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Prevalence and maternal determinants of early and late introduction of complementary foods: results from the Growing Up in New Zealand cohort study. Br J Nutr 2023; 129:491-502. [PMID: 35403582 PMCID: PMC9876814 DOI: 10.1017/s000711452200112x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A nationally generalisable cohort (n 5770) was used to determine the prevalence of non-timely (early/late) introduction of complementary food and core food groups and associations with maternal sociodemographic and health behaviours in New Zealand (NZ). Variables describing maternal characteristics and infant food introduction were sourced, respectively, from interviews completed antenatally and during late infancy. The NZ Infant Feeding Guidelines were used to define early (≤ 4 months) and late (≥ 7 months) introduction. Associations were examined using multivariable multinomial regression, presented as adjusted relative risk ratios and 95 % confidence intervals (RRR; 95% CI). Complementary food introduction was early for 40·2 % and late for 3·2 %. The prevalence of early food group introduction were fruit/vegetables (23·8 %), breads/cereals (36·3 %), iron-rich foods (34·1 %) and of late were meat/meat alternatives (45·9 %), dairy products (46·2 %) and fruits/vegetables (9·9 %). Compared with infants with timely food introduction, risk of early food introduction was increased for infants: breastfed < 6months (2·52; 2·19-2·90), whose mothers were < 30 years old (1·69; 1·46-1·94), had a diploma/trade certificate v. tertiary education (1·39; 1·1-1·70), of Māori v. European ethnicity (1·40; 1·12-1·75) or smoked during pregnancy (1·88; 1·44-2·46). Risk of late food introduction decreased for infants breastfed < 6 months (0·47; 0.27-0·80) and increased for infants whose mothers had secondary v. tertiary education (2·04; 1·16-3·60) were of Asian v. European ethnicity (2·22; 1·35, 3·63) or did not attend childbirth preparation classes (2·23; 1·24-4·01). Non-timely food introduction, specifically early food introduction, is prevalent in NZ. Interventions to improve food introduction timeliness should be ethnic-specific and support longer breast-feeding.
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Helle C, Hillesund ER, Øverby NC. Associations between infant and maternal characteristics measured at child age 5 months and maternal feeding styles and practices up to child age two years. PLoS One 2022; 17:e0261222. [PMID: 34995296 PMCID: PMC8740973 DOI: 10.1371/journal.pone.0261222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/27/2021] [Indexed: 11/18/2022] Open
Abstract
Facilitating positive feeding practices from infancy may be an important strategy to prevent childhood overweight and obesity. Since the feeding situation early in life constitutes a bidirectional relationship, it is important to understand the impact of both maternal and infant characteristics on maternal feeding practices to intervene in a customized and tailored way. Few studies have concurrently examined associations between maternal and infant characteristics in relation to early maternal feeding practices. The aim of the present study was to explore potential associations between infant and maternal characteristics measured at child age five months, and maternal feeding styles and practices during the child’s first two years. Cross-sectional data from a Norwegian randomized controlled trial in which participants responded to questionnaires at child age 5 months (n = 474), 12 months (n = 293) and 24 months (n = 185) were used to explore potential associations. All maternal and child predictor variables were collected at child age five months. Maternal feeding styles and practices were mapped using subscales from the Infant Feeding Questionnaire at child age 5 and 12 months and the Child Feeding Questionnaire and the Parental Feeding Style Questionnaire at child age 24 months. The subscale-scores were split into roughly equal tertiles, and the upper or lower tertile for the outcome of interest were used to create binary outcome variables. Multivariable binary logistic regression models were conducted for each outcome. We found that maternal education and mental health symptoms as well as infant weight, temperament and feeding mode were associated with maternal feeding styles and practices over time. Our findings indicate that risk factors which may have long-term implications for child weight and health outcomes can be identified early. Larger, population-based studies with a longitudinal design are needed to further explore these pathways.
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Affiliation(s)
- Christine Helle
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
- * E-mail:
| | - Elisabet R. Hillesund
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Nina C. Øverby
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
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Arora A, Manohar N, Hector D, Bhole S, Hayen A, Eastwood J, Scott JA. Determinants for early introduction of complementary foods in Australian infants: findings from the HSHK birth cohort study. Nutr J 2020; 19:16. [PMID: 32070350 PMCID: PMC7029498 DOI: 10.1186/s12937-020-0528-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/29/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The purpose of this study was to examine the timing of introduction of complementary (solid) foods among infants in South Western Sydney, Australia, and describe the maternal and infant characteristics associated with very early introduction of solids. METHODS Mother-infant dyads (n = 1035) were recruited into the "Healthy Smiles Healthy Kids" study by Child and Family Health Nurses at the first post-natal home visit. Data collected via telephone interviews at 8, 17, 34 and 52 weeks postpartum included timing of introduction of solids and a variety of maternal and infant characteristics (n = 934). Multiple logistic regression was used to identify factors independently associated with the risk of introducing solids very early, which for the purpose of this study was defined as being before 17 weeks. RESULTS The median age of introduction of solids was 22 weeks. In total, 13.6% (n = 127) of infants had received solids before 17 weeks and 76.9% (n = 719) before 26 weeks of age. The practice of introducing solids early decreased with older age of the mother. Compared to women < 25 years of age, those who were 35 years or older were 72% less likely to introduce solids very early (OR = 0.28, CI95 0.14-0.58). Single mothers had more than twice the odds of introducing solids before the age of 17 weeks compared to married women (OR = 2.35, CI95 1.33-4.16). Women who had returned to work between 6 to 12 months postpartum were 46% less likely to introduce solids very early compared with those who were not working at the child's first birthday (OR = 0.54, CI95 0.30-0.97). Women born in Vietnam and Indian sub-continent had lower odds of introducing solids very early compared to Australian born women (OR = 0.42, CI95 0.21-0.84 and OR = 0.30, CI95 0.12-0.79, respectively). Infants who were exclusively formula-fed at 4 weeks postpartum had more than twice the odds of receiving solids very early (OR = 2.34, CI95 1.49-3.66). CONCLUSIONS Women who are younger, single mothers, those not working by the time of child's first birthday, those born in Australia, and those who exclusively formula-feed their babies at 4 weeks postpartum should be targeted for health promotion programs that aim to delay the introduction of solids in infants to the recommended time.
