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Gispert-Llauradó M, Escribano J, Ferré N, Grote V, Koletzko B, Ambrosini G, Verduci E, Gruszfeld D, Xhonneux A, Luque V. Association between early dietary patterns and cardiometabolic health at age 8: a confirmatory analysis of the European Childhood Obesity Project. Nutr J 2025; 24:18. [PMID: 39881311 PMCID: PMC11776328 DOI: 10.1186/s12937-025-01080-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 01/08/2025] [Indexed: 01/31/2025] Open
Abstract
BACKGROUND & AIM Metabolic and cardiovascular health outcomes are strongly influenced by diet. Dietary habits established in early childhood may persist into adulthood. This study aimed to examine the association between dietary patterns at both 2 and 8 years of age, explaining the maximum variability of high- and low-quality fats, sugars, and fibre, and cardiometabolic markers at age 8 years. METHODS This was a secondary analysis of the European Childhood Obesity Project, formerly a randomized clinical trial across five European countries performed in healthy term newborns. Children in the study were categorized at ages 2 and 8 years into two groups based on cluster analysis of dietary patterns (DP) derived from Reduction Rank Regression (RRR). A cross-sectional and prospective analysis was conducted to evaluate the associations between these DPs and cardiometabolic outcomes, including body mass index (BMI), blood pressure (BP), and biochemical markers. Triglycerides, HDL cholesterol and insulin resistance index (HOMA-IR) were also categorized as altered versus normal values. Asociations between dietary patterns and health outcomes were assessed using linear and logistic regression models, adjusting for covariates based on a step-wise approach. RESULTS A total of 336 children were classified based on quality of nutrient intakes into either a "Poor-Quality dietary pattern" (PQ-DP) (48% and 66% of infants at 2 and 8 years, respectively) or the "Health-Conscious dietary pattern" (HC-DP) (52% and 34% of infants at 2 and 8 years, respectively). Following a PQ-DP at both ages 2 and 8 was associated with higher triglycerides (β = 0.061, p = 0.049), systolic and diastolic BP (β = 13.019, p < 0.001 & β = 7.612, p = 0.014, respectively) and altered levels of HOMA-IR (OR = 3.1, p = 0.037, 95% CI = 1.1-9.1) at 8 years, compared to children with an HC-DP at both ages, after adjusting for confounders. CONCLUSION Adherence to a dietary pattern with a poorer nutritional profile in early childhood and school age is associated with worse cardiometabolic risk markers at 8 years old.
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Affiliation(s)
- Mariona Gispert-Llauradó
- Paediatrics, Nutrition and Development Research Unit, Universitat Rovira i Virgili. Reus, Tarragona, Spain
- Paediatrics, Nutrition and Development Research Unit, Institut d'Investigació Sanitària Pere Virgili. Reus, Tarragona, Spain
| | - Joaquin Escribano
- Paediatrics, Nutrition and Development Research Unit, Universitat Rovira i Virgili. Reus, Tarragona, Spain.
- Paediatrics, Nutrition and Development Research Unit, Institut d'Investigació Sanitària Pere Virgili. Reus, Tarragona, Spain.
| | - Natalia Ferré
- Paediatrics, Nutrition and Development Research Unit, Universitat Rovira i Virgili. Reus, Tarragona, Spain
- Paediatrics, Nutrition and Development Research Unit, Institut d'Investigació Sanitària Pere Virgili. Reus, Tarragona, Spain
| | - Veit Grote
- Department of Paediatrics, Dr. von Hauner Children's Hospital, LMU - Ludwig Maximilians Universität Munich, LMU University Hospitals, München, Germany
- German Center for Child and Adolescent Health, site Munich, Lindwurmstraße 4, 80337, München, Germany
| | - Berthold Koletzko
- Department of Paediatrics, Dr. von Hauner Children's Hospital, LMU - Ludwig Maximilians Universität Munich, LMU University Hospitals, München, Germany
- German Center for Child and Adolescent Health, site Munich, Lindwurmstraße 4, 80337, München, Germany
| | - Gina Ambrosini
- School of Population and Global Health, University of Western Australia, Clifton Street Building, Clifton St, 6009, Nedlands, Perth, WA, Australia
| | - Elvira Verduci
- Metabolic Diseases Unit, Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Via Lodovico Castelvetro, 32, 20154, Milano, MI, Italy
- Department of Health Sciences, University of Milan, Via di Rudini 8, 20146, Milan, Italy
| | - Dariusz Gruszfeld
- Neonatal Department, Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Annick Xhonneux
- Groupe Santé CHC, bd Patience et Beaujonc 2 ‑ (B), 4000, Liège, Belgium
| | - Veronica Luque
- Paediatrics, Nutrition and Development Research Unit, Universitat Rovira i Virgili. Reus, Tarragona, Spain.
