Building nutritionally meaningful classification for grocery product groups: the LoCard Food Classification process

Analysing customer loyalty card data is a novel method for assessing nutritional quality and changes in a population's food consumption. However, prior to its use, the thousands of grocery products available in stores must be reclassified from the retailer's original hierarchical structure into a structure that is suitable for the use of nutrition and health research. We created LoCard Food Classification (LCFC) and examined how it reflects the nutritional quality of the grocery product groups. Nutritional quality was considered the main criterion guiding the reclassification of the 3574 grocery product groups. Information on the main ingredient of the product group, purpose of use, and carbon footprint were also used at the more granular levels of LCFC. The main challenge in the reclassification was a lack of detailed information on the type of products included in each group, and that some of the groups included products that have opposite health effects. The final LCFC has four hierarchical levels and it is openly available online. After reclassification, the product groups were linked with the Finnish food composition database, and the nutrient profile was assessed by calculating the Nutrient Rich Food Index (NRFI) for each product group. Standard deviation in NRFI decreased from 0.21 of the least granular level to 0.08 of the most granular level of LCFC indicating that the most granular level of LCFC has more homogeneous nutritional quality. Studies that apply LCFC to examine loyalty card data with health and environmental outcomes are needed to further demonstrate its validity.

Is parental socioeconomic status associated with irregularity of energy intake among children?

Background

The timing of eating, chrono-nutrition, is a relatively new research area, where the focus is not on only what we eat but also when we eat and of irregularity between days. Chrono-nutrition have been associated with cardiovascular risk factors among adults. Societal factors influence the chrono-nutrition, but there is limited research on how different socioeconomic factors are associated with chrono-nutrition, especially among children. The aim of this study is to examine the association between parental socioeconomic status and irregularity of children’s energy intake.

Methods

We used data from the DAGIS (Increased Health and Wellbeing in Preschools) study in years 2015-2016, in which 864 preschool children participated (age 3-6 years old). Childreńs dietary intake was measured by a 3-day food record. We included only children that had complete data from all three days and the child was at day care on two of those days and one day was a weekend day (n = 568). To calculate the irregularity score, the absolute difference between the daily energy intake and 3-day mean intake for each three days was divided by the 3-day mean energy intake, multiplied by 100 and then averaged over the 3 days; this served as a measure of irregularity of energy intake, with a low score indicating a more regular energy intake and a higher more irregular energy intake. The parents reported highest parental educational level and household income on a questionnaire. The associations were tested by general linear models on SPSS.

Results

No association was found between parental educational level or household income with irregularity of children’s energy intake.

Conclusions

There was no association between parental socioeconomic status and children’s irregularity of energy intake. Other aspects of children’s chrono-nutrition should also be tested to be able to conclude that children’s chrono-nutrition is not influenced by parental socioeconomic status.

Key messages

• We found no association between parental socioeconomic status and irregularity in children’s energy intake.

• Chrono-nutrition among children is under-examined.

Implementation, home mediators and children’s sugary drink consumption - results from DAGIS study

Background and objectives

The effectiveness of a health behavior intervention can depend on the extent to which the intervention is implemented; higher degree of implementation (DOI) might associate with larger intervention effects. This study examined whether the parental DOI of an health behavior intervention had an effect on children's consumption of sugar-sweetened beverages (SSB) and was the effect mediated by home factors.

Methods

the DAGIS preschool intervention was conducted in 2017-2018 in Finland among 3-6-year-olds with valid data from 476 children. At baseline and follow-up parents reported 1) children's SSB consumption in a semi-quantified food frequency questionnaire, 2) availability of SSB at home, parental role modelling of drinking SSB, and norm (parental view on the suitable amount of SSB for children), and 3) DOI: a dichotomized sum variable on several aspects of parental program implementation. In the analyses, high and low DOI were compared to control group. Mediation analysis of the effect of DOI on the change in children's SSB consumption via change in availability, role modelling and norm was conducted with R statistical software.

Results

High DOI was associated with reduced consumption of SSB (B -27.71, 95% CI -49.05, -4.80). No mediated effects were found. All studied mediators impacted the change in SSB consumption, but the DOI had no effect on the change in mediators.

Conclusions

Intervention effect on the consumption of SSB was only found in the high DOI group, which supports the importance of assessing intervention implementation. Since the found effect was not mediated by the studied mediators, other possible mediators should be examined, as understanding intervention mediators is crucial in developing successful interventions.