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Affiliation(s)
- Amit Arora
- School of Health Sciences, Western Sydney University Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751 Australia
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145 Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW 2010 Australia
| | - Narendar Manohar
- School of Health Sciences, Western Sydney University Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Debra Hector
- Cancer Australia, Surry Hills, NSW 2010 Australia
| | - Sameer Bhole
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW 2010 Australia
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Surry Hills, NSW 2010 Australia
- Oral Health Alliance, Oral Health Centre, University of Queensland, Brisbane, QLD 4006 Australia
- Metro North Oral Health Services, Stafford, QLD Australia
| | - Andrew Hayen
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Ultimo, NSW Australia
| | - John Eastwood
- Community Paediatrics, Sydney Local Health District, NSW Health, Croydon, Australia
- School of Women’s and Children’s Health, University of New South Wales, Kensington, NSW Australia
- School of Medicine, Griffith University, Gold Coast, QLD Australia
| | - Jane Anne Scott
- School of Public Health, Curtin University, Perth, WA Australia
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Hakola L, Miettinen ME, Syrjälä E, Åkerlund M, Takkinen HM, Korhonen TE, Ahonen S, Ilonen J, Toppari J, Veijola R, Nevalainen J, Knip M, Virtanen SM. Association of Cereal, Gluten, and Dietary Fiber Intake With Islet Autoimmunity and Type 1 Diabetes. JAMA Pediatr 2019; 173:953-960. [PMID: 31403683 PMCID: PMC6692682 DOI: 10.1001/jamapediatrics.2019.2564] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Dietary proteins, such as gluten, have been suggested as triggers of the disease process in type 1 diabetes (T1D). OBJECTIVE To study the associations of cereal, gluten, and dietary fiber intake with the development of islet autoimmunity (IA) and T1D. DESIGN, SETTING, AND PARTICIPANTS The prospective birth cohort Finnish Type 1 Diabetes Prediction and Prevention Study recruited children with genetic susceptibility to type 1 diabetes from September 1996 to September 2004 from 2 university hospitals in Finland and followed up every 3 to 12 months up to 6 years for diet, islet autoantibodies, and T1D. Altogether 6081 infants (78% of those invited) participated in the study. Dietary data were available for 5714 children (94.0%) and dietary and IA data were available for 5545 children (91.2%), of whom 3762 (68%) had data on islet autoantibodies up to age 6 years. Information on T1D was available for all children. Data were analyzed in 2018 and end point data were updated in 2015. EXPOSURES Each child's intake of cereals, gluten, and dietary fiber was calculated from repeated 3-day food records up to 6 years. MAIN OUTCOMES AND MEASURES Islet autoimmunity was defined as repeated positivity for islet cell antibodies and at least 1 biochemical autoantibody of 3 analyzed, or T1D. Data on the diagnosis of T1D were obtained from Finnish Pediatric Diabetes Register. RESULTS Of 5545 children (2950 boys [53.2%]), 246 (4.4%) developed IA and of 5714 children (3033 boys [53.1%]), 90 (1.6%) developed T1D during the 6-year follow-up. Based on joint models, the intake of oats (hazard ratio [HR], 1.08; 95% CI, 1.03-1.13), wheat (HR, 1.09; 95% CI, 1.03-1.15), rye (HR, 1.13; 95% CI, 1.03-1.23), gluten-containing cereals (HR, 1.07; 95% CI, 1.03-1.11), gluten without avenin from oats (HR, 2.23; 95% CI, 1.40-3.57), gluten with avenin (HR, 2.06; 95% CI, 1.45-2.92), and dietary fiber (HR, 1.41; 95% CI, 1.10-1.81) was associated with the risk of developing IA (HRs for 1 g/MJ increase in intake). The intake of oats (HR, 1.10; 95% CI, 1.00-1.21) and rye (HR, 1.20; 95% CI, 1.03-1.41) was associated with the risk of developing T1D. After multiple testing correction, the associations with IA remained statistically significant. CONCLUSIONS AND RELEVANCE A high intake of oats, gluten-containing cereals, gluten, and dietary fiber was associated with an increased risk of IA. Further studies are needed to confirm or rule out the findings and study potential mechanisms.
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Affiliation(s)
- Leena Hakola
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | - Maija E. Miettinen
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland,Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Essi Syrjälä
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | - Mari Åkerlund
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland,Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Hanna-Mari Takkinen
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland,Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Tuuli E. Korhonen
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Suvi Ahonen
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland,Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland,Tampere University Hospital, Research, Development and Innovation Center, Tampere, Finland
| | - Jorma Ilonen
- Immunogenetics Laboratory, University of Turku and Turku University Hospital, Turku, Finland
| | - Jorma Toppari
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland,Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Riitta Veijola
- Department of Pediatrics, PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland,Oulu University Hospital, Oulu, Finland
| | - Jaakko Nevalainen
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | - Mikael Knip
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland,Folkhälsan Research Center, Helsinki, Finland,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland,Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Suvi M. Virtanen
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland,Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland,Tampere University Hospital, Research, Development and Innovation Center, Tampere, Finland,Center for Child Health Research, Tampere University, Tampere University Hospital, Tampere, Finland
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Abstract
PURPOSE OF REVIEW Evidence is mounting that disturbances in the gut microbiota play a role in the rising incidence of type 1 diabetes (T1D) and new technologies are expanding our ability to understand microbial function and host interactions. Longitudinal data from large cohorts of children at risk of T1D are nor solidifying our understanding of the function of the microbiota in this disease. RECENT FINDINGS Although taxonomic changes in the gut microbiota associated with T1D are relatively modest, a functional defect in production of short-chain fatty acids (SCFAs) remains as a unifying feature across multiple studies and populations. Dysbiosis of the microbiota in T1D has been linked to decreased gut barrier and exocrine pancreas function. We explore factors contributing to the disturbed microbiota in T1D such as infant diet, probiotic use and genetic risk linked to defective immune regulation. We also discuss the interplay between immunotherapy, the gut immune response and the microbiota. SUMMARY Functional alterations in the microbiota are linked to pathogenesis of T1D and these findings provide a rationale for future investigations aimed at establishing a healthy microbiota and promoting SCFA production and prevention of T1D.