- Paediatrics, Nutrition and Development Research Unit, Institut d'Investigació Sanitària Pere Virgili. Reus, Tarragona, Spain.
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Jaeger V, Koletzko B, Luque V, Gruszfeld D, Verduci E, Xhonneux A, Grote V. Eating Frequency in European Children from 1 to 96 Months of Age: Results of the Childhood Obesity Project Study. Nutrients 2023; 15:nu15040984. [PMID: 36839341 PMCID: PMC9958886 DOI: 10.3390/nu15040984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023] Open
Abstract
We aimed to investigate the eating frequency (EF) in children over age, and examined the influence of country, sex, feeding mode and weight status on EF. We used the dietary data of the Childhood Obesity Project, which comprised European children from five countries. Dietary data of 3-days weighed and estimated records were available monthly from 1 to 9 and at 12-, 24-, 36-, 48-, 60-, 72- and 96-months old. Generalized additive mixed effects models were used to estimate EF trajectories with EF as outcome and applying age splines. Additionally, the models were further adjusted for country, feeding mode, sex or weight status. Data from 1244 children were analysed. EF was highest at 1 month with on average 7.3 ± 1.9 feeds per day, and fell to 5.1 ± 1.1 eating occasions at the age 96 months. Night feeding was similarly often than day feeding at 1 month but declined thereafter. Significant differences in EF were observed between countries (p < 0.05), with the highest EF in Poland, and between infant feeding modes, with a higher EF in breastfed than non-breastfed infants (p < 0.05). Sex and body weight were not associated with EF. Despite the importance of EF towards total energy intake, no association with weight status was found.
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Affiliation(s)
- Vanessa Jaeger
- Division of Metabolism and Nutritional Medicine, Department of Pediatrics, Dr. von Hauner Children’s Hospital, LMU University Hospitals, 80337 Munich, Germany
| | - Berthold Koletzko
- Division of Metabolism and Nutritional Medicine, Department of Pediatrics, Dr. von Hauner Children’s Hospital, LMU University Hospitals, 80337 Munich, Germany
- Correspondence:
| | - Veronica Luque
- Paediatrics Research Unit, Universitat Rovira I Virgili-IISPV, 43201 Reus, Spain
- Serra Hunter Fellow, Universitat Rovira I Virgili-IISPV, 43201 Reus, Spain
| | - Dariusz Gruszfeld
- Neonatal Department and Neonatal Intensive Care Unit, Children’s Memorial Health Institute, 04-730 Warsaw, Poland
| | - Elvira Verduci
- Department of Paediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy
| | - Annick Xhonneux
- Groupe Santé CHC, Bd. Patience et Beaujonc 2—(B), 4000 Liège, Belgium
| | - Veit Grote
- Division of Metabolism and Nutritional Medicine, Department of Pediatrics, Dr. von Hauner Children’s Hospital, LMU University Hospitals, 80337 Munich, Germany
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Jaeger V, Koletzko B, Luque V, Ferré N, Gruszfeld D, Gradowska K, Verduci E, Zuccotti GV, Xhonneux A, Poncelet P, Grote V. Distribution of energy and macronutrient intakes across eating occasions in European children from 3 to 8 years of age: The EU Childhood Obesity Project Study. Eur J Nutr 2023; 62:165-174. [PMID: 35930067 PMCID: PMC9899743 DOI: 10.1007/s00394-022-02944-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/15/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE We aimed to characterize the distribution of energy and macronutrient intakes across eating occasions (EO) in European children from preschool to school age. METHODS Data from 3-day weighed food records were collected from children at ages 3, 4, 5, 6 and 8 years from Belgium, Germany, Italy, Poland and Spain. Food intakes were assigned to EO based on country-specific daytimes for breakfast, lunch, supper and snacks (morning, afternoon). The average energy and nutrient intakes were expressed as percentage of total energy intake (%E). Nutrients were additionally expressed as percentage per EO (%EEO). Foods were assigned to food groups; variation in intake was calculated via coefficient of variation (CV). We analyzed age trends in diurnal intake using mixed-effects beta regression. RESULTS The 740 healthy children included in the analysis consumed the largest proportion of daily energy at lunch (31%E ± 8, M ± SD) and supper (26%E ± 8), followed by breakfast (19%E ± 7) and snacks [afternoon (16%E ± 8); morning (8%E ± 7)], with the most variable intake at morning snack (CV = 0.9). The nutrient composition at lunch and supper was highest for fat (36 ± 9%ELunch; 39 ± 11%ESupper) and protein (18 ± 5%ELunch; 18 ± 6%ESupper) and at breakfast and snacks for carbohydrates (54 ± 12%EBreakfast; 62 ± 12%ESnacks). High-sugar content foods were consumed in relatively large proportions at breakfast and snacks. Food intakes varied significantly with age, with lower snack intakes at later ages (p < 0.001). CONCLUSION Possibly unhealthy EOs with high-fat intakes and high-sugar-content foods were observed. Changes in nutrient composition of EOs may be beneficial for health. TRIAL REGISTRY ClinicalTrials.gov: NCT00338689; 19/June/2006.
