Food intake, diet quality and behavioral problems in children: results from the GINI-plus/LISA-plus studies.

BACKGROUND/AIMS: To assess the association between food intake and diet quality and behavioral problems at the 10-year follow-up of the two population-based birth cohorts of the studies German Infant Nutritional Intervention and 'Influences of lifestyle-related factors on the immune system and the development of allergies in childhood'. METHODS: Cross-sectional data on food intake over the past year were collected by a parent-reported food frequency questionnaire. Diet quality was based on reference values of food amounts of the optimized mixed diet. Behavioral problems were assessed by a parent-reported Strengths and Difficulties Questionnaire. Relationships between food category intake, diet quality and behavior problems were examined using multivariable regression modeling adjusted for gender, sociodemographic characteristics, body mass index, physical exercise, television viewing/PC use and total energy intake. A total of 3,361 children with complete data were analyzed. RESULTS: Children with increased intake of confectionery had increased odds of having emotional symptoms [adjusted odds ratio (OR(adj)) 1.19, 95% confidence interval (CI) 1.08-1.32] compared to children with low intake. A higher diet quality score was associated with lower likelihood of emotional symptoms (OR(adj) 0.89, 95% CI 0.80-0.98). The unadjusted significant relationship between diet quality and hyperactivity/inattention was attenuated by adjusting for several confounders to an OR(adj) of 0.92 (95% CI 0.82-1.03). CONCLUSIONS: Increased consumption of high-sugar products and lower diet quality are associated with a higher likelihood of emotional symptoms in children.

Passive smoking and behavioural problems in children: results from the LISAplus prospective birth cohort study.

OBJECTIVE: To analyse the association between pre- and postnatal exposure to tobacco smoke and child behavioural problems and to further investigate the influence of trimester-specific exposure to maternal smoking and the impact of paternal smoking at home on the same outcome. METHODS: Data of 3097 German children recruited at birth for a population-based, prospective study were used. Detailed information on children's tobacco smoke exposure was collected by self-administered questionnaires at each follow-up. Behavioural outcomes were measured by the Strengths and Difficulties Questionnaire applied at 10-year follow-up. RESULTS: Children exposed to environmental tobacco smoke at home showed increased risks of hyperactivity/inattention problems. Only smoking during the entire pregnancy increased the risk for conduct and hyperactivity/inattention problems (proportional odds ratio (pOR)=1.58, 95% confidence interval (CI)=1.06-2.37 and pOR=1.67, CI=1.03-2.72). Pre- and postnatal exposure to paternal smoking was associated with hyperactivity/inattention problems in children of non-smoking mothers (pOR=1.97, CI=1.06-3.65). Effect estimates were adjusted for study centre, sex, parental educational level, mother's age at birth, having a single parent and time spent in front of a screen. CONCLUSIONS: Not only maternal smoking during pregnancy but also paternal smoking at home should be considered as a risk for hyperactivity/inattention problems in children.

Regional and socio-economic differences in food, nutrient and supplement intake in school-age children in Germany: results from the GINIplus and the LISAplus studies.

OBJECTIVE: To describe regional differences between eastern and western Germany with regard to food, nutrient and supplement intake in 9-12-year-old children, and analyse its association with parental education and equivalent income. DESIGN: Data were obtained from the 10-year follow-up of the two prospective birth cohort studies - GINIplus and LISAplus. Data on food consumption and supplement intake were collected using an FFQ, which had been designed for the specific study population. Information on parental educational level and equivalent income was derived from questionnaires. Logistic regression modelling was used to analyse the effect of parental education, equivalent income and region on food intake, after adjusting for potential confounders. SETTING: Germany. SUBJECTS: A total of 3435 children aged 9-12 years. RESULTS: Substantial regional differences in food intake were observed between eastern and western Germany. Intakes of bread, butter, eggs, pasta, vegetables/salad and fruit showed a significant direct relationship with the level of parental education after adjusting for potential confounders, whereas intakes of margarine, meat products, pizza, desserts and soft drinks were inversely associated with parental education. Equivalent income had a weaker influence on the child's food intake. CONCLUSIONS: Nutritional education programmes for school-age children should therefore account for regional differences and parental education.

