Pregnancy and Infants' Outcome: Nutritional and Metabolic Implications.

Pregnancy is a complex period of human growth, development, and imprinting. Nutrition and metabolism play a crucial role for the health and well-being of both mother and fetus, as well as for the long-term health of the offspring. Nevertheless, several biological and physiological mechanisms related to nutritive requirements together with their transfer and utilization across the placenta are still poorly understood. In February 2009, the Child Health Foundation invited leading experts of this field to a workshop to critically review and discuss current knowledge, with the aim to highlight priorities for future research. This paper summarizes our main conclusions with regards to maternal preconceptional body mass index, gestational weight gain, placental and fetal requirements in relation to adverse pregnancy and long-term outcomes of the fetus (nutritional programming). We conclude that there is an urgent need to develop further human investigations aimed at better understanding of the basis of biochemical mechanisms and pathophysiological events related to maternal-fetal nutrition and offspring health. An improved knowledge would help to optimize nutritional recommendations for pregnancy.

Evidenced-based, practical food portion sizes for preschool children and how they fit into a well balanced, nutritionally adequate diet.

BACKGROUND: Healthy eating guidelines for 1-4-year-old children are available but evidence-based portion sizes have not been specified. Parents and early-years providers are concerned about under- or over-feeding young children. The present study aimed to report detailed information about appropriate average portion size ranges and suggest a practical food plan for feeding preschool children, providing adequate nutrient intakes within energy requirements. METHODS: Two sources of information were used to obtain an appropriate portion size range for the types of foods normally eaten by this age group. Median portions of a variety of foods were combined into a food plan fulfilling healthy eating guidelines regarding the number of servings from each food group. The nutrient and energy content of the plan was assessed and compared with recommended adequate nutrient intakes and percentage energy contributions from macronutrients. UK children, aged 1-4 years, taking part in Avon Longitudinal Study of Parents and Children and National Diet and Nutrition Survey, were used in the present study. RESULTS: Portion size ranges were developed for 164 foods. The theoretical food plan using foods with high to medium nutrient density was shown to provide an adequate intake of all nutrients, except vitamin D, for which there are very few food sources. CONCLUSIONS: These practical food portion size ranges could be used both in early years settings and in advice to parents. The food plan emphasises the need to include a variety of nutrient-dense foods if a balanced diet is to be achieved for preschool children.

Sources of vitamin D and calcium in the diets of preschool children in the UK and the theoretical effect of food fortification.

BACKGROUND: Dietary intakes of vitamin D are very low in the UK. Dietary calcium is also necessary to promote bone health. The fortification of foods with vitamin D could be a safe and effective way of increasing intake. METHODS: Diets of preschool children, 755 at 18 months and 3.5 years, from the Avon Longitudinal Study of Parents and Children were assessed using dietary records completed by parents. Energy, vitamin D and calcium intakes were calculated. Multinomial logistic regression was used to estimate the odds ratio for being in the highest/lowest quartile of intake. Intakes were recalculated to test different fortification regimes. RESULTS: Vitamin D intakes were low; all children were below the UK and US dietary recommendations. Calcium intakes decreased between the two ages as a result of reduced milk consumption. Children in the lowest quartile for vitamin D intake at 18 months were twice as likely to remain in that quartile at 3.5 years (odds ratio = 2.35; 95% confidence interval = 1.56-3.55). The majority of foods provide no vitamin D with fat spreads and milk as the main sources. The contribution from breakfast cereals increased, from 6% to 12%, as a result of the increased consumption of fortified cereals. Dairy foods provided the highest contribution to calcium at 18 months but were less important at 3.5 years. Theoretical intakes from different fortification regimens suggest that milk fortified at 2 µg 100 g(-1) vitamin D would provide most children with adequate but not excessive intakes. CONCLUSIONS: Dietary vitamin D intakes were very low and calcium intakes were mostly adequate. Fortification of milk with vitamin D could be a good way to boost intakes.

Identification of a dietary pattern prospectively associated with increased adiposity during childhood and adolescence.