Key messages

Preschool children’s temperament and its associations with energy intake

Background and objectives

Child's temperament dimensions have been linked with different weight outcomes as well as dietary factors such as consumption of fruit and vegetables, sugar-rich foods and drinks and an overall dietary quality. Links between temperament dimensions and energy intake, however, remain under-examined. This study expands the literature by investigating associations between child's temperament dimensions and energy intake.

Methods

Altogether 505 Finnish children aged 3-6 years provided data for the analyses. The data is a part of the DAGIS (Increased Health and Wellbeing in Preschools) study conducted in 2015-2016. Child's energy intake was measured with 3-day food records. To be included, children had to 1) have food record for two preschool days and one weekend day and 2) to have consumed both lunch and an afternoon snack in the preschool on the two preschool days. The very short form of Children's Behavior Questionnaire was used to measure child's temperament dimensions. Concurrent associations between three temperament dimensions (surgency, negative affectivity, and effortful control) and energy intake were examined using linear regression models adjusted for child's age, sex, mother's highest education, and moderate-to-vigorous physical activity.

Results

Surgency, temperament dimension referring to characteristics such as impulsivity, high activity level and high approach, was positively associated with energy intake. Effortful control or negative affectivity were not associated with energy intake.

Conclusions

The findings imply that temperamental surgency may be one relevant determinant of energy intake among preschool children. The result is in line with previous studies linking child's surgency as well as its specific facets, such as impulsivity, with weight outcomes and food approach behaviors. Considering child's individual temperament dimensions when counselling families in eating issues could be beneficial.

Key messages

• Surgency, a temperament dimension referring to characteristics such as impulsivity, high activity level and high approach, was positively associated with energy intake.

• When promoting children’s balanced eating, tailored support for parents acknowledging child’s temperament could be beneficial.

Food insecurity among Finnish private sector service workers and food pantry clients

Background

There is a paucity of comparable quantitative data on the prevalence and predictors of food insecurity in high-income countries. We applied the Household Food Insecurity Access Scale (HFIAS) to assess food insecurity among i) the Service Union United members; female-dominated, low-income employees of the Finnish private service sector, and ii) a convenience sample of Finnish food pantry clients.

Methods

The HFIAS classification was based on 9 validated questions capturing respondents' perceptions on food scarcity and behavioural responses to food insecurity due to lack of resources during the past month. The resulting indicator categorized respondents as food secure, and mildly, moderately and severely food insecure. We performed cross-tabulations and regression models to assess if education, housing, self-perceived health, income, and resource scarcity associated with levels of food insecurity. In addition, gender, age, and self-perceived disadvantage were assessed among the food pantry clients.

Results

Among the service workers (n = 6 573, 6% of those invited), 35% were food secure, 29% mildly or moderately food insecure, and 36% severely food insecure. The respective proportions were 28%, 26%, and 46% among the 129 food pantry clients. All assessed variables were associated to food insecurity status in the service workers (p < 0.01 for all). Among the food pantry clients, men (OR 1.60; 95% CI 1.09 − 4.80) and homeless/tenants in community rental units (OR 7.12; 95% CI 2.42 − 20.95) were most likely to experience severe food insecurity.

Conclusions

Alongside the food pantry clients the majority of the service workers demonstrated some degree of food insecurity, with a considerable proportion being severely food-insecure. This predominantly low-income group is subject to rapid changes in the labour market and social security systems. The data demonstrated that well-known SES indicators and self-perceived health are linked to food insecurity.

Key messages

Severe food insecurity was common among predominantly low-income private sector service workers and food pantry clients. Food insecurity is linked to SES indicators and wellbeing.

Grocery purchase data in the study of alcohol use - A validity study

BACKGROUND

Alcohol use epidemiology is facing challenges as survey response rates decline. In addition, population surveys fail to capture a large proportion of alcohol consumed and are expensive to conduct. This study aims to aid in complementing traditional epidemiological methods by validate grocery purchase data in the research on population alcohol use.

METHODS

The LoCard study subjects were loyalty card holders of a grocery retail co-operative, which possessed more than 45 % market share in Finland. One third of those who consented to the analyses of their grocery purchases were presented a questionnaire including a Food Frequency Questionnaire on the web; N = 11,818 responded. The relationship between beer purchase frequency and self-reported beer drinking frequency was studied for association and agreement in different subgroups using crosstabulations and Poisson regression modeling.