Infant-onset eczema in relation to mental health problems at age 10 years: results from a prospective birth cohort study (German Infant Nutrition Intervention plus).

BACKGROUND: Cross-sectional studies suggest an association between eczema and mental health problems, but the temporal relationship is unclear. OBJECTIVE: To assess the association between infant-onset eczema and mental health problems in a prospective study. METHODS: Between 1995 and 1998, a birth cohort study was recruited and followed until age 10 years. Physician-diagnosed eczema, comorbidities, and a broad set of environmental exposures were assessed at age 1, 2, 3, 4, 6, and 10 years. First, we investigated the association between infant-onset eczema (age 1-2 years) and mental health problems at age 10 years according to the Strengths and Difficulties Questionnaire. Second, we analyzed the likelihood of mental health problems at age 10 years in relation to the course of eczema. RESULTS: A total of 2916 infants were eligible for analysis. Compared with participants never diagnosed as having eczema, children with infant-onset eczema had a significantly increased risk for possible/probable mental health problems (Strengths and Difficulties Questionnaire total score) at age 10 years (odds ratio, 1.49; 95% CI, 1.13-1.96) and for emotional symptoms (odds ratio, 1.62; 95% CI, 1.25-2.09). Eczema limited to infancy predicted a significantly higher risk for conduct problems at age 10 years. The strength of the association between eczema and emotional problems at age 10 years increased with increasing eczema persistence. CONCLUSION: Infants with eczema are at increased risk for mental health problems at age 10 years. Even if cleared afterward, eczema at age 1 to 2 years may cause persistent emotional and behavioral difficulties.

Elder siblings enhance the effect of filaggrin mutations on childhood eczema: results from the 2 birth cohort studies LISAplus and GINIplus.

BACKGROUND: Several studies showed a protective effect of elder siblings on eczema development, which is in line with the hygiene hypothesis. However, findings are not consistent, and there might exist different causal pathways for the development of eczema. Especially barrier disturbances as found in children with mutations in the filaggrin gene (FLG) seem to play an important role. OBJECTIVES: To investigate the interaction between FLG mutations and the presence of elder siblings on the development of eczema in 2 independent birth cohorts. METHODS: We used data from 2 German birth cohorts (LISAplus, GINIplus) up to the age of 6 years. Genotyping for FLG mutations (R501X, 2282del4) was performed in 1039 (LISAplus) and 1828 (GINIplus) children. Data on eczema (diagnosis and symptoms) and elder siblings were obtained by parental questionnaires. The association among eczema, FLG mutations, and elder siblings was analyzed longitudinally by using generalized estimating equations. RESULTS: We found no protective effect of elder siblings on eczema development. On the contrary, children with FLG mutations had a significantly higher risk for eczema if they had elder siblings. Attending day care centers lessened this effect. After excluding 303 children who attended early day care, the odds ratio for interaction between FLG mutations and elder siblings was 3.27 (95% CI, 1.14-9.36) in LISAplus and 2.41 (95% CI, 1.06-5.48) in GINIplus. CONCLUSION: Our findings did not confirm a protective sibling effect. The prevalence of eczema in children with filaggrin deficiency was higher if elder siblings were present. Our results give evidence for complex skin-driven pathogenic mechanisms that might be different depending on children's genetic backgrounds.

Fatty acid composition of serum glycerophospholipids in children.

OBJECTIVE: To determine reference values for fatty acid (FA) composition of serum glycerophospholipids (GPs) in children with a new high-throughput method. STUDY DESIGN: The GP FA composition of 1326 serum samples obtained from a cohort of 951 children at 2 and 6 years, participating in the German Influences of Lifestyle Related Factors on the Immune System and the Development of Allergies in Childhood (LISA) study, was analyzed with a new high-throughput method. Only 2 simple preparation steps were necessary to obtain fatty acid methyl esters selectively from serum GPs. The FA status was determined by separating and quantifying the fatty acid methyl esters with high-resolution capillary gas chromatography. RESULTS: FA values in serum GPs were in very good agreement with other published values in serum or plasma phospholipids for most of the analyzed FAs. No major age and sex differences in GP FA composition were observed. CONCLUSION: The serum GP FA values obtained from children aged 2 and 6 years may serve as reference values in clinical practice (eg, for monitoring and improving therapeutic interventions). Furthermore, they can serve as a reference point for interpreting FA values in clinical and epidemiological studies.

