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.

Dietary patterns in pregnancy and associations with socio-demographic and lifestyle factors.

OBJECTIVE: To obtain distinct dietary patterns in the third trimester of pregnancy using principal components analysis (PCA); to determine associations with socio-demographic and lifestyle factors. DESIGN AND METHODS: A total of 12 053 pregnant women partaking in a population-based cohort study recorded current frequency of food consumption via questionnaire in 1991-1992. Dietary patterns identified using PCA were related to social and demographic characteristics and lifestyle factors. RESULTS: Five dietary patterns were established and labelled to best describe the types of diet being consumed in pregnancy. The 'health conscious' component described a diet based on salad, fruit, rice, pasta, breakfast cereals, fish, eggs, pulses, fruit juices, white meat and non-white bread. The 'traditional' component loaded highly on all types of vegetables, red meat and poultry. The 'processed' component was associated with high-fat processed foods. The 'confectionery' component was characterized by snack foods with high sugar content and the final 'vegetarian' component loaded highly on meat substitutes, pulses, nuts and herbal tea and high negative loadings were seen with red meat and poultry. There were strong associations between various socio-demographic variables and all dietary components; in particular, a 'health conscious' diet was positively associated with increasing education and age and non-white women. There was a negative association with increased parity, single, non-working women, those who smoked and who were overweight pre-pregnancy. Opposite associations were seen with the 'processed' component. CONCLUSIONS: Distinct dietary patterns in pregnancy have been identified. There is clear evidence of social patterning associated with the dietary patterns, these social factors need to be accounted for in future studies using dietary patterns. This study will form the basis for further work investigating pregnancy outcome.

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.

Examining the association between early life social adversity and BMI changes in childhood: a life course trajectory analysis.

BACKGROUND: A number of studies have found associations between multiple aspects of social adversity and obesity in childhood, yet this research has largely been limited to cross-sectional data. OBJECTIVES: This study aimed to address this limitation by using life course trajectory methods to determine whether multiple aspects of social adversity in early childhood are associated with changes in body mass index (BMI) throughout childhood. METHODS: Associations between multiple measures of social adversity from birth to 4 years and subsequent BMI trajectories to age 17 were examined in 7021 children in the Avon Longitudinal Study of Parents and Children. RESULTS: Higher BMI throughout ages 12-17 were observed for children whose parents had separated, were exposed to frequent residential mobility or who experienced moderate or great household financial difficulty in early childhood. After adjustment for confounding variables, associations were attenuated but remained for both moderate (two moves) and high (≥3 moves) residential mobility (mean % difference in BMI at age 17 for children experiencing moderate and high residential mobility before age 4 compared with those experiencing no moves: 2.3; 95% CI: 0.5-4.2; P = 0.015 and 4.2; 95% CI: 1.4-7.0; P = 0.004, respectively). CONCLUSIONS: Associations between BMI and social adversity in childhood are present but largely explained by background socioeconomic position. However, there remain small but important differences between the BMI of children who are exposed to frequent residential mobility in early childhood after adjustment for socioeconomic and other confounders.

Perceptual visual dysfunction, physical impairment and quality of life in Bangladeshi children with cerebral palsy.

BACKGROUND: Cerebral palsy (CP) is the most common cause of motor disability in children and is often accompanied by sensory and/or cognitive impairment. The aim of this study was to characterise visual acuity impairment, perceptual visual dysfunction (PVD) and physical disability in a community-based sample of Bangladeshi children with CP and to assess the impact of these factors on the quality of life of the children. METHODS: A key informant study was used to recruit children with CP from Sirajganj district. Gross Motor Function Classification System (GMFCS) levels and visual impairment were assessed by a physiotherapist and an optometrist, respectively. Assessments of visual perception were performed and standardised questionnaires were administered to each child's main carer to elicit indicators of PVD and parent-reported health-related quality of life. A generalised linear regression analysis was conducted to assess the determinants of the quality of life scores. RESULTS: 180 children were recruited. The median age was 8 years (IQR: 6-11 years); 112 (62%) were male; 57 (32%) had visual acuity impairment and 95 (53%) had some parent-reported PVD. In analyses adjusted for age, sex, GMFCS and acuity impairment, visual attention (p<0.001) and recognition/navigation (p<0.001) were associated with total health-related quality of life, and there were similar trends for total PVD score (p=0.006) and visual search (p=0.020). CONCLUSIONS: PVD is an important contributor in reducing quality of life in children with CP, independent of motor disability and acuity impairment. Better characterisation of PVD is important to help design interventions for affected children, which may improve their quality of life.