RESULTS

The association between beer purchase frequency and self-reported beer drinking frequency was good (Gamma = .556). The agreement between beer purchase frequency and drinking frequency was only fair (Kappa = .189). Limiting the data to those single adult households that reported making at least 61 % of their grocery purchases from this grocery retailer and collapsing the frequency categories to three instead of six increased the agreement to good (Kappa = .463).

CONCLUSIONS

Information on beer purchase frequency from the loyalty card database can be used to rank people according to their drinking frequency and to estimate beer drinking frequency with fair to good accuracy, depending on what share of grocery purchases they make from the grocery retailer in question.

Alcohol purchases from a large Finnish retail chain before and after a change in alcohol legislation

Background

In January 2018, the legal limit for alcoholic beverages in grocery stores changed from 4.7 to 5.5 % alcohol. The increased availability of stronger beer, cider and ready-to-drink beverages was expected to increase the total amount of 100% alcohol bought. The study aimed to examine how the change in alcohol legislation affected the purchasing of 100% alcohol from grocery stores by comparing the years 2017 and 2018.

Methods

The study data consisted of 47,066 loyalty card holders of Finland's largest retail chain, who gave their consent and provided background information by an online questionnaire. The data contained the type, volume and alcoholic content of the purchases, from which we calculated the amount of 100% alcohol bought. The mean individual alcohol purchases in the years 2017 and 2018 were compared by age, gender, level of education and household income using repeated measurements ANOVA models.

Results

There was only a small, non-significant change in the total amount of 100% alcohol between 2017 and 2018 (mean 1.9 l and 2.0 l, respectively, p = 0.220). Lower income was associated with a decrease in total 100% alcohol purchased, whereas higher income groups showed an increase. Increase in 100% alcohol bought as ready-to-drink beverages was seen in all population groups.

Conclusions

The availability of stronger alcoholic beverages in grocery stores did not result in a notable overall increase in total purchases of 100% alcohol. The increased purchases of alcohol as ready-to-drink beverages were, on the average, compensated for by decreased purchases of alcohol as other beverages. The association of income with total alcohol purchases may indicate the effect of price in consumer behavior.

Key messages

The raise in the legal limit of alcohol content raised did not result in a significant increase in the total amount of 100% alcohol bought from grocery stores. Alcohol purchased as ready-to-drink beverages increased in all population groups.

Children’s food intake in relation to preschool-level facilitators and barriers of healthy nutrition

Background

Childcare is an important setting for young children’s food consumption as, in Finland, most children eat three meals a day in childcare. Thus, it is important to recognize determinants of children’s dietary intake in childcare. The aim of this study was to examine food-related factors at preschool and manager-level and their association with children’s fruit, vegetable and fibre intake at preschool.

Methods

The study was a part of the cross-sectional DAGIS survey conducted in 2015-2016. It aimed to examine 3-6-year-old preschoolers’ energy balance-related behaviors in Finland. Preschool managers from 58 preschools filled in a questionnaire on food and nutrition related factors at preschool such as kitchen type, food policies, food education, the manager’s possibilities to impact fruit and vegetable supply and cooperation challenges with the catering service. Preschool personnel kept food record for the children (n = 585) on two preschool days. Multilevel linear and logistic regression analyses were conducted with age, gender and municipality as confounders, preschool-level factors as independent variables and children’s vegetable (g/day) and fruit (yes vs. no) consumption, and fibre intake (g/MJ) as outcome variables.

Results

Having many written food policies in the preschool was associated with higher intake of vegetables (p = 0.01) and fibre (p = 0.03) among the children. Having at least 2 out of 3 different cooperation challenges with the catering service was associated with higher intake of fibre (0.03) and lower odds of eating fruits (p = 0.01).

Conclusions

Written food policies and manager-reported challenges with the catering service were associated with children’s vegetable, fruit and fiber intake at preschool. Factors that are relatively distal from the meal situations may impact children’s food intake at preschool and should be taken into account when promoting healthy food intake at preschool, but more studies are needed.

Key messages

Written food policies and good cooperation between the preschool and catering services may be of benefit to children’s healthy food intake at preschool. The relation between preschool and manager-level factors and children’s food intake are very little studied, and thus more studies are needed before conclusions can be made.

