Association of Nutrition in Early Childhood with Body Composition and Leptin in Later Childhood and Early Adulthood

OBJECTIVES

Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), this study aimed to replicate the finding of the Etude Longitudinale Alimentation Nutrition Croissance des Enfants (ELANCE) that low fat intake in early childhood was associated with increased adiposity in adulthood.

METHODS

Diet was assessed at 8 and 18 months using 3-day food records. Body composition variables were measured at 9 and 17 years, and serum leptin at 9 years. Associations were modelled using adjusted linear regression.

RESULTS

In replication analyses, in contrast to ELANCE, there was a positive association between fat intake (% energy) at 18 months and fat mass (FM) at 9 years (B coefficient 0.10 (95% CI 0.03, 0.20) kg, p = 0.005). There was no association with serum leptin. In extended analyses fat intake at 18 months was positively associated with FM in boys (0.2 (0.00, 0.30), p = 0.008) at 9 years but not in girls. Fat intake was positively associated with serum leptin concentration in boys (0.2 (0.1, 0.4) ng/mL, p = 0.011) but not in girls.

CONCLUSIONS

Our results did not corroborate the findings from the ELANCE study. A high fat diet in early life may have implications for later childhood and adolescent obesity.

Snack Portion Sizes for Preschool Children Are Predicted by Caregiver Portion Size, Caregiver Feeding Practices and Children's Eating Traits

Caregivers are mostly responsible for the foods young children consume; however, it is unknown how caregivers determine what portion sizes to serve. This study examined factors which predict smaller or larger than recommended snack portion sizes in an online survey. Caregivers of children aged 2 to 4 years were presented with 10 snack images, each photographed in six portion sizes. Caregivers (n = 659) selected the portion they would usually serve themselves and their child for an afternoon snack. Information on child eating traits, parental feeding practices and demographics were provided by caregivers. Most caregivers selected portions in line with recommended amounts for preschool children, demonstrating their ability to match portion sizes to their child's energy requirements. However, 16% of caregivers selected smaller than recommended low energy-dense (LED, e.g., fruits and vegetables) snacks for their child which was associated with smaller caregiver's own portion size, reduced child food liking and increased satiety responsiveness. In contrast, 28% of caregivers selected larger than recommended amounts of high energy-dense (HED, e.g., cookies, crisps) snacks for their child which were associated with larger caregiver's own portion size, greater frequency of consumption, higher child body mass index (BMI), greater pressure to eat and lower child food liking. These findings suggest that most caregivers in this study select portions adjusted to suit their child's age and stage of development. Future interventions could provide support to caregivers regarding the energy and nutrient density of foods given the relatively small portion sizes of LED and large portions of HED snacks offered to some children.

Mothers' perceptions of the influences on their child feeding practices - A qualitative study

Children's diets are important determinants of their health, but typically do not meet recommendations. Parents' feeding practices, such as pressure or restriction, are important influences on child diets, but reasons why parents use particular feeding practices, and malleability of such practices, are not well understood. This qualitative study aimed to explore mothers' perceptions of influences on their feeding practices, and assess whether an intervention promoting recommended feeding practices was perceived as influential. The Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) Program was a cluster-randomised controlled trial involving 542 families aiming to improve child diets. Following the trial, when children were two years old, 81 intervention arm mothers were invited to participate in qualitative interviews, and 26 accepted (32%). Thematic analysis of interview transcripts used a tabular thematic framework. Eight major themes were identified regarding perceived influences on child feeding practices. Broadly these encompassed: practical considerations, family setting, formal information sources, parents' own upbringing, learning from friends and family, learning from child and experiences, and parents' beliefs about food and feeding. Additionally, the Melbourne InFANT Program was perceived by most respondents as influential. In particular, many mothers reported being previously unaware of some recommended feeding practices, and that learning and adopting those practices made child feeding easier. These findings suggest that a variety of influences impact mothers' child feeding practices. Health practitioners should consider these factors in providing feeding advice to parents, and researchers should consider these factors in planning interventions.

Sources of vitamin D and calcium in the diets of preschool children in the UK and the theoretical effect of food fortification

BACKGROUND

Dietary intakes of vitamin D are very low in the UK. Dietary calcium is also necessary to promote bone health. The fortification of foods with vitamin D could be a safe and effective way of increasing intake.

METHODS

Diets of preschool children, 755 at 18 months and 3.5 years, from the Avon Longitudinal Study of Parents and Children were assessed using dietary records completed by parents. Energy, vitamin D and calcium intakes were calculated. Multinomial logistic regression was used to estimate the odds ratio for being in the highest/lowest quartile of intake. Intakes were recalculated to test different fortification regimes.