BACKGROUND: Specific dietary risk factors for excess adiposity in young people are poorly understood. However, studies in adults suggest dietary energy density, fat and fibre are critical dietary factors. OBJECTIVE: To examine longitudinal relationships between a dietary pattern (DP) characterised by dietary energy density, % total energy from fat and fibre density and fat mass (FM) in children from 7 to 15 years of age. DESIGN: Subjects were 6772 children from the UK Avon Longitudinal Study of Parents and Children. Dietary intake was assessed using a 3-day food diary at 7, 10 and 13 years of age. An energy-dense, high-fat, low-fibre DP was identified using reduced rank regression and subjects scored for the DP at each age. FM was measured at 11, 13 and 15 years and FM index (FMI) calculated as FM/height((x)). Longitudinal models were adjusted for dietary misreporting, physical activity and maternal factors. RESULTS: DP z-scores at all ages were positively associated with later FMI. A 1 s.d. unit increase in DP z-score was longitudinally associated with an average increase in FMI z-score of 0.04 s.d. units (95% confidence interval (CI), 0.01-0.07). For each 1 s.d. unit increase in DP z-score, the odds of being in the highest quintile for FMI (as a marker of excess adiposity) increased by 13% (95% CI, 1-27%). CONCLUSIONS: Dietary habits during childhood are associated with increased adiposity in adolescence, with specific implications for dietary energy density, fat and fibre intake. Improving diet quality may reduce the risk of obesity in young people.

Dietary patterns in pregnancy and respiratory and atopic outcomes in childhood.

BACKGROUND: Studies of the relation between maternal diet in pregnancy and respiratory and atopic outcomes in the offspring have focused on the effects of individual nutrients and foods rather than dietary patterns. A study was undertaken to determine whether dietary patterns in pregnancy are related to childhood asthma and related outcomes. METHODS: In a population-based birth cohort, the Avon Longitudinal Study of Parents and Children (ALSPAC), dietary patterns in pregnancy previously identified using principal components analysis ("health conscious", "traditional", "processed", "vegetarian" and "confectionery") were related to early wheezing phenotypes and eczema; wheezing, hay fever, eczema, doctor-diagnosed asthma, atopy and total IgE at 7 years; lung function and bronchial responsiveness at 8-9 years. In regression models, confounders were controlled for using propensity scores. RESULTS: Univariately, the "health conscious" pattern was positively associated with eczema, total IgE, forced expiratory volume in 1 s and forced expiratory flow and negatively associated with early wheezing and asthma (unadjusted odds ratios per standard deviation increase in pattern score for early persistent wheeze and asthma: 0.78 (95% CI 0.70 to 0.87), p = 7.3x10(-6), N = 8886 and 0.90 (95% CI 0.84 to 0.97), p = 0.007, N = 7625, respectively). The "processed" pattern was positively associated with early wheezing and negatively associated with atopy and forced vital capacity. On controlling for confounders, the effects were substantially attenuated and became non-significant (adjusted odds ratios for the associations of the "health conscious" pattern with early persistent wheeze and asthma: 1.00 (0.86 to 1.16), p = 0.99 and 0.95 (0.86 to 1.04), p = 0.27, respectively). CONCLUSIONS: In this cohort, dietary patterns in pregnancy did not predict asthma and related outcomes in the offspring after controlling for confounders.

A prospective analysis of dietary energy density at age 5 and 7 years and fatness at 9 years among UK children.

OBJECTIVE: To analyse whether high dietary energy density (DED) is associated with increased fat mass and risk of excess adiposity in free-living children. DESIGN: Longitudinal, observational cohort study. SUBJECTS: Six hundred and eighty-two healthy children from the Avon Longitudinal Study of Parents and Children. MEASUREMENTS: Diet was assessed at age 5 and 7 years using 3-day diet diaries, and DED (kJ g(-1)) was calculated excluding drinks. Fat mass was estimated at age 9 years using Dual-Energy X-ray Absorptiometry. To adjust for body size, fat mass index (FMI) was calculated by dividing fat mass (kg) by height (m(5.8)). Excess adiposity was defined as the top quintile of logFMI. RESULTS: Mean DED at age 5 years was higher among children with excess adiposity at age 9 years compared to the remaining sample (8.8+/-0.16 vs 8.5+/-0.07 kJ g(-1)), but there was no evidence of an association with excess adiposity at age 9 years (odds ratio (OR)=1.14, 95% confidence interval (CI) 0.90-1.44) after controlling for potential confounders. Mean DED at age 7 years was higher among children with excess adiposity compared to the remaining sample (9.1+/-0.12 vs 8.8+/-0.06 kJ g(-1)) and a 1 kJ g(-1) rise in DED increased the odds of excess adiposity at 9 years by 36% (OR=1.36, 95% CI 1.09-1.69) after controlling for potential confounders. CONCLUSION: Higher DED at age 7 years, but not age 5 years, is a risk factor for excess adiposity at age 9 years, perhaps reflecting deterioration in the ability to compensate for extra calories in an energy-dense diet. DED tracks strongly from age 5 to 7 years suggesting intervention to alter dietary habits need to commence at younger ages to prevent the formation of preferences for energy dense foods.