Burden of allergy diets in Finnish day care reduced by change in practices

BACKGROUND

Nonessential allergy diets in children with mild symptoms may harm the development of immunological tolerance and impose a burden on families and day care. We aimed to reduce the high prevalence of allergy diets in day care by reforming the practices for inquiring about need of special diets from parents.

METHODS

We developed a new special diet form and an information leaflet based on the new allergy guidelines. The new form was implemented into 40 Finnish day care centres in the capital region in 2013-2015. The questionnaires on practices concerning special diets in day care centres and allergy knowledge were collected from the personnel.

RESULTS

After 2 years, the new special diet form was used by 64% of families with food-allergic children, and the prevalence of allergy diets in day care centres decreased by 43% to 4.3% (IQ range 3.05-5.96). A significant decrease was found in the prevalence of all basic (milk, grains, egg) and most other allergy diets (P for trend < 0.01). The new practice was well accepted by day care and kitchen personnel. Lack of updated allergy knowledge was noted among day care personnel.

CONCLUSIONS

The burden of allergy diets in day care settings could be decreased by simple pragmatic changes based on current allergy guidelines. Old allergy attitudes persisted among day care personnel, indicating the need for continuous education.

The reliability and validity of a short food frequency questionnaire among 9-11-year olds: a multinational study on three middle-income and high-income countries

OBJECTIVE

The main aim of this study was to assess the reliability and validity of a food frequency questionnaire with 23 food groups (I-FFQ) among a sample of 9-11-year-old children from three different countries that differ on economical development and income distribution, and to assess differences between country sites. Furthermore, we assessed factors associated with I-FFQ's performance.

METHODS

This was an ancillary study of the International Study of Childhood Obesity, Lifestyle and the Environment. Reliability (n=321) and validity (n=282) components of this study had the same participants. Participation rates were 95% and 70%, respectively. Participants completed two I-FFQs with a mean interval of 4.9 weeks to assess reliability. A 3-day pre-coded food diary (PFD) was used as the reference method in the validity analyses. Wilcoxon signed-rank tests, intraclass correlation coefficients and cross-classifications were used to assess the reliability of I-FFQ. Spearman correlation coefficients, percentage difference and cross-classifications were used to assess the validity of I-FFQ. A logistic regression model was used to assess the relation of selected variables with the estimate of validity. Analyses based on information in the PFDs were performed to assess how participants interpreted food groups.

RESULTS

Reliability correlation coefficients ranged from 0.37 to 0.78 and gross misclassification for all food groups was <5%. Validity correlation coefficients were below 0.5 for 22/23 food groups, and they differed among country sites. For validity, gross misclassification was <5% for 22/23 food groups. Over- or underestimation did not appear for 19/23 food groups. Logistic regression showed that country of participation and parental education were associated (P⩽0.05) with the validity of I-FFQ. Analyses of children's interpretation of food groups suggested that the meaning of most food groups was understood by the children.

CONCLUSION

I-FFQ is a moderately reliable method and its validity ranged from low to moderate, depending on food group and country site.

Breastfeeding and introduction of complementary foods during infancy in relation to the risk of asthma and atopic diseases up to 10 years

BACKGROUND

It has been hypothesized that changes in diet during early life may have contributed to the increase in childhood asthma and atopy. The long-term effect of the timing and content of infant feeding on the incidence of asthma and atopic diseases in children is unclear.

OBJECTIVE

To investigate the associations between duration of breastfeeding and the timing of introduction of complementary foods during the first 6 months and parental-reported asthma, wheeze and atopic eczema up to 10 years of age.

METHODS

Infant feeding practices (breastfeeding and introduction of complementary foods) of 1924 singleton children participating in the Study of Eczema and Asthma To Observe the influence of Nutrition (SEATON) birth cohort were prospectively collected up to 6 months with outcomes (wheeze, atopic eczema and asthma) being assessed at 1, 2, 5 and 10 years. Data were analysed using generalized estimating equations and discrete hazards models with adjustment for confounders.

RESULTS

By 6 months, 59% and 35% of mothers had stopped exclusive and total breastfeeding, respectively. Although formula feeding was adversely associated with wheeze in the past 12 months (adjusted OR for no formula feeding: 070, 95% CI 0.50-0.97), and the introduction of biscuits/bread after 5 months of age adversely associated with atopic eczema (adjusted OR 1.34, 95% CI 1.06-1.69), these results lost their statistical significance after adjustment for multiple testing. Stratification of the results by the presence of eczema by 6 months of age and family atopic history did not substantially differ from the results of the whole study population.