RESULTS

Vitamin D intakes were low; all children were below the UK and US dietary recommendations. Calcium intakes decreased between the two ages as a result of reduced milk consumption. Children in the lowest quartile for vitamin D intake at 18 months were twice as likely to remain in that quartile at 3.5 years (odds ratio = 2.35; 95% confidence interval = 1.56-3.55). The majority of foods provide no vitamin D with fat spreads and milk as the main sources. The contribution from breakfast cereals increased, from 6% to 12%, as a result of the increased consumption of fortified cereals. Dairy foods provided the highest contribution to calcium at 18 months but were less important at 3.5 years. Theoretical intakes from different fortification regimens suggest that milk fortified at 2 μg 100 g(-1) vitamin D would provide most children with adequate but not excessive intakes.

CONCLUSIONS

Dietary vitamin D intakes were very low and calcium intakes were mostly adequate. Fortification of milk with vitamin D could be a good way to boost intakes.

Diet, growth, and obesity development throughout childhood in the Avon Longitudinal Study of Parents and Children

Publications from the Avon Longitudinal Study of Parents and Children covering diet, growth, and obesity development during childhood are reviewed. Diet was assessed by food frequency questionnaires and food records. Growth data were collected by routine measurements, and in standardized clinics, body fatness was assessed by bioelectrical impedance and DXA (dual-energy X-ray absorptiometry) scans. Diets changed dramatically during the preschool period with an increase in the intake of free (added) sugars (12.3% rising to 16.4% of energy) that remained similar until adolescence. This was due to increased intake of energy-dense, nutrient-poor foods. Two periods of rapid growth were identified; infancy and mid-childhood (ages 7-11 y) and both were associated with obesity development. Diets with high energy density were associated with increasing fat mass from mid-childhood until adolescence. Genetic and dietary factors showed independent associations with increasing adiposity. At all ages studied, there were dietary inequalities related to maternal educational attainment that may influence inequalities found in obesity development. The Avon Longitudinal Study of Parents and Children has provided valuable insights into how disparities in diet and growth may affect the development of ill health in adulthood.

Mediators of improved child diet quality following a health promotion intervention: the Melbourne InFANT Program

BACKGROUND

Young children's diets are currently suboptimal. Given that mothers have a critical influence on children' diets, they are typically a target of interventions to improve early childhood nutrition. Understanding the maternal factors which mediate an intervention's effect on young children's diets is important, but has not been well investigated. This research aimed to test whether maternal feeding knowledge, maternal feeding practices, maternal self-efficacy, and maternal dietary intakes acted as mediators of the effect of an intervention to improve child diet quality.

METHODS

The Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program was a cluster-randomized controlled trial, conducted from 2008-2010. This novel, low-dose, health promotion intervention was delivered quarterly over 15 months and involved educational activities, promotion of peer discussion, a DVD and written materials. Post-intervention, when children were approximately 18 months of age, child diets were assessed using multiple 24-hour recalls and a purpose-developed index of diet quality, the Obesity Protective Dietary Index. Maternal mediators were assessed using a combination of previously validated and purpose-deigned tools. Mediation analysis was conducted using the test of joint significance and difference of coefficients methods.

RESULTS

Across 62 parents' groups in Melbourne, Australia, 542 parents were recruited. Post- intervention, higher maternal feeding knowledge and lower use of foods as rewards was found to mediate the direct intervention effect on child diet quality. While other aspects of maternal feeding practices, self-efficacy and dietary intakes did not act as mediators, they were associated with child diet quality.

CONCLUSIONS

Mediation analysis of this novel health promotion intervention showed the importance of maternal feeding knowledge and use of foods as rewards in impacting child diet quality. The other maternal factors assessed were appropriate targets but further research on how to impact these in an intervention is important. This evidence of intervention efficacy and mediation provides important insights for planning future interventions.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN81847050, registered 23 November 2007.

Diet and growth in infancy: relationship to socioeconomic background and to health and development in the Avon Longitudinal Study of Parents and Children

To assess the relationship between diet and growth in infancy and socioeconomic background, all publications from the Avon Longitudinal Study of Parents and Children (ALSPAC) covering breastfeeding, diet and growth in infancy, and the associations of these factors with socioeconomic background and later health and developmental outcomes were reviewed. Diet was assessed by parent-completed food records and parent-completed food frequency questionnaires covering infant feeding practices. Infancy growth was monitored through routine screening and by standardized measurements. Indicators of socioeconomic background were obtained by parent-completed questionnaires. Childhood outcomes were measured by standardized procedures. Rapid early weight gain was associated with later obesity. Longer breastfeeding duration was associated with lower body fat, but not lower body mass index, and with higher IQ in mid-childhood. Breastfed infants were better at regulating their energy intake than bottle-fed infants. In bottle-fed infants, energy intake at 4 months was associated with greater weight gain up to 5 years of age. Feeding cow's milk as a main drink in infancy was associated with anemia and high salt intake. Maternal education was a strong determinant of dietary differences: low education was associated with never breastfeeding and not following feeding guidelines. ALSPAC has provided unique insights into the relationship between diet and growth in infancy and later developmental outcomes.