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Affiliation(s)
- Patrick G Gavin
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, Queensland, Australia
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Rewers M, Hyöty H, Lernmark Å, Hagopian W, She JX, Schatz D, Ziegler AG, Toppari J, Akolkar B, Krischer J. The Environmental Determinants of Diabetes in the Young (TEDDY) Study: 2018 Update. Curr Diab Rep 2018; 18:136. [PMID: 30353256 PMCID: PMC6415767 DOI: 10.1007/s11892-018-1113-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW The environmental triggers of islet autoimmunity leading to type 1 diabetes (T1D) need to be elucidated to inform primary prevention. The Environmental Determinants of Diabetes in the Young (TEDDY) Study follows from birth 8676 children with T1D risk HLA-DR-DQ genotypes in the USA, Finland, Germany, and Sweden. Most study participants (89%) have no first-degree relative with T1D. The primary outcomes include the appearance of one or more persistent islet autoantibodies (islet autoimmunity, IA) and clinical T1D. RECENT FINDINGS As of February 28, 2018, 769 children had developed IA and 310 have progressed to T1D. Secondary outcomes include celiac disease and autoimmune thyroid disease. While the follow-up continues, TEDDY has already evaluated a number of candidate environmental triggers, including infections, probiotics, micronutrient, and microbiome. TEDDY results suggest that there are multiple pathways leading to the destruction of pancreatic beta-cells. Ongoing measurements of further specific exposures, gene variants, and gene-environment interactions and detailed "omics" studies will provide novel information on the pathogenesis of T1D.
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Affiliation(s)
- Marian Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, 1775 Aurora Ct, Aurora, CO, 80045, USA.
| | - Heikki Hyöty
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Fimlab Laboratories, Pirkanmaa Hospital District, Tampere, Finland
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skane University, Malmö, Sweden
| | | | - Jin-Xiong She
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | | | - Anette-G Ziegler
- Forschergruppe Diabetes e.V. and Institute of Diabetes Research, Helmholtz Zentrum, Munich, Germany
| | - Jorma Toppari
- Institute of Biomedicine, Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | - Beena Akolkar
- Department of Pediatrics, Turku University Hospital, Turku, Finland
- National Institutes of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Jeffrey Krischer
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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Riikonen A, Hadley D, Uusitalo U, Miller N, Koletzko S, Yang J, Andrén Aronsson C, Hummel S, Norris JM, Virtanen SM. Milk feeding and first complementary foods during the first year of life in the TEDDY study. MATERNAL & CHILD NUTRITION 2018; 14:e12611. [PMID: 29693777 PMCID: PMC6156929 DOI: 10.1111/mcn.12611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 02/15/2018] [Accepted: 03/01/2018] [Indexed: 12/20/2022]
Abstract
The aim was to describe milk feeding patterns and first weaning foods during the first year of life in a large prospective birth cohort of infants with increased genetic risk for Type 1 diabetes (T1D) recruited in 4 different countries: the United States, Finland, Germany, and Sweden. All enrolled children with dietary information (n = 8,673) were included in the analyses; 1,307 (15%) children who dropped out before the first birthday were excluded from some analyses. Supplementary milk feeding in the first 3 days of life was common in all the four countries, although the type of the supplementary milk differed by country and by maternal T1D. Donated human milk was commonly used only in Finland. In all the countries, the most common first supplementary food was cow's milk-based infant formula, especially among offspring of mothers with T1D. The use of specific types of infant formulas differed notably by country: Extensively hydrolysed formulas were most used in Finland, partially hydrolysed ones in the United States and in Germany, and soy formulas only in the United States. Infant formulas commonly included probiotics, prebiotics, and starches. During the first year of life, most of the infants received conventional cow's milk. Overall, milk feeding during the first 3 days of life and thereafter until the first birthday differed markedly by maternal T1D status and across countries. These descriptive data may be useful in understanding early infant feeding practices and in planning potential interventions, which affect infant feeding.
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Affiliation(s)
- Anne Riikonen
- Public Health Promotion, Department of Public Health SolutionsNational Institute for Health and WelfareHelsinkiFinland
- Faculty of Social SciencesUniversity of TampereTampereFinland
| | - David Hadley
- TransMed Systems, Inc.CupertinoCAUSA
- Population Health Research Institute, St George'sUniversity of LondonLondonUK
| | - Ulla Uusitalo
- Health Informatics Institute, Morsani College of MedicineUniversity of South FloridaTampaFloridaUSA
| | - Nicole Miller
- University of Massachusetts Amherst MPH in Nutrition GraduateMassachusettsMAUSA
| | - Sibylle Koletzko
- Dr.von Hauner Children's HospitalLudwig Maximilians UniversityMunichGermany
| | - Jimin Yang
- Health Informatics Institute, Morsani College of MedicineUniversity of South FloridaTampaFloridaUSA
| | | | - Sandra Hummel
- Institute of Diabetes ResearchHelmholtz Zentrum MünchenMunichGermany
| | - Jill M. Norris
- Department of EpidemiologyColorado School of Public HealthAuroraColoradoUSA
| | - Suvi M. Virtanen
- Public Health Promotion, Department of Public Health SolutionsNational Institute for Health and WelfareHelsinkiFinland
- Faculty of Social SciencesUniversity of TampereTampereFinland
- Research Center for Child HealthTampere University and University Hospital and the Science Center of Pirkanmaa Hospital DistrictTampereFinland
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Helle C, Hillesund ER, Øverby NC. Timing of complementary feeding and associations with maternal and infant characteristics: A Norwegian cross-sectional study. PLoS One 2018; 13:e0199455. [PMID: 29949644 PMCID: PMC6021099 DOI: 10.1371/journal.pone.0199455] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/07/2018] [Indexed: 12/19/2022] Open
Abstract
Norwegian Health authorities recommend solid food to be introduced between child age 4-6 months, depending on both the mother´s and infant's needs. The aim of this paper is to describe timing of complementary feeding in a current sample of Norwegian mother/infant-dyads and explore potential associations between timing of introduction to solid foods and a wide range of maternal and infant characteristics known from previous literature to influence early feeding interactions. The paper is based on data from the Norwegian randomized controlled trial Early Food for Future Health. In 2016, a total of 715 mothers completed a web-based questionnaire at child age 5.5 months. We found that 5% of the infants were introduced to solid food before 4 months of age, while 14% were not introduced to solid food at 5.5 months of age. Introduction of solid food before 4 months of age was associated with the infant not being exclusive breastfed the first month, receiving only formula milk at 3 months, the mother being younger, not married/cohabitant, smoking, less educated and having more economic difficulties. Not being introduced to solid food at 5.5 months was associated with the infant being a girl, being exclusive breastfed the first month, receiving only breastmilk at 3 months, the mother being older, married and having 3 or more children. This study shows that there are still clear socioeconomic differences regarding timing of complementary feeding in Norway. Infants of younger, less educated and smoking mothers are at higher risk of not being fed in compliance with the official infant feeding recommendations. Our findings emphasize the importance of targeting socioeconomically disadvantaged mothers for support on healthy feeding practices focusing on the infant`s needs to prevent early onset of social inequalities in health.