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Affiliation(s)
- Vanessa Jaeger
- grid.5252.00000 0004 1936 973XDivision of Metabolic and Nutritional Medicine, Department of Paediatrics, Dr. von Hauner Children’s Hospital, LMU University Hospitals, LMU - Ludwig-Maximilians-Universität Munich, Lindwurmstr. 4, 80337 Munich, Germany
| | - Berthold Koletzko
- Division of Metabolic and Nutritional Medicine, Department of Paediatrics, Dr. von Hauner Children's Hospital, LMU University Hospitals, LMU - Ludwig-Maximilians-Universität Munich, Lindwurmstr. 4, 80337, Munich, Germany.
| | - Veronica Luque
- grid.410367.70000 0001 2284 9230Paediatrics Research Unit, Universitat Rovira I Virgili, IISPV, Reus, Spain ,grid.410367.70000 0001 2284 9230Serra Hunter Fellow, Universitat Rovira I Virgili, IISPV, Reus, Spain
| | - Natàlia Ferré
- grid.410367.70000 0001 2284 9230Paediatrics Research Unit, Universitat Rovira I Virgili, IISPV, Reus, Spain
| | - Dariusz Gruszfeld
- grid.413923.e0000 0001 2232 2498Neonatal Department and Neonatal Intensive Care Unit, Children’s Memorial Health Institute, Warsaw, Poland
| | - Kinga Gradowska
- grid.413923.e0000 0001 2232 2498Neonatal Department and Neonatal Intensive Care Unit, Children’s Memorial Health Institute, Warsaw, Poland
| | - Elvira Verduci
- grid.4708.b0000 0004 1757 2822Department of Paediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Gian Vincenzo Zuccotti
- grid.4708.b0000 0004 1757 2822Department of Paediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Annick Xhonneux
- grid.433083.f0000 0004 0608 8015Centre Hospitalier Chretien St. Vincent, Rocourt, Liège‑Rocourt, Belgium
| | - Pascale Poncelet
- grid.4989.c0000 0001 2348 0746Department of Paediatrics, University Children’s Hospital, Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Veit Grote
- grid.5252.00000 0004 1936 973XDivision of Metabolic and Nutritional Medicine, Department of Paediatrics, Dr. von Hauner Children’s Hospital, LMU University Hospitals, LMU - Ludwig-Maximilians-Universität Munich, Lindwurmstr. 4, 80337 Munich, Germany
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Ladino L, Sánchez N, Vázquez-Frias R, Koletzko B. Latin American Considerations for Infant and Young Child Formulae. Nutrients 2021; 13:nu13113942. [PMID: 34836196 PMCID: PMC8620542 DOI: 10.3390/nu13113942] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 01/01/2023] Open
Abstract
Infant formula is the only acceptable substitute for breastmilk from 0 to 6 months old when human milk cannot be provided in sufficient amounts. Manufacturers have developed options that intend to meet the changing needs of the child aged from six to twelve months (follow-on formulae) and after the age of one year (young child formulae). The international code for marketing breast milk substitute stipulates standards for marketing practices of these products. In Latin America there are local variations of marketing practices. Novel marketing strategies such as advertising through social media and influencers pose new threats for breastfeeding success in Latin America. This review aims to examine variations in local regulations for marketing of infant formulae and to analyze the emerging phenomenon of influencer advertising. We reviewed the local norms for Latin American countries and examined differences and possible gaps. Emerging evidence of influencer marketing was explored. The results indicate that national regulations differ among Latin American countries, particularly with respect to product labelling and the requirement to use a local native language, highlighting the cost of the product, and different regulations prohibiting certain messages and illustrations. Regarding new marketing strategies, there is limited evidence on advertising infant formula through social media influencers, where different categories of marketing strategies can be described. More transparent reporting of social marketing by formula providers and more independent research on novel marketing strategies are needed.