CONCLUSION AND CLINICAL RELEVANCE

Our results suggest that the nature of infant feeding during the first 6 months seems not to substantially influence the long-term risk of asthma and atopic diseases in children, nor in children at high risk of atopic disease because of a family history of atopic disease.

Introduction of complementary foods in infancy and atopic sensitization at the age of 5 years: timing and food diversity in a Finnish birth cohort

OBJECTIVE

To study the associations between timing and diversity of introduction of complementary foods during infancy and atopic sensitization in 5-year-old children.

METHODS

In the Finnish DIPP (type 1 diabetes prediction and prevention) birth cohort (n = 3781), data on the timing of infant feeding were collected up to the age of 2 years and serum IgE antibodies toward four food and four inhalant allergens measured at the age of 5 years. Logistic regression was used for the analyses.

RESULTS

Median duration of exclusive and total breastfeeding was 1.4 (interquartile range: 0.2-3.5) and 7.0 (4.0-11.0) months, respectively. When all the foods were studied together and adjusted for confounders, short duration of breastfeeding decreased the risk of sensitization to birch allergen; introduction of oats <5.1 months and barley <5.5 months decreased the risk of sensitization to wheat and egg allergens, and oats additionally associated with milk, timothy grass, and birch allergens. Introduction of rye <7.0 months decreased the risk of sensitization to birch allergen. Introduction of fish <6 months and egg ≤11 months decreased the risk of sensitization to all the specific allergens studied. The introduction of <3 food items at 3 months was associated with sensitization to wheat, timothy grass, and birch allergens; the introduction of 1-2 food items at 4 months and ≤4 food items at 6 months was associated with all endpoints, but house dust mite. These results were particularly evident among high-risk children when the results were stratified by atopic history, indicating the potential for reverse causality.

CONCLUSIONS

The introduction of complementary foods was consecutively done, and with respect to the timing of each food, early introduction of complementary foods may protect against atopic sensitization in childhood, particularly among high-risk children. Less food diversity as already at 3 months of age may increase the risk of atopic sensitization.

Early introduction of root vegetables in infancy associated with advanced ß-cell autoimmunity in young children with human leukocyte antigen-conferred susceptibility to Type 1 diabetes

AIMS

Early introduction of supplementary foods has been implicated to play a role in the development of ß-cell autoimmunity. We set out to study the effects of breastfeeding and age at introduction of supplementary foods on the development of ß-cell autoimmunity.

METHODS

A prospective birth cohort of 6069 infants with HLA-DQB-conferred susceptibility to Type 1 diabetes was recruited between 1996 and 2004. Antibodies against islet cells, insulin, glutamate dehydroxylase and islet antigen 2 were measured at 3- to 12-month intervals. The families recorded at home the age at introduction of new foods and, for each visit, completed a structured dietary questionnaire. The endpoint was repeated positivity for islet cell antibodies plus at least one other antibody and/or clinical Type 1 diabetes (n = 265).

RESULTS

Early introduction of root vegetables (by the age of 4 months) was related to increased risk of developing positivity for the endpoint [hazard ratio (95% CI) for the earliest third 1.75 (1.11-2.75) and for the middle third 1.79 (1.22-2.62) compared with the last third (> 4 months), likelihood ratio test P = 0.006], independently of the introduction of other foods and of several putative socio-demographic and perinatal confounding factors. Introducing wheat, rye, oats and/or barley cereals (P = 0.013) and egg (P = 0.031) early was related to an increased risk of the endpoint, but only during the first 3 years of life.

CONCLUSIONS

Early introduction of root vegetables during infancy is independently associated with increased risk of ß-cell autoimmunity among Finnish children with increased genetic susceptibility to Type 1 diabetes.

Maternal vitamin D during pregnancy and its relation to immune-mediated diseases in the offspring

Vitamin D deficiency during pregnancy is fairly common in many parts of the world. However, currently there is no consensus on the optimal vitamin D intake during pregnancy. Vitamin D is known to be of great importance for the homeostatic functions within the immune system. Maternal vitamin D status during pregnancy may therefore affect the developing immune system of the fetus, thus contributing to the later development of immune-mediated diseases. This chapter introduces the basics of vitamin D during pregnancy and discusses the role of maternal vitamin D intake in the development of asthma, allergic diseases, autoimmune diseases, cancer, and infections in the offspring. So far, the strongest observational evidence underlines the potential of maternal vitamin D intake during pregnancy to influence the likelihood of asthma and allergic outcomes in the offspring. Somewhat conflicting findings imply that there might be critical time windows of exposure to adequate vitamin D levels during pregnancy. More research is needed in order to fully understand the contribution of maternal vitamin D status during pregnancy to the progress of immune-mediated diseases.