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Affiliation(s)
- Christine Helle
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Elisabet R. Hillesund
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Nina C. Øverby
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
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Uusitalo U, Lee HS, Andrén Aronsson C, Vehik K, Yang J, Hummel S, Silvis K, Lernmark Å, Rewers M, Hagopian W, She JX, Simell O, Toppari J, Ziegler AG, Akolkar B, Krischer J, Virtanen SM, Norris JM. Early Infant Diet and Islet Autoimmunity in the TEDDY Study. Diabetes Care 2018; 41:522-530. [PMID: 29343517 PMCID: PMC5829968 DOI: 10.2337/dc17-1983] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/08/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine duration of breastfeeding and timing of complementary foods and risk of islet autoimmunity (IA). RESEARCH DESIGN AND METHODS The Environmental Determinants of Diabetes in the Young (TEDDY) study prospectively follows 8,676 children with increased genetic risk of type 1 diabetes (T1D) in the U.S., Finland, Germany, and Sweden. This study included 7,563 children with at least 9 months of follow-up. Blood samples were collected every 3 months from birth to evaluate IA, defined as persistent, confirmed positive antibodies to insulin (IAAs), GAD, or insulinoma antigen-2. We examined the associations between diet and the risk of IA using Cox regression models adjusted for country, T1D family history, HLA genotype, sex, and early probiotic exposure. Additionally, we investigated martingale residuals and log-rank statistics to determine cut points for ages of dietary exposures. RESULTS Later introduction of gluten was associated with increased risk of any IA and IAA. The hazard ratios (HRs) for every 1-month delay in gluten introduction were 1.05 (95% CI 1.01, 1.10; P = 0.02) and 1.08 (95% CI 1.00, 1.16; P = 0.04), respectively. Martingale residual analysis suggested that the age at gluten introduction could be grouped as <4, 4-9, and >9 months. The risk of IA associated with introducing gluten before 4 months of age was lower (HR 0.68; 95% CI 0.47, 0.99), and the risk of IA associated with introducing it later than the age of 9 months was higher (HR 1.57; 95% CI 1.07, 2.31) than introduction between 4 and 9 months of age. CONCLUSIONS The timing of gluten-containing cereals and IA should be studied further.
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Muggaga C, Ongeng D, Mugonola B, Okello-Uma I, Kaaya NA, Taylor D. Influence of Sociocultural Practices on Food and Nutrition Security in Karamoja Subregion of Uganda. Ecol Food Nutr 2017; 56:424-447. [DOI: 10.1080/03670244.2017.1366318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- C. Muggaga
- Department of Food Science and Postharvest Technology, Gulu University, Gulu, Uganda
| | - D. Ongeng
- Department of Food Science and Postharvest Technology, Gulu University, Gulu, Uganda
| | - B. Mugonola
- Department of Rural Development and Agribusiness, Gulu University, Gulu, Uganda
| | - I. Okello-Uma
- Department of Food Science and Postharvest Technology, Gulu University, Gulu, Uganda
| | - N. A. Kaaya
- Department of Food technology and Nutrition, School of Food Science, Nutrition and Bio-science Engineering, College of Agricultural and Environmental Sciences, Kampala, Uganda
| | - D. Taylor
- Department of Geography, National University of Singapore, Singapore
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Beyerlein A, Uusitalo UM, Virtanen SM, Vehik K, Yang J, Winkler C, Kersting M, Koletzko S, Schatz D, Aronsson CA, Larsson HE, Krischer JP, Ziegler AG, Norris JM, Hummel S. Intake of Energy and Protein is Associated with Overweight Risk at Age 5.5 Years: Results from the Prospective TEDDY Study. Obesity (Silver Spring) 2017; 25:1435-1441. [PMID: 28650578 PMCID: PMC5529234 DOI: 10.1002/oby.21897] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/03/2017] [Accepted: 05/09/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The associations of energy, protein, carbohydrate, and fat intake with weight status up to the age of 5.5 years were prospectively assessed in The Environmental Determinants of Diabetes in the Young (TEDDY) study. METHODS Food record data (over 3 days) and BMI measurements between 0.25 and 5.5 years were available from 5,563 children with an increased genetic risk for type 1 diabetes followed from shortly after birth. Odds ratios (ORs) were calculated for overweight and obesity by previous intake of energy, protein, carbohydrate, and fat with adjustment for potential confounders. RESULTS Having overweight or obesity at the age of 5.5 years was positively associated with mean energy intake in previous age intervals (e.g., adjusted OR [95% CI] for overweight: 1.06 [1.04-1.09] per 100 kcal intake at the age of 4.5-5.0 years) and with protein intake after the age of 3.5 and 4.5 years, respectively (e.g., adjusted OR for overweight: 1.06 [1.03-1.09] per 1% of energy intake at the age of 4.5-5.0 years). The respective associations with carbohydrate and fat intake were less consistent. CONCLUSIONS These findings indicate that energy and protein intake are positively associated with increased risk for overweight in childhood but yield no evidence for potential programming effects of protein intake in infancy.