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Affiliation(s)
- Liliana Ladino
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism IINGM, Universidad El Bosque, Bogotá 110121, Colombia;
- Nutrition Working Group, Latin-American Society for Pediatric Gastroenterology Hepatology and Nutrition LASPGHAN, Mexico City 11560, Mexico;
| | - Nathalia Sánchez
- Research and Education Center on Nutrition, CIENutrition, Bogotá 110221, Colombia;
| | - Rodrigo Vázquez-Frias
- Nutrition Working Group, Latin-American Society for Pediatric Gastroenterology Hepatology and Nutrition LASPGHAN, Mexico City 11560, Mexico;
- Department of Gastroenterology and Nutrition, Hospital Infantil de México Federico Gómez, Mexico City 06720, Mexico
| | - Berthold Koletzko
- Department Pediatrics, Medical Centre of LMU Munich, Ludwig Maximilians University of Munich, Dr. von Hauner Children’s Hospital, 80539 München, Germany
- Correspondence: ; Tel.: +49-89-4400-52811
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Dietary patterns acquired in early life are associated with cardiometabolic markers at school age. Clin Nutr 2021; 40:4606-4614. [PMID: 34229265 DOI: 10.1016/j.clnu.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND & AIMS it has previously been described that dietary patterns established early in life tracked to late childhood. The aim of the present work was to analyse the association of dietary patterns that tracked from 2 to 8y with cardiometabolic markers at 8y of age. METHODS The 3 identified patterns at 2y (that previous analyses showed to track to age 8y) were: "CoreDP", loaded for vegetables, fruits, fish, olive oil, etc.; "F&SDP", loaded by poor-quality fats and sugars; and "ProteinDP", mainly loaded by animal protein sources. Cardiometabolic markers at 8y were systolic blood pressure (SBP), insulin resistance (HOMA-IR), and triglycerides, and BMI z-score. To examine whether the association of diet with the outcomes was the result of a direct effect of diet at either two or 8y, or synergy between them, we used structural equation models. RESULTS the associations between the patterns and the health outcomes were: CoreDP was inversely associated with SBP and HOMA-IR; ProteinDP was directly associated with HOMA-IR and SBP; and adherence to F&SDP was directly associated with triglycerides and SBP. The associations between the patterns and the health outcomes were independent of BMI and were the result of a direct effect of diet at 2y, an indirect effect of diet at 2y through diet at 8y or a combination between both pathways. CONCLUSION dietary patterns acquired in early life, persisting to later childhood, were associated with cardiometabolic markers at school age independently of BMI.
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Larrosa S, Luque V, Grote V, Closa-Monasterolo R, Ferré N, Koletzko B, Verduci E, Gruszfeld D, Xhonneux A, Escribano J. Fibre Intake Is Associated with Cardiovascular Health in European Children. Nutrients 2020; 13:12. [PMID: 33374515 PMCID: PMC7822117 DOI: 10.3390/nu13010012] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We aimed at analysing the association between dietary fibre intake during childhood and cardiovascular health markers. METHODS We used observational longitudinal analysis and recorded diet using 3-day diaries at the ages of 3, 4, 5, 6, and 8 years in children from the EU Childhood Obesity Project Trial. At the age of 8, waist circumference, systolic and diastolic blood pressure (SBP and DBP) and biochemical analyses (lipoproteins, triglycerides and homeostasis model for insulin resistance (HOMA-IR)) were evaluated. Those parameters were combined into a cardiometabolic risk score through the sum of their internal z-scores. RESULTS Four-hundred children (51.8% girls) attended to the 8-year visit with a 3-day diary. Adjusted linear regression models showed that children who repeatedly stayed in the lowest tertile of fibre intake during childhood had higher HOMA-IR (p = 0.004), higher cardiometabolic risk score (p = 0.02) and a nonsignificant trend toward a higher SBP at 8 years. The higher the dietary intake of soluble fibre (from fruits and vegetables) at 8 years, the lower the HOMA-IR and the cardiometabolic risk score (p = 0.002; p = 0.004). SBP was directly associated with fibre from potatoes and inversely with fibre from nuts and pulses. CONCLUSION A diet rich in dietary fibre from fruits, vegetables, pulses and nuts from early childhood was associated to a healthier cardiovascular profile, regardless of children's weight.