Feasibility and compliance in a nutritional primary prevention trial in infants at increased risk for type 1 diabetes

AIM

The international Trial to Reduce IDDM in the Genetically at Risk (TRIGR) was launched to determine whether weaning to a highly hydrolysed formula in infancy reduces the incidence of type 1 diabetes in children at increased genetic disease susceptibility. We describe here the findings on feasibility and compliance from the pilot study.

METHODS

The protocol was tested in 240 children. The diet of the participating children was assessed by self-administered dietary forms, a structured questionnaire and a food record. Blood samples were taken and weight and height measured at birth and at 3, 6, 9, 12, 18 and 24 months.

RESULTS

A majority of the subjects (84%) were exposed to the study formula at least for 2 months. Linear growth or weight gain over the first 2 years of life was similar in the two study groups. The levels of IgA and IgG antibodies to cow's milk and casein were higher in the cow's milk-based formula group than in the hydrolysed formula group during the intervention period (p<0.05), reflecting the difference in the intake of cow's milk protein.

CONCLUSION

This randomized trial on infant feeding turned out to be feasible, and dietary compliance was acceptable. Valuable experience was gained for the planning and sample size estimation of the study proper.

Maternal vitamin D intake during pregnancy is inversely associated with asthma and allergic rhinitis in 5-year-old children

BACKGROUND

Vitamin D is known to have a number of immunological effects and it may play a role in preventing allergic diseases. Objectives To study the effect of maternal intake of vitamin D during pregnancy on the emergence of asthma, allergic rhinitis (AR), and atopic eczema by the age of 5 years in children with HLA-DQB1-conferred susceptibility for type 1 diabetes.

METHODS

Children (1669) participating in the population-based birth cohort study were followed for asthma, AR, and atopic eczema assessed by validated questionnaire at 5 years. Maternal diet was assessed by a food-frequency questionnaire.

RESULTS

The mean maternal intake of vitamin D was 5.1 (SD 2.6) microg from food and 1.4 (2.6) microg from supplements. Only 32% of the women were taking vitamin D supplements. When adjusted for potential confounders, maternal intake of vitamin D from food was negatively related to risk of asthma [hazard ratio (HR) 0.80; 95% confidence interval (CI) 0.64-0.99] and AR [HR 0.85; 95% CI 0.75-0.97]. Vitamin D supplements alone were not associated with any outcome. Adjustment for maternal intake of other dietary factors did not change the results.

CONCLUSION

Maternal vitamin D intake from foods during pregnancy may be negatively associated with risk of asthma and AR in childhood.

Age at introduction of new foods and advanced beta cell autoimmunity in young children with HLA-conferred susceptibility to type 1 diabetes

AIMS/HYPOTHESIS

Evidence for the role of infant feeding in the development of beta cell autoimmunity is inconsistent. We set out to study the effects of breastfeeding and of age at introduction of supplementary foods on the development of beta cell autoimmunity.

SUBJECTS AND METHODS

A prospective birth cohort of 3,565 infants with HLA-DQB1-conferred susceptibility to type 1 diabetes was recruited between 1996 and 2001 from two university hospital areas in Finland. Blood samples were collected at 3- to 12-month intervals to measure antibodies against islet cells, insulin, glutamate dehydroxylase and islet antigen 2. The families kept a record on the age at introduction of new foods, and for each visit completed a structured dietary questionnaire. The endpoint was repeated positivity for islet cell antibodies together with at least one of the other three antibodies.

RESULTS

The overall or exclusive duration of breastfeeding was not associated with the risk of developing the endpoint. An early age at introduction of fruits and berries (< or =4 months) was related to increased risk of developing positivity for the endpoint (hazard ratio [95% CI] for earliest tertile 2.02 [1.03-3.95] and for midtertile 1.97 [1.06-3.64] compared with latest tertile >4 months). Also, introducing roots between 3 and 3.9 months (midtertile) was related to increased risk of the endpoint (hazard ratio [95% CI] for the earliest tertile 1.04 [0.57-1.90] and for midtertile 1.82 [1.19-2.79] compared with latest tertile). These associations were independent of several putative socio-demographic and perinatal confounding factors.