Dietary patterns and risk of asthma: results from three countries in European Community Respiratory Health Survey-II.

Dietary patterns offer an alternative to the analysis of individual foods or nutrients in nutritional epidemiological studies. The aim of the present study was to identify dietary patterns common to different European countries and examine their associations with asthma. In five study centres (two in Germany, two in the UK and one in Norway), 1174 adults aged 29-55 years completed a FFQ and respiratory symptoms questionnaire. A meta-analytic approach was used to identify the dietary patterns and analyse them in relation to current asthma, asthma symptoms and bronchial responsiveness (BHR). Two patterns emerged, generally correlating with the same foods at different centres: one associated with intake of meats and potatoes; the other with fish, fruits and vegetables. There was no evidence that the fish, fruits and vegetables pattern was associated with asthma (OR 1.11 (95 % CI 0.93, 1.33)), symptom score (ratio of means 1.07 (0.98, 1.17)) or BHR (regression coefficient - 0.01 ( - 0.12, 0.10)), though these CI appeared to rule out large protective effects of consuming these foods. There was no overall evidence that the meat and potato pattern was associated with asthma (OR 1.02 (0.79, 1.31)), symptom score (ratio of means 1.07 (0.84, 1.36)) or BHR (regression coefficient - 0.08 ( - 0.27, 0.10)), but there was heterogeneity between centres in the association with symptom score: a negative association at the two German centres; a positive association at the others. Heterogeneity in a multi-centre observational study of diet could suggest alternative explanations for apparent effects of diet, such as uncontrolled confounding.

A new FFQ designed to measure the intake of fatty acids and antioxidants in children.

OBJECTIVE: The present paper describes the systematic development of an FFQ to assess the intake of fatty acids and antioxidants in school-aged children. In addition, a validation study applying 24 h dietary recalls was performed. DESIGN: Using the variance-based Max_r method, a list of eighty-two foods was compiled from data obtained by 3 d weighed dietary records. The foods were used to design an FFQ, the comprehensibility of which was evaluated in a feasibility study. In addition, the FFQ was validated in a subset of 101 children from the German Infant Nutritional Intervention Study (GINI PLUS) against one 24 h dietary recall. RESULTS: The feasibility study attested a good acceptance of the FFQ. Mean intake of foods compared well between the FFQ and the 24 h dietary recall, although intake data generated from the FFQ tended to be higher. This difference became less apparent at the nutrient level, although the estimated average consumption of arachidonic acid and EPA using the FFQ still exceeded values recorded with the 24 h recall method by 45 % and 29 %, respectively. CONCLUSIONS: On the basis of the systematic selection process of the food list, the established practicability of the FFQ and the overall plausibility of the results, the use of this FFQ is justified in future epidemiological studies.

Period-specific growth, overweight and modification by breastfeeding in the GINI and LISA birth cohorts up to age 6 years.

Children's weight/growth development is age-specific and may be influenced by breastfeeding. We therefore assessed velocities of weight, length, body-mass-index and overweight/obesity development from birth up to age 6 years overall and in relation to breastfeeding. The method of this study is based on pooled data of the birth-cohorts GINI-plus and LISA-plus and follows 7,643 healthy full-term neonates in four study-centers in Germany. Up to nine anthropometric measurements are available. Overweight/obesity is percentile-defined according to WHO-Child-Growth-Standards. Fully-breastfed is defined as breastfed for at least 4 months. Piecewise-linear-random-coefficient-models were applied to assess growth trajectories and velocities between 0-3, 3-6, 6-12, 12-24 and beyond 24th months. Velocities for weight-, length- and BMI-development are highest in the first 3 months after birth and diminish, with differing pace, in the periods that follow. For overweight and obesity, peak-velocities are estimated in periods 6-12 and 3-6 months. The difference in the velocity of weight gain for breastfed vs. other children is -18 g/month in the first 3 month, -93 g/month between month 3 and 6, -14 g/month between month 6 and 12 and -3 g/month beyond the 24th month. Velocities in length are not different between breastfed and non-breastfed children. Over time, a slightly lower risk (difference < 2%) of being overweight was estimated for breastfed children, after adjustment for study-center, socio-economic-status and maternal smoking in pregnancy. Infants fully-breastfed gain less weight, but grow equally in length in the first 12 months of life versus mixed or formula-fed children. The protective effect of breastfeeding on becoming overweight is related to its weight-velocity-modifying-effect in early infancy.