Multivariate analysis of diet in children at four and seven years of age and associations with socio-demographic characteristics.

AIM: We have previously reported on distinct dietary patterns obtained from principal components analysis (PCA) of food frequency questionnaires from 3-y-old children. In this study, we repeat these analyses at 4 and 7 y of age. DESIGN: As part of regular self-completion questionnaires, the primary source of data collection in the Avon Longitudinal Study of Parents and Children, parents were asked to record the frequency of consumption of 57 different food types for their children. A total of 9550 subjects (68% of original cohort) were available from the 4-y data sweep and 8286 (59%) from the 7-y. METHODS: Distinct dietary patterns were identified at each age using PCA. These were then related to social and demographic characteristics of the parent and child. RESULTS: Three dietary patterns were established cross-sectionally at both 4 and 7 y of age to best describe the types of diet being consumed. One component at both time points described a diet based on 'junk'-type foods with high-fat and sugar content, processed and convenience foods. A second described the 'traditional' British diet based on meat, potatoes and vegetables. The final, a 'health-conscious' pattern was associated with vegetarian style foods, rice, pasta, salad and fruit. At both time points, the 'junk' pattern was significantly more likely in white children, where maternal education level was low and where the child had more siblings. The 'traditional' pattern was more likely in girls, where the mother had a partner and in nonvegetarians (both mother and child). The 'health-conscious' pattern was more likely with increasing levels of education and increasing maternal age. CONCLUSION: We have demonstrated consistent dietary patterns in cross-sectional analyses at two ages in these children with similar socio-demographic associations evident at each age. Future analyses will track these dietary patterns over time and form a basis for the study of a variety of childhood outcomes.

Lack of replication for the myosin-18B association with mathematical ability in independent cohorts.

Twin studies indicate that dyscalculia (or mathematical disability) is caused partly by a genetic component, which is yet to be understood at the molecular level. Recently, a coding variant (rs133885) in the myosin-18B gene was shown to be associated with mathematical abilities with a specific effect among children with dyslexia. This association represents one of the most significant genetic associations reported to date for mathematical abilities and the only one reaching genome-wide statistical significance. We conducted a replication study in different cohorts to assess the effect of rs133885 maths-related measures. The study was conducted primarily using the Avon Longitudinal Study of Parents and Children (ALSPAC), (N = 3819). We tested additional cohorts including the York Cohort, the Specific Language Impairment Consortium (SLIC) cohort and the Raine Cohort, and stratified them for a definition of dyslexia whenever possible. We did not observe any associations between rs133885 in myosin-18B and mathematical abilities among individuals with dyslexia or in the general population. Our results suggest that the myosin-18B variant is unlikely to be a main factor contributing to mathematical abilities.

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.

Amblyopia treatment outcomes after preschool screening v school entry screening: observational data from a prospective cohort study.