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Affiliation(s)
- Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Ulla M. Uusitalo
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Suvi M. Virtanen
- Unit of Nutrition, National Institute for Health and Welfare, Helsinki; University of Tampere, Tampere, School of Health Sciences; Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere; and The Science Center of Pirkanmaa Hospital District, Tampere, Finland
| | - Kendra Vehik
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jimin Yang
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Christiane Winkler
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Mathilde Kersting
- Research Institute of Child Nutrition (FKE), Pediatric University Clinic, Ruhr-University Bochum, Germany
| | - Sibylle Koletzko
- Dr. v. Hauner Children’s Hospital, University Munich Medical Center, Munich, Germany
| | - Desmond Schatz
- Departments of Pediatrics and Pathology and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - Carin Andrén Aronsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital SUS, Malmö, Sweden
| | - Helena Elding Larsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital SUS, Malmö, Sweden
| | - Jeffrey P. Krischer
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Anette-G. Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Jill M. Norris
- Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Sandra Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Forschergruppe Diabetes e.V., Neuherberg, Germany
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12
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Frohnert BI, Ide L, Dong F, Barón AE, Steck AK, Norris JM, Rewers MJ. Late-onset islet autoimmunity in childhood: the Diabetes Autoimmunity Study in the Young (DAISY). Diabetologia 2017; 60:998-1006. [PMID: 28314946 PMCID: PMC5504909 DOI: 10.1007/s00125-017-4256-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/08/2017] [Indexed: 01/13/2023]
Abstract
AIMS/HYPOTHESIS We sought to assess the frequency, determinants and prognosis for future diabetes in individuals with islet autoimmunity and whether these factors differ depending on the age of onset of islet autoimmunity. METHODS A prospective cohort (n = 2547) of children from the general population who had a high-risk HLA genotype and children who had a first-degree relative with type 1 diabetes were followed for up to 21 years. Those with the persistent presence of one or more islet autoantibodies were categorised as early-onset (<8 years of age, n = 143, median 3.3 years) or late-onset (≥8 years of age, n = 64, median 11.1 years), and were followed for a median of 7.4 and 4.7 years, respectively. Progression to diabetes was evaluated by Kaplan-Meier analysis with logrank test. Factors associated with progression to diabetes were analysed using the parametric accelerated failure time model. RESULTS Children with late-onset islet autoimmunity were more likely to be Hispanic or African-American than non-Hispanic white (p = 0.004), and less likely to be siblings of individuals with type 1 diabetes (p = 0.04). The frequencies of the HLA-DR3/4 genotype and non-HLA gene variants associated with type 1 diabetes did not differ between the two groups. However, age and HLA-DR3/4 were important predictors of rate of progression to both the presence of additional autoantibodies and type 1 diabetes. Late-onset islet autoimmunity was more likely to present with a single islet autoantibody (p = 0.01) and revert to an antibody-negative state (p = 0.01). Progression to diabetes was significantly slower in children with late-onset islet autoimmunity (p < 0.001). CONCLUSIONS/INTERPRETATION A late onset of islet autoimmunity is more common in African-American and Hispanic individuals. About half of those with late-onset islet autoimmunity progress to show multiple islet autoantibodies and develop diabetes in adolescence or early adulthood. Further investigation of environmental determinants of late-onset autoimmunity may lead to an understanding of and ability to prevent adolescent and adult-onset type 1 diabetes.
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Affiliation(s)
- Brigitte I Frohnert
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado, 1775 Aurora Court, A140, Aurora, CO, 80045, USA.
| | - Lisa Ide
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado, 1775 Aurora Court, A140, Aurora, CO, 80045, USA
| | - Fran Dong
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado, 1775 Aurora Court, A140, Aurora, CO, 80045, USA
| | - Anna E Barón
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Andrea K Steck
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado, 1775 Aurora Court, A140, Aurora, CO, 80045, USA
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Marian J Rewers
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado, 1775 Aurora Court, A140, Aurora, CO, 80045, USA
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Introduction of complementary foods in Sweden and impact of maternal education on feeding practices. Public Health Nutr 2016; 20:1054-1062. [PMID: 27917749 DOI: 10.1017/s1368980016003104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To describe the introduction of complementary foods in a population-based cohort in relation to recommendations and explore the possible impact of maternal education on infant feeding practices. DESIGN Prospective data from the All Babies in Southeast Sweden (ABIS) cohort study were used. The ABIS study invited all infants born in south-east Sweden during October 1997-October 1999 (n 21 700) to participate. A questionnaire was completed for 16 022 infants. During the infants' first year parents continuously filed in a diary covering introduction of foods. SETTING Sweden. SUBJECTS Infants (n 9727) with completed food diaries. RESULTS Potatoes, vegetables, fruits/berries and porridge were the foods first introduced, with a median introduction between 19 and 22 weeks, followed by introduction of meat, cow's milk, follow-on formula and sour milk/yoghurt between 24 and 27 weeks. Early introduction of any food, before 16 weeks, occurred for 27 % of the infants and was more common in infants of mothers with low education. Overall, potatoes (14·7 %), vegetables (11·1 %), fruits/berries (8·5 %), porridge (7·4 %) and follow-on formula (2·7 %) were the foods most frequently introduced early. The majority of infants (≥70 %) were introduced to potatoes, vegetables, fruits/berries and porridge during concurrent breast-feeding, but introduction during concurrent breast-feeding was less common in infants of mothers with low education. CONCLUSIONS Most infants were introduced to complementary foods timely in relation to recommendations. Low maternal education was associated with earlier introduction of complementary foods and less introduction during concurrent breast-feeding. Still, the results indicated exposure to fewer foods at 12 months in infants of mothers with low education.