Burden of otitis media and pneumonia in children up to 6 years of age: results of the LISA birth cohort.

Infections play an important role in childhood. For Germany, few data are available on the epidemiology of infectious diseases such as otitis media and pneumonia in children. We therefore described the prevalence, first episode proportions and recurrence of these childhood infection diseases in selected regions of Germany in children up to 6 years of age. The analysis was based on data from the LISA Study, a prospective population-based birth cohort study including 3,097 full-term infants. Information was collected by parent questionnaire. The first episode proportions for the first 6 years of life were high for otitis media (66.7%; 95%CI 0.65-0.69) and pneumonia (13.5%; 95%CI 0.12-0.15). The annual first episode proportions for otitis media ranged from 7.3% to 25.6% and for pneumonia from 1.4% to 3.4%; both peaked during the second year. The average number of otitis media episodes was 2.2 (SD 2.0) episodes per child within the first 2 years. During the first 2 years of life, hospitalisations due to otitis and pneumonia occurred in up to 7.8 per thousand and 3.0 per thousand of the children, respectively. On average, 50.6% of the children with otitis media were treated with antibiotics during the first year of life. In conclusion, this analysis shows that infectious diseases, especially otitis media, are very frequent childhood diseases in Germany. Thus, parents and physicians should not per se worry about a high frequency of otitis media during early childhood.

Hospital admission in children up to the age of 2 years.

The description and analysis of the utilisation of medical services is of particular importance reflecting childhood morbidity. Therefore, our aim was to describe episode- and person-based rates of hospital admission in Germany, by focusing on the three most important clinically relevant categories, accident injuries, respiratory and digestive diseases in children up to the age of 2 years. The analysis was based on data from the LISA-study, a prospective population based birth cohort study including 3097 full-term infants. Information was collected by parent questionnaires and data was analysed concerning gender, region and social status. In the age-group 7-24 months, 14.5% of all children were at least once hospitalised, 2.5% for accident injuries, 3.0% for respiratory and 4.7% for digestive diseases. More boys than girls were admitted to hospital due to respiratory diseases (4.2% vs. 1.7%) and more children from East compared to West Germany due to digestive diseases (7.2% vs. 3.5%). In families with median or low level education more children were admitted for digestive diseases than with high (6.5% and 6.5% vs. 3.6%). The number of hospitalisation episodes per person showed that most children were hospitalised only once during the period from 7 to 24 months. In conclusion this analysis shows that hospital admission is common and not equally distributed concerning sex, parental education and region in German children. Physicians should pay special attention to these susceptive subgroups and differences in health related behaviour and in the distribution of health facilities have to be reduced. Additionally, multiple admissions play only a minor role concerning hospital admission in children up to the age of 2 years.

Fish consumption, allergic sensitisation and allergic diseases in adults.

BACKGROUND: Previous studies have suggested that fish intake plays a protective role in the development of allergic diseases because of its high content of n-3 very long chain polyunsaturated fatty acid (VLC-PUFA). However, it is not clear whether fish intake also has a beneficial effect in adulthood, when allergic diseases are thought to be predominantly manifested. METHODS: Data from 388 adults from German study centres within the European Community Respiratory Health Study II were analysed. These subjects completed an extensive interviewer-administered questionnaire as well as a food frequency questionnaire, lung function measurement and blood drawing for specific IgE testing at the study centre. RESULTS: Allergic sensitisation (RAST >or=2) was negatively associated with high fish consumption (adjusted OR 0.20, 95% CI 0.05-0.83) and high docosahexaenoic acid (DHA) intake (adjusted OR 0.26, 95% CI 0.07-0.95) in females but not in males when comparing the fourth quartile with the first quartile of intake. No other outcome was related to fish or DHA consumption. CONCLUSIONS: The findings of this study suggest that adult females with a high fish and DHA intake have a lower rate of allergic sensitisation. It is not understood why this association was only seen in females, but gender-related differences in metabolism of PUFAs could be a possible explanation.