BACKGROUND/AIMS: Preschool screening for amblyopia has controversially been abandoned in some localities within the United Kingdom, on the basis that there is no clear evidence of benefit to support its continuation. Data collected within a birth cohort study were used to examine visual outcomes at 7(1/2) years in children who did or did not receive preschool vision screening. METHODS: Monocular logMAR visual acuity with and without a pinhole was assessed by orthoptists. Contemporary records were used to identify children who had been offered and/or received preschool screening. RESULTS: Of 6081 children, 24.9% had been offered preschool screening and 16.7% had attended. The prevalence of amblyopia was approximately 45% lower in the children who received preschool screening than in those who did not (1.1% v 2.0%, p = 0.05). The mean acuity in the worse seeing eyes after patching treatment was better for amblyopic children who received preschool screening than for those who did not; 0.14 v 0.20 logMAR (p <0.001). These effects did not persist in an intention to screen analysis. CONCLUSIONS: Preschool screening at 37 months was associated with an improved treatment outcome for individuals with amblyopia. However, the improvement was clinically small and disappeared when considering all children offered screening rather than only those who received it. Further research is needed into improving the effectiveness of vision screening for preschool children, while in the interim these data do not conflict with current recommendations for school entry screening by orthoptists.

Drinks consumed by 18-month-old children: are current recommendations being followed?

OBJECTIVE: To examine the types of drinks consumed by children at 18 months of age, determine any associations with socio-demographic characteristics and investigate the use of a bottle for providing these drinks. DESIGN: A total of 1026 randomly chosen children from the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC) were studied. METHODS: As part of a dietary diary completed when their children were 18 months of age, mothers were asked to record all drinks consumed over a 24 h period and to report the containers used to give these drinks. Socio-demographic characteristics were obtained via self-completion questionnaire. RESULTS: Dietary records were available for 1026 children at 18 months. A wide variety of drinks were given at this age. In all, 64% of children had received at least one drink in a bottle and 10% solely used a bottle. Bottle users consumed a significantly greater volume of milk drinks compared to those who used a cup or other container. The types of drinks consumed and adherence to the guidelines on weaning were associated with several socio-demographic characteristics. In particular, children with mothers of lower educational level were more likely to receive fizzy drinks and low-calorie soft drinks, more likely to drink from a bottle, and less likely to drink from a cup. CONCLUSION: We have shown that certain groups of mothers with 18-month-old children are not following the current guidelines on weaning. Assuming these guidelines have scientific validity, it is clear that nutritional education needs to be targeted at these mothers to help them feed their children in the optimal way, to protect from nutritional deficiencies, possible later obesity and poor dental health. SPONSORSHIP: University of Bristol.

Reduced birth weight in boys with hypospadias: an index of androgen dysfunction?

Anthropometric birth measurements analysed for 51 boys with hypospadias identified in a prospective cohort study showed significant reductions in mean values for birth weight, length, and head circumference compared with controls. The absence of the usual sex dimorphism for these variables suggests that the results represent a marker of fetal androgen dysfunction in this subgroup of infants.

How to help children with neurodevelopmental and visual problems: a scoping review.

Children with visual impairment and a condition affecting their neurodevelopment (children with VND) may require extensive and specialised help but evidence on the most effective strategies for visual improvement is lacking. We defined a PICO format (Population, Intervention, Comparator, Outcome) for a scoping review and systematically searched 13 databases. Two reviewers assessed the abstracts for inclusion and a third arbitrated in cases of disagreement. We abstracted data from included studies. We found 4450 abstracts from which we identified 107 papers for inclusion. Of these, 42 related to interventions involving a change in visual input or function: 5 controlled trials, 8 before and after studies and 29 case reports. The strongest evidence supported the provision of spectacles to improve distance or near vision and the use of ultraviolet light as environmental modification for training. Less strong but suggestive evidence supported training/practice routines to improve acuity or oculomotor control. Interventions exist to help children with VND and current recommendations that they are assessed by a vision specialist are supported by the evidence. More information is needed on the effectiveness of training/practice programmes which may promote improved function, and of environmental modifications to facilitate engagement of children with VND with the surroundings.

Associations between flavored milk consumption and changes in weight and body composition over time: differences among normal and overweight children.