Adjusting for energy intake in dietary pattern investigations using principal components analysis.

OBJECTIVE: The effect of energy adjustment on variables entered into principal component analysis (PCA) to derive dietary patterns has received little attention. DESIGN AND METHODS: As part of regular self-completion questionnaires, used in the Avon Longitudinal Study of Parents and Children, pregnant women were asked to record the frequency of consumption of a variety of food items. A total of 12 053 women completed the questionnaire. Individual dietary types were identified using PCA, before and after adjusting the food variables for energy intake. Associations with estimated nutrient intakes and with birthweight were examined for the two solutions and when energy adjustment was performed at a later stage of the analysis. RESULTS: Slight differences were seen in terms of the components extracted and the factor loadings obtained. The associations with nutrient intakes showed that there was a general reduction in the size of the correlation coefficients for the energy-adjusted components compared to the unadjusted components. There did not appear to be any difference in the size of the effects of the dietary pattern scores on birthweight, whether energy was adjusted for before entry into the PCA or after. CONCLUSIONS: In this sample, it is not necessary to adjust for energy intake before entry into a PCA analysis to determine dietary patterns when using food frequency questionnaire data. Effects of energy intake can be determined at a later stage in the analytical process.This study determines the effect of adjusting for energy on dietary patterns resulting from PCA and the subsequent effect on future outcomes.

Quality of food eaten in English primary schools: school dinners vs packed lunches.

OBJECTIVE: To compare the food and nutrient intakes of primary school children eating school dinners and packed lunches. SUBJECTS: Six-hundred and twenty-one 7-year-old children participating in the Avon Longitudinal Study of Parents and Children in South West England. METHODS: Diet was assessed by 3-day unweighed food record. RESULTS: The composition of both types of school meals compared unfavourably with dietary guidelines. Intakes of energy, non-starch polysaccharides (NSP), calcium, iron, folate, retinol equivalents, zinc, copper, magnesium, iodine and riboflavin were too low, and intakes of total and saturated fat were too high. However, children who ate school dinners had higher lunchtime intakes of protein, starch, NSP and most vitamins and minerals and lower intakes of sugar (14.2 and 20.9% of energy in school dinners and packed lunches, respectively, P<0.001) and saturated fat (12.0 and 16.2%, P<0.001). Only around half of the recommended amount of fruit and vegetables was eaten by children having either type of school meal. There were also differences in the whole day's nutrient intake according to school meal type. Children eating packed lunches had lower daily intakes of potassium and zinc, and higher intakes of sugar and saturated fat. Differences in nutrient intake were independent of maternal education. CONCLUSIONS: The food and nutrient content of both school dinners and packed lunches needed improvement. However, the standard of food brought from home by children was, if anything, worse than that served at school. Recent moves to improve school dinners will need to be complemented by education about what constitutes a healthy packed lunch.

Fish consumption in mid-childhood and its relationship to neuropsychological outcomes measured in 7-9 year old children using a NUTRIMENTHE neuropsychological battery.