Dietary changes and associations with metabolic improvements in adults with type 2 diabetes during a patient-centred dietary intervention: an exploratory analysis

OBJECTIVES

Describe dietary intake of participants enrolled in a non-prescriptive dietary intervention and dietary changes at 6 months and explore whether these changes had a role in observed improvements in glycated haemoglobin (HbA1c), weight, lipids and blood pressure.

DESIGN

Secondary analysis of data from the Early ACTivity in Diabetes randomised controlled trial.

PARTICIPANTS

262 patients with newly diagnosed type 2 diabetes randomised to the dietary intervention.

OUTCOMES AND ANALYSIS

Changes in energy intake, macronutrients, fibre and alcohol and in weight, waist circumference, lipids, HbA1c and blood pressure at baseline and 6 months. Multivariate models were used to examine associations between dietary changes and metabolic variables.

RESULTS

Men reported reducing mean energy intake from 1903±462 kcal to 1685 kcal±439 kcal (p<0.001), increasing carbohydrate intake from 42.4±6.6% to 43.8±6.6% (p=0.002) and reducing median alcohol intake from 13 (0-27) g to 5 (0-18) g (p<0.001). Women reported reducing mean energy intake from 1582±379 kcal to 1459±326 kcal (p<0.001) with no change to macronutrient distribution and alcohol. Fibre intake was maintained. In men (n=148), weak and clinically insignificant associations were found between increased carbohydrates and reduction in HbA1c (β=-0.003 (-0.006, -0.001); p=0.009), increased fibre and reduction in total cholesterol (β=-0.023 (-0.044, -0.002); p=0.033), decreased total fat and reduction in low-density lipoprotein (LDL)-cholesterol (β=0.024 (0.006, 0.001); p=0.011), and decreased alcohol and reduction in diastolic blood pressure (β=0.276 (0.055, 0.497); p=0.015). In women (n=75), associations were found between a decrease in transfats and reductions in waist circumference (β=-0.029 (0.006, 0.052); p=0.015), total cholesterol (β=0.399 (0.028, 0.770); p=0.036) and LDL cholesterol (β=0.365 (0.042, 0.668); p=0.028).

CONCLUSIONS

Clinically important metabolic improvements observed in a patient-centred dietary intervention were not explained by changes in macronutrients. However, a non-prescriptive approach may promote a reduction in total energy intake while maintaining fibre consumption.

TRIAL REGISTRATION NUMBER

The Early ACTID trial number ISRCTN92162869.

Are diet and feeding behaviours associated with the onset of and recovery from slow weight gain in early infancy?

Infants with slow weight gain cause concern in parents and professionals, but it is difficult to be certain whether such infants are genetically small or whether their energy intake is insufficient. The aim of the present study was to assess the impact of diet and feeding behaviours on slow weight gain early in infancy. The sample was 11 499 term infants from the Avon Longitudinal Study of Parents and Children (ALSPAC). A total of 507 cases of slow weight gain from birth to 8 weeks were identified and the remaining 10 992 infants were used as controls. It was found that infants who gained weight slowly between birth and 8 weeks were more likely to exhibit feeding problems such as weak sucking and slow feeding during this period. Feeding problems were substantially reduced during the recovery phase (8 weeks to 2 years) when these infants exhibited enhanced catch-up in weight. The proportion of mothers breast-feeding in the 4th week after birth was higher for slow weight gainers, but they were more likely to switch to formula at the start of recovery. During recovery, slow-weight gain infants had a slightly higher energy intake from formula and solids than controls. In conclusion, feeding problems seem to be the most important factors associated with the onset of early slow weight gain. Subsequently, a reduction of feeding problems and an increase in overall energy intake may contribute to their weight recovery. Health professionals should look for feeding problems in the first few weeks after birth and help mothers establish adequate feeding practices.