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Affiliation(s)
- Susana Larrosa
- Paediatrics, Nutrition and Development Research Unit, Universitat Rovira i Virgili, IISPV, 43204 Reus, Spain; (S.L.); (R.C.-M.); (N.F.)
| | - Veronica Luque
- Paediatrics, Nutrition and Development Research Unit, Universitat Rovira i Virgili, IISPV, 43204 Reus, Spain; (S.L.); (R.C.-M.); (N.F.)
- Serra Hunter Fellow, Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Veit Grote
- Department Paediatrics, Dr. von Hauner Children’s Hospital, University Hospital, LMU Ludwig-Maximilians-Universität, 80337 Munich, Germany; (V.G.); (B.K.)
| | - Ricardo Closa-Monasterolo
- Paediatrics, Nutrition and Development Research Unit, Universitat Rovira i Virgili, IISPV, 43204 Reus, Spain; (S.L.); (R.C.-M.); (N.F.)
| | - Natalia Ferré
- Paediatrics, Nutrition and Development Research Unit, Universitat Rovira i Virgili, IISPV, 43204 Reus, Spain; (S.L.); (R.C.-M.); (N.F.)
| | - Berthold Koletzko
- Department Paediatrics, Dr. von Hauner Children’s Hospital, University Hospital, LMU Ludwig-Maximilians-Universität, 80337 Munich, Germany; (V.G.); (B.K.)
- Else Kröner-Seniorprofessor of Paediatrics, LMU Ludwig-Maximilians-Universität, 80337 Munich, Germany
| | - Elvira Verduci
- Department of Health Sciences, University of Milan, 20146 Milano, Italy;
- Department of Pediatrics Ospedale Vittore Buzzi, University of Milan, 20154 Milano, Italy
| | - Dariusz Gruszfeld
- Neonatal Department, Children’s Memorial Health Institute, 04-730 Warsaw, Poland;
| | | | - Joaquin Escribano
- Paediatrics, Nutrition and Development Research Unit, Universitat Rovira i Virgili, IISPV, 43204 Reus, Spain; (S.L.); (R.C.-M.); (N.F.)
- Serra Hunter Fellow, Universitat Rovira i Virgili, 43201 Reus, Spain
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Iguacel I, Álvarez L, Cabero MJ, Monje L, Moreno LA, Rodriguez-Palmero M, Rivero M, Samper P, Rodríguez G. Rapid infancy weight gain during the complementary feeding period in a cohort of Spanish infants. CHILD AND ADOLESCENT OBESITY 2019. [DOI: 10.1080/2574254x.2019.1651170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Isabel Iguacel
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Departamento de Fisiatría y Enfermería; Universidad de Zaragoza, Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain
| | - Lino Álvarez
- Cátedra Ordesa de Nutrición Infantil, Facultad de Medicina, Universidad de Cantabria, Santander, Spain
| | - Mª Jesús Cabero
- Cátedra Ordesa de Nutrición Infantil, Facultad de Medicina, Universidad de Cantabria, Santander, Spain
| | - Laura Monje
- Servicio de Pediatría, Hospital Universitario “Marqués de Valdecilla”, Santander, Spain
| | - Luis A. Moreno
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Departamento de Fisiatría y Enfermería; Universidad de Zaragoza, Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain
| | | | - Montserrat Rivero
- Cátedra Ordesa de Nutrición Infantil, Laboratorios Ordesa, Barcelona, Spain
| | - Pilar Samper
- Departamento de Pediatría, Radiología y Medicina Física, Universidad de Zaragoza, Zaragoza, Spain
| | - Gerardo Rodríguez
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Departamento de Fisiatría y Enfermería; Universidad de Zaragoza, Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Departamento de Pediatría, Radiología y Medicina Física, Universidad de Zaragoza, Zaragoza, Spain
- Red de Salud Materno Infantil y del Desarrollo (SAMID), RETICS ISCIII, Madrid, Spain
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Judd AL, Beck KL, McKinlay C, Jackson A, Conlon CA. Validation of a Complementary Food Frequency Questionnaire to assess infant nutrient intake. MATERNAL AND CHILD NUTRITION 2019; 16:e12879. [PMID: 31343830 PMCID: PMC7038889 DOI: 10.1111/mcn.12879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/21/2019] [Accepted: 07/23/2019] [Indexed: 11/26/2022]
Abstract