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Nucci AM, Virtanen SM, Sorkio S, Bärlund S, Cuthbertson D, Uusitalo U, Lawson ML, Salonen M, Berseth CL, Ormisson A, Lehtonen E, Savilahti E, Becker DJ, Dupré J, Krischer JP, Knip M, Åkerblom HK. Regional differences in milk and complementary feeding patterns in infants participating in an international nutritional type 1 diabetes prevention trial. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27714970 DOI: 10.1111/mcn.12354] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/02/2016] [Accepted: 06/07/2016] [Indexed: 01/24/2023]
Abstract
Differences in breastfeeding, other milk feeding and complementary feeding patterns were evaluated in infants at increased genetic risk with and without maternal type 1 diabetes (T1D). The Trial to Reduce IDDM in the Genetically at Risk is an international nutritional primary prevention double-blinded randomized trial to test whether weaning to extensively hydrolyzed vs. intact cow's milk protein formula will decrease the development of T1D-associated autoantibodies and T1D. Infant diet was prospectively assessed at two visits and seven telephone interviews between birth and 8 months. Countries were grouped into seven regions: Australia, Canada, Northern Europe, Southern Europe, Central Europe I, Central Europe II and the United States. Newborn infants with a first-degree relative with T1D and increased human leukocyte antigen-conferred susceptibility to T1D were recruited. A lower proportion of infants born to mothers with than without T1D were breastfed until 6 months of age in all regions (range, 51% to 60% vs. 70% to 80%). Complementary feeding patterns differed more by region than by maternal T1D. In Northern Europe, a higher proportion of infants consumed vegetables and fruits daily compared with other regions. Consumption of meat was more frequent in all European regions, whereas cereal consumption was most frequent in Southern Europe, Canada and the United States. Maternal T1D status was associated with breastfeeding and other milk feeding patterns similarly across regions but was unrelated to the introduction of complementary foods. Infant feeding patterns differed significantly among regions and were largely inconsistent with current recommended guidelines.
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Affiliation(s)
- Anita M Nucci
- Department of Nutrition, Georgia State University, Atlanta, Georgia, USA
| | - Suvi M Virtanen
- Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland.,School of Health Sciences, University of Tampere, Tampere, Finland.,Center for Child Health Research, Tampere University Hospital, University of Tampere, Tampere, Finland.,The Science Center of Pirkanmaa Hospital District, Tampere, Finland
| | - Susa Sorkio
- Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Sonja Bärlund
- Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - David Cuthbertson
- Pediatrics Epidemiology Center, University of South Florida, Tampa, Florida, USA
| | - Ulla Uusitalo
- Pediatrics Epidemiology Center, University of South Florida, Tampa, Florida, USA
| | - Margaret L Lawson
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Marja Salonen
- Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Anne Ormisson
- Department of Paediatrics, University of Tartu, Tartu, Estonia
| | - Eveliina Lehtonen
- Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Erkki Savilahti
- Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Dorothy J Becker
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,University of Pittsburgh, Pittsburgh, PA
| | - John Dupré
- Robarts Research Institute, London, Ontario, Canada
| | - Jeffrey P Krischer
- Pediatrics Epidemiology Center, University of South Florida, Tampa, Florida, USA
| | - Mikael Knip
- Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland.,Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Hans K Åkerblom
- Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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15
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Andrén Aronsson C, Lee HS, Koletzko S, Uusitalo U, Yang J, Virtanen SM, Liu E, Lernmark Å, Norris JM, Agardh D. Effects of Gluten Intake on Risk of Celiac Disease: A Case-Control Study on a Swedish Birth Cohort. Clin Gastroenterol Hepatol 2016; 14:403-409.e3. [PMID: 26453955 PMCID: PMC4897964 DOI: 10.1016/j.cgh.2015.09.030] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/22/2015] [Accepted: 09/25/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Early nutrition may affect the risk of celiac disease. We investigated whether amount of gluten in diet until 2 years of age increases risk for celiac disease. METHODS We performed a 1-to-3 nested case-control study of 146 cases, resulting in 436 case-control pairs matched for sex, birth year, and HLA genotype generated from Swedish children at genetic risk for celiac disease. Newborns were annually screened for tissue transglutaminase autoantibodies (tTGA). If tested tTGA positive, time point of seroconversion was determined from frozen serum samples taken every 3 months. Celiac disease was confirmed by intestinal biopsies. Gluten intake was calculated from 3-day food records collected at ages 9, 12, 18 and 24 months. Odds ratios (OR) were calculated through conditional logistic regression. RESULTS Breastfeeding duration (median, 32 wk) and age at first introduction to gluten (median, 22 wk) did not differ between cases and tTGA-negative controls. At the visit before tTGA seroconversion, cases reported a larger intake of gluten than controls (OR, 1.28; 95% confidence interval [CI], 1.13-1.46; P = .0002). More cases than controls were found in the upper third tertile (ie, >5.0 g/d) before they tested positive for tTGA seroconversion than controls (OR, 2.65; 95% CI, 1.70-4.13; P < .0001). This finding was similar in children homozygous for DR3-DQ2 (OR, 3.19; 95% CI, 1.61-6.30; P = .001), heterozygous for DR3-DQ2 (OR, 2.24; 95% CI, 1.08-4.62; P = .030), and for children not carrying DR3-DQ2 (OR, 2.43; 95% CI, 0.90-6.54; P = .079). CONCLUSIONS The amount of gluten consumed until 2 years of age increases the risk of celiac disease at least 2-fold in genetically susceptible children. These findings may be taken into account for future infant feeding recommendations.
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Affiliation(s)
- Carin Andrén Aronsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Hye-Seung Lee
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Sibylle Koletzko
- Dr. von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany
| | - Ulla Uusitalo
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Jimin Yang
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Suvi M Virtanen
- National Institute for Health and Welfare, Nutrition Unit, Helsinki, Finland; School of Health Sciences, University of Tampere, Finland; Research Center for Child Health, Tampere University and University Hospital, Science Center of Pirkanmaa Hospital District, University of Tampere, Finland
| | - Edwin Liu
- Digestive Health Institute, Children's Hospital Colorado, University of Colorado Denver, Aurora, Colorado
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Campus, University of Colorado Denver, Aurora, Colorado
| | - Daniel Agardh
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
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16
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Andrén Aronsson C, Uusitalo U, Vehik K, Yang J, Silvis K, Hummel S, Virtanen SM, Norris JM. Age at first introduction to complementary foods is associated with sociodemographic factors in children with increased genetic risk of developing type 1 diabetes. MATERNAL & CHILD NUTRITION 2015; 11:803-14. [PMID: 24034553 PMCID: PMC4122645 DOI: 10.1111/mcn.12084] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Infant's age at introduction to certain complementary foods (CF) has in previous studies been associated with islet autoimmunity, which is an early marker for type 1 diabetes (T1D). Various maternal sociodemographic factors have been found to be associated with early introduction to CF. The aims of this study were to describe early infant feeding and identify sociodemographic factors associated with early introduction to CF in a multinational cohort of infants with an increased genetic risk for T1D. The Environmental Determinants of Diabetes in the Young study is a prospective longitudinal birth cohort study. Infants (N = 6404) screened for T1D high risk human leucocyte antigen-DQ genotypes (DR3/4, DR4/4, DR4/8, DR3/3, DR4/4, DR4/1, DR4/13, DR4/9 and DR3/9) were followed for 2 years at six clinical research centres: three in the United States (Colorado, Georgia/Florida, Washington) and three in Europe (Sweden, Finland, Germany). Age at first introduction to any food was reported at clinical visits every third month from the age of 3 months. Maternal sociodemographic data were self-reported through questionnaires. Age at first introduction to CF was primarily associated with country of residence. Root vegetables and fruits were usually the first CF introduced in Finland and Sweden and cereals were usually the first CF introduced in the United States. Between 15% and 20% of the infants were introduced to solid foods before the age of 4 months. Young maternal age (<25 years), low educational level (<12 years) and smoking during pregnancy were significant predictors of early introduction to CF in this cohort. Infants with a relative with T1D were more likely to be introduced to CF later.