BACKGROUND: Long-chain polyunsaturated fatty acids (LCPUFA), particularly n-3 LCPUFA, play a central role in neuronal growth and the development of the human brain. Fish is the main dietary source of n-3 LCPUFA. To assess the relation between fish consumption, estimated dietary n-3 LCPUFA intake and cognition and behaviour in childhood in a multi-centre European sample. METHODS: Children from 2 European studies, CHOP and NUHEAL, were assessed at 8 and 7.5 years of age, respectively. Different outcomes of neuropsychological development (assessed with the standardized NUTRIMENTHE Neuropsychological Battery (NNB) consisting of 15 subtests) were related with outcomes from a food-frequency questionnaire (FFQ) focussing on the consumption of fish. RESULTS: A total of 584 children completed the FFQ and the neuropsychological tests. We found no associations with calculated DHA or EPA intakes for any of the neuropsychological domains. Children who consumed 2 fish meals per week including one of fatty fish, showed no substantive differences in the cognitive domains from the children who did not. However negative associations with fatty fish consumption were found for social problems (p = 0.019), attention problems (p = 0.012), rule-breaking problems (p = 0.019) and aggressive behaviour problems (p = 0.032). No association was observed with internalizing problems. Higher levels of externalizing problems (p = 0.018) and total problems (p = 0.018) were associated with eating less fatty fish. CONCLUSIONS: Children who consumed 2 fish meals per week including one of fatty fish were less likely to show emotional and behavioural problems than those who did not.

Does birth weight predict childhood diet in the Avon longitudinal study of parents and children?

STUDY OBJECTIVE: Low birth weight predicts cardiovascular disease in adulthood, and one possible explanation is that children with lower birth weight consume more fat than those born heavier. Therefore, the objective of this study was to investigate associations between birth weight and childhood diet, and in particular, to test the hypothesis that birth weight is inversely related to total and saturated fat intake. DESIGN: Prospective cohort study. SETTING: South west England. PARTICIPANTS: A subgroup of children enrolled in the Avon longitudinal study of parents and children, with data on birth weight and also diet at ages 8, 18, 43 months, and 7 years (1152, 998, 848, and 771 children respectively). MAIN RESULTS: Associations between birth weight and diet increased in strength from age 8 to 43 months, but had diminished by age 7 years. Fat, saturated fat, and protein intakes were inversely, and carbohydrate intake was positively associated with birth weight at 43 months of age, after adjusting for age, sex, and energy intake. After adjustment for other confounders, all associations were weakened, although there was still a suggestion of a relation with saturated fat (-0.48 (95% CI -0.97, 0.02) g/day per 500 g increase in birth weight. Similar patterns were seen in boys and girls separately, and when the sample was restricted to those with complete data at all ages. CONCLUSIONS: A small inverse association was found between birth weight and saturated fat intake in children at 43 months of age but this was not present at 7 years of age. This study therefore provides little evidence that birth weight modifies subsequent childhood diet.

Premature adiposity rebound in children treated for acute lymphoblastic leukemia.

The adiposity rebound (AR), when body mass index begins to increase after its nadir in childhood, is a critical period for the regulation of energy balance and adult obesity risk. The aim of the present study was to test whether children treated for acute lymphoblastic leukemia (ALL) experience premature AR. This might, in part, explain their tendency to develop obesity. Timing of AR was assessed by visual inspection of body mass index plots in 68 patients treated for ALL in first remission. This sample comprised all eligible patients treated in Scotland between 1991 and 1998, age 30 months or less at the time of diagnosis. Timing of AR in patients was compared against a cohort of 889 healthy British children studied during the 1990s using the same method. AR occurred significantly earlier in the patients treated for ALL (chi(2) test, P < 0.001). The AR had occurred in 43% (29 of 68) of the patients and 4% (40 of 889) of the comparison group by age 37 months. At 49 months AR had occurred in 81% (55 of 68) of the patients and 21% (190 of 889) of the comparison group. Treatment of ALL is associated with a significantly advanced AR. This might, in part, explain the extremely high prevalence of obesity in long-term survivors. Clinical management should focus on minimizing excess weight gain during therapy to reduce long-term obesity risk.

Stereoacuity at age 3.5 y in children born full-term is associated with prenatal and postnatal dietary factors: a report from a population-based cohort study.