Dietary assessment in infants is challenging but necessary to understand the relationship between nutrition and growth and development. Currently no simple, validated methods exist to assess nutrient intake in New Zealand (NZ) infants. Therefore, this study aimed to assess the relative validity and reproducibility of a Complementary Food Frequency Questionnaire (CFFQ) to determine nutrient intakes of NZ infants. Ninety-five parent-infant pairs (infant age 10 ± 1 months) completed the CFFQ twice (CFFQ-1 and CFFQ-2), 4 weeks apart (to assess reproducibility). A 4-day weighed food record (4dWFR) was collected between CFFQ administrations (to assess validity). Validity and reproducibility were assessed for intakes of energy and 18 nutrients using Bland-Altman analysis, Pearson's correlation coefficients, cross-classification, and weighted Kappa (κ). The CFFQ showed acceptable validity: Nutrients from the CFFQ were comparable with the 4dWFR (bias, 9-28%), correlation between methods ranged from r = .18 (saturated fat) to r = .81 (iron; mean r = .52), 54% (mean) of participants were correctly classified (range 39% to 67%), and 7.1% (mean) misclassified into opposite tertiles (range 2.1% to 14.7%). There was acceptable agreement between the CFFQ and 4dWFR (κ = 0.20-0.60). The CFFQ showed good reproducibility: Correlations ranged from r = .34 (folate) to r = .80 (zinc); for 16 nutrients, >50% of participants were correctly classified, and for all nutrients, <10% of participants were grossly misclassified. All nutrients showed acceptable to good agreement (κ > 0.20). The CFFQ has acceptable relative validity and good reproducibility for assessing nutrient intake in NZ infants aged 9-12 months, making it a useful tool for use in future research.
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Affiliation(s)
- Amy L Judd
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Kathryn L Beck
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | | | - Ashleigh Jackson
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Cathryn A Conlon
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
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Luque V, Escribano J, Closa-Monasterolo R, Zaragoza-Jordana M, Ferré N, Grote V, Koletzko B, Totzauer M, Verduci E, ReDionigi A, Gruszfeld D, Socha P, Rousseaux D, Moretti M, Oddy W, Ambrosini GL. Unhealthy Dietary Patterns Established in Infancy Track to Mid-Childhood: The EU Childhood Obesity Project. J Nutr 2018; 148:752-759. [PMID: 29982656 DOI: 10.1093/jn/nxy025] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 02/05/2018] [Indexed: 11/13/2022] Open
Abstract
Background Dietary habits established in infancy may persist into adulthood and determine long-term health. Objectives The aims of this work were to describe dietary patterns, predictors of adherence to them, and their tracking from ages 1 to 8 y in European children. Methods Three-day food diaries were prospectively collected at ages 1, 2, 3, 4, 5, 6 and 8 y. Foods were allocated to 1 of 29 food groups, which were included in exploratory factor analyses at each children's age. The tracking of patterns through childhood was assessed by an estimated general equation model. Results At age 1 y (n = 633), 2 patterns were identified. One was labeled "core foods" (CORE), since it was positively loaded for vegetables, fish, olive oil, and white and red meat, and negatively loaded for ready-to-eat infant products, sugar, and confectioneries. The other was positively loaded for saturated spreads, sugar, fruit juices, and confectioneries, and negatively loaded for olive oil, fish, and cow milk; this was labeled as the "poor-quality fats and added sugars" (F&S) pattern. From ages 2 to 8 y, 3 patterns were repeatedly identified: CORE, F&S, and a "high protein sources" (PROT) pattern that was positively loaded for milk, flavored milks, fish, eggs, white and processed meat, chips, and olive oil, and negatively loaded for fresh fruits at almost all time points. Of those children in the highest quartiles of the CORE, F&S, and PROT patterns at 2 y, 45%, 72%, and 36%, respectively, remained in the highest quartile at 8 y [OR = 2.01 (1.08, 3.8), OR = 3.6 (1.5, 8.4) and OR = 0.80 (0.4,1.6), respectively; P = 0.510]. Conclusions Dietary patterns are established between 1 and 2 y of age and track into mid-childhood. A dietary pattern characterized by added sugars, unhealthy fats, and poor consumption of fish and olive oil was the most stable throughout childhood. Further analyses will reveal whether those dietary patterns are associated with metabolic disease risk.