A health promotion intervention can affect diet quality in early childhood

Initiatives to promote children's nutrition and prevent childhood obesity are vital. Dietary patterns are a useful way to characterize whole diets, though no previous early childhood health promotion trial to our knowledge has assessed intervention impact using this approach. This research aimed to assess the effect of a healthy eating and physical activity intervention on young children's dietary patterns. The Melbourne Infant Feeding Activity and Nutrition Trial Program was a health promotion, cluster-randomized controlled trial involving 542 families. Child diets were assessed by multiple 24-h recalls postintervention at ~18 mo of age. An Obesity Protective Dietary Index (OPDI) was created and dietary patterns were also assessed by principal components analysis (PCA). These outcomes were used to compare intervention and control participants to test the effectiveness of the intervention. Children in the intervention arm scored higher (15.6 ± 5.9) than those in the control arm (14.5 ± 6.7) for the OPDI (scores out of 30, P = 0.01). Three dietary patterns were identified by PCA; however, the scores did not substantially differ between the intervention and control arms. In conclusion, this paper presents novel results in both the evaluation of an early childhood health promotion intervention and the assessment of child dietary patterns. The results highlight the capacity for such an initiative to improve child diets and the need for further research in this area.

Sources of vitamin A in the diets of pre-school children in the Avon Longitudinal Study of Parents and Children (ALSPAC)

Vitamin A is essential for growth and development. We investigated whether high consumption of energy-dense nutrient-poor foods in the diets of pre-school children is detrimental to diet quality with respect to vitamin A. Data were collected from 755 children at 18-months and 3½-years, from the Avon Longitudinal Study of Parents and Children, using 3-day unweighed dietary records completed by parents in 1994 and 1996, respectively. Energy, carotene and retinol intakes were calculated. The quality of the diet declined from 18-months to 3½-years with respect to vitamin A. Preformed retinol intakes decreased by -54 μg/day on average (p = 0.003). Carotene intakes were similar at each age although there was a 23% increase in energy intake by 3½-years. Longitudinally those in the highest quartile of intake at 18-months were twice as likely to remain in the highest quartile at 3½-years for retinol (OR 2.21 (95% CI 1.48-3.28)) and carotene (OR 1.66 (95% CI 1.11-2.50)) than to change quartiles. Nutrient-rich core foods provided decreasing amounts of carotene and preformed retinol over time (both p < 0.001). Vegetables and milk contributed the highest proportion of carotene at both ages, but milk's contribution decreased over time. Milk and liver were the largest sources of retinol. Nutrient-poor foods provided an increased proportion of energy (p < 0.001) with low proportions of both nutrients; however fat spreads made an important contribution. It is recommended that pre-school children should take vitamin supplements; only 19% at 18-months did this, falling to 11% at 3½-years. Care should be taken to choose nutrient-rich foods and avoid energy-dense, nutrient-poor foods when feeding pre-school children.

Demographic and socio-economic factors related to food intake and adherence to nutritional recommendations in a cohort of pre-school children

Objective

To examine: (i) children's food intake and adherence to both Canada's Food Guide for Healthy Eating and Dietary Reference Intakes; and (ii) the social and demographic factors related to children's food intake.

Design

A cross-sectional study.

Setting

Data were obtained through the Quebec Longitudinal Study of Child Development 1998–2010, a representative sample (n 2103) of children born in 1998 in the province of Quebec, Canada. Information on energy, macronutrient and food consumption was derived from responses to a 24 h dietary recall interview addressed to children's mothers and day-care staff when the children were 4 years old.

Subjects

A total of 1549 children aged 4 years who participated in a nutritional sub-study.

Results

The mean daily total energy intake was 6360 kJ (1520 kcal) for girls and 6916 kJ (1653 kcal) for boys. For boys and girls alike, energy intake was comprised of approximately 54 % carbohydrates, 31 % fats and 15 % proteins. The mean number of servings consumed from each of the four essential food groups closely approached the dietary recommendations made by Canada's Food Guide for Healthy Eating; however, <2 % of the children in the present study actually met the full dietary guidelines. The dietary intake of pre-school children was associated with socio-economic and demographic factors, most notably mother's level of education, mother's immigrant status and sex of the child.

Conclusions

Diet-related disparities associated with socio-economic and demographic factors exist from as early as 4 years of age.

Measuring dietary sodium intake in infancy: a review of available methods

It has been hypothesised that infancy may be a particularly sensitive period with respect to the effect of dietary sodium (salt) intake on later blood pressure. If this is the case, interventions to reduce dietary sodium intake in infancy could have major public health impact by reducing cardiovascular disease in the future. However, research in this area is hampered by difficulties of how to measure dietary sodium intake in infancy. Here we review the literature with an aim to describe different methods that have been used for research purposes, how these have been used and their relative strengths and limitations. We identified five studies that were relevant to our aim. In epidemiological and intervention studies sodium intake in infancy has been assessed via parents using diet diaries, which appear to be feasible and acceptable to parents. In these studies, sodium concentration in breast milk is assumed not to vary from one woman to the next, which may not be correct but has been poorly studied. The gold standard method - 24 h urinary excretion of sodium - was used in only one study and there is debate about the most appropriate way to collect urine for research purposes in infants. None of the studies directly compared different methods for determining infant dietary sodium intake. We conclude that research is required to determine the best methods of estimating dietary sodium intake in infants in different research contexts.