Vitamin E intake in relation to allergic sensitization and IgE serum concentration.

BACKGROUND: A protective role of dietary vitamin E intake on disorders related to the immune system, such as allergic diseases, has been suggested. However, results from epidemiological studies are conflicting. OBJECTIVES: The aim of present study was to analyze whether dietary vitamin E intake is related to the prevalence of allergic sensitization and total serum IgE concentrations in adult subjects. METHODS: The present study population consisted of 366 adults aged 29 to 54 years participating in the German centers of the European Community Respiratory Health Survey (ECRHS) II, Erfurt and Hamburg. A validated food frequency questionnaire was used to gather information on dietary vitamin E intake. Total serum IgE concentrations and specific IgE to common allergens were analyzed by using the Pharmacia CAP System. Allergic sensitization was defined as specific serum IgE concentration > or = 0.35 kU/l. RESULTS: The risk for allergic sensitization was substantially decreased in the middle quartiles (aOR: 0.42; 95% CI: 0.22-0.81) and the highest quartile (aOR: 0.22; 95% CI: 0.08-0.60) of total dietary vitamin E intake, after adjustment for potential confounders. Total serum IgE concentration was not statistically significantly associated with dietary vitamin E intake. CONCLUSIONS: The findings of this study suggest that dietary vitamin E intake might play a protective role in the development of allergic sensitization.

Maternal diet during pregnancy in relation to eczema and allergic sensitization in the offspring at 2 y of age.

BACKGROUND: Maternal diet during pregnancy might be one of the factors that influences fetal immune responses associated with childhood allergy. OBJECTIVE: We analyzed the association between maternal diet during the last 4 wk of pregnancy and allergic sensitization and eczema in the offspring at 2 y of age. DESIGN: Data from 2641 children at 2 y of age were analyzed within a German prospective birth cohort study (LISA). Maternal diet during the last 4 wk of pregnancy was assessed with a semiquantitative food-frequency questionnaire, which was administered shortly after childbirth. RESULTS: High maternal intake of margarine [adjusted odds ratio (aOR): 1. 49; 95% CI: 1.08, 2.04] and vegetable oils (aOR: 1.48; 95% CI: 1.14, 1.91) during the last 4 wk of pregnancy was positively associated and high maternal fish intake (aOR: 0.75; 95% CI: 0.57, 0.98) was inversely associated with eczema during the first 2 y in the offspring. High celery (aOR: 1.85; 95% CI: 1.18, 2.89) and citrus fruit (aOR: 1.73; 95% CI: 1.18, 2.53) intakes increased the risk of sensitization against food allergens. In turn, sensitization against inhalant allergens was positively related to a high maternal intake of deep-frying vegetable fat (aOR: 1.61; 95% CI: 1.02, 2.54), raw sweet pepper (aOR: 2.16; 95% CI: 1.20, 3.90), and citrus fruit (aOR: 1.72; 95% CI: 1.02, 2.92). CONCLUSIONS: We suggest that the intake of allergenic foods and foods rich in n-6 polyunsaturated fatty acids during pregnancy may increase and foods rich in n-3 polyunsaturated fatty acids may decrease the risk of allergic diseases in the offspring.

Sodium intake and bronchial hyperresponsiveness in adults.