BACKGROUND: Observational studies suggested that breast-feeding benefits the visual development of preterm children, which has been attributed to the presence of docosahexaenoic acid (DHA) in breast milk but not most formula milks. Randomized studies showed that preterm children require a dietary supply of DHA in the first few weeks of life for optimal visual development, but it is unclear whether full-term children experience similar benefits from breast milk or DHA supplements. OBJECTIVE: The objective of this study was to compare stereoacuity at age 3.5 y in healthy, full-term children who were breast-fed and in similar children who had not been breast-fed after adjustment for socioeconomic status and maternal diet. DESIGN: Prospectively collected data on maternal diet during pregnancy (including intake of oily fish), the child's diet, and the socioeconomic status of the family were examined. Stereoacuity at age 3.5 y was assessed. RESULTS: Children who had been breast-fed for 4 mo were more likely to achieve high-grade stereopsis, or stereoscopic vision, than were children who had not been breast-fed (adjusted odds ratio: 2.77; 95% CI: 1.54, 4.97). The mother's antenatal blood DHA content was associated with her intake of oily fish (P < 0.0001). Children whose mothers ate oily fish during pregnancy were also more likely to achieve high-grade stereopsis than were children whose mothers did not eat oily fish (adjusted odds ratio: 1.57; 95% CI: 1.00, 2.45). CONCLUSIONS: The results of this study suggest that for full-term infants, breast-feeding is associated with enhanced stereopsis at age 3.5 y, as is a maternal DHA-rich antenatal diet, irrespective of later infant feeding practice.

Glucose and insulin responses to manufactured and whole-food snacks.

To determine whether realistic snacks containing added sugar evoke excessive insulin responses, 10 healthy subjects consumed four different snack meals, similar in fat and total energy content. Two snacks were based on sugary, manufactured products (chocolate-coated candy bar; cola drink with crisps) and two on whole foods (raisins and peanuts; bananas and peanuts). After the processed-food snacks, plasma-glucose levels tended to rise higher and to fall lower than after the whole-food snacks. The area under the plasma insulin curve was 70% greater after the manufactured snacks than after the raisin-peanut snack. The banana-peanut snack evoked an intermediate insulin response. One subject had pathological insulinaemia after both manufactured snacks but normal responses after both whole-food snacks. These findings suggest that foods and drinks containing added fiber-depleted sugars stress and sometimes overwhelm homeostatic mechanisms but also suggest that the insulin response to food is influenced by the physical state of the food.

Particle size of wheat, maize, and oat test meals: effects on plasma glucose and insulin responses and on the rate of starch digestion in vitro.

When normal volunteers ate isocaloric wheat-based meals, their plasma insulin responses (peak concentration and area under curve) increased stepwise: whole grains less than cracked grains less than coarse flour less than fine flour. Insulin responses were also greater with fine maizemeal than with whole or cracked maize grains but were similar with whole groats, rolled oats, and fine oatmeal. The peak-to-nadir swing of plasma glucose was greater with wheat flour than with cracked or whole grains. In vitro starch hydrolysis by pancreatic amylase was faster with decreasing particle size with all three cereals. Correlation with the in vivo data was imperfect. Oat-based meals evoked smaller glucose and insulin responses than wheat- or maize-based meals. Particle size influences the digestion rate and consequent metabolic effects of wheat and maize but not oats. The increased insulin response to finely ground flour may be relevant to the etiology of diseases associated with hyperinsulinemia and to the management of diabetes.

Family, socioeconomic and prenatal factors associated with failure to thrive in the Avon Longitudinal Study of Parents and Children (ALSPAC).

BACKGROUND: The epidemiological profile of infants failing to thrive is unclear. The aim of this study is to investigate the prenatal and socioeconomic factors associated with these infants using standardized weight gain conditional on previous weight. METHODS: In a large UK population cohort study, 11 718 infants born at term in 1991-1992 with no major congenital abnormalities were identified. Using a weight gain criterion conditional on initial weight from birth to 6-8 weeks, 6-8 weeks to 9 months, and birth to 9 months, the slowest gaining 5% were identified. RESULTS: None of the prenatal factors was associated with failure to thrive in the multivariable analysis nor were traditional markers of socioeconomic deprivation such as poor parental education or low occupational status. Parental height was significantly correlated with slow infant weight gain in both separate periods and from birth to 9 months (Pearson's r = +0.20, P < 0.001). Eight times as many infants born to shorter parents (8.7%, 95% CI: 6.6, 11.3) showed slow weight gain as infants born to taller parents (1.1%, 95% CI: 0.5, 2.5). Higher parity was also related to slow infant weight gain; infants born in the fourth or subsequent pregnancy were twice as likely to fail to thrive from birth to 9 months (8.3%, 95% CI: 6.4, 10.6) as first-born infants (3.4%, 95% CI: 2.9, 10.6). CONCLUSIONS: Future studies need to take account of parental height when calculating growth standards and look at why failure to thrive is more common, not in poorer families but in larger families.