Consumption of ‘extra’ foods (energy-dense, nutrient-poor) among children aged 16–24 months from western Sydney, Australia

Objective

This study evaluates the contribution of energy-dense, nutrient-poor ‘extra’ foods to the diets of 16–24-month-old children from western Sydney, Australia.

Design

An analysis of cross-sectional data collected on participants in the Childhood Asthma Prevention Study (CAPS), a randomised trial investigating the primary prevention of asthma from birth to 5 years. We collected 3-day weighed food records, calculated nutrient intakes, classified recorded foods into major food groups, and further classified foods as either ‘core’ or ‘extras’ according to theAustralian Guide to Healthy Eating.

Setting

Pregnant women, whose unborn child was at risk of developing asthma because of a family history, were recruited from all six hospitals in western Sydney, Australia. Data for this study were collected in clinic visits and at participants’ homes at the 18-month assessment.

Participants

Four hundred and twenty-nine children participating in the CAPS study; 80% of the total cohort.

Results

The mean consumption of ‘extra’ foods was ∼150 g day− 1and contributed 25–30% of the total energy, fat, carbohydrate and sodium to the diets of the study children. ‘Extra’ foods also contributed around 20% of fibre, 10% of protein and zinc, and about 5% of calcium. Children in the highest quintile of ‘extra’ foods intake had a slightly higher but not significantly different intake of energy from those in the lowest quintile. However, significant differences were evident for the percentage of energy provided by carbohydrate and sugars (higher) and protein and saturated fat (lower). The intake of most micronutrients was also significantly lower among children in the highest quintile of consumption. The intake of ‘extra’ foods was inversely associated with the intake of core foods.

Conclusions

The high percentage of energy contributed by ‘extra’ foods and their negative association with nutrient density emphasise the need for dietary guidance for parents of children aged 1–2 years. These preliminary data on commonly consumed ‘extra’ foods and portion sizes may inform age-specific dietary assessment methods.

Food and nutrient intakes of a population sample of 7-year-old children in the south-west of England in 1999/2000 - what difference does gender make?

OBJECTIVES

To describe the diet of schoolchildren aged 7 years, and identify gender differences in food and nutrient intakes.

SUBJECTS

A cohort of children resident in the south-west of England in 1999/2000.

METHODS

Diet was assessed using three 1-day unweighed food diaries. Nutrient intakes were compared with dietary reference values for this age group, and with children aged 7-10 years in the British National Diet and Nutrition Survey. Food and nutrient intakes were contrasted between boys and girls.

RESULTS

Median nutrient intakes exceeded the reference nutrient intake (RNI) for most nutrients. Median intakes of iron and zinc were below the RNI. Median sodium intake was greater than the maximum set by the Scientific Advisory Committee on Nutrition. The mean energy intake for boys and girls, respectively, were 7.3 and 6.8 MJ, this is below the estimated average requirement. The percentage of energy from fat was 35.3% for boys and 36.1% for girls. Boys had higher iron intakes than girls, even after adjustment for energy intake. There were differences in the types of foods eaten between boys and girls; girls ate more fruit and vegetables (P = 0.001) and boys ate more breakfast cereals (P = 0.016).

CONCLUSIONS

The dietary intakes of these 7-year-old children were adequate for most nutrients. However, a reduction in the sodium content of the diet would be advantageous. Fruit and vegetable consumption should be encouraged particularly among boys.

Trends in waist circumferences in young British children: a comparative study

OBJECTIVE

To compare waist circumference (a measure of central fatness) and body mass index (BMI, a measure of general fatness) between a contemporary cohort and similar aged British children measured in 1987.

DESIGN

: Comparative study of two cohorts. The first was a cross-sectional survey and the second an ongoing longitudinal survey.

SETTING

: The cross-sectional study was conducted throughout Great Britain during 1987. The ongoing longitudinal study was conducted in the Avon region between 1995 and 1998.

PARTICIPANTS

A total of 1821 children were measured in the cross-sectional study, and around 1000 children were measured in the longitudinal study. Ages ranged between 2 and 5 y.

MAIN OUTCOME MEASURES

Waist circumference, height, weight and BMI. Values were expressed as mean+/-s.d. Age-related measures were compared.

