = 577 low‐quality evidence). Likewise, lower total fat intake probably made little or no difference to triglycerides in children over a six‐ to 12‐month period (MD ‐0.01 mmol/L, 95% CI ‐0.08 to 0.06 1 RCT n = 618 moderate‐quality evidence). However, lower total fat intake probably made little or no difference to HDL‐C over a six‐ to 12‐month period (MD ‐0.03 mmol/L, 95% CI ‐0.08 to 0.02 1 RCT n = 618 moderate‐quality evidence), nor a two‐ to five‐year period (MD ‐0.01 mmol/L, 95% CI ‐0.06 to 0.04 1 RCT n = 522 moderate‐quality evidence). Lower fat intake probably slightly decreased low‐density lipoprotein (LDL) cholesterol over six to 12 months (MD ‐0.12 mmol/L, 95% CI ‐0.20 to ‐0.04 1 RCT n = 618, moderate‐quality evidence) and over two to five years (MD ‐0.09, 95% CI ‐0.17 to ‐0.01 1 RCT n = 623 moderate‐quality evidence), compared to controls. Lower fat intake probably slightly reduced total cholesterol over six to 12 months compared to controls (MD ‐0.15 mmol/L, 95% CI ‐0.24 to ‐0.06 1 RCT n = 618 moderate‐quality evidence), but may make little or no difference over longer time periods. Compared to controls, lower total fat intake (30% or less TE) probably decreased BMI in children over a one‐ to two‐year period (MD ‐1.5 kg/m 2, 95% CI ‐2.45 to ‐0.55 1 RCT n = 191 moderate‐quality evidence), with no other differences evident across the other time points (two to five years: MD 0.00 kg/m 2, 95% CI ‐0.63 to 0.63 1 RCT n = 541 greater than five years MD ‐0.10 kg/m 2, 95% CI ‐0.75 to 0.55 1 RCT n = 576 low‐quality evidence). Lower versus usual or modified total fat intake may have made little or no difference to weight over a six‐ to twelve month period (mean difference (MD) ‐0.50 kg, 95% confidence interval (CI) ‐1.78 to 0.78 1 RCT n = 620 low‐quality evidence), nor a two‐ to five‐year period (MD ‐0.60 kg, 95% CI ‐2.39 to 1.19 1 RCT n = 612 low‐quality evidence). In addition, the inclusion of hypercholesteraemic children in two trials raised concerns about applicability. No meta‐analyses were possible, since only one RCT reported the same outcome at each time point range for all outcomes, and cohort studies were too heterogeneous.įor the RCTs, concerns about imprecision and poor reporting limited our confidence in our findings. Twenty‐three were conducted in high‐income countries. We included 24 studies comprising three parallel‐group RCTs (n = 1054 randomised) and 21 prospective analytical cohort studies (about 25,059 children completed).
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