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Affiliation(s)
- Veronica Luque
- Pediatrics, Nutrition and Development Research Unit, Universitat Rovira i Virgili, IISPV, Reus, Spain
| | - Joaquin Escribano
- Pediatrics, Nutrition and Development Research Unit, Universitat Rovira i Virgili, IISPV, Reus, Spain
| | - Ricardo Closa-Monasterolo
- Pediatrics, Nutrition and Development Research Unit, Universitat Rovira i Virgili, IISPV, Reus, Spain
| | - Marta Zaragoza-Jordana
- Pediatrics, Nutrition and Development Research Unit, Universitat Rovira i Virgili, IISPV, Reus, Spain
| | - Natàlia Ferré
- Pediatrics, Nutrition and Development Research Unit, Universitat Rovira i Virgili, IISPV, Reus, Spain
| | - Veit Grote
- Children's University Hospital, University of Munich Medical Centre, Munich, Germany
| | - Berthold Koletzko
- Children's University Hospital, University of Munich Medical Centre, Munich, Germany
| | - Martina Totzauer
- Children's University Hospital, University of Munich Medical Centre, Munich, Germany
| | - Elvira Verduci
- Department of Pediatrics, San Paolo Hospital, University of Milan, Milan, Italy
| | - Alice ReDionigi
- Department of Pediatrics, San Paolo Hospital, University of Milan, Milan, Italy
| | - Dariusz Gruszfeld
- Neonatal Department and Department of Gastroenterology, Children's Memorial Health Institute, Warsaw, Poland
| | - Piotr Socha
- Department of Gastroenterology, Children's Memorial Health Institute, Warsaw, Poland
| | | | - Melissa Moretti
- University Children's Hospital Queen Fabiola, ULB, Brussels, Belgium
| | - Wendy Oddy
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Gina L Ambrosini
- School of Population and Global Health, University of Western Australia, Perth, Australia
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Micronutrient intake adequacy in children from birth to 8 years. Data from the Childhood Obesity Project. Clin Nutr 2018; 37:630-637. [DOI: 10.1016/j.clnu.2017.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 02/02/2017] [Accepted: 02/02/2017] [Indexed: 11/16/2022]
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11
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Ferré N, Rubio-Torrents C, Luque V, Closa-Monasterolo R, Grote V, Koletzko B, Socha P, Gruszfeld D, Langhendries JP, Sengier A, Verduci E, Escribano J. Influence of Feeding Types during the First Months of Life on Calciuria Levels in Healthy Infants: A Secondary Analysis from a Randomized Clinical Trial. ANNALS OF NUTRITION AND METABOLISM 2017; 70:132-139. [DOI: 10.1159/000468156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/18/2017] [Indexed: 11/19/2022]
Abstract
Background/Aims: Dietary factors can modify calciuria. We aim to investigate urinary calcium excretion in healthy infants according to their protein. Methods: Secondary data analysis from a randomized clinical trial where healthy term infants were randomized after birth to a higher (HP) or lower (LP) protein content formula that was consumed until age 1 year. A non-randomized group of breastfed (BF) infants was used for reference. Anthropometry, dietary intakes and calciuria (calcium/creatinine ratios) from spot urine samples were assessed at ages 3 and 6 months. At 6 months, the kidney volumes were assessed using ultrasonography, and the serum urea and creatinine levels were determined. Results: BF infants showed the highest calciuria levels, followed by the HP and the LP groups (p < 0.001 for all comparisons). Either protein intakes or formula types modulated the calciuria in linear regression models adjusted for other influencing dietary factors. The usual cut-off values classified 37.8% (BF), 16.8% (HP) and 4.9% (LP) of the infants as hypercalciuric. Conclusions: Feeding types during the first months of life affect calciuria, with BF infants presenting the highest levels. We propose new cut-off values, based on feeding types, to prevent the overestimation in hypercalciuria diagnoses among BF infants.
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Damianidi L, Gruszfeld D, Verduci E, Vecchi F, Xhonneux A, Langhendries JP, Luque V, Theurich MA, Zaragoza-Jordana M, Koletzko B, Grote V. Protein intakes and their nutritional sources during the first 2 years of life: secondary data evaluation from the European Childhood Obesity Project. Eur J Clin Nutr 2016; 70:1291-1297. [PMID: 27329609 DOI: 10.1038/ejcn.2016.108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 03/07/2016] [Accepted: 05/07/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND/OBJECTIVES High protein intake in infancy affects future obesity risk and other health outcomes. We aim to describe total protein intake and its sources in a birth cohort in five European countries over the first 2 years of life. SUBJECTS/METHODS A total of 746 formula-fed infants were included. Three-day weighed dietary records at 6, 7, 8, 9, 12, 18 and 24 months of age were used. Kruskal-Wallis, ANOVA and Friedman's tests were used to assess possible differences in nutritional intake among countries and over time. RESULTS Dairy products were the main components of the infants' diets. Cow's milk was rarely introduced before 12 months of age, whereas infants' formula was the main contributor of protein intake. Food choices and protein intake differed among countries (P<0.001). Protein intake often exceeded European recommendations from 9 months onwards, partly because of the substitution of dairy protein (mainly infant formula) by meat protein. Two nutritional patterns were identified that were characterised by differences in energy, fat, protein and animal protein intake. Finally, food consumption was not always in line with protein intakes, and thus infants from some countries showed high consumption of specific food groups but relatively low protein intakes. CONCLUSIONS During weaning, over-limited substitution of dairy products with other sources (especially meat) resulted in relatively high protein intakes in formula-fed infants. Differences in preferences of specific protein sources from complementary foods existed among European countries. Great opportunities in improving early nutrition were revealed, although cultural and geographical differences should always be considered.
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Affiliation(s)
- L Damianidi
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Center, München, Germany
| | - D Gruszfeld
- Children's Memorial Health Institute, Warsaw, Poland
| | - E Verduci
- Department of Pediatrics, San Paolo Hospital, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - F Vecchi
- Department of Pediatrics, San Paolo Hospital, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | | | | | - V Luque
- Paediatrics Research Unit, Universitat Rovira i Virgili, Reus, Spain
| | - M A Theurich
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Center, München, Germany
| | | | - B Koletzko
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Center, München, Germany
| | - V Grote
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Center, München, Germany
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Standardization of the Food Composition Database Used in the Latin American Nutrition and Health Study (ELANS). Nutrients 2015; 7:7914-24. [PMID: 26389952 PMCID: PMC4586568 DOI: 10.3390/nu7095373] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/20/2015] [Accepted: 09/02/2015] [Indexed: 11/21/2022] Open
Abstract
Between-country comparisons of estimated dietary intake are particularly prone to error when different food composition tables are used. The objective of this study was to describe our procedures and rationale for the selection and adaptation of available food composition to a single database to enable cross-country nutritional intake comparisons. Latin American Study of Nutrition and Health (ELANS) is a multicenter cross-sectional study of representative samples from eight Latin American countries. A standard study protocol was designed to investigate dietary intake of 9000 participants enrolled. Two 24-h recalls using the Multiple Pass Method were applied among the individuals of all countries. Data from 24-h dietary recalls were entered into the Nutrition Data System for Research (NDS-R) program after a harmonization process between countries to include local foods and appropriately adapt the NDS-R database. A food matching standardized procedure involving nutritional equivalency of local food reported by the study participants with foods available in the NDS-R database was strictly conducted by each country. Standardization of food and nutrient assessments has the potential to minimize systematic and random errors in nutrient intake estimations in the ELANS project. This study is expected to result in a unique dataset for Latin America, enabling cross-country comparisons of energy, macro- and micro-nutrient intake within this region.
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