BACKGROUND/OBJECTIVES: Few studies have investigated the associations between flavored milk consumption and body composition in children. We aimed to examine the prospective relationships between flavored milk consumption and body fat. SUBJECTS/METHODS: Subjects included 2270 children from the Avon Longitudinal Study of Parents and Children. Flavored milk consumption at age 10 years was assessed using dietary records; consumption was dichotomized as consumers and non-consumers. Percent body fat was measured using dual-energy X-ray absorptiometry at 11 and 13 years. Body weight at 11 and 13 years was included as a secondary outcome. Associations were also examined in a subset of plausible reporters to evaluate the influence of dietary reporting errors. There was an effect of interaction between flavored milk and baseline weight on body fat (P-interaction <0.02). RESULTS: In plausible reporters, overweight/obese children who consumed flavored milk had less favorable changes in body fat compared with non-consumers (adjusted means: -0.16%, 95% CI: -3.8, 3.5 vs -3.4%, 95% CI: -6.5, -0.42, P=0.02). Similar associations with body weight were observed. The adjusted mean percent body fat for overweight/obese girls who consumed flavored milk was greater at age 13 compared with 11 years (39.7%, 95% CI: 32, 47 vs 38.3%, 95% CI: 32, 44). The mean percent body fat for overweight/obese boys was similar between consumers and non-consumer is at 13 years (30.4%, 95% CI: 20, 41 vs 30.1%, 95% CI: 21, 40). CONCLUSIONS: Overweight/obese children who consumed flavored milk had less favorable changes in body composition over time. Although more research is needed, discouraging flavored milk consumption may be one beneficial strategy to address childhood obesity.

Maternal mood and neuroendocrine programming: effects of time of exposure and sex.

Adverse exposures that influence growth in prenatal and early postnatal periods are considered to influence vulnerability to chronic diseases via their effects on the neuroendocrine system. In humans, the assessment of the underlying mechanisms has been restricted. The present study aimed to investigate the effects of adverse early-life exposures, specifically maternal mood, on hypothlamic-pituitary-adrenal (HPA) axis, sympathetic nervous system (SNS) and parasympathetic nervous system (PNS) responses to an acute physiological stressor. In addition, we conducted a preliminary examination into whether these effects varied by time of exposure and sex. One hundred and thity-nine individuals (mean age 15.12 years) were recruited from the ALSPAC (Avon Longitudinal Study of Parents and Children) birth cohort. Participants underwent the CO(2) stress test and indices of the PNS, SNS and HPA axis were measured. Pre-existing data on demographic and psychosocial factors of the mothers during pregnancy (18 and 32 weeks) and postnatally (8 weeks and 8 months) were extracted, as were participants' clinical and demographic data at birth. Increases in both pre- and postnatal anxiety and depression were associated with greater SNS reactivity to the stressor and slower recovery, as well as blunted HPA axis responses. Programming effects on the SNS appeared to be restricted to male offspring only. No consistent relationships were evident for any of the measures of pre-stress function. We have found preliminary evidence that both pre- and postnatal maternal anxiety and depression have sustained programming effects on the SNS and HPA axis. Effects on the SNS were restricted to male offspring.

Associations between dietary patterns at 6 and 15 months of age and sociodemographic factors.

BACKGROUND/OBJECTIVES: Data from the Avon Longitudinal Study of Parents and Children (ALSPAC) have previously shown that dietary patterns are observable by 3 years. However, it is not clear when dietary patterns emerge. We aimed to describe dietary patterns in early life and their associations with maternal and infant sociodemographic characteristics. SUBJECTS/METHODS: Principal component analysis was applied to diet questionnaires of ALSPAC participants at 6 months (n = 7052) and 15 months (n = 5610) to extract dietary patterns. The sociodemographic factors associated with dietary patterns were investigated using regression analyses. RESULTS: Four dietary patterns were extracted at both 6 and 15 months. A traditional-style pattern characterized by home-prepared meats, vegetables and desserts, a second pattern characterized by ready-prepared baby foods and a third pattern characterized by discretionary foods such as biscuits, sweets and crisps were identified at both ages. At 6 months, the fourth pattern was characterized predominantly by breastfeeding and at 15 months, by contemporary-style foods including herbs, legumes, nuts, raw fruit and vegetables. Higher maternal age and education, number of siblings and lower body mass index (BMI) was associated with higher scores on the breastfeeding or meat, vegetables and desserts patterns, whereas higher discretionary food pattern scores were associated with younger maternal age, lower education, higher BMI and more siblings. Associations between sociodemographic factors and the ready-prepared baby food pattern scores were inconsistent across ages. CONCLUSIONS: Dietary patterns emerge from infancy and are associated with sociodemographic characteristics.

A comparison of dietary patterns derived by cluster and principal components analysis in a UK cohort of children.

BACKGROUND/OBJECTIVES: The objective of this study was to identify dietary patterns in a cohort of 7-year-old children through cluster analysis, compare with patterns derived by principal components analysis (PCA), and investigate associations with sociodemographic variables. SUBJECTS/METHODS: The main caregivers in the Avon Longitudinal Study of Parents and Children (ALSPAC) recorded dietary intakes of their children (8279 subjects) using a 94-item food frequency questionnaire. Items were then collapsed into 57 food groups. Dietary patterns were identified using k-means cluster analysis and associations with sociodemographic variables examined using multinomial logistic regression. Clusters were compared with patterns previously derived using PCA. RESULTS: Three distinct clusters were derived: Processed (4177 subjects), associated with higher consumption of processed foods and white bread, Plant-based (2065 subjects), characterized by higher consumption of fruit, vegetables and non-white bread, and Traditional British (2037 subjects), associated with higher consumption of meat, vegetables and full-fat milk. Membership of the Processed cluster was positively associated with girls, younger mothers, snacking and older siblings. Membership of the Plant-based cluster was associated with higher educated mothers and vegetarians. The Traditional British cluster was associated with council housing and younger siblings. The three clusters were similar to the three dietary patterns obtained through PCA; each principal component score being higher on average in the corresponding cluster. CONCLUSIONS: Both cluster analysis and PCA identified three dietary patterns very similar both in the foods associated with them and sociodemographic characteristics. Both methods are useful for deriving meaningful dietary patterns.

Childhood diet and behavioural problems: results from the ALSPAC cohort.

OBJECTIVE: To investigate whether a 'junk food' diet at 81 months of age is associated with the development of behavioural problems over the following 16 months. SUBJECTS/METHODS: The study used data from the Avon Longitudinal Study of Parents and Children (ALSPAC) and 12,942 children were included. The main outcome measure was behavioural problems, measured using the Strengths and Difficulties Questionnaire (SDQ). SDQ scores were available at 81 and 97 months of age. Child-based dietary data were collected at 81 months by food frequency questionnaire; from this a 'junk food' score was derived, and mean weekly non-milk extrinsic sugar (NMES) intake estimated. Statistical analyses examined the associations between dietary exposures at 81 months and SDQ outcomes at 97 months. Children with SDQ scores suggesting behavioural problems at baseline were excluded in order to identify new cases. Adjustments were made for potential confounders such as socioeconomic status. RESULTS: Unadjusted analyses suggested associations between the 'junk food' score at 81 months and both total difficulties and pro-social behaviour at 97 months. However, adjustment for baseline SDQ scores attenuated these associations, with confidence intervals including the null for both total difficulties (OR (95% CI): 1.05 (0.92, 1.21); P=0.45) and pro-social behaviour (1.13 (1.00, 1.26); P=0.04). Adjustment for other potential confounders further attenuated the effects. Adjustment for confounders similarly attenuated modest associations between NMES intake and behavioural problems. CONCLUSIONS: There was no evidence to support an association between a 'junk food' diet at 81 months of age and behavioural problems after 16 months.