BACKGROUND: Several investigations suggested a relationship between sodium intake and asthma and bronchial hyperresponsiveness (BHR), respectively. However, clinical and epidemiological studies did not show consistent finding. OBJECTIVE: We analysed the association between dietary sodium intake and BHR to methacholine among 613 adults aged 20-65 years as one of the two German centres of the European Community Respiratory Health Survey (ECRHS). METHODS: Dietary sodium intake was estimated from a 3-day weighed record of food intake. We applied multiple logistic regression models contrasting the three higher quartiles of sodium intake versus the lowest to assess the risk of BHR and mild BHR estimated by PD20 and PD10, respectively, controlling for potential confounders and stratified for sex. In addition, we analysed PD20 (dose of methacholine causing a fall of 20% in forced expiratory volume in 1s) as continuous variable expressed as transformed dose-response slope (tDRS) in the linear model. RESULTS: Women were as expected more likely to be bronchial hyperresponsive (PD20: 26.1%; PD10: 52.2%) than men (PD20:15.8%; PD10: 34.8%) and had a lower mean daily sodium intake (2.36 g) compared with men (3.15 g). Logistic regression did not show any significant relationship between sodium intake and BHR in terms of PD20 after adjustment for age group, education, smoking status, body mass index and height in men or women. However, mild BHR assessed as PD10 was statistically significant positively related to the third (OR: 2.35; CI: 1.11-5.00) and highest quartile of sodium intake (OR: 2.28; CI: 1.06-4.88) in women, but not in men for third quartile (OR: 1.29; CI: 0.68-2.44) and for fourth quartile (OR: 1.07; CI: 0.56-2.07), respectively. CONCLUSION: Sodium intake by several food items does not alter BHR assessed as PD20 to methacholine but may increase mild BHR assessed as PD10. We conclude that, in addition, PD10 has to be considered when the effect of sodium intake on BHR is studied.

Early diet and the risk of allergy: what can we learn from the prospective birth cohort studies GINIplus and LISAplus?

Recently, the American Academy of Pediatrics and the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition published new guidelines on early nutrition and allergy prevention in infants and children. This article reviews epidemiologic evidence from 2 prospective German birth cohort studies, the GINIplus and the LISAplus, regarding maternal diet during pregnancy and feeding patterns in early life and the risk of allergy in light of the new recommendations. The 2 cohorts include a total of 9088 infants who were recruited within different regions of Germany between 1995 and 1999. A subgroup of 2252 infants with a hereditary risk of atopy was enrolled in a double-blind, randomized trial to investigate the effect of feeding regimen in infancy on the development of allergy with the strict recommendation that allergenic solid food be introduced late in the study. The results of the GINIplus and LISAplus studies mainly support the new finding regarding allergy prevention that a delayed introduction of solid foods or the avoidance of highly allergenic foods during the first year does not seem to be beneficial for allergy prevention. A very early introduction of solid foods and a high diversity before week 17 of age may increase the risk of later allergy. We showed that a high intake of margarine, vegetable oils, and some allergenic fruit and vegetables during pregnancy was associated with an increased risk of allergies, especially eczema. Because maternal diet during pregnancy is not reflected in the current recommendations, it should be the focus of future studies.

Long-term effects of hydrolyzed protein infant formulas on growth--extended follow-up to 10 y of age: results from the German Infant Nutritional Intervention (GINI) study.

BACKGROUND: Previous analysis in a prospective, population-based cohort reported reduced weight gain in children fed extensively hydrolyzed casein (eHF-C) formula during the first year of life but showed no effect on growth between 1 and 6 y of life. No studies have been conducted in children up to the age of 10 y. OBJECTIVE: The objective was to investigate potential differences in body mass index (BMI) over the first 10 y of life between infants fed within the intervention period of the first 16 wk of life with partially hydrolyzed whey (pHF-W), extensively hydrolyzed whey (eHF-W), eHF-C, or cow-milk formula (CMF) and infants exclusively breastfed (BF) within the intervention period. DESIGN: This was a prospective, randomized, double-blind trial in full-term neonates with atopic heredity in the German birth cohort German Infant Nutritional Intervention (GINI) followed through the first 10 y of life. Analyses of absolute and World Health Organization (WHO)-standardized BMI trajectories for 1840 infants [pHF-W (n = 253), eHF-W (n = 265), eHF-C (n = 250), CMF (n = 276), and BF (n = 796)] were conducted according to intention-to-treat principles. RESULTS: Except for the previously reported slower BMI gain in infants fed with eHF-C formula within the first year of life, no significant differences in absolute or WHO-standardized BMI trajectories were shown between the pHF-W, eHF-W, eHF-C, CMF, and BF groups thereafter up to the age of 10 y. CONCLUSIONS: Extension of the follow-up period from 6 to 10 y for this randomized controlled trial showed no long-term consequences on BMI for the 4 infant formulas considered. These data need to be confirmed in future studies.

