Are dietary patterns in early childhood associated with alcohol consumption at the age of 17 years? Analysis of data from the Avon Longitudinal Study of Parents and Children (ALSPAC) prospective cohort study.

OBJECTIVE: To examine the relationship between a posteriori dietary patterns in early childhood and alcohol consumption in adolescence. DESIGN: Data were obtained from the Avon Longitudinal Study of Parents and Children (ALSPAC) prospective cohort study. Dietary information was obtained using FFQ at the age of 3 and 7 years. The association between dietary patterns, derived using principal components analysis and the Alcohol Use Disorders Identification Test (AUDIT) scores (to assess harmful intake) and frequency of alcohol consumption at the age of 17 years were examined. Secondary analysis considered sugar intake as a percentage of total energy intake. SETTING: Women who gave birth between 1 April 1991 and 31 December 1992 in the Avon area in southwest England were eligible for the ALSPAC cohort study. PARTICIPANTS: Totally, 14 541 pregnancies were enrolled in ALSPAC during its initial recruitment phase. For this analysis, complete data were available for between 3148 and 3520 participants. RESULTS: Adherence to the 'healthy' dietary pattern at both 3 and 7 years of age was positively associated with consuming more than one alcoholic drink per week at 17 years of age, whilst adherence to the 'traditional' dietary pattern at both ages was protective of harmful alcohol intake at 17 years of age. Sugar intake was not associated with either alcohol outcome after adjustment for ethnicity, maternal level of education, parental social class and maternal AUDIT score. CONCLUSIONS: For the population studied, changes to diet in early childhood are unlikely to have an impact on harmful alcohol use in adolescence given the lack of consistency across the results.

Intake of n-3 polyunsaturated fatty acids in childhood, FADS genotype and incident asthma.

Longitudinal evidence on the relation between dietary intake of n-3 (ω-3) very-long-chain polyunsaturated fatty acids, i.e. eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), in mid-childhood and asthma risk is scarce. We aimed to investigate whether a higher intake of EPA and DHA from fish in childhood is associated with a lower risk of incident asthma.In the Avon Longitudinal Study of Parents and Children, dietary intakes of EPA and DHA from fish were estimated by food frequency questionnaire at 7 years of age. We used logistic regression, controlling for confounders, to analyse associations between intake of EPA and DHA (quartiles) and incidence of doctor-diagnosed asthma at age 11 or 14 years, and explored potential effect modification by a fatty acid desaturase (FADS) polymorphism (rs1535). Replication was sought in the Swedish BAMSE birth cohort.There was no evidence of association between intake of EPA plus DHA from fish and incident asthma overall (n=4543). However, when stratified by FADS genotype, the odds ratio comparing the top versus bottom quartile among the 2025 minor G allele carriers was 0.49 (95% CI 0.31-0.79; ptrend=0.006), but no inverse association was observed in the homozygous major A allele group (OR 1.43, 95% CI 0.83-2.46; ptrend=0.19) (pinteraction=0.006). This gene-nutrient interaction on incident asthma was replicated in BAMSE.In children with a common FADS variant, higher intake of EPA and DHA from fish in childhood was strongly associated with a lower risk of incident asthma up to mid-adolescence.

The relationship between dietary intakes and plasma concentrations of PUFA in school-age children from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort.

An adequate intake of PUFA plays a vital role in human health. Therefore, it is important to assess PUFA intakes in different populations and validate them with biomarkers, but only a few small studies are in paediatric populations. We calculated the dietary intake of PUFA and their main food sources in children and assessed associations between PUFA intakes and plasma proportions. Dietary intakes of 7-year-old children (n 8242) enrolled in the Avon Longitudinal Study of Parents and Children were calculated from the parental-completed FFQ. Plasma PUFA were measured in 5571 children 8 months later, and 4380 children had complete dietary and plasma data. The association between dietary and plasma PUFA proportions was estimated using Spearman's correlation coefficients, quintile cross-classification and Cohen's κ coefficients. Mean total PUFA intake was 13·2 g/d (sd 4·2), contributing 6·5 % of total energy intake; n-6 PUFA contributed 5·2 % and n-3 PUFA 0·7 %. The n-6:n-3 ratio was 7·9:1. Mean intakes of EPA and DHA were 35·7 mg/d and 49·7 mg/d, respectively. Most n-3 and n-6 PUFA intakes were weakly correlated with their respective plasma lipids (0·07 ≤ r ≤ 0·16, P < 0·001). The correlation between dietary and plasma DHA was stronger though (r = 0·34, P < 0·001), supported by a modest level of agreement between quintiles (k = 0·32). The results indicate that the FFQ was able to reasonably rank the long-chain (LC) PUFA, DHA, in this paediatric population. Public health initiatives need to address the suboptimal ratio of n-6:n-3 PUFA and very low n-3 LC-PUFA intakes in school-age children in the UK.