RESULTS

At equivalent ages, mean waist circumference values were greater in the contemporary children, compared with children measured in the earlier cross-sectional study in 1987 (P<0.05). Although boys from the contemporary cohort had the larger absolute waist circumference measurements, the absolute and percentage differences in waist circumference between the cohorts were greater for the girls. Mean BMI values were slightly but significantly higher in the contemporary children compared with children measured in the earlier cross-sectional study (P<0.05). The proportional increase in waist circumference for each age-sex group generally exceeded the proportional increase in BMI.

CONCLUSION

These results suggest that central fatness in young British children has increased over the period of 1987-97 to a greater extent than general fatness. This should be of concern since evidence associates greater central adiposity with adverse levels of cardiovascular risk factors in children. Furthermore, the study highlights important shortcomings of the BMI measurement, in that it provides no information on body fat distribution and can mask true obesity-related risk in children.

Frequency of food items consumed by young rural and urban African children--essential knowledge to provide dietary advice in caries prevention

AIMS

To determine the variety and frequency of consumption of food items, including cariogenic items, among 4-24-month-old black South African children.

SETTING AND PARTICIPANTS

A rural area of low socioeconomic status, Ndunakazi, KwaZulu/Natal Province [n=105]; two urban areas in Gauteng Province: Soweto (low to middle socioeconomic status) [n=100], and the northern suburbs of Johannesburg and Sandton (middle to upper socioeconomic status) [n=101].

METHODS

Dietary intake was assessed using a food frequency questionnaire and analysed using SAS.

OUTCOME MEASURES

Weekly frequencies for: number of times each food item was recorded; total consumption for each food item for the combined group of children and the three individual geographical areas. Food items were ranked in descending order according to the combined group of children within five selected food groups (carbohydrates, sugars, fruit and vegetables, milk and milk products, other foods and snacks). Only individual area results were listed.

RESULTS

The preferred foods and frequency of consumption of these foods were identified. Significant differences were found between rural and urban groups for most of the food items, but not between urban groups. Food items were 'flagged' according to their cariogenic potential.

CONCLUSION

The study provided valuable new information suitable for adapting and developing dietary advice relevant to caries prevention in African children

The effect of maternal smoking status, educational level and age on food and nutrient intakes in preschool children: results from the Avon Longitudinal Study of Parents and Children

OBJECTIVE

Studies in adults have demonstrated that smoking status is associated with dietary quality, with smokers tending to have diets that conform less closely to guidelines on healthy eating than nonsmokers. However, there is very little information on the relation between children's dietary quality and parental smoking status. The objective of this study was to investigate the relation between maternal smoking status and nutrient intake in preschool children, allowing for the possible confounding effects of maternal educational level and age at delivery.

SUBJECTS

In total, 993 children aged 18 months participating in the Avon Longitudinal Study of Parents and Children.

METHODS

Diet was assessed by a 3-day food record. Maternal smoking status and educational level and age at delivery were assessed by questionnaire.

RESULTS

In multivariate analysis, the children of smokers had significantly higher intakes of monounsaturated fatty acids and starch, and lower intakes of nonstarch polysaccharides (NSP). They were also less likely to have eaten poultry, buns, cakes and puddings, wholemeal bread and fruit, and more likely to have drunk sugar-sweetened soft drinks. Intakes of NSP and most vitamins and minerals increased significantly with increasing maternal education. Children of more highly educated mothers were less likely to have eaten chocolate, crisps and white bread, and more likely to have consumed wholemeal bread, fruit and fruit juice.

CONCLUSIONS

The children of nonsmokers and more highly educated mothers consumed a diet that conformed more closely to current guidelines on healthy eating. These dietary differences may contribute to the excess of ill-health observed in the children of smokers and of less-educated mothers.

Current knowledge and recent developments in consumer exposure assessment of pesticides: a UK perspective

Techniques employed in the assessment of consumer exposure to pesticides are currently being reviewed in the UK. This is not a formal process as is happening in the USA. However, the advent of probabilistic approaches and sophisticated computer models has prompted regulators, industry and other stakeholders in the UK to recognize the need for refinements in the risk-assessment process. Sources of information and data necessary to explore such refinements are disparate. This review aims to collate the information to present a coherent picture of the current knowledge, the data available and the stakeholders involved. It can then be used as a resource with which to investigate further more specific issues. Although focussing on the UK, the European context is included and reference is made to US models and developments that should be investigated. Factors hampering progress include the lack of sufficient data on which to base quantitative analysis, especially in the residential pesticides sector, and lack of experience in using and interpreting probabilistic models. At present, such techniques are being approached with some caution in the UK and in Europe, although their utility for cumulative assessment is accepted. Communicating results to both risk managers and consumers will be a considerable challenge.

Drinks consumed by 18-month-old children: are current recommendations being followed?

OBJECTIVE

To examine the types of drinks consumed by children at 18 months of age, determine any associations with socio-demographic characteristics and investigate the use of a bottle for providing these drinks.