CONCLUSIONS/INTERPRETATION

Our findings suggest that an early age at introduction of fruits and berries and roots associates independently with beta cell autoimmunity, contradicting earlier findings from smaller birth cohort studies.

Intake of vitamin D by Finnish children aged 3 months to 3 years in relation to sociodemographic factors

OBJECTIVE

To study the total daily intake of vitamin D from food and supplements among Finnish children aged 3 months to 3 years, the dietary sources of vitamin D and the association between vitamin D intake and sociodemographic factors.

SUBJECTS AND METHODS

The subjects are participants in the Finnish Type I Diabetes Prediction and Prevention Nutrition Study born between October 1997 and October 1998. At the age of 3 and 6 months, 1, 2 and 3 years, 342 (72% of the invited families), 298 (63%), 267 (56%), 233 (49%) and 209 (44%) families, respectively, participated in the present study. Food consumption was assessed by a 3-day food record. A structured questionnaire was used to record the parents' socioeconomic status.

RESULTS

The mean dietary vitamin D intake exceeded the recommendation (10 microg/day) at the age of 3 (11.0 microg) and 6 months (12.0 microg), but decreased thereafter being 9.8, 5.0 and 4.1 microg at 1, 2 and 3 years of age, respectively. Among the children 91, 91, 81, 42 and 26% used vitamin D supplements at the age of 3 and 6 months, and 1, 2 and 3 years, respectively. In children not using vitamin D supplements, vitamin D intake was less than 10 microg/day at all ages. Vitamin D intake from food did not differ in children who used and did not use vitamin D supplements. Vitamin D supplements were the main source of vitamin D intake in all age groups studied, followed by vitamin D-fortified infant formula in 3-month-olds and infant formula and baby foods in 6-month-olds. After the age of 1 year, the most important food sources of vitamin D were margarine, fish, baby foods, low-fat milk and eggs. Sociodemographic factors, especially the number of children in the family and maternal age, were associated with the total vitamin D intake and vitamin D supplement use.

CONCLUSION

Vitamin D supplements are not used according to the dietary recommendations in a substantial proportion of Finnish children.

Infant feeding patterns in the Finnish type I diabetes prediction and prevention nutrition study cohort

OBJECTIVE

To investigate infant feeding patterns during the first 2 y and their relation to sociodemographic factors.

DESIGN

A population-based cohort study.

SETTING

Oulu and Tampere University Hospital district areas 1996-1999, Finland.

SUBJECTS AND METHODS

All newborn infants (n=675) with increased genetic risk for type I diabetes were invited to the study in 1996-1997. Of these, 429 (64%) completed the dietary follow-up form by the time they reached 2 y of age.

RESULTS

The median duration of exclusive breastfeeding (BF) was 1.8 months (range 0-6 months) and that of total BF 7.0 months (0.3-25 months). Among the infants 20% were exclusively breastfed at least 4 months (recommendation 4-6 months). Infants were introduced to infant formula at the median age of 1.8 months (range 0-25 months) and other supplementary foods at the median age of 3.5 months (1-6 months). Infant's ponderal index at birth was inversely associated with the duration of total BF. The age of introduction of supplementary foods correlated positively with the duration of total BF. Longer parental education and increased maternal age were associated with a longer duration of BF and older age at introduction of supplementary foods. Infant formula and other supplementary foods were added earlier to the diet of the boys than that of the girls.

CONCLUSION

Duration of breastfeeding in Finland is shorter than recommended. Compliance with the current recommendations on the timing of introduction of first supplementary food and dairy products is relatively poor. The diet during infancy seems to be conspicuously influenced by the duration of parental education, maternal age and the sex of the infant.