Growth of infants fed formula rich in canola oil (low erucic acid rapeseed oil).

BACKGROUND & AIMS: Canola oil is a variety of rapeseed oil low in erucic acid (<2%). For many years, canola oil has been widely used as an ingredient in infant formula in Europe, but not in North America due to safety concerns. A number of studies have used variable canola content of infant formulas to investigate the effects of linoleic acid: α-linolenic acid ratio on visual function of infants. However, little published data is available to compare the safety of canola versus non-canola containing infant formula. The aim of this study is to investigate whether infant formulas containing canola oil support normal growth in infants as assessed by weight and length gain. METHODS: Re-analyses of data on infant weight and length gain from a prospective randomized double-blind trial in full-term infants in the German Infant Nutritional Intervention study (GINI). This analysis compared growth in infants receiving infant formulas with or without canola oil from week 4 to month 7. Absolute weight and length, weight and length gain in gram or cm per day and standardized weight and length measurements were analyzed by analyses of variance and a longitudinal random effects model. Standardization was conducted according to the new WHO 2006 age- and sex-specific child growth standards. RESULTS: Absolute and standardized weight and length measures did not differ between the formula groups with or without canola oil. This was true for both, analyses within each of the three anthropometric measurement periods (4-6 weeks, 3-4 months, 6-7 months) and for the longitudinal analyses over the whole period from 4 weeks to 7 months of life. Power analyses confirmed that sample size was sufficient to detect a difference of 3 g per day between 14 and 120 days between the two formula groups. CONCLUSIONS: Infant formula containing canola oil supports normal infant growth as assessed by weight and length gain.

Prenatal and postnatal tobacco smoke exposure and development of insulin resistance in 10 year old children.

In this study, we evaluated the association between prenatal and postnatal exposure to environmental tobacco smoke and the development of insulin resistance in 10 year old children. Fasting blood samples were collected from 470 children participating in two prospective birth cohorts. Of those 276 were selected population based and enriched with 194 children exceeding the 85th percentile of body mass index in this age group. Children already having diabetes type 1 or 2 at the age of 10 years were excluded. Fasting blood insulin and glucose levels and calculated HOMA index for insulin resistance assessment were analysed using generalised additive models. Potential confounders were adjusted for. Insulin resistance was increased by 24% in children frequently exposed to environmental tobacco smoke during childhood (MR(adj) = 1.24, p = 0.001), while glucose levels were not. Exclusion of prenatally exposed children did not attenuate the association (MR(adj) = 1.25, p = 0.006). After stratification, the effect sizes were identical within overweight children and the population based sample of children. Insulin resistance and fasting insulin levels were increasing with increasing numbers of cigarettes smoked in children's home. Maternal smoking during the third trimester of pregnancy increased children's insulin levels (MR(adj) = 1.19, p = 0.037), and even more so, if children were exclusively breastfed after birth (MR(adj) = 1.31, p = 0.016). Increased mean ratios were found for smoking of a third person in addition to maternal smoking. Positive dose-dependent associations and independent effects of postnatal exposure suggest involvement of environmental tobacco smoke in the risk for development of insulin resistance in children.

Effect of hydrolysed formula feeding on taste preferences at 10 years. Data from the German Infant Nutritional Intervention Program Plus Study.

BACKGROUND & AIMS: There is some evidence that the type of infant formula received in early infancy has an influence on later food preferences. How long potential effects of taste programming persist is however not clear. Therefore, the aim of present study was to investigate whether feeding with different kinds of infant formula is associated with the acceptance of infant formula at 10 years of age. METHODS: Preference testing was conducted in 833 10-year old children being part of the interventional subgroup of the German Infant Nutritional Intervention Program Plus Study (GINIplus). If they were not exclusively breastfed, these children have been fed with either one of three hydrolysed formulas or a cow's milk formula during the first four months of life. RESULTS: Feeding with any kind of hydrolysed formula in infancy was positively associated with a higher acceptance of extensively hydrolysed casein formula (aOR: 1.88; 95% CI 1.08, 3.29) after adjusting for sex and study centre. CONCLUSIONS: Although this study did not show consistent associations and thus leaves some questions unanswered, it might stimulate further research on the potential programming effect of early infant feeding.