DESIGN

A total of 1026 randomly chosen children from the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC) were studied.

METHODS

As part of a dietary diary completed when their children were 18 months of age, mothers were asked to record all drinks consumed over a 24 h period and to report the containers used to give these drinks. Socio-demographic characteristics were obtained via self-completion questionnaire.

RESULTS

Dietary records were available for 1026 children at 18 months. A wide variety of drinks were given at this age. In all, 64% of children had received at least one drink in a bottle and 10% solely used a bottle. Bottle users consumed a significantly greater volume of milk drinks compared to those who used a cup or other container. The types of drinks consumed and adherence to the guidelines on weaning were associated with several socio-demographic characteristics. In particular, children with mothers of lower educational level were more likely to receive fizzy drinks and low-calorie soft drinks, more likely to drink from a bottle, and less likely to drink from a cup.

CONCLUSION

We have shown that certain groups of mothers with 18-month-old children are not following the current guidelines on weaning. Assuming these guidelines have scientific validity, it is clear that nutritional education needs to be targeted at these mothers to help them feed their children in the optimal way, to protect from nutritional deficiencies, possible later obesity and poor dental health.

SPONSORSHIP

University of Bristol.

Fat content of the diet among pre-school children in Britain; relationship with food and nutrient intakes

OBJECTIVE

To investigate the relationship between the percentage of energy from fat and food and nutrient intakes at 18 and 43 months of age.

DESIGN

Diet was assessed using a 3 day unweighed food record. The children were divided into quartiles of fat intake as a percentage of energy (QFI), and food and nutrient intakes in the different QFIs were compared.

SUBJECTS

A total of 1026 children at 18 months and 863 children at 43 months, taking part in the Avon Longitudinal Study of Pregnancy and Childhood, participated.

RESULTS

At 18 months the mean (s.d.) fat intake was 31.2 (2.8) % of energy in the lowest QFI and 43.1 (2.2) % in the highest. Energy intake increased slightly with increasing QFI. The percentage of energy derived from total sugar, and in particular non-milk extrinsic sugar fell as QFI increased, as did the ratio of polyunsaturated to saturated fatty acids. Intakes of retinol equivalents and zinc increased significantly with increasing QFI, while intakes of iron and most water soluble vitamins fell. There was a particularly marked fall in vitamin C intake as fat intake increased, from 11.8 mg/MJ in the lowest QFI, to 6.0 mg/MJ in the highest (P<0.001). Consumption of whole milk increased substantially with percentage energy from fat, from 51 g/MJ in the lowest QFI to 116 g/MJ in the highest (P<0.001), while consumption of fruit and fruit juice fell. The results obtained at 43 months were very similar.

CONCLUSIONS

The chances of a suboptimal intake of zinc and retinol were higher at lower fat intakes. However, intakes of the fat-soluble vitamins E and D were unrelated to fat intake and intakes of iron and vitamin C fell as fat intakes increased. Some suggestions for improving diet in this age group have been given.

SPONSOR

University of Bristol.

Food and nutrient intakes of a population sample of 3-year-old children in the south west of England in 1996

OBJECTIVE

To investigate food and nutrient intakes in 3-year-old children.

SUBJECTS

Eight hundred and sixty-three children resident in South West England (69% of those invited at this age), a randomly selected sub-sample of the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC).

METHODS

Diet was assessed using a 3-day descriptive food record. Food and nutrient intakes were compared with intakes at 18 months in the same children, with intakes in the British National Diet and Nutrition Survey (NDNS) of pre-school children, and with dietary reference values (DRVs).

RESULTS

Intakes of energy and most nutrients had increased between 18 and 43 months. The macronutrient content of the diet had also changed, the percentage of energy from starch rose from 21 to 23% and from non-milk extrinsic (NME) sugar from 12 to 16%, while the polyunsaturated to saturated fat ratio increased from 0.26 to 0.33. When compared with the NDNS, intakes of energy and all nutrients were higher with the exception of NME sugar. Energy intakes were below the estimated average requirements. Mean intakes of iron and vitamin D were below the Reference Nutrient Intake. Fewer children were eating beef at 43 months than at 18 months. Total daily meat consumption was lower than in the NDNS. The proportion of children consuming any vegetables dropped between 18 and 43 months, although fruit eating remained constant.

CONCLUSIONS

The diets of 3-year-olds in this study were adequate in most nutrients. Our results suggest that energy requirements of pre-school children in the 1990s are less than the DRV. Nutrient and food intakes changed between 18 and 43 months. Children were eating less meat than their counterparts in the NDNS.