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Affiliation(s)
- Carin Andrén Aronsson
- Department of Clinical SciencesLund University/CRCMalmöSweden
- Institute of Diabetes ResearchHelmholtz Zentrum MünchenKlinikum rechts der lsarTechnische UniversitätMünchenGermany
| | - Ulla Uusitalo
- Morsani College of Medicine, University of South FloridaPediatrics Epidemiology CenterTampaFloridaUSA
| | - Kendra Vehik
- Morsani College of Medicine, University of South FloridaPediatrics Epidemiology CenterTampaFloridaUSA
| | - Jimin Yang
- Morsani College of Medicine, University of South FloridaPediatrics Epidemiology CenterTampaFloridaUSA
| | | | - Sandra Hummel
- Institute of Diabetes ResearchHelmholtz Zentrum MünchenKlinikum rechts der lsarTechnische UniversitätMünchenGermany
| | - Suvi M. Virtanen
- Nutrition UnitNational Institute for Health and WelfareHelsinkiFinland
- School of Health SciencesUniversity of TampereTampereFinland
- Research Center for Child HealthTampere University and University HospitalTampereFinland
| | - Jill M. Norris
- Department of Epidemiology, Colorado School of Public HealthUniversity of Colorado, Anschutz Medical CampusAuroraColoradoUSA
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Abstract
Type 1 diabetes (T1D) is an autoimmune disease that results from the destruction of the β cells of the pancreas in genetically at-risk individuals. The autoimmune process that precedes the development of T1D is believed to be triggered by environmental factors, including nutrition. Early introduction of complementary foods has been implicated in the etiology of T1D as a possible explanation of the increasing incidence of the disease, particularly in children younger than 5 years of age. Infant feeding recommendations have been designed to promote adequate growth, provide essential nutrients, and reduce the risk of developing chronic illnesses. The World Health Organization and the American Academy of Pediatrics recommend exclusive breastfeeding to 6 months of age followed by continued breastfeeding as complementary foods are introduced. A lack of compliance with these recommendations has been observed in the general population as well as in infants at high risk for T1D. Dietary factors such as the provision of breast milk and duration of breastfeeding, the age at introduction of cow's milk and gluten-containing foods, as well as other complementary feeding have been investigated. However, the evidence that early infant feeding patterns are linked with T1D currently remains inconclusive.
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Affiliation(s)
- Anita M. Nucci
- Department of Nutrition, Georgia State University, P.O. Box 3995, Atlanta, GA 30303-3995, USA
| | - Suvi M. Virtanen
- Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
- Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
- The Science Center of Pirkanmaa Hospital District, Tampere, Finland
| | - Dorothy J. Becker
- Division of Endocrinology and Diabetes, University of Pittsburgh and Children's Hospital of Pittsburgh of UPMC, 4401 Penn Ave, Pittsburgh, PA 15224, USA
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18
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Aronsson CA, Lee HS, Liu E, Uusitalo U, Hummel S, Yang J, Hummel M, Rewers M, She JX, Simell O, Toppari J, Ziegler AG, Krischer J, Virtanen SM, Norris JM, Agardh D. Age at gluten introduction and risk of celiac disease. Pediatrics 2015; 135:239-45. [PMID: 25601977 PMCID: PMC4306795 DOI: 10.1542/peds.2014-1787] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2014] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES The goal of this study was to determine whether age at introduction to gluten was associated with risk for celiac disease (CD) in genetically predisposed children. METHODS TEDDY (The Environmental Determinants of Diabetes in the Young) is a prospective birth cohort study. Newborn infants (N = 6436) screened for high-risk HLA-genotypes for CD were followed up in Finland, Germany, Sweden, and the United States. Information about infant feeding was collected at clinical visits every third month. The first outcome was persistent positive for tissue transglutaminase autoantibodies (tTGA), the marker for CD. The second outcome was CD, defined as either a diagnosis based on intestinal biopsy results or on persistently high levels of tTGA. RESULTS Swedish children were introduced to gluten earlier (median: 21.7 weeks) compared with children from Finland (median: 26.1 weeks), Germany, and the United States (both median: 30.4 weeks) (P < .0001). During a median follow-up of 5.0 years (range: 1.7-8.8 years), 773 (12%) children developed tTGA and 307 (5%) developed CD. Swedish children were at increased risk for tTGA (hazard ratio: 1.74 [95% CI: 1.47-2.06]) and CD (hazard ratio: 1.76 [95% CI: 1.34-2.24]) compared with US children, respectively (P < .0001).Gluten introduction before 17 weeks or later than 26 weeks was not associated with increased risk for tTGA or CD, adjusted for country, HLA, gender, and family history of CD, neither in the overall analysis nor on a country-level comparison. CONCLUSIONS In TEDDY, the time to first introduction to gluten introduction was not an independent risk factor for developing CD.
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Affiliation(s)
| | - Hye-Seung Lee
- Pediatrics Epidemiology Center, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Edwin Liu
- Digestive Health Institute, University of Colorado, Children's Hospital Colorado, Denver, Colorado
| | - Ulla Uusitalo
- Pediatrics Epidemiology Center, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Sandra Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, and Klinikum rechts der Isar, Technische Universität München, and Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Jimin Yang
- Pediatrics Epidemiology Center, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Michael Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, and Klinikum rechts der Isar, Technische Universität München, and Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Marian Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, Colorado
| | - Jin-Xiong She
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Georgia Regents University, Augusta, Georgia
| | - Olli Simell
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Jorma Toppari
- Department of Physiology and Pediatrics, University of Turku, Turku, Finland
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, and Klinikum rechts der Isar, Technische Universität München, and Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Jeffrey Krischer
- Pediatrics Epidemiology Center, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Suvi M Virtanen
- National Institutes for Health and Welfare, Nutrition Unit, Helsinki, Finland; School of Health Sciences, University of Tampere, Tampere, Finland; Research Center for Child Health, Tampere University and University Hospital and the Science Center of Pirkanmaa Hospital District, Tampere, Finland; and
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, Aurora, Colorado
| | - Daniel Agardh
- Department of Clinical Sciences, Lund University, Malmö, Sweden
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Mothers’ restrictive eating and food neophobia and fathers’ dietary quality are associated with breast-feeding duration and introduction of solid foods: the STEPS study. Public Health Nutr 2014; 18:1991-2000. [DOI: 10.1017/s1368980014002663] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveThe purpose of the present study was to examine the association between parental eating behaviours and dietary patterns and feeding practices of infants and young children.DesignData on infant-feeding practices were collected from each infant’s birth via parentally self-administered follow-up diaries. Three questionnaires, the Three-Factor Eating Questionnaire, the Food Neophobia Scale and the Index of Diet Quality, were administered when the children were aged 4 and 13 months.SettingSouth-western Finland.SubjectsFamilies participating in the STEPS longitudinal cohort study (n1797).ResultsMean duration of exclusive breast-feeding was 2·4 months and total duration of breast-feeding averaged 8·1 months. The first solid food was introduced into children’s diets at the age of 3·9 months, on average. Mothers with highly restrictive eating were more likely to introduce solid foods sooner than mothers who ranked lower in these behaviours (3·8 monthsv.4·0 months,P=0·012). Neophobic mothers breast-fed exclusively (2·0v. 2·6 months,P=0·038) and in total (7·2v. 8·5 months,P=0·039) for shorter times than average mothers, even after adjusting for various demographic characteristics. Fathers’ diet quality was associated with total breast-feeding duration and with introduction of complementary foods in unadjusted analyses and with total breast-feeding duration also after adjusting for confounding factors.ConclusionsMothers’ and fathers’ eating patterns and practices are associated with the feeding practices of infants and young children. Health promotion interventions seeking to improve parents’ eating patterns might lead to more favourable feeding practices for infants and young children.
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Liu E, Lee HS, Aronsson CA, Hagopian WA, Koletzko S, Rewers MJ, Eisenbarth GS, Bingley PJ, Bonifacio E, Simell V, Agardh D. Risk of pediatric celiac disease according to HLA haplotype and country. N Engl J Med 2014; 371:42-9. [PMID: 24988556 PMCID: PMC4163840 DOI: 10.1056/nejmoa1313977] [Citation(s) in RCA: 225] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The presence of HLA haplotype DR3-DQ2 or DR4-DQ8 is associated with an increased risk of celiac disease. In addition, nearly all children with celiac disease have serum antibodies against tissue transglutaminase (tTG). METHODS We studied 6403 children with HLA haplotype DR3-DQ2 or DR4-DQ8 prospectively from birth in the United States, Finland, Germany, and Sweden. The primary end point was the development of celiac disease autoimmunity, which was defined as the presence of tTG antibodies on two consecutive tests at least 3 months apart. The secondary end point was the development of celiac disease, which was defined for the purpose of this study as either a diagnosis on biopsy or persistently high levels of tTG antibodies. RESULTS The median follow-up was 60 months (interquartile range, 46 to 77). Celiac disease autoimmunity developed in 786 children (12%). Of the 350 children who underwent biopsy, 291 had confirmed celiac disease; an additional 21 children who did not undergo biopsy had persistently high levels of tTG antibodies. The risks of celiac disease autoimmunity and celiac disease by the age of 5 years were 11% and 3%, respectively, among children with a single DR3-DQ2 haplotype, and 26% and 11%, respectively, among those with two copies (DR3-DQ2 homozygosity). In the adjusted model, the hazard ratios for celiac disease autoimmunity were 2.09 (95% confidence interval [CI], 1.70 to 2.56) among heterozygotes and 5.70 (95% CI, 4.66 to 6.97) among homozygotes, as compared with children who had the lowest-risk genotypes (DR4-DQ8 heterozygotes or homozygotes). Residence in Sweden was also independently associated with an increased risk of celiac disease autoimmunity (hazard ratio, 1.90; 95% CI, 1.61 to 2.25). CONCLUSIONS Children with the HLA haplotype DR3-DQ2, especially homozygotes, were found to be at high risk for celiac disease autoimmunity and celiac disease early in childhood. The higher risk in Sweden than in other countries highlights the importance of studying environmental factors associated with celiac disease. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.).
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Affiliation(s)
- Edwin Liu
- From the Digestive Health Institute, Children's Hospital Colorado (E.L.), and the Barbara Davis Center (E.L., M.J.R., G.S.E.), University of Colorado Denver, Aurora; the Pediatrics Epidemiology Center, University of South Florida, Tampa (H.-S.L.); the Diabetes and Celiac Disease Unit, Department of Clinical Sciences, Lund University, Malmo, Sweden (C.A.A., D.A.); Pacific Northwest Diabetes Research Institute, Seattle (W.A.H.); Dr. von Hauner Children's Hospital, Ludwig Maximilian University, Munich (S.K.), the Center for Regenerative Therapies Dresden, Technische Universitaet Dresden, Dresden (E.B.), and Forschergruppe Diabetes, Helmholz Zentrum München, Neuherberg (E.B.) - all in Germany; the School of Clinical Sciences, University of Bristol, Bristol, United Kingdom (P.J.B.); and the Department of Pediatrics, University of Turku, Turku University Hospital, Turku, Finland (V.S.)
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