Validity and reproducibility of a food frequency questionnaire for pregnant Finnish women

The authors developed a self-administered 181-item food frequency questionnaire (FFQ) to assess dietary intake during pregnancy for Finnish women from August 1995 to July 1996. In the validation study (n = 113), the data that were collected by using two 5-day food records completed during the eighth month of pregnancy were compared with FFQ data. The intake of foods and nutrients was higher as determined by FFQ than that assessed using food records. Pearson correlation coefficients for nutrients, after adjustment for energy, ranged from 0.19 (vitamin E) to 0.70 (thiamin) and, for foods, from 0.03 (high-fat milk) to 0.84 (low-fat milk). Energy adjustment improved the correlations for nutrients. Correction for attenuation improved correlations for both foods and nutrients. On average, 70% of the foods and 69% of the nutrients fell into the same or adjacent quintiles, according to the FFQ and the food record. In the reproducibility study, 111 women completed the FFQs twice at a 1-month interval. The intraclass correlation coefficients for nutrients ranged from 0.42 (ethanol) to 0.72 (sucrose, riboflavin, and calcium), and for foods, they ranged from 0.44 (ice cream) to 0.91 (coffee). The authors conclude that the FFQ has an acceptable reproducibility and represents a useful tool for categorizing pregnant women according to their dietary intake.

Short-term exclusive breastfeeding predisposes young children with increased genetic risk of Type I diabetes to progressive beta-cell autoimmunity

AIMS/HYPOTHESIS

This study aimed to establish the relation between early infant nutrition and signs of beta-cell autoimmunity in young children.

METHODS

We identified and observed from birth 2949 infants with increased genetic risk of Type I (insulin-dependent) diabetes mellitus (HLA DQB1*02/ *0302 or DQB1*0302/x, x = other than *02, *0301 or *0602) and monitored them for islet cell antibodies at 3 to 6 month intervals. If an infant seroconverted to islet cell antibody positivity, all of his or her samples were also analysed for autoantibodies to insulin, GAD65 (GADA) and to the protein tyrosine phosphatase related IA-2 molecule (IA-2A). Our case-control study comprises the first 65 children who seroconverted to islet cell antibody positivity before the age of 4 years and 390 control children who were islet cell antibody-negative (six control children/ case). We monitored the duration of exclusive and total breastfeeding and the age at which cows' milk was introduced.

RESULTS

Infants who had been breastfed exclusively for at least 4 months had lower risk of seroconversion to positivity for IA-2A or all four autoantibodies [odds ratio (OR) 0.24; 95 % CI 0.06-0.94 and OR 0.17; 95 % CI 0.03-0.86, respectively] than those infants who had been breastfed exclusively for less than 2 months. The risk of seroconversion to positivity for IA-2A or all four autoantibodies was higher in those younger than 2 months (OR 4.37; 95 % CI 1.33-14.42 and OR 5.02; 95 % CI 1.27-19.89) or aged 2 to 3.9 months (OR 5.50; 95 % CI 1.21-25.04 and 6.19; 95% CI 1.10-34.84) when they first received cows' milk than in those aged 4 months or older.

CONCLUSIONS/INTERPRETATION

These observations suggest that short-term breastfeeding and the early introduction of cows' milk-based infant formula predispose young children who are genetically susceptible to Type I diabetes to progressive signs of beta-cell autoimmunity.

Folate, vitamin D, and iron intakes are low among pregnant Finnish women

OBJECTIVE

To evaluate dietary habits and nutrient intake of Finnish pregnant women, to relate these to the use of dietary supplements, and to explore possible dietary variations according to age and education.

DESIGN

A random dietary survey using two five day estimated food records.

SETTING

Pregnant women from 13 maternity clinics in the city of Oulu, Finland.

SUBJECTS

One hundred and eighteen pregnant women in their third trimester.

MAIN RESULTS

The main sources of energy were cereal products and milk products. The consumption of fish and poultry was low. Women with a higher educational level consumed more vegetables, fruit, fruit juices, and tea and less sausages, inner organs and coffee than women with a lower educational level. Younger women (< 25 y) consumed more sugar and pork and less berries, butter and inner organs than older women. On average 15% of the total energy was supplied by protein, 33% by fats, 52% by carbohydrates, and 12% by sucrose. Compared to the Nordic nutrition recommendations, the proportion of polyunsaturated fatty acids and the intake of dietary fibre were low and the intake of sugar high. The intakes of vitamins and minerals met or exceeded the recommended allowances, except for vitamin D, folate, and iron. Of the subjects 70% used dietary supplements. With the exception of vitamin D, folate, and iron, both the supplement users and non-users had an adequate nutrient intake from their diet.

CONCLUSIONS

A balanced diet covers the increased nutrient requirements during pregnancy, with the exception for vitamin D, folate, and iron. The use of dietary supplements during pregnancy is excessive and partly focused on the wrong nutrients. Young and less educated, and smoking pregnant women need more nutritional guidance.