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

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

Is maternal education level associated with diet in 10-year-old children?

OBJECTIVE: To examine the associations between maternal education level and diet in 10-year-old children. DESIGN: Three-day diet diaries (child completed with parental help) were collected. Height and weight were measured in research clinics. Maternal education level was derived from a questionnaire completed during pregnancy and classified into low, medium or high. One-way ANOVA was undertaken to compare maternal education groups for nutrient intakes and the Kruskal-Wallis test used for food consumption. SETTING: Avon Longitudinal Study of Parents and Children (ALSPAC), Bristol, UK. SUBJECTS: Children (n 7474) who provided dietary data at age 10 years. RESULTS: A large proportion (60 %) of the sample was classified as plausible reporters, with under-reporting accounting for 36 %. No clear differences were found for intakes of energy or macronutrients between maternal education groups for plausible reporters. However, there were marked differences in micronutrient intakes especially for vitamin C, retinol equivalents and folate, highlighting lower diet quality with lower maternal education level. Intakes of fruit and vegetables showed a positive gradient with increasing maternal education (57 % v. 79 % consumed fresh fruit in low and high educational groups, respectively). A trend towards higher intake in the lower educated group was shown for less healthy foods (meat pies P < 0·001; sausages, burgers and kebabs P < 0·001). CONCLUSIONS: The quality of children's diet at 10 years was related to maternal education level. Lower maternal education was associated with less healthy food choices that could be detrimental to health. Further research is needed to establish if these associations can be explained by other socio-economic factors.

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

OBJECTIVES: Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), this study aimed to replicate the finding of the Etude Longitudinale Alimentation Nutrition Croissance des Enfants (ELANCE) that low fat intake in early childhood was associated with increased adiposity in adulthood. METHODS: Diet was assessed at 8 and 18 months using 3-day food records. Body composition variables were measured at 9 and 17 years, and serum leptin at 9 years. Associations were modelled using adjusted linear regression. RESULTS: In replication analyses, in contrast to ELANCE, there was a positive association between fat intake (% energy) at 18 months and fat mass (FM) at 9 years (B coefficient 0.10 (95% CI 0.03, 0.20) kg, p = 0.005). There was no association with serum leptin. In extended analyses fat intake at 18 months was positively associated with FM in boys (0.2 (0.00, 0.30), p = 0.008) at 9 years but not in girls. Fat intake was positively associated with serum leptin concentration in boys (0.2 (0.1, 0.4) ng/mL, p = 0.011) but not in girls. CONCLUSIONS: Our results did not corroborate the findings from the ELANCE study. A high fat diet in early life may have implications for later childhood and adolescent obesity.

Influences on child fruit and vegetable intake: sociodemographic, parental and child factors in a longitudinal cohort study.