Some determinants of whole-gut transit time: a population-based study.

Slow whole-gut transit time may be associated with an increased risk of gallstones, and possibly bowel cancer, but its determinants are unknown. We looked for these determinants in a community-based study of 884 women aged 25-69 years and 677 men aged 40-69 years. Transit time was estimated using prospective examination of three stools and a questionnaire about bowel habit. Diet and alcohol intake were assessed using a validated food frequency questionnaire. In women < 50 years not taking oral contraceptives, mean transit time was relatively constant across 10-year age bands (62 to 63 h). In older women it was also relatively constant, but was significantly shorter (58 to 59 h), suggesting an effect of female sex hormones. In women taking oral contraceptives, mean transit-time was 6 h longer than in women of the same age not taking them (95% CI 1.4 to 10.6 h). In men drinking > 40 g alcohol/day, mean transit time was 49 h compared with 54 h in those drinking < 20 g/day (p < 0.0001). In alcohol-abstaining men, an effect of dietary NSP (non-starch polysaccharide or fibre) intake was clearly apparent. Alcohol consumption quickened transit in both sexes; oral contraceptive usage slowed it in women. Body mass index in both sexes, soluble NSP in men, and insoluble NSP in women also significantly and negatively affected transit time. The food groups which were related to transit time were potatoes and cooked fruit in men, and pulses and bread in women.(ABSTRACT TRUNCATED AT 250 WORDS)

Intestinal transit time in the population calculated from self made observations of defecation.

STUDY OBJECTIVES: To assess the feasibility of estimating intestinal transit time in the general population using self recorded data on stool form, frequency of defecation, and the interdefecatory time interval. DESIGN: Prospective measurement of bowel function. SETTING: Bristol, Avon, UK between 1987 and 1989. SUBJECTS: Subjects were drawn from 1897 people who comprised 72.2% of a stratified random sample of all men aged 40-69 years and women aged 25-69 years on the lists of 19 general medical practitioners. Altogether 1561 subjects (59.4%) recorded bowel function and a subsample of 98 (50 women and 48 men) had intestinal transit time measured. MEASUREMENTS AND MAIN RESULTS: The interdefecatory time interval and stool form (on a validated 1-6 scale sensitive to transit time) were recorded prospectively from three consecutive defecations. In the subsample the mean intestinal transit time was measured simultaneously using a four marker, two stool x ray technique. Multiple regression analysis was used to assess the extent to which intestinal transit time could be predicted from the defecatory data. The formulas obtained were then applied to the whole study population. In women, intestinal transit time was best predicted by the formula 103-1.23 (DF)--4.69 (SFS)+0.638 (IDTI), where DF is the stated defecation frequency per week, IDTI is the interdefecatory time interval, and SFS is the sum of the three stool form scores, for which the correlation coefficient r = 0.736. For men the intestinal transit time = 79-1.33 (DF)--1.88 (SFS)+0.329 (IDTI), for which the correlation coefficient r = 0.541. The predicted intestinal transit time was longer in women than men at equivalent ages. Women of childbearing age had longer transit times than older women. CONCLUSIONS: Observations made by untrained subjects can be used to estimate intestinal transit time in epidemiological studies. A gender related difference in transit time exists.

Gallstones in a community free of obesity but prone to slow intestinal transit.