Fat content of the diet among preschool children in southwest Britain: II. relationship with growth, blood lipids, and iron status

OBJECTIVE

In most countries, it is recommended that adults restrict fat intake to 30% to 35% of energy to reduce the risk of coronary heart disease and certain cancers. However, the appropriate level of fat in the diet of children is hotly debated. It has been generally accepted that fat intake by children under 2 years of age should not be limited because of fears that nutrient intakes and thus growth and iron status might be compromised. However, there is very little longitudinal information on the relationship between fat intake and growth in representative populations of free-living children under 2 years old. The objective of this study was to investigate the relationship between fat intake as a percentage of energy, and nutrient adequacy, growth, blood lipids, and iron status in 18- and 43-month-old children.

DESIGN

This study forms part of the Avon Longitudinal Study of Parents and Children (ALSPAC)-a geographically-based cohort study in southwest England. A randomly selected subsample of the ALSPAC cohort attended research clinics approximately every 6 months from birth, at which a variety of anthropometric and other measurements were made. Dietary intakes at 18 and 43 months were assessed using a 3-day unweighed food record. A capillary blood sample was taken at 18 months for measurement of hemoglobin and ferritin levels. Nonfasting venous blood samples were taken at 31 and 43 months and analyzed for total and high-density lipoprotein cholesterol. The children were divided into quartiles of fat intake as a percentage of energy (QFI). QFI groups were compared for the number of children reaching recommended nutrient intakes, and for anthropometry, measures of iron status, and blood lipid levels.

PARTICIPANTS

Nine hundred fifty-one children at 18 months and 805 children at 43 months.

RESULTS

The mean (standard deviation) percentages of energy from fat in each quartile at 18 months were 31.2 (2.8), 36.1 (0.9), 39.1 (0.8), and 43.1 (2.2), corresponding to a fat intake in grams of 37.3 (8.1), 44.3 (8.1), 50.4 (10.2), and 55.4 (12.7). The number of children failing to reach recommended intake levels for zinc and vitamin A fell with increasing fat intake, while the number of children consuming less than the recommendations for iron and vitamin C rose at both ages. Despite this, there was no association between fat intake at 18 months and mean height or body mass index (BMI) at either 18 or 31 months. Fat intake at 43 months was also unassociated with concurrent or subsequent height or BMI. There was also no significant increase in the number of children falling below the tenth percentile for height or BMI as QFI fell. Mean ferritin levels at 18 months fell in both sexes as QFI increased. Total cholesterol levels at 31 months were significantly associated with QFI at 18 months, and rose from 3.99 mmol/l in the lowest QFI in boys, to 4.31 mmol/l in the highest QFI. QFI at 43 months was unassociated with cholesterol levels.

CONCLUSIONS

These data do not suggest that fat intakes are an important determinant of growth in these children, even before the age of 2 years, or that children at the bottom of the range of fat intakes are experiencing delayed growth. On the other hand, there is also no evidence in this study that children on higher fat intakes are at a greater risk of becoming obese. In contrast to a number of US studies, we have not found children on lower fat intakes to have lower iron intakes-indeed higher fat intakes were associated with a greater chance of consuming less than the recommended intake of iron and with lower ferritin levels. The association of higher fat intakes with higher total cholesterol levels among boys is of concern, as there is evidence that the process of atherosclerosis begins during the preschool years.

Food and nutrient intake in a cohort of 8-month-old infants in the south-west of England in 1993

OBJECTIVE

To investigate food and nutrient intakes in 8-month-old infants.

DESIGN

Prospective study.

SETTING

Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC), south-west England.

SUBJECTS

A total of 1131 singleton Caucasian infants (82% of those invited) from a 10% random sample of ALSPAC, known as Children in Focus (CIF).

METHODS

Diet was assessed using a structured 3-day unweighed dietary record. Food and nutrient intakes were compared with intakes from the 6--9 month age group of a British infant feeding survey, which formed part of the National Diet and Nutrition Survey (NDNS). Nutrient intakes were compared with dietary reference values (DRV).

RESULTS

Intakes of energy and most nutrients were very similar between CIF and NDNS. The main difference was in the type of fat eaten resulting in a higher polyunsaturated to saturated fatty acid ratio in CIF (0.34) compared with NDNS (0.21). Other differences included the much lower calcium and iodine intakes in CIF compared with the NDNS. Differences in the proportion of consumers of formula and cow's milk accounted for most of the nutrient differences. Energy intakes were similar to the estimated average requirements (EAR), however, breastfed infants were slightly below and non-breastfed were slightly above the EAR. Mean intakes of zinc and vitamin D were below the Reference Nutrient Intakes.

CONCLUSIONS

The diets of 8-month-old infants in this study were adequate in most nutrients. Breastfed infants had slightly lower energy intakes than non-breastfed infants.