OBJECTIVE: To examine the sociodemographic, parental and child factors that predict fruit and vegetable consumption in 7-year-old children. DESIGN: Diet was assessed using three 1d unweighed food diaries. The child's daily fruit and vegetable consumption was calculated by summing the weight of each type of fruit, fruit juice and vegetable consumed. The various others factors measured were assessed by a questionnaire at different time points. SETTING: The Avon Longitudinal Study of Parents and Children (ALSPAC). SUBJECTS: A total of 7285 children aged 7 years residing in the south-west of England during 1999-2000. RESULTS: Median daily fruit and vegetable consumption (201 g) was below the recommendations for this age group (320 g). Girls ate more fruit and vegetables per unit energy (30.3 g/MJ) than boys (26.7 g/MJ; P =< 0.001). The predictors of fruit and vegetable consumption were mostly similar. Fruit and vegetable consumption was associated with maternal consumption, maternal education status and parental rules about serving fruit/vegetables every day, food expenditure per person and whether the child was choosy about food. Vegetable consumption was also associated with the other characteristics of the child, such as whether the child enjoyed food and whether the child tried a variety of foods. CONCLUSIONS: Children are not eating recommended amounts of fruit and vegetables, particularly boys. Consumption of fruit and vegetables appears to be influenced by parental rules about daily consumption and parental consumption and by the child's choosiness. Parent's actions could influence this. These findings may prove useful for those planning healthy eating campaigns for children.

Is sugar-sweetened beverage consumption associated with increased fatness in children?

OBJECTIVE: We assessed whether sugar-sweetened beverage (SSB) consumption increases fatness in British children. METHODS: Data from a subsample of the Avon Longitudinal Study of Parents and Children were analyzed. Diet was assessed at ages 5 y (n = 521) and 7 y (n = 682) using 3-d diet diaries. Beverages were categorized into SSB, low energy, fruit juice, milk, and water. Fat mass was measured at age 9 y using dual-energy x-ray absorptiometry. The association between consumption of SSB at each age and fatness was examined using linear regression adjusted for potentially confounding variables. RESULTS: SSB accounted for 15% of all drinks consumed and 3% of total energy intake at both ages. There was no evidence of an association between SSB consumption at 5 or 7 y of age and fatness at age 9 y. There was a small positive correlation between low-energy drinks at age 5 and 7 y and fatness at 9 y (age 5 y, rho = 0.21, P < 0.001; age 7 y, rho = 0.16, P < 0.001), which was explained by existing overweight status at ages 5 and 7 y. CONCLUSION: In this cohort of British children there was no evidence of an association between SSB consumption at age 5 or 7 y and fatness at age 9 y. The positive relation between consumption of low-energy beverages and fatness at 9 y, which was explained by overweight status at 5 and 7 y, suggests that heavier children may consume low-energy beverages as part of an ineffective weight-control program.

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

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

Pregnancy diet and associated outcomes in the Avon Longitudinal Study of Parents and Children.

All publications covering diet during pregnancy that stemmed from the Avon Longitudinal Study of Parents and Children were reviewed. Diet was assessed using a food frequency questionnaire. Socioeconomic background, maternal mental health, and the health and development of the offspring were assessed using a variety of methods, such as direct measurement, self-completion questionnaires, and assays of biological samples. Differences in diet, including specific food and nutrient intakes and dietary patterns, were associated with maternal educational attainment, smoking habits, and financial difficulty. There were marginal intakes, compared with recommendations, of the key nutrients iron, magnesium, potassium, and folate. Maternal diet during pregnancy was predictive of offspring diet during childhood. There were independent associations between prenatal fish consumption and lower frequency of maternal depressive and anxiety symptoms, as well as lower frequency of intrauterine growth retardation. Consistent evidence that fish consumption during pregnancy benefited the neurocognitive development of the child was also found. Two constituents of fish, n-3 polyunsaturated fatty acids and iodine, were associated with these benefits in children. The findings from the Avon Longitudinal Study of Parents and Children strengthen the recommendation to eat fish regularly during pregnancy.

Dietary patterns in the Avon Longitudinal Study of Parents and Children.

