Association between glucose dips and the feeling of hunger in a dietary intervention study among students with early and late chronotype-secondary analysis of a randomized cross-over nutrition trial.

Consumption of foods with high glycaemic index (GI) can cause hyperglycemia, thus increasing postprandial hunger. Since circadian rhythm differs inter-individually, we describe glucose dips after breakfast/dinner with high/medium estimated meal GI among students with early (n = 22) and late chronotype (n = 23) and examine their relation to the feeling of hunger in a secondary analysis of a randomized cross-over nutrition trial. Glucose dips reflect the difference between the lowest glucose value recorded 2-3 h postprandially and baseline, presented as percentage of average baseline level. Associations between glucose dips and the feeling of hunger were analyzed using multilevel linear models. Glucose dips were lower after medium GI meals than after high GI meals among both chronotype groups (p = 0.03). Among early chronotypes, but not among late chronotypes, glucose dip values were lower after breakfast than after dinner (-4.9 % vs. 5.5 %, p = 0.001). Hunger increased throughout the day among both chronotypes but glucose dips were not related to the feeling of hunger at the meal following breakfast. Interestingly, lower glucose dip values 2-3 h postprandially occurred particularly after medium GI meals and were seen after breakfast among early chronotypes. These glucose dips did not predict hunger at meals after breakfast.

Associations of chronotype and social jetlag with eating jetlag and their changes among German students during the first COVID-19 lockdown. The Chronotype and Nutrition study.

Due to their biologically later chronotype, young students are vulnerable to a discrepant sleeping pattern between work- and free days, coined social jetlag (SJL). This study examined whether a later chronotype and/or a larger SJL are related to an analogous discrepancy in meal timing defined as eating jetlag (EJL) and whether chronotype and/or changes in SJL during the first COVID-19 related lockdown in Germany associated with changes in EJL. Baseline data were collected from September 2019-January 2020 among 317 students (58% females) aged 18-25 years of which a total of 156 students (67% females) completed an online follow-up survey in June-July 2020 (1st lockdown). Data were collected on daily routines, timing of meals/snacks, and physical activity. Chronotype was determined using the Munich ChronoType Questionnaire; SJL and EJL correspond to the difference in the daily midpoint of sleep/eating duration between work- and free days. Multivariable linear regression revealed that students with a later chronotype or a larger SJL experienced a larger EJL (padjusted = 0.0124 and padjusted<0.0001). A later chronotype at baseline and reductions in SJL during lockdown associated with concurrent reductions in EJL (padjusted = 0.027 and padjusted<0.0001). In conclusion, students with a later chronotype exhibit a more erratic meal pattern, which associates with SJL. During lockdown, flexible daily schedules allowed students to align the meal timing with their inner clock.

Vegetarian diets in children: a systematic review.

PURPOSE: While the prevalence of children on vegetarian diets is assumed to be on the rise in industrialized countries, there are hardly any representative data available. In general, vegetarian diets are presumed to be healthy; nevertheless, there are concerns as to whether the dietary specifications required during infancy, childhood, and adolescence can be met. Therefore, the objective of this systematic review was to evaluate studies on the dietary intake and the nutritional or health status of vegetarian infants, children, and adolescents. METHODS: The database MEDLINE was used for literature search. In addition, references of reviews and expert opinions were considered. Inclusion criteria were (1) sufficient dietary information to define vegetarian type diet and (2) characteristics of nutritional or health status. Case reports and studies from non-industrialized countries were excluded. RESULTS: 24 publications from 16 studies published from 1988 to 2013 met our criteria. Study samples covered the age range from 0 to 18 years, and median sample size was 35. Five studies did not include a control group. With regard to biomarkers, anthropometry, and dietary or nutritional intake, the outcomes were diverse. Growth and body weight were generally found within the lower reference range. The intakes of folate, vitamin C, and dietary fiber were relatively high compared to reference values and/or control groups. Low status of vitamin B12 was reported in one study and low status of vitamin D in two studies. CONCLUSIONS: Due to the study heterogeneity, the small samples, the bias towards upper social classes, and the scarcity of recent studies, the existing data do not allow us to draw firm conclusions on health benefits or risks of present-day vegetarian type diets on the nutritional or health status of children and adolescents in industrialized countries.

Home-made and commercial complementary meals in German infants: results of the DONALD study.

BACKGROUND: Infant complementary food can be home-made or bought as ready-to-eat commercial products. The nutrient composition of commercial products is regularised in a European Commission guideline, whereas the preparation of home-made complementary meals is the responsibility of caregivers. In the present study, the composition of commercial and home-made complementary meals as eaten by healthy German infants was compared. METHODS: Of 8226 complementary meals (74% commercial and 26% home-made) recorded in 1083, 3-day weighed dietary records from 396 participants (6-12 months old) of the German DONALD (DOrtmund Nutritional and Anthropometric Longitudinally Designed) study were analysed. RESULTS: Median energy density (kcal 100 g(-1)) was highest in commercial and home-made cereal-milk meals (89 kcal 100 g(-1)). In home-made savoury and cereal-fruit meals, the energy density was significantly higher compared to their commercial counterparts. Median protein contents were highest in savoury and cereal-milk meals (>2.5 g 100 g(-1)) and dairy-fruit meals (2-4 g 100 g(-1)). Added sugars were found in less than a quarter of meals. Highest median sodium contents were found not only in commercial savoury meals (median 38 mg 100 g(-1)) and vegetable meals (32 mg 100 g(-1)), but also in home-made cereal-milk meals (36 mg 100 g(-1)). Both median fat and iron contents were higher in home-made meals compared to commercial savoury and cereal-fruit meals. CONCLUSIONS: With the exception of the higher sodium content in commercial savoury meals for older infants, the lower fat content in commercial savoury and cereal-fruit meals, and the added sugar content in some commercial dairy-fruit meals, a comparison of commercial and home-made complementary meals did not reveal any serious inadequacy.

Lunch habits of German children and adolescents: composition and dietary quality.

BACKGROUND/AIMS: Data from the ongoing, open-cohort Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study were used to describe warm family lunch meals and the association of the lunch composition with total diet quality. METHODS: 2,095 three-day weighed dietary records, collected between 2004 and 2009, from a 4- to 18-year-old DONALD study subgroup were used. RESULTS: Warm lunch (eating occasions between 11.30 a.m. and 2.29 p.m. including at least one course that is typically consumed warm) was eaten on 68.8% of all record days. Meat lunch (>50%) was predominant, followed by vegetarian (25%), fish (13%) and sweet lunch meals (3%). The prevalence of desserts at lunch was high and beverages were drunk at 80% of lunch meals. A meat lunch was associated with a higher protein (+1.4% energy intake, %E) and fat intake (+1.7%E) than a sweet lunch; also densities of vitamin A, folate and iron were higher. A dessert at lunch decreased protein intake slightly (-0.2%E), but increased carbohydrate (+0.7%E) and added sugar intake (+1.4%E) as well as density of calcium (+18 mg/MJ). CONCLUSION: Our study proves the impact of lunch on daily dietary quality and yields valuable insights on the development of food and meal-based dietary guidelines.

[The DONALD cohort. An updated overview on 25 years of research based on the Dortmund Nutritional and Anthropometric Longitudinally Designed study]. / Die DONALD Kohorte. Ein aktueller Überblick zu 25 Jahren Forschung im Rahmen der Dortmund Nutritional and Anthropometric Longitudinally Designed Study.

The DONALD study has been conducted in Dortmund, Germany since 1985 to examine the complex relations between nutritional intake, metabolism and growth from infancy to adulthood. Every year, approximately 40 infants are newly recruited into the open cohort study. Examinations conducted at ages 3, 6, 9, 12, 18, 24 months and then annually until young adulthood, comprise anthropometry, a 3 day weighed dietary record, a 24 h urine sample (from age 3-4 years onwards), medical examinations and parental interviews. Since 2005, participants are invited for follow-up visits during adulthood (including fasting blood samples). Approximately 1,400 children have been recruited into the study up to 2010. Recent findings revealed e.g. (i) the relevance of early life factors for subsequent development of body composition and puberty timing, (ii) the relation between pubertal hormonal status and puberty onset, (iii) age and time trends in iodine status and modern dietary habits and (iv) potential furan and benzol exposition by commercial weaning foods. Future analyses will provide insight into the extent to which health in young adulthood is receptive to diet, anthropometric pattern and hormonal status in distinct potentially critical periods during childhood.

Breastfeeding trends in healthy infants since 1990-results of the DONALD study.

Exclusive breastfeeding is recommended for infants during the first 6 months of life. The aim of this analysis was to examine time trends in breastfeeding between 1990 and 2013 in Germany using data from the DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) Study. Although partial breastfeeding was observed to constantly increase over time in both 3-month and 6-month-old infants, fully breastfeeding rates did not further increase in 3-month-old infants since 2002, and even showed a tendency to decrease in 6-month-old infants. In conclusion, this finding emphasises the need for improvements in breastfeeding promotion in Germany, which currently seems to be ineffective in case of continuation of full breastfeeding until the age of 6 months.

Evaluation of dietary fibre intake from infancy to adolescence against various references--results of the DONALD Study.

OBJECTIVE: To evaluate dietary fibre intake from infancy to adolescence against various reference standards expressed on a body weight, age or energy intake (EI) basis and to describe age and 15-year time trends. DESIGN AND SUBJECTS: The ongoing longitudinal (open cohort) Dortmund Nutritional and Anthropometric Longitudinally Designed Study with a total of 7810 3-day dietary records from 980 infants, children and adolescents aged 6 months to 18 years collected between 1990 and 2004. RESULTS: Absolute dietary fibre intakes (g/day) increased with age from infancy to adolescence; dietary fibre density (g/1000 kcal) reached a maximum at 1 year and remained constant after the transition to the family diet. Expressed as g/kg body weight, dietary fibre intake increased during infancy with a maximum at 1 year, but decreased thereafter during childhood and adolescence. Dietary fibre intake was low irrespective of the reference used and showed no time trends, with the exception of a small negative trend in 4-8-year olds and 9-13-year-old girls. CONCLUSION: As intake of dietary fibre in our sample was significantly associated with EI and fibre density remained constant after infancy, our data support an energy-based approach for establishing a reference value for children and adolescents.

Time trends in the consumption of dairy foods in German children and adolescents.

OBJECTIVE: Examination of time trends in the consumption of dairy food and their impact on fat and calcium intakes in German children and adolescents. DESIGN: Dietary records from the DONALD Study (DOrtmund Nutritional and Anthropometric Longitudinally Designed Study). METHODS: A total of 5068 3-day weighed dietary records from 914 1 to 13-y-old children and adolescents collected between 1986 and 2001 were analysed using a mixed linear model, in which the means of the data and the covariance structure specific to the DONALD Study were modelled. RESULTS: During the study period, the consumption of 'milk products' in children and adolescents >/=4 y remained stable, since the reduced consumption of 'fluid milk' (between -2.8 and -7.4 g/day/study year) was compensated for by an increased consumption of 'yoghurt' (between +2.4 and +3.3 g/day/study year). The consumption of 'cheese' increased in subjects >/=4 y (between +0.2 and +0.7 g/day/study year). In 1 to 3-y-old children, the decreased intake of 'fluid milk' (-6.5 g/day/study year) was not compensated for by the increased intake of 'formula' (+3.5 g/day/study year). The percentage of 'low-fat milk products' significantly increased (although not significant in 9-13-y-old boys) to nearly 25% of milk products. The impact of dairy food on fat intake (as percentage of energy intake) remained stable with the exception of a slight reduction in 4-8 y olds, the impact of dairy on calcium (as percentage of US adequate intake) decreased only in 1-3 y olds. CONCLUSIONS: The consumption of dairy food remained widely stable over time in >/=4-y-old children and adolescents, but decreased in 1-3 y olds. A further decline in this age group would be undesirable as is the shift from common milk to formula. The intake of 'low-fat milk products' increased and should be continuously promoted.

Ten-year trends in vitamin and mineral intake from fortified food in German children and adolescents.

OBJECTIVE: We investigated time trends in consumption patterns, and energy and nutrient intakes (protein, fat, carbohydrates, added sugars, vitamins A, E, C, B1, B2 and B6, niacin, folate, calcium and iron) from fortified food in children and adolescents between 1987 and 1996 in Germany. DESIGN: Mixed longitudinal survey (DONALD study) with 3 d weighed dietary records (n=2062 from 594 subjects), one subject per family per year chosen by random. SETTING: Dortmund (Western Germany) district cohort. SUBJECTS: 285 males, 309 females; mean age 6 y (2-13 y). RESULTS: Almost all children and adolescents consumed fortified food irrespective of the year studied. