Energy intake of 1 to 18 year old German children and adolescents

Empirically derived portion sizes from the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study for 4- to 18-year-old children and adolescents to simplify analysis of dietary data using FFQ

OBJECTIVE

To apply FFQ, knowledge about portion sizes is relevant. According to increased energy and nutrient requirements, average portion sizes of foods are supposed to increase during growth. We provide empirically derived portion sizes for 4- to 18-year-olds in different age groups to facilitate analyses of FFQ data in children and adolescents.

DESIGN

Using data from the dynamic DOrtmund Nutritional and Anthropometric Longitudinally Designed cohort study, quantile regression for smoothing percentiles was used to derive portion sizes as a function of age from which age- and food group-specific portion sizes were calculated as median food group intake (g).

SETTING

Dortmund, Germany.

PARTICIPANTS

Data from 3-day weighed dietary records (WDR) of 1,325 participants (♀: 653) were analysed. Participants provided in total 9,828 WDR (on average 7·5 per participant) between 1985 and 2022. WDR were grouped into five age groups, whereby each age group covered 3 years of age.

RESULTS

In total, 11 955 food items were reported and categorised into sixteen major food groups with seventy-one sub-groups. Portion sizes tended to increase with age, except for milk- and plant-based alternatives. Comparing 4- to 6-year-olds to 16- to 18-year-olds, portion size increased between 22·2 % (processed meat: 18 g v. 22 g) and 173·3 % (savoury snacks: 15 g v. 41 g).

CONCLUSION

We provide empirically derived portion sizes for children and adolescents. These data are useful to establish dietary assessment methods based on estimates of portion sizes, such as FFQ, for children and adolescents.

Place of Residence Is Associated with Dietary Intake and BMI-SDS in Children and Adolescents: Findings from the DONALD Cohort Study

We aimed to determine whether place of residence in the German urban food environment is associated with habitual dietary intake (energy, macronutrients, and food groups) and body mass index (standard deviation score of BMI and BMI-SDS). Our hypothesis was that place of residence may explain some variation in dietary intake and nutritional outcomes. For the cross-sectional analyses of DONALD study data, we grouped participants according to their geocoded residence in the north or south of Dortmund. We applied robust multi-level mixed effects regression models using residence as a predictor and (1) BMI-SDS or (2) dietary data (daily intake of energy (kcal), macronutrients (energy percentage), or food groups (g/1000 kcal)) as the outcome. Models were adjusted for age, sex, and household socio-economic status. An analysis was carried out on 1267 anthropometric measurements collected annually from 360 participants aged 6-18 years (935 3-day weighed dietary records from 292 participants) between 2014 and 2019. In the fully adjusted models, residence in the south was associated with a lower BMI-SDS (β = -0.42, p = 0.02), lower intake of sugar-sweetened beverages (β = -47.00, p = 0.04), and higher intake of vegetables (β = 11.13, p = 0.04). Findings suggest that the place of residence, beyond individuals' socio-economic statuses, may be a contributing factor to dietary quality.

Relevance of fructose intake in adolescence for fatty liver indices in young adulthood

PURPOSE

To examine the association between fructose intake in adolescence and fatty liver indices (hepatic steatosis index (HSI), fatty liver index (FLI)) in young adulthood.

METHODS

Overall, 246 participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study who had a fasting blood sample in adulthood (18-36 years), at least two 3-day weighed dietary records for calculating fructose intakes and other fructose-containing sugars (total (TS), free (FS), added sugar (AS)) as well as two complete 24-h urine samples for calculating sugar excretion (fructose excretion (FE), fructose + sucrose excretion (FE + SE)) in adolescence (males: 9.5-16.5 years; females: 8.5-15.5 years) were analysed using multivariable linear regression analyses.

RESULTS

On the level of dietary intake, no prospective associations were observed between adolescent fructose intake and both adult fatty liver indices, whereas higher FS intakes were associated with lower levels of HSI (Ptrend = 0.02) and FLI (Ptrend = 0.03). On the urinary excretion level, however, a higher FE (Ptrend = 0.03) and FE + SE (Ptrend = 0.01) in adolescence were prospectively related to higher adult FLI values. No associations were observed between adolescent sugar excretion and adult HSI.

CONCLUSION

The present study does not provide unambiguous support for a detrimental impact of adolescent fructose intake on adult liver health. Nonetheless, further examinations estimating exposure by means of urinary excretion as well as dietary intake levels appear warranted.

Sugar intake among German adolescents: trends from 1990 to 2016 based on biomarker excretion in 24-h urine samples

Trend analyses based on dietary records suggest decreases in the intakes of total sugar (TS), added and free sugar since 2005 among children and adolescents in Germany. In terms of age trends, TS intake decreased with increasing age. However, self-reported sugar intake in epidemiological studies is criticised, as it may be prone to bias due to selective underreporting. Furthermore, adolescents are more susceptible to underreporting than children. We thus analysed time and age trends in urinary fructose excretion (FE), sucrose excretion (SE) and the sum of both (FE + SE) as biomarkers for sugar intake among 8·5-16·5-year-old adolescents. Urinary sugar excretion was measured by UPLC-MS/MS in 997 24-h urine samples collected from 239 boys and 253 girls participating in the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study cohort between 1990 and 2016. Time and age trends of log-transformed FE, SE and FE + SE were analysed using polynomial mixed-effects regression models. Between 1990 and 2016, FE as well as FE + SE decreased (linear time trend: P = 0·0272 and P < 0·0001, respectively). A minor increase in excretion during adolescence was confined to FE (linear age trend: P = 0·0017). The present 24-h excretion measurements support a previously reported dietary record-based decline in sugar intake since 2005. However, the previously seen dietary record-based decrease in TS from childhood to late adolescence was not confirmed by our biomarker analysis, suggesting a constant sugar intake for the period of adolescence.

Prediction of human dietary δ15N intake from standardised food records: validity and precision of single meal and 24-h diet data

Natural stable isotope ratios (δ¹⁵N) of humans can be used for nutritional analyses and dietary reconstruction of modern and historic individuals and populations. Information about an individual's metabolic state can be obtained by comparison of tissue and dietary δ¹⁵N. Different methods have been used to estimate dietary δ¹⁵N in the past; however, the validity of such predictions has not been compared to experimental values. For a total of 56 meals and 21 samples of 24-h diets, predicted and experimental δ¹⁵N values were compared. The δ¹⁵N values were predicted from self-recorded food intake and compared with experimental δ¹⁵N values. Predicted and experimental δ¹⁵N values were in good agreement for meals and preparations (r = 0.89, p < .001) as well as for the 24-h diets (r = 0.76, p < .001). Dietary δ¹⁵N was mainly determined by the amount of fish, whereas the contribution of meat to dietary δ¹⁵N values was less pronounced. Prediction of human dietary δ¹⁵N values using standardised food records and representative δ¹⁵N data sets yields reliable data for dietary δ¹⁵N intake. A differentiated analysis of the primary protein sources is necessary when relating the proportion of animal-derived protein in the diet by δ¹⁵N analysis.

Salt, fruit and vegetable consumption and blood pressure development: a longitudinal investigation in healthy children

Low salt intake and high fruit and vegetable intake (FVI) have been shown to reduce blood pressure (BP) in adults. Longitudinal data on the independent effect of both FVI and salt intake on BP in healthy normotensive children are not available yet. In the present study, we aimed to characterise the concomitant influence of salt intake and FVI on BP development throughout childhood and adolescence. We examined 435 healthy subjects, for whom at least three repeated measurements of BP had been taken and who had provided 24 h urine samples and 3 d weighed dietary records between 4 and 18 years of age. BP was measured using a mercury sphygmomanometer (Mercuro 300, WelchAllyn) and salt intake was determined based on 24 h Na excretion. The intra-individual change in salt intake was almost significantly associated with the change in systolic BP (SBP, P= 0·06) and marginally (P= 0·09) with that in diastolic BP (DBP) in puberty, but not in pre-puberty. A 1 g/d increase in salt intake was associated with a 0·2 mmHg increase in SBP. In pre-puberty, but not in puberty, differences in FVI between children predicted between-person variations in SBP and DBP (P= 0·03). Corresponding findings were obtained for 24 h K excretion (a urinary indicator for FVI). A 100 g/d lower FVI was related to a 0·4 mmHg higher BP value. In conclusion, in healthy children and adolescents with BP in the low-normal range, both salt intake and FVI may already start to influence BP, although at a small magnitude. The potential importance of establishing healthy eating habits in childhood for later BP development emphasises the role of higher FVI and lower salt intake in the prevention of hypertension in the long run.

Time trends in dietary fat intake in a sample of German children and adolescents between 2000 and 2010: not quantity, but quality is the issue

Dietary fat intake in childhood may influence the risk for developing chronic diseases. The objective of the present study was to examine secular trends in the parameters of fat intake between 2000 and 2010 in a sample of German children and adolescents (n 808) participating in the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study. Dietary data from 4380 3 d weighed dietary records were analysed using repeated-measures regression to determine time trends in fat quantity, i.e. the intake of total fat, and in fat quality, i.e. the ratios of SFA, MUFA and PUFA. In young children (2-3 years) and in adolescents (13-18 years), total fat intake remained stable over time, but decreased by 0·08 % of total energy (%E) per year in 4-12-year-old children. In 2010, median fat intake was at the upper end of the recommendations. SFA intake decreased slightly in 2-3- and 4-12-year-old children by 0·09 and 0·05 %E per year, respectively. MUFA and PUFA intakes remained stable in all the age groups except in adolescents. Here, PUFA intake decreased initially, but increased between 2005 and 2010. In 2010, only between 3 and 18 % of the respective age groups had an intake of SFA or PUFA within the recommendations. In conclusion, fat quantity and quality did not change substantially between 2000 and 2010. Fat quality, in particular, needs to be improved, since a large percentage of our sample did not meet the recommended intakes for SFA and PUFA.

Under- and over-reporting of energy intake in slovenian adolescents

OBJECTIVE

To examine under- and over-reporting of energy intake (EI) among adolescents and to compare relative food and nutrient intakes of under-reporters (UR), over-reporters (OR), and the whole population to acceptable reporters (AR).

DESIGN

All adolescents completed food frequency questionnaires at regional health centers, and a subgroup also completed a 3-day weighed dietary protocol at home.

SETTING

This study is a part of the first national representative study on dietary habits of Slovenian adolescents.

PARTICIPANTS

In total, 2,813 adolescents entering high school (10% of the population); participation rate was 95%.

MAIN OUTCOME MEASURES

Absolute EI and relative intakes of food and nutrients.

ANALYSIS

Prodi (version 5.2 expert plus, Nutri-Science, Stuttgart, Germany, 2004) software was used to evaluate dietary intakes; t test, analysis of variance, and Mann-Whitney testing were used for differences between means, and chi-square was used for differences between proportions. Level of significance was set at P = .05.

RESULTS

The prevalence of UR and OR was 34% and 10% among boys, and 27% and 11% among girls. Under-reporters reported lower energy percentage from carbohydrates, higher energy percentage from fats and proteins, and higher micronutrient densities than AR.

CONCLUSIONS AND IMPLICATIONS

Under-reporting and over-reporting are widespread among Slovenian adolescents. Exclusion of UR and OR does not influence mean value of EI when assessing the diet of a group as a whole.

Food intake in Slovenian adolescents and adherence to the Optimized Mixed Diet: a nationally representative study

Objectives

To investigate the food intake of Slovenian adolescents and to compare it with food-based dietary guidelines developed for children and adolescents, named the Optimized Mixed Diet (OMD). The OMD is a useful tool for the evaluation of food intake of adolescents.

Design

All adolescents completed an FFQ at a regional health centre; a subgroup also completed a 3 d weighed dietary protocol at home.

Setting

This study is a part of the first national representative study on the dietary habits of Slovenian adolescents.

Subjects

This cross-sectional study included a representative sample of 2813 Slovenian adolescents entering high school, aged 14–17 years, from all ten geographical regions of Slovenia.

Results

The greatest deviations from the recommended intakes of the main food groups in the OMD were significantly lower intakes of (P < 0·001, mean): vegetables (179 and 163 g/d in boys and girls, respectively), bread/cereals (271 and 226 g/d), potatoes/rice/pasta (212 and 163 g/d); in boys also a significantly lower intake of fruits (mean: 321 g/d, P < 0·001) and a significantly higher intake of meat/meat products (mean: 126 g/d, P < 0·001). Additionally, the results show too high intake of sugar-sweetened beverages and too low intakes of fish and plant oils in both genders.

Conclusions

The food intake pattern of Slovenian adolescents deviates markedly from a healthy eating pattern. Nutrition education and interventions are needed for Slovenian adolescents.

Direction of associations between added sugar intake in early childhood and body mass index at age 7 years may depend on intake levels

Dietary factors, especially during early childhood, have been discussed as potentially critical for the development of childhood overweight. This study evaluated associations between added sugar intake during early childhood and BMI and body fat at age 7 y. Analysis was based on data from 216 participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study. Life-course plots were constructed to evaluate the association between added sugar intake at different ages (0.5, 1, 1.5, and 2 y) and BMI SD score (BMI-SDS) and % body fat (%BF) at age 7 y. Multivariable analyses were performed for the periods identified as critical for later BMI and body fat. Added sugar intake at age 1 y and the change in intake levels during the second year of life emerged as potentially critical. At age 1 y, a higher total added sugar intake was related to a lower BMI-SDS at age 7 y [adjusted β ± SE: -0.116 ± 0.057 BMI-SDS/percent energy (%En) added sugar; P = 0.04]. Conversely, an increase in total added sugar in the second year of life (Δ%En between age 1 and 2 y) tended to be associated with a higher BMI-SDS (adjusted β ± SE: 0.074 ± 0.043 BMI-SDS/Δ%En added sugar; P = 0.09). No associations were observed with %BF. In conclusion, added sugar intake at low intake levels during early childhood does not appear to be critical for BMI and body fat at age 7 y. However, detrimental effects on BMI development may emerge when added sugar intakes are increased to higher levels.

Characteristics of energy under-reporting in children and adolescents

Under-reporting (UR) of food intake is an issue of concern, as it may distort the relationships studied between diet and health. This topic has been scarcely addressed in children. The objective of the study was to assess the extent of UR in French children and investigate associated covariates. A total of 1455 children aged 3-17 years were taken from the nationally representative cross-sectional French étude Individuelle Nationale des Consommations Alimentaires (INCA2) dietary survey (2006-7). Food intake was reported in a 7 d diet record. Socio-economic status, sedentary behaviour, weight perception variables and food habits were collected by questionnaires. Weight and height were measured. Under-reporters were identified according to the Goldberg criterion adapted to children. Multivariate logistic regressions investigated the associations between UR and covariates. Rates of under-reporters were 4·9 and 26·0 % in children aged 3-10 and 11-17 years, respectively (P < 0·0001), without significant differences between boys and girls. Overall, UR was positively associated with a lower socio-economic status, overweight, skipping breakfast and dinner, a higher contribution of proteins to energy intake (EI), and a lower contribution of simple carbohydrates to EI. Under-reporters aged 3-10 years also had a higher sedentary behaviour and a lower snack-eating frequency. In adolescents, UR was also associated with a less-frequent school canteen attendance, a perception of being overweight, a wish to weigh less, and current and past restrictive diets. In conclusion, under-reporters differ from plausible reporters in several characteristics related to diet, lifestyle, weight status and socio-economic status. Therefore, it is important to consider this differential UR bias when investigating diet-disease associations in children.

Whole grain in children's diet: intake, food sources and trends

OBJECTIVE

To quantify the intake of grain and whole grain, and their food sources, as well as to investigate the age and time trends over the last decade in a sample of German children and adolescents.

METHODS

Dietary records from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study were used for conducting this work. A total of 5067 3-day weighed dietary records of 821 2- to 18-year-old children and adolescents collected between 1997 and 2008 were analysed using linear mixed-effect models, in which the means of the data and the covariance structure (children of the family, repeated measurements) were modelled.

RESULTS

Mean whole-grain intake was between 20 and 33 g/day in the sample and highest in 13-18 year olds. No whole grain intake was recorded in 19% of all dietary records. Total grain intake increased significantly with age (P<0.0001), even after adjustment for energy intake. Whole-grain intake (g/day) increased significantly with age in the unadjusted model (P<0.0001). This increase disappeared after adjustment for energy intake (P>0.05) and became a negative trend after adjustment for grain intake (P<0.01). There were no significant time trends during the study period. Bread had the highest effect on grain intake in the total sample (50%), followed by rice/pasta (21%), cake (13%), grain (9%), RTECs (5%) and muesli (2%).

CONCLUSIONS

The whole-grain intake in this sample of German children and adolescents was far below the FBDG. The decreasing percentage of whole grain per grain intake with age contradicts the common concept of stable dietary habits during childhood and adolescents.

Lifestyle intervention in obese children with variations in the melanocortin 4 receptor gene

Because information on weight changes after lifestyle intervention in children with mutations in the melanocortin 4 receptor (MC4R) gene is scarce, we compared weight changes after lifestyle intervention between children with and without MC4R variations. A group of 514 overweight children (aged 5-16 years), who presented to participate in a 1-year lifestyle intervention based on exercise, behavior, and nutrition therapy were screened for MC4R mutations. For comparison, children with MC4R mutations leading to reduced receptor function (group A) were each of them randomly matched with five children of same age and gender without MC4R mutations (group B). Changes of weight status were analyzed as change of BMI standard deviation scores (BMI-SDSs). Furthermore, 16 children (3.1%) harbored MC4R mutations leading to reduced receptor function, and 17 (3.3%) children carried variations not leading to reduced receptor function. Children with and without MC4R mutations reduced their overweight at the end of intervention to a similar degree (P = 0.318 between groups based on an intention-to-treat analysis). The maintenance of weight loss after intervention among children with MC4R mutations leading to reduced receptor function failed in contrast to children without such mutations (P < 0.001 adjusted for BMI-SDS at baseline, age, and gender in an intention-to-treat analysis). In conclusion, children with MC4R mutations leading to reduced receptor function were able to lose weight in a lifestyle intervention but had much greater difficulties to maintain this weight loss supporting the impact of these mutations on weight status.

Noninvasive markers of oxidative DNA stress, RNA degradation and protein degradation are differentially correlated with resting metabolic rate and energy intake in children and adolescents

Urinary excreted RNA and DNA catabolites are used as noninvasive markers for metabolic processes: 8-oxo-2'-deoxyguanosine (8-oxodG) potentially represents oxidative stress to DNA/deoxyribonucleotidetriphosphate pool, modified ribonucleoside pseudouridine (psi) originating mainly from degraded rRNA and tRNA reflects RNA turnover. Modified amino acid gamma-carboxyglutamic acid (Gla) stems from degraded proteins reflecting turnover of proteins. Aim of the present study was to investigate (44 healthy males, 3-18 y) how excretion rates of 8-oxodG, psi, and Gla are related to resting metabolic rate and energy intake. Excretion rates of 8-oxodG (pmol/kg/d), psi (micromol/kg/d), and Gla (micromol/kg/d) were significantly correlated with resting metabolic rate (kJ/kg/d): r = 0.108 (p = 0.029), 0.691 and 0.552 (p < 0.0001), respectively. Excretion rates of 8-oxodG, psi, and Gla were also significantly correlated with energy intake (kJ/kg/d): r = 0.108 (p = 0.036), 0.602 and 0.462 (p < 0.0001). 8-oxodG and Gla excretion was significantly correlated with psi excretion: r = 0.174 (p = 0.005) and 0.709 (p < 0.0001). These results indicate close relationships between whole-body RNA and protein degradation and metabolic rate. The relationship between 8-oxodG excretion and metabolic rate, however, is less strong suggesting that factors other than metabolic rate considerably affect the oxidative stress to DNA.

Breastfeeding duration in families with type 1 diabetes compared to non-affected families: results from BABYDIAB and DONALD studies in Germany

BACKGROUND

There are only a few small studies that compare breastfeeding rates in mothers with and without type 1 diabetes (T1D).

STUDY DESIGN

We studied breastfeeding duration in 665 German infants whose mother and/or father had T1D from the BABYDIAB Study (data collected between 1992 and 2000) and compared it with data from 268 German infants of unaffected parents from the DONALD Study.

RESULTS

Infants with a parent who had T1D were less likely to be breastfed and breastfed for shorter lengths of time than infants from unaffected families. Mothers with T1D showed a positive long-term breastfeeding time trend, but did not reach the rates of the DONALD Study.

CONCLUSIONS

This study identified minor secular trends influencing the differences in breastfeeding initiation and duration between families affected with T1D and those without.

Intrafamilial associations of lipid profiles and the role of nutrition: the Tehran lipid and glucose study

BACKGROUND

The role of gene and environment in the genesis of abnormal lipid profile is still a controversial issue.

OBJECTIVE

To clarify the importance of certain parental risk factors associated with lipid profiles of children and adolescents.

METHODS

We conducted this cross-sectional population-based study in district 13 in the east of metropolitan Tehran. One hundred and thirteen eligible families comprising 455 subjects (including 229 offspring, aged 5-25 years) were enrolled into the study. Anthropometric data were measured using a standard protocol. To measure lipid profiles, venous blood was obtained in the morning after the subjects had fasted for 12-14 h overnight. Dietary intakes were assessed by means of a 2-day dietary recall questionnaire.

RESULTS

The chances of having elevated serum total cholesterol were higher in sons of fathers with high cholesterol intake (OR = 3.1; CI = 1.1-9.2) and mothers with high saturated fatty acid (SFA) intake (3.4; 1.1-10.8). Positive correlations were seen between the energy intake of fathers and serum total cholesterol of their daughters (r = 0.34, p < 0.01); between the SFA intake of fathers and serum triglycerides (TGs) of their sons (0.29, p < 0.01) and between mothers' body mass index and daughters' serum TGs (0.23, p < 0.03). The chances of having low serum high-density lipoprotein cholesterol were lower in sons of mothers with high carbohydrate intake (11.0; 2.8-42.8) and mothers with high serum high-density lipoprotein cholesterol (6.8; 1.7-27.0). There were higher chances of having elevated serum low-density lipoprotein cholesterol in sons with fathers having high SFA intake (4.5; 1.4-14.3), with mothers having high serum TGs (6.1; 1.3-29.0) and with mothers having high cholesterol intake (4.3; 1.2-15.2).

CONCLUSION

The results indicate independent associations between diet contents and the lipid profiles of parents and their offspring as well as between lipid profiles and diet contents among spouses.

Breakfast glycemic index affects subsequent daily energy intake in free-living healthy children

BACKGROUND

Experimental studies have reported that the effect of a meal's glycemic index (GI) on subsequent energy intake depends on the timing of the subsequent meal.

OBJECTIVE

We examined whether the timing of the next meal after breakfast modifies the effect of the breakfast GI (GI(br)) on subsequent daytime energy intake of healthy free-living children.

DESIGN

Analyses included 381 participants of the DOrtmund Nutritional and Anthropometrical Longitudinally Designed (DONALD) Study who had provided weighed dietary records at ages 2, 4-5, and 7 y.

RESULTS

At all ages, among children who consumed their next meal in the early postprandial phase (after 3-4 h), children with a lower GI(br) consumed more calories throughout the remainder of the day than did children with a higher GI(br), independent of major dietary confounders. For the age groups 2, 4-5, and 7 y, energy intakes in tertiles 1 and 3 were 785 kcal (95% CI: 743-830 kcal) and 717 kcal (678-758 kcal), P for trend = 0.2; 993 kcal (941-1047 kcal) and 949 kcal (900-1000 kcal), P for trend = 0.05; 1255 (1171-1344) and 1166 (1090-1247 kcal), P for trend = 0.03, respectively. Conversely, among children consuming their next meal in the late postprandial phase (>3-4 h), subsequent daytime energy intake was not associated with GI(br).

CONCLUSION

This study confirms differential early and late postprandial effects of the GI(br) on subsequent daytime energy intake for free-living children at different ages. Interestingly, the apparent short-term satiating effect of a higher GI(br), in particular, persisted throughout the day, if a second breakfast was consumed midmorning.

Energy and nutrient intakes by pre-school children in Flanders-Belgium

The objective of this cross-sectional study was to investigate energy and nutrient intakes in pre-school children in Flanders-Belgium, using multistage clustered sampling. Diets of 661 children (338 boys; 323 girls) between 2·5 and 6·5 years old were assessed, with parentally reported 3 d estimated diet records. Usual energy and nutrient intakes were compared with national and international recommendations. Statistical modelling was used to account for within-individual variation. Mean daily energy intakes (boys, 6543 kJ; girls, 5757 kJ) approached the estimated energy requirements (EER) (boys, 6040 kJ; girls, 5798 kJ) for children < 4 years old. For children at least 4 years old, mean energy intakes (boys, 6408 kJ; girls, 5914 kJ) were below the EER of 6995 and 6740 kJ/d, respectively. Mean energy percentage (en%) derived from saturated fatty acids (SFA) (13–14 en%) was above the acceptable macronutrient distribution range (AMDR) upper level of 12 en%. Mean percentages derived from MUFA (10–11 en%) and PUFA (4–5 en%) were below the AMDR lower levels of 12 and 8 en%, respectively. For fibre, iron and vitamin D intakes, < 15 % of the children reached the recommended dietary allowances. Everybody exceeded the tolerable upper intake levels for sodium. Although diets in Belgian children were adequate in most nutrients, the implications of low iron, vitamin D and fibre intakes should be investigated. Furthermore, this affluent diet, characterised by SFA, MUFA and PUFA intakes differing from the recommendations and excessive sodium intakes, might increase the risk for CVD in later life.

Convenience food in the diet of children and adolescents: consumption and composition

Despite an increasing trend towards the use of convenience food, there is to date little debate on it in the nutritional sciences. In the present study, we present and evaluate data on consumption frequencies and composition of savoury convenience food in German families using data from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study. The DONALD Study is an ongoing, longitudinal (open cohort) study (started 1985), collecting detailed data on diet, development, and metabolism in infants, children and adolescents. Dietary intake was measured by yearly repeated 3 d weighed dietary records (n 1558) in 554 subjects (278 boys; 276 girls), 3-18 years old, between 2003 and 2006. A total of 1345 (86%) 3 d dietary records mentioned consumption of at least one convenience food. Convenience food consumption (percentage of total food intake, g/d) increased with age from approximately 3% in the 3-8 year olds to 7% in 14-18-year-old boys and 5% in 14-18-year-old girls (P < 0.0001) but remained constant during the study period. Convenience foods contributed more to total fat (g/d) (P < 0.001) and less to total carbohydrate (P < 0.0001) than to total energy (kJ/d) intake. The 700 convenience-food products recorded by our sample had on average fourteen ingredients; 4% were flavourings and 16% were food additives. In conclusion, convenience foods were widely consumed by our sample of German children and adolescents and their consumption increased with age. The composition of convenience food was characterised by a high fat content and a high number of flavourings and food additives.

Dietary intake and nutritional status of children and adolescents in Europe

The objective of this project was to collect and evaluate data on nutrient intake and status across Europe and to ascertain whether any trends could be identified. Surveys of dietary intake and status were collected from across Europe by literature search and personal contact with country experts. Surveys that satisfied a defined set of criteria – published, based on individual intakes, post-1987, adequate information provided to enable its quality to be assessed, small age bands, data for sexes separated above 12 years, sample size over 25 and subjects representative of the population – were selected for further analysis. In a small number of cases, where no other data for a country were available or where status data were given, exceptions were made. Seventy-nine surveys from 23 countries were included, and from them data on energy, protein, fats, carbohydrates, alcohol, vitamins, minerals and trace elements were collected and tabulated. Data on energy, protein, total fat and carbohydrate were given in a large number of surveys, but information was very limited for some micronutrients. No surveys gave information on fluid intake and insufficient gave data on food patterns to be of value to this project. A variety of collection methods were used, there was no consistency in the ages of children surveyed or the age cut-off points, but most surveys gave data for males and females separately at all ages. Just under half of the surveys were nationally representative and most of the remainder were regional. Only a small number of local surveys could be included. Apart from anthropometric measurements, status data were collected in only seven countries. Males had higher energy intakes than females, energy intake increased with age but levelled off in adolescent girls. Intakes of other nutrients generally related to energy intakes. Some north–south geographical trends were noted in fat and carbohydrate intakes, but these were not apparent for other nutrients. Some other trends between countries were noted, but there were also wide variations within countries. A number of validation studies have shown that misreporting is a major problem in dietary surveys of children and adolescents and so all the dietary data collected for this project should be interpreted and evaluated with caution In addition, dietary studies rely on food composition tables for the conversion of food intake data to estimated nutrient intakes and each country uses a different set of food composition data which differ in definitions, analytical methods, units and modes of expression. This can make comparisons between countries difficult and inaccurate. Methods of measuring food intake are not standardised across Europe and intake data are generally poor, so there are uncertainties over the true nutrient intakes of children and adolescents across Europe. There are insufficient data on status to be able to be able to draw any conclusions about the nutritional quality of the diets of European children and adolescents.

Issues in dietary intake assessment of children and adolescents

Studies of food habits and dietary intakes face a number of unique respondent and observer considerations at different stages from early childhood to late adolescence. Despite this, intakes have often been reported as if valid, and the interpretation of links between intake and health has been based, often erroneously, on the assumption of validity. However, validation studies of energy intake data have led to the widespread recognition that much of the dietary data on children and adolescents is prone to reporting error, mostly through under-reporting. Reporting error is influenced by body weight status and does not occur systematically across different age groups or different dietary survey techniques. It appears that the available methods for assessing the dietary intakes of children are, at best, able to provide unbiased estimates of energy intake only at the group level, while the food intake data of most adolescents are particularly prone to reporting error at both the group and the individual level. Moreover, evidence for the existence of subject-specific responding in dietary assessments challenges the assumption that repeated measurements of dietary intake will eventually obtain valid data. Only limited progress has been made in understanding the variables associated with misreporting in these age groups, the associated biases in estimating nutrient intakes and the most appropriate way to interpret unrepresentative dietary data. Until these issues are better understood, researchers should exercise considerable caution when evaluating all such data.

Changes of cardiovascular risk factors in obese children effects of inpatient and outpatient interventions

OBJECTIVE

The aim of the study was to compare the benefits of 2 different therapeutic approaches on cardiovascular risk factors (CVRF) in obese children and adolescents.

METHODS

We analyzed the changes of weight status (as standard deviation score-body mass index [SDS-BMI]), blood pressure, lipids, and insulin levels in obese children (age range, 10-14 years) during a 1-year outpatient intervention based on lifestyle changes (group A, n = 124) and during a 6-week inpatient intervention program with dietary restriction and exercise therapy (group B, n = 119). In addition, we studied these parameters in 65 obese children without intervention for 1 year (control group).

RESULTS

Age, degree of overweight, sex, and CVRF did not differ significantly between the control group and the intervention groups at baseline. During the observation period, CVRF did not change in the control group, whereas SDS-BMI slightly increased (+0.1 SDS-BMI). The SDS-BMI decreased significantly (P < 0.001) in group A (SDS-BMI, -0.40) and comparably in group B (SDS-BMI, -0.43). The decreases of total (P < 0.001) and low-density lipoprotein-cholesterol levels (P = 0.049) were significantly greater in group B, whereas triglyceride (P = 0.040) and insulin (P = 0.006) levels decreased significantly and were more pronounced in group A. High-density lipoprotein-cholesterol level increased significantly (P < 0.001) only in group A. Blood pressure decreased significantly (P < 0.01) and comparably in both intervention groups (A and B).

CONCLUSIONS

In contrast to obese children without intervention, CVRF improved in obese children with intervention. The 6-week inpatient intervention led to a significant greater decrease of total and low-density lipoprotein-cholesterol levels as compared with the 1-year outpatient intervention, although the outpatient intervention yielded a significantly greater improvement in insulin, triglycerides, and high-density lipoprotein-cholesterol levels.

Long-term follow-up of cardiovascular disease risk factors in children after an obesity intervention

BACKGROUND

Data concerning the long-term improvement of cardiovascular disease (CVD) risk factors after an obesity intervention in children are limited.

OBJECTIVE

We studied changes in weight status and CVD risk factors in children in an intervention program and evaluated whether these changes were sustained 1 y after the end of the intervention.

DESIGN

We analyzed changes in the SD score (SDS) of body mass index [BMI; in kg/m2 (SDS-BMI)], blood pressure (BP), lipids, and homeostasis model assessment index of insulin resistance (HOMA-IR) over the course of 2 y in 240 obese (BMI > 97th percentile) children aged 6-14 y (x age: 10.4 y; x BMI: 26.9). Of these 240 children, 203 participated in a 1-y intervention program of physical exercise, nutrition education, and behavior therapy. We compared these children with 37 obese children who underwent no intervention and with 12 normal-weight children of the same age and sex.

RESULTS

Obese children had significantly (P < 0.05) higher BP, HOMA-IR, and insulin, triacylglycerol, and LDL-cholesterol concentrations and lower HDL-cholesterol concentrations than did normal-weight children. Twenty-nine children dropped out of the intervention. Only in the 126 children who reduced their SDS-BMI did BP (8% and 12% decreases in systolic and diastolic BP, respectively), lipids (12% and 5% decreases in triacylglycerol and LDL cholesterol, respectively; 7% increase in HDL cholesterol), insulin (13% decrease), and HOMA-IR (17% decrease) improve significantly (P < 0.05). Reduction in SDS-BMI and all benefits regarding CVD risk factors were sustained 1 y after the end of the intervention in the children whose SDS-BMI decreased.

CONCLUSIONS

Long-term multidisciplinary intervention led to a reduction in SDS-BMI in most of the obese children 1 y after the end of the intervention. Reduction in SDS-BMI was accompanied by an improvement in CVD risk factors.

Vitamin intakes from supplements and fortified food in German children and adolescents: results from the DONALD study

Frequent consumption of supplements is a common behavior in adults, as well as children and adolescents. We report on vitamin intake from consuming supplements, taking into account the vitamin intake from fortified and usual foods. A total of 5990 3-d weighed dietary records from 931 German subjects (452 males, 479 females, 2-18 y of age) between 1986 and 2003 from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study were evaluated. We identified 133 different vitamin-containing supplements in 451 records (7.5%). Slightly more males (8.0%) than females (7.1%) consumed supplements, with highest frequencies found between ages 15 and 18 y. For the majority (10 of 13) of vitamins (vitamin A, vitamin E, vitamin K, thiamin, riboflavin, vitamin B-6, vitamin B-12, niacin, biotin, and vitamin C), intake from usual and fortified food already reached or exceeded 80% of the recommended dietary allowances in all age groups. In the case of folate and pantothenic acid, intake from supplements was necessary to achieve at least 80% of recommended dietary allowances for half of the age groups, especially in females. Supplements with vitamin D considerably helped increase vitamin intake but failed to achieve 80% of references in almost all age groups. Intakes of vitamin A and folic acid exceeded the tolerable upper level most frequently in many age groups and were most pronounced in up to 32% and 13% of children aged 2-3 y. Intake of vitamin D, vitamin E, and vitamin C exceeded the tolerable upper level in single age groups only (<7% of subjects). For the other vitamins, no exceeded limits were identified. The ubiquitous availability of supplements might indicate that even healthy children and adolescents profit by taking them. However, it is difficult to evaluate whether consumers receive more benefits or risks from the unrestricted consumption of supplements as they are marketed today.

Long-term protein intake and dietary potential renal acid load are associated with bone modeling and remodeling at the proximal radius in healthy children

BACKGROUND

Protein and alkalizing minerals are increasingly described as playing a major role in influencing bone status, not only in the elderly but also in children and adolescents.

OBJECTIVE

We examined whether the long-term dietary protein intake and diet net acid load are associated with bone status in children.

DESIGN

In a prospective study design in 229 healthy children and adolescents aged 6-18 y, long-term dietary intakes were calculated from 3-d weighed dietary records that were collected yearly over the 4-y period before a one-time bone analysis. Dietary acid load was characterized as potential renal acid load (PRAL) by using an algorithm including dietary protein, phosphorus, magnesium, and potassium. Proximal forearm bone variables were measured by peripheral quantitative computed tomography.

RESULTS

After adjustment for age, sex, and energy intake and control for forearm muscularity, BMI, growth velocity, and pubertal development, we observed that long-term dietary protein intake was significantly positively associated with periosteal circumference (P < 0.01), which reflected bone modeling, and with cortical area (P < 0.001), bone mineral content (P < 0.01), and polar strength strain index (P < 0.0001), which reflected a combination of modeling and remodeling. Children with a higher dietary PRAL had significantly less cortical area (P < 0.05) and bone mineral content (P < 0.01). Long-term calcium intake had no significant effect on any bone variable.

CONCLUSIONS

Long-term dietary protein intake appears to act anabolically on diaphyseal bone strength during growth, and this may be negated, at least partly, if dietary PRAL is high, ie, if the intake of alkalizing minerals is low.

How to measure dietary intake and food habits in adolescence: the European perspective

AIM

This paper deals with some methodological aspects of data collection in the context of measuring dietary intake in individuals in their adolescence life stage.

METHOD

Experiences from three partners of the HELENA project in dietary intake measurement in children and adolescents are presented in this paper with emphasis on characteristics of under-reporting, long-term diet measurement and food patterns (Dortmund DONALD group), influences of survey duration on under-reporting (Ghent group) and meal habits (Spanish AVENA group).

RESULTS

Under-reporters in the DONALD Study, particularly female adolescents, had a significantly higher body mass index (BMI) than non-under-reporters; BMI could not be explained by different long-term dietary patterns during childhood and adolescence clustered according to fat consumption; consumers of fast food had higher BMI values than nonconsumers. In the Ghent experience, the decline in population mean energy intake as calculated over selected clusters of days is 184 kcal (6.5%) in boys and 116 (5.6%) in girls; the cluster of 1 recording day and the cluster of 3 recording days were not significantly different but they were both significantly different from the 7-day cluster; no significant interaction was observed between the effect of time and BMI. In the AVENA Study, the percentage of adolescents skipping breakfast was higher in females (8.6%) than in males (3.5%, P<0.001); higher BMI values were observed in those skipping breakfast than in those notskipping breakfast, but differences were statistically significant in males at 15 y and in females at 14 and 17 y; adolescents avoiding some food groups for breakfast had higher BMI values (carbohydrates, fruits and pastries in males and milk, fruits and pastries in females).

CONCLUSION

Dietary and nutrient intake data in the HELENA project will be obtained by means of repeated 24-h dietary recalls. Data from HELENA might be a basis for developing complex approaches like Healthy Eating Indices.

Ghrelin levels before and after reduction of overweight due to a low-fat high-carbohydrate diet in obese children and adolescents

BACKGROUND

There are conflicting results for ghrelin changes in reduction of overweight. Increasing ghrelin levels in weight reduction are considered to be responsible for compensatory mechanisms that make the reduction of overweight unlikely to be sustained.

METHODS

We have analyzed fasting serum ghrelin levels, weighed dietary record and, as biochemical markers of clinically relevant reduction of overweight, leptin, adiponectin and insulin levels and insulin resistance measured by homeostasis model assessment (HOMA) at baseline and after a 1-y outpatient weight reduction program based on a high-carbohydrate and low-fat diet in 37 obese children (median age 10 y). We divided these children into two subgroups according to their degree of weight loss (substantial reduction of overweight: decrease in SDS-BMI > or = 0.5). Furthermore, we analyzed ghrelin levels in 16 normal-weight children.

RESULTS

Obese children demonstrated significant (P<0.001) lower ghrelin levels compared to normal-weight children. Daily caloric intake (P = 0.004) and percentage fat content decreased significantly (P<0.001), while percentage carbohydrate content increased significantly (P = 0.003) between baseline and 1-y follow-up in the obese children. The substantial reduction of overweight in 16 children (median SDS-BMI = -0.7) was associated with significant changes in insulin resistance (median decrease of HOMA 27%; P = 0.013), insulin (median decrease 25%, P = 0.036), adiponectin (median increase 15%; P = 0.003), and leptin levels (median decrease 19%; P = 0.023), while there were no significant changes in ghrelin levels (median increase 4%; P = 0.326). In the 21 children without substantial reduction of overweight (median SDS-BMI = -0.3), there were no significant changes in insulin resistance and in insulin, adiponectin, leptin and ghrelin levels.

CONCLUSIONS

We conclude that in obese children, low-fat high-carbohydrate diet-induced weight loss does not change ghrelin secretion, but significantly decreases leptin levels, increases adiponectin levels and improves insulin resistance determined by significantly decreased insulin resistance indices as well as lowered serum insulin levels.

Consumption of homegrown products does not increase dietary intake of arsenic, cadmium, lead, and mercury by young children living in an industrialized area of Germany

The dietary intake of arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb) was studied among young German children with different food consumption behaviour (consumption of own grown foodstuffs and of products from the supermarket). The study area comprised an industrialized and a rural area of West Germany. Dietary intake of contaminants was measured by the duplicate method according to the WHO guideline. A total 588 duplicate portions were collected daily from 84 individuals between May and September 1998. Intake of food groups was calculated from dietary records. Determination of As, Cd, Hg, and Pb was performed following high-pressure digestion of lyophilized samples by atomic absorption spectrometry (AAS). Geometric mean weekly intake [microg/(kgbw x week)] was as follows: As 1.4, Cd 2.3, Hg 0.16, and Pb 5.3. Geometric mean intake corresponded to the percentage of the provisional tolerable weekly intake (PTWI) as follows: As 9.7%, Cd 32%, Hg 3.3%, Pb 21%. As and Hg intake were mainly influenced by fish consumption. The amount of cereals and bakery wares mainly determined the Cd and Pb intake. Children living in the industrialized area with a substantial food consumption of own grown vegetables or products from domestic animals products had no increased dietary intake of the metals.

Using the concept of Food Based Dietary Guidelines to Develop an Optimized Mixed Diet (OMD) for German children and adolescents

OBJECTIVE

To apply for the first time FAO/WHO standards for Food Based Dietary Guidelines (FBDG) to develop a total diet concept named Optimized Mixed Diet (OMD) for children and adolescents in a European country.

METHODS

Exact 7-day menus were composed for sample age groups of children (4-6 years) and adolescents (13-14 years), taking into account the German meal patterns, common non-fortified foods, and sensory preferences of children (practical criteria). Food amounts and food selection within the menus were optimized so far as to achieve a total of reference intakes for 22 nutrients (scientific criteria). Simple food based messages were deduced.

RESULTS

Compared to the existing high-fat, low plant food diet reported from the DONALD Study (Dortmund Nutritional and Anthropometric Longitudinally Designed Study), the OMD is lower in fat and saturated fatty acids and contains ample amounts of plant foods. Reference nutrient densities for age groups between 1 and 18 years were achieved or exceeded, except folate. Foods from the optimized menus were summarized into 11 food groups based on nutritional and practical considerations. Proportions of food groups by weight are independent of age and can be used to recalculate food amounts for various age groups or energy requirements, respectively. For simplification, "recommended" foods were distinguished from "tolerated" foods by their nutrient densities; based on food amounts, 3 simple rules for food consumption were deduced, i.e. beverages and plant foods: ample; animal foods: moderate; high-fat, high-sugar foods: sparingly.

CONCLUSIONS

Exact menus and food amounts are a prerequisite to ascertain nutrient adequacy of FBDG. The OMD demonstrates that a single diet concept with a core of quantified food groups can be adequate for age groups between 1 and 18 years within a country, such as Germany.

Vitamin and mineral supplements use in German children and adolescents between 1986 and 2003: results of the DONALD Study

BACKGROUND/AIMS

Dietary supplements may contribute to a considerable proportion to micronutrient intake. However, little is known about the consumption of supplements in children and adolescents, especially in Germany. We therefore examined patterns and time trends in supplement consumption in healthy children and adolescents.

METHODS

A total of 5,990 3-day records from 931 subjects 2-18 years of age from the DONALD Study between 1986 and 2003 were examined.

RESULTS

(a) Supplement type: A total of 166 different supplements were reported: 49% vitamin-mineral combinations, 31% vitamin, 13% mineral, 7% fluorine supplements. 12% (vitamin) and 13% (mineral) were single nutrient supplements. Vitamin C (72%), B(1) (57%), B(2) (54%), calcium (44%), magnesium (31%) and phosphorus (20%) were the most frequent added nutrients. (b) Users: In 25.8% (males 13.2%, females 12.6%) of the records, supplement usage was documented. Fluorine supplements were by far the most often consumed items (18.1%) followed by vitamins (4.5%), vitamin-mineral combinations (3.6%), minerals (2.4%), and multiple usage (2.6%). (c) Time trend: We found a marked time trend in supplement consumption in the past 18 years with a peak between 1994 and 1996 and lower usage before and after that time (independent of age and gender). (d) Associated factors: Supplement usage was influenced by age, year of study, season, smoking and number of persons in families, education level and employment of mothers, whereas gender or the number of children per family failed to have any effect.

CONCLUSION

Supplement usage is a common behaviour in German children and adolescents and changing with time. Type and frequency of supplement usage is age dependent. Those nutrients found mostly in supplements are not the critical ones. In evaluations of children's diet it is mandatory to separate fluorine from other supplements.

Fortifying food with folic acid improves folate intake in German infants, children, and adolescents

Folate is a critical nutrient and programs to enhance folate intake have been established or are under consideration. We investigated to what extent consumers (C) profit from folic acid-fortified food and dietary supplements compared to nonconsumers (NC) of these products. A total of 6135 weighed records from 861 subjects (47% males, 53% females, age 6 mo to 18 y) from the Dortmund Nutritional and Anthropometric Longitudinally Designed Study between 1990 and 2001 were evaluated. In 61% of the records, at least 1 item fortified with folic acid was reported, and in total 644 different items with a wide range of fortification levels were found. These were primarily commercial infant food (i.e., infant formula, weaning food) (44%), breakfast cereals (20%), and soft drinks (11%). Median dietary folate equivalents (DFEs) in NC increased from 65 and 62 microg/d in boys and girls at 6-12 mo of age, respectively, to 184 and 143 microg/d in adolescents 15-18 y of age. In C, DFEs increased from 109 and 100 microg/d in boys and girls at 6-12 mo of age, respectively, to 370 and 276 microg/d in adolescents 15-18 y of age. Irrespective of gender, NC had 50-70% the DFE intakes of C with a tendency for higher percentages in younger than in older children and adolescents. Folate intakes by male and female consumers of fortified food or supplements exceeded the upper levels in 1.7 and 1.2% of subjects, respectively. Currently, a fortification program for staple foods (e.g., grain products) does not seem necessary in Germany if children and adolescents consume food already fortified with folic acid.

Pattern of long-term fat intake and BMI during childhood and adolescence—results of the DONALD Study

OBJECTIVE

Adverse dietary habits have been discussed as being conducive to the increased prevalence of obesity in children and adolescents. No single dietary factor has been clearly identified so far. We analyzed long-term fat intake patterns during childhood and adolescence and their influence on body fatness.

METHODS

Four clusters with different patterns of percent energy from fat were found in 228 individuals from the age of 2-18 y participating in the DONALD Study (Dortmund Nutritional Anthropometric Longitudinally Designed Study) with at least 10 yearly weighed dietary records between 1985 and 2002. Clusters were evaluated with regard to macronutrient and food group intakes and body mass index (BMI).

RESULTS

The mean energy density and the ratio of energy intake to estimated basal metabolic rate per subject differed significantly between clusters. All calculated macronutrients (per energy intake) with the exception of dietary fiber differed significantly as well as intakes of Meat/Fish/Eggs, Fats/Oils and Fruit/Vegetables. Although these differences in dietary characteristics persisted during the study period, no differences of BMI (calculated as standard deviation score) were found either at the first or last examination per subject. The mean BMI during the study period differed significantly, with the highest BMI in the low fat intake cluster.

CONCLUSION

BMI could not be explained by different dietary patterns during childhood and adolescence in this long-term evaluation of dietary records. Underreporting especially in obese subjects, the problem of detecting minor overconsumption of energy intake that favors the development of obesity over long periods, and the small study sample may explain these conflicting results.

Estimation of the dietary intake of acrylamide by German infants, children and adolescents as calculated from dietary records and available data on acrylamide levels in food groups

Dietary intakes of acrylamide for the general population were estimated by FAO/WHO to be in the range of 0.3 to 0.8 microg/(kg(bw) *d). It was supposed that children and adolescents would generally have intakes twice to three times higher than adults. However, relevant data is rare. Therefore, 3- or 7-day dietary records (n = 2956) from infants, children and adolescents aged 0.5 to 18 years from the DONALD study (2001) and other studies (RUB studies) were evaluated to estimate the potential dietary intake of acrylamide. Statistical data of the intake of 6 food groups relevant for acrylamide exposure were combined with available data for ranges of acrylamide concentrations in more than 1500 foods in Germany. Scenarios were calculated assuming minimum, median and maximum acrylamide concentration in food groups. Assuming median (minimum; maximum) acrylamide concentrations in foods and mean consumed food amounts, the calculated intake of acrylamide ranged from 0.21-0.43 (0.12-0.19; 0.98-1.79) microg/(kg(bw) *d) between the age groups from <1 to <19 years in the DONALD study and was 0.61 (0.21; 2.58) microg/(kg(bw) *d) from 1 to <7 years in the RUB studies. The highest intake was calculated for children aged 1-<7 years. The highest proportions of total intake of acrylamide came from the intake of commercial baby food (86-91%) in infants, and bread (18-46%), pastries (16-35%), and potato products (7-35%) in children and adolescents, depending on scenario and age. Our estimated data are in the range of reports from the literature for adolescents and adults in Germany and other European countries and lower than reports for infants. Our results do not confirm that children and adolescents will have higher exposures to acrylamide than adults. Practical suggestions to lower the risk of acrylamide exposure by food without decreasing the quality of the nutrition in the diet are given.

Time trends in the consumption of dairy foods in German children and adolescents

OBJECTIVE

Examination of time trends in the consumption of dairy food and their impact on fat and calcium intakes in German children and adolescents.

DESIGN

Dietary records from the DONALD Study (DOrtmund Nutritional and Anthropometric Longitudinally Designed Study).

METHODS

A total of 5068 3-day weighed dietary records from 914 1 to 13-y-old children and adolescents collected between 1986 and 2001 were analysed using a mixed linear model, in which the means of the data and the covariance structure specific to the DONALD Study were modelled.

RESULTS

During the study period, the consumption of 'milk products' in children and adolescents >/=4 y remained stable, since the reduced consumption of 'fluid milk' (between -2.8 and -7.4 g/day/study year) was compensated for by an increased consumption of 'yoghurt' (between +2.4 and +3.3 g/day/study year). The consumption of 'cheese' increased in subjects >/=4 y (between +0.2 and +0.7 g/day/study year). In 1 to 3-y-old children, the decreased intake of 'fluid milk' (-6.5 g/day/study year) was not compensated for by the increased intake of 'formula' (+3.5 g/day/study year). The percentage of 'low-fat milk products' significantly increased (although not significant in 9-13-y-old boys) to nearly 25% of milk products. The impact of dairy food on fat intake (as percentage of energy intake) remained stable with the exception of a slight reduction in 4-8 y olds, the impact of dairy on calcium (as percentage of US adequate intake) decreased only in 1-3 y olds.

CONCLUSIONS

The consumption of dairy food remained widely stable over time in >/=4-y-old children and adolescents, but decreased in 1-3 y olds. A further decline in this age group would be undesirable as is the shift from common milk to formula. The intake of 'low-fat milk products' increased and should be continuously promoted.

Predictors to success in outpatient training in obese children and adolescents

OBJECTIVE

The treatment of obese children and adolescents is not yet satisfactorily effective. It is not clear which participants can profit by a long-time outpatient therapy.

DESIGN

Longitudinal, clinical intervention study based on a 1-y outpatient training programme consisting of physical exercise, nutrition course and behaviour therapy for children and their parents.

SUBJECTS

A total of 75 obese children (age 7-15 y; standard duration scores of body mass index(SDS-BMI)+1.9-+3.8).

MEASUREMENTS

We characterised the participants as to their willingness to change their behaviour (changes in weight status, number of attempts at therapy, participation in exercise groups), somatic characteristics (BMI of children and family members, gender, age), socioeconomic status (level of education of the children and their parents, working mother), exercise and dietary habits, dietary intake as well as the quality of dietary records. These factors were related to the success of the treatment using a multiple logistic regression.

RESULTS

A total of 27 (37%) of the children were unsuccessful after treatment. For 48 (63%) of the children, there was a median weight loss of about 0.4 SDS-BMI (range -0.2 to -1.1). The only significant difference (P<0.0001) between these successful children and the unsuccessful ones was that they had taken part in the exercise groups before training began.

CONCLUSION

A training for the obese children and their parents enables the majority of the participants to reduce weight. Previous participation in exercise groups can be considered as a predictor to success of the treatment.

Associations between intake of added sugars and intakes of nutrients and food groups in the diets of German children and adolescents

The aim of the present analysis was to evaluate the effect of intake of added sugars on intakes of nutrients and food groups. We used a mixed linear model (PROC MIXED) to analyse data from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study (an ongoing longitudinal cohort study between infancy and adulthood). Between July 1985 and August 2001, 3 d weighed dietary records (n 4993) from 849 children and adolescents (416 male, 433 female) aged 2-18 years were collected and evaluated. Overall mean intake of added sugars was 12.4 (SD 5.3) (median 12.0) % energy. Fat intake (% energy) and intake of all analysed nutrients (as % reference values for nutrient intakes) fell across quintiles 1-5 of energy intake from added sugars (P<0.001). With the exception of 'Sugary foods' and 'Beverages' (significant increase, P<0.0001) and 'Dairy' (NS), intake of all other food groups decreased with increasing intake of added sugars (P<0.0001). In conclusion, we found a slight, but statistically significant, nutrient-dilution effect of added sugars and a significant reduction in intake of important nutrient-bearing food groups. However, the DONALD study gives no clear indicator on grounds of micronutrient dilution for a quantitative limit on intake of added sugars.

Long-term follow-up of overweight children: after training, after a single consultation session, and without treatment

BACKGROUND

A satisfactory treatment of childhood obesity has not yet been found. An individual consultation session is the usual practice while experts recommend an outpatient training program consisting of a combination of physical exercise, nutrition education, and behavior therapy.

METHODS

We analyzed degree of overweight (SDS-BMI) after one and two years in overweight children (aged 6-15 years) who had had a single consultation session (n = 66) and who had finished a one-year, structured outpatient training program consisting of physical exercise, nutrition education, and behavior therapy (n = 81). Furthermore we collected data on changes in weight for a control group of overweight children not receiving any treatment (n = 100) over the same period of time.

RESULTS

There was no significant change in the degree of overweight over the period of two years either for the control group or for those having received single consultation. The participants of the training were in mean significantly less overweight than at the beginning of the training (P < 0.001), both after one year (mean change in SDS-BMI -0.38) and after the second year (mean change in SDS-BMI -0.30).

CONCLUSIONS

Overweight children not receiving treatment do not reduce in weight. A single consultation session is not sufficient to achieve weight reduction in children. Weight reduction over at least two years can be achieved in part of the participants of a long-term, specialized treatment.

Markers of the validity of reported energy intake

Energy intake (EI) is the foundation of the diet, because all other nutrients must be provided within the quantity of food needed to fulfill the energy requirement. Thus if total EI is underestimated, it is probable that the intakes of other nutrients are also underestimated. Under conditions of weight stability, EI equals energy expenditure (EE). Because at the group level weight may be regarded as stable in the timescale of a dietary assessment, the validity of reported EI can be evaluated by comparing it with either measured EE or an estimate of the energy requirement of the population. This paper provides the first comprehensive review of studies in which EI was reported and EE was measured using the doubly labeled water technique. These conclusively demonstrate widespread bias to the underestimation of EI. Because energy requirements of populations or individuals can be conveniently expressed as multiples of the basal metabolic rate (BMR), EE:BMR, reported EI may also be expressed as EI:BMR for comparison. Values of EI:BMR falling below the 95% confidence limit of agreement between these two measures signify the presence of underreporting. A formula for calculating the lower 95% confidence limit was proposed by Goldberg et al. (the Goldberg cutoff). It has been used by numerous authors to identify individual underreporters in different dietary databases to explore the variables associated with underreporting. These studies are also comprehensively reviewed. They explore the characteristics of underreporters and the biases in estimating nutrient intake and in describing meal patterns associated with underreporting. This review also examines some of the problems for the interpretation of data introduced by underreporting and particularly by variable underreporting across subjects. Future directions for research are identified.

Familial clustering of obesity and the role of nutrition: Tehran Lipid and Glucose Study

OBJECTIVE

To clarify the hypothesis that parent's dietary intakes are associated with their offspring's body mass index.

DESIGN

Observational analytical cross-sectional survey among inhabitants of district 13 in the east of Tehran.

SUBJECTS

A total of 117 healthy families comprising 474 subjects including 240 offspring (3-25 y old).

MEASUREMENTS

Weight and height were measured by a standard protocol and body mass index (kg/m(2)) was calculated. Dietary intakes were assessed by means of a 2 day dietary recall questionnaire.

RESULTS

The prevalence of overweight was 11.8% in offspring of normal-weight parents, 19.0% in offspring of overweight fathers and normal-weight mothers, 25.4% in offspring of overweight mothers and normal-weight fathers and 40.8% in offspring with both parents overweight. The Offspring's overweight was significantly and independently associated with high-energy intake of both parents (odds ratio; 95% CI 2.7; 1.6-4.5). Adjusted for the sex of parents, the chances of offspring being overweight were higher in overweight (3.8; 1.5-9.2) and high-energy-intake mothers (2.6; 1.2-5.6) and high-energy-intake fathers (2.0; 1.1-3.9) as compared with children of normal-weight parents. High fat intake of husbands was an independent risk factor increasing the chances of their wives being overweight (2.1; 1.5-3.6) and vice versa (1.8; 1.2-2.8).

CONCLUSION

The observed familial obesity pattern was shown to be associated with the familial dietary intakes. Hence, familial intervention seems essential to stop the accelerated rise in the prevalence of overweight and obesity in our community.

Fortification masks nutrient dilution due to added sugars in the diet of children and adolescents

High intakes of added sugars have often been suspected of lowering nutrient density, especially in the diet of children and adolescents. Because fortified foods, which currently contribute considerably to the intake of vitamins and minerals, are often also sweetened with added sugars, they could counteract this nutrient dilution. Data from the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD)-Study were used to assess the effects of added sugars, fortified food and energy intakes, time and age on nutrient densities. A total of 4993 3-d weighed dietary records from 849 children and adolescents 2-18 y old, collected between 1985 and 2001 were analyzed using a mixed linear model, in which the means of the data and the covariance structure specific to the DONALD-Study was modeled. In general, nutrient densities in the diets of children and adolescents were above recommended nutrient densities. Added sugars intake [in percentage of energy intake (E%)] was positively associated with energy intake (MJ/d; P < 0.05) and intake of fortified food (E%; P < 0.0001). Positive effects of fortification on nutrient densities (usually P < 0.0001) exceeded the negative effects of added sugars intake (usually P < 0.01) for most nutrients, in some cases even twofold. Associations between energy intake and nutrient densities were negative and, with the exception of thiamin in 2- to 3-y-olds, statistically significant. Time and age trends were heterogeneous. Our data did not show significant nutrient dilution because of added sugars. The positive effect of fortification on nutrient densities was greater than the negative effect of added sugars. Therefore, fortification should more often be considered in dietary analyses.

Measured consumption of tap water in German infants and young children as background for potential health risk assessments: data of the DONALD Study

Contaminated tap water can become a health risk, e.g. by metals or environmental pollution particularly for sensitive population groups such as infants and young children. There is a lack of data on exactly measured water intake. In the DONALD Study, individual food and fluid intakes were measured by use of 3-day weighed diet records. Here we report on the distribution of individual intakes of tap water in 504 healthy normally nourished subjects aged 3-36 months (1962 diet records) between 1990 and 1998. We calculate scenarios for potential tap water contamination. Tap water intake per kg body weight was significantly higher in formula-fed (FF) infants than in breast-fed (BF) infants. The estimated median intake of lead and nitrate per kg body weight from tap water was higher in FF infants than in BF infants or mixed fed (MF) young children. The scenarios based on intakes at the median, P95 or maximums show that higher risks for exceeding the presently existing maximums could be expected in FF infants. Our data could also be used for estimations of potential risks from other contaminants of tap water.