OBJECTIVES: To verify anecdotal reports that gallstones were frequent in a remote community where obesity is rare and to look for possible explanations of their occurrence, including slow intestinal transit. DESIGN: Population survey of gallbladder status and stool form. SETTING: Two villages in Ladakh, a mountainous region of northern India; for comparison, a stratified random sample from general practitioners' lists in East Bristol. SUBJECTS: Women aged 25-59 years, 437 in Ladakh and 974 in Bristol. MAIN OUTCOME MEASURES: Presence of gallstones on ultrasonography and response to questionnaires about parity, the intake of dried legume seeds (pulses) and bowel function including the form or appearance of the stools on a seven-point, transit-sensitive scale. Weight, height and waist circumference were also recorded. RESULTS: Gallstone disease was at least as frequent in Ladakh as in Bristol although Ladakhi women were uniformly slim and their weight, waist size and body mass index failed to rise with age. After adjustment for age, gallstone disease was associated with higher body mass index and waist size in Bristol but not in Ladakh. It was associated with increased parity in Bristol, but not significantly so after adjusting for age and not at all in Ladakh. Gallstone disease was not directly associated with bowel function but Ladakhis often reported their stools to be lumpy (42.4 vs. 26.5% of Bristol women) and seldom as soft or loose (6.4 vs. 42.5%), implying that their intestinal transit tends to be slow. CONCLUSION: Gallstones can be common in a population free of obesity but prone to intestinal stasis.

Associations between dietary intakes and blood cholesterol concentrations at 31 months.

OBJECTIVE: The initial stages of atherosclerosis have been shown to occur in children as young as 3. Elevated total and LDL cholesterol concentrations and low HDL concentrations are a well-established risk factor for atherosclerosis. The objective of this study was to investigate the dietary determinants of blood lipid concentrations at 31 months of age. SUBJECTS: A randomly selected group of children (214 boys, 175 girls) in south-west England forming part of the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC) cohort. DESIGN: Three-day dietary records were obtained at 18 months. At 31 months a non-fasting blood sample was taken and analysed for total and HDL cholesterol and triglyceride, and measures of height and weight were taken. RESULTS: Among boys, total cholesterol concentrations were positively associated with the intake of total fat (r=0.209, P=0.002) and saturated fatty acids (r=0.211, P=0.002). Among girls, HDLC was positively associated with energy intake (r=0.204, P=0.018), and negatively associated with intakes of polyunsaturated fat, saturated fat and sugar in multivariate analysis. There were no associations between the intakes of non-starch polysaccharides (fibre) or dietary cholesterol and total or HDL cholesterol concentrations in either sex. Among boys, higher intakes of breakfast cereals were associated with lower total cholesterol (r=-0.187, P=0.008). Among girls, higher intakes of biscuits and meat and meat products were associated with higher HDLC concentrations. CONCLUSIONS: These data suggest that the dietary determinants of blood lipid concentrations differ between boys and girls. Reducing saturated fat intake in boys would be likely to lead to an improvement in blood lipid profiles. In this study there is no evidence to suggest that an increase in the intake of polyunsaturated fat by pre-school children would result in improved blood lipid profiles.

Dietary intake and sources of non-starch polysaccharide in English men and women.

Up-to-date information is unavailable on intakes of non-starch polysaccharide (NSP) in Britain. We surveyed 739 men aged 40-69 years and 976 women aged 25-69 years using a validated food-frequency questionnaire focused on carbohydrates. Mean NSP intake in the three decades of men was 15.5-16.4 g/day and in the five decades of women it was 14.3-15.3 g/day, with no clear effect of age. These NSP intakes are higher than those from a 1977 survey but well short of the recent government-recommended population mean of 18 g/day. However, nine people consumed over 32 g/day. The relative contribution of food groups to NSP intake varied with age and sex. Women obtained more NSP from raw fruit and salad, brown breads and breakfast cereals. Their preference for these foods probably explains why, overall, their NSP intakes were close to those of men. Younger people and men obtained relatively more of their NSP from potatoes cooked with fat and from pulses and less from raw fruit. The largest single source of soluble NSP was potatoes and half of this came from potatoes cooked with fat. In older women raw fruit and salad were equally important. Pulses provided about 10% of soluble NSP in younger women, cooked vegetables about 10% in older women. Increased potato consumption deserves attention as a means of obtaining the metabolic benefits of a high soluble NSP intake.