Publications from the Avon Longitudinal Study of Parents and Children that used empirically derived dietary patterns were reviewed. The relationships of dietary patterns with socioeconomic background and childhood development were examined. Diet was assessed using food frequency questionnaires and food records. Three statistical methods were used: principal components analysis, cluster analysis, and reduced rank regression. Throughout childhood, children and parents have similar dietary patterns. The "health-conscious" and "traditional" patterns were associated with high intakes of fruits and/or vegetables and better nutrient profiles than the "processed" patterns. There was evidence of tracking in childhood diet, with the "health-conscious" patterns tracking most strongly, followed by the "processed" pattern. An "energy-dense, low-fiber, high-fat" dietary pattern was extracted using reduced rank regression; high scores on this pattern were associated with increasing adiposity. Maternal education was a strong determinant of pattern score or cluster membership; low educational attainment was associated with higher scores on processed, energy-dense patterns in both parents and children. The Avon Longitudinal Study of Parents and Children has provided unique insights into the value of empirically derived dietary patterns and has demonstrated that they are a useful tool in nutritional epidemiology.

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

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

Energy-dense, low-fiber, high-fat dietary pattern is associated with increased fatness in childhood.

BACKGROUND: Evidence for the dietary determinants of obesity in children is limited. OBJECTIVE: The objective was to identify a dietary pattern that explained dietary energy density (DED), fiber density (FD), and percentage of energy intake from fat and analyze its relation to fatness in children. DESIGN: The subjects were 521 (at ages 5 and 9 y) and 682 (at ages 7 and 9 y) children participating in the Avon Longitudinal Study of Parents and Children. Diet was assessed with the use of 3-d diet diaries at ages 5 and 7 y. Reduced rank regression derived a dietary pattern with the use of DED, fiber, and fat intake as intermediate variables. Fat mass was measured at age 9 y with the use of dual-energy X-ray absorptiometry. Fat mass index (FMI) was calculated, and excess adiposity was defined (as the top quintile of logFMI). RESULTS: Pattern score at ages 5 and 7 y was correlated with DED (r = 0.8), FD (r = -0.7), and percentage of energy intake from fat (r = 0.5). An increase of 1 SD of pattern score at ages 5 and 7 y, respectively, was associated with a 0.15-kg (95% CI: -0.1, 0.45 kg) and a 0.28-kg (95% CI: 0.05, 0.53 kg) higher fat mass at age 9 y, after controlling for confounders. The adjusted odds of excess adiposity at age 9 y for children in quintile 5 compared with quintile 1 of dietary pattern score at ages 5 and 7 y, respectively, were 2.52 (95% CI: 1.13, 6.08) and 4.18 (95% CI: 2.07, 9.38). CONCLUSION: An energy-dense, low-fiber, high-fat diet is associated with higher fat mass and greater odds of excess adiposity in childhood.

Common variation in the WNK1 gene and blood pressure in childhood: the Avon Longitudinal Study of Parents and Children.

WNK1 gene variants have been associated with adult blood pressure. We aimed to investigate relationships between WNK1 variants and blood pressure, as well as blood pressure change with age, in a longitudinal childhood study. Associations between single nucleotide polymorphisms in WNK1 and blood pressure and the rate of blood pressure change between 7 and 11 years were examined in the Avon Longitudinal Study of Parent and Children Study (n=5326 for systolic blood pressure at 11 years). We observed associations (P<0.05) with diastolic blood pressure gradient with age for 33 of 82 typed and imputed polymorphisms, including polymorphisms in exons 4, 10, and 11 (rs10774466, rs1012729, and rs9804992). The minor allele (G) of rs1012729 (frequency: 25.6%) was associated with a gender-adjusted change in a diastolic blood pressure gradient of -0.11 mm Hg/y (95% CI: -0.20 to -0.03 mm Hg/y; P=0.0054). No associations were shown with the systolic blood pressure gradient. At age 11 years, 30 polymorphisms showed association (P<0.05) with systolic blood pressure, including variants in exons 4 and 10 (rs10774466 and rs1012729). Only 3 polymorphisms were associated with diastolic blood pressure at 11 years. In exploration of polymorphism-dietary cation interactions on systolic blood pressure at 11 years, 59 reached significance (P<0.05; 12.3 expected by chance), mostly (n=33) related to dietary calcium. The findings show that common intronic and exonic WNK1 variants are associated with diastolic blood pressure gradient from 7 to 11 years and with systolic blood pressure at 11 years. Our study suggests that previously reported effects of WNK1 variants on blood pressure are mediated via effects on the gradient of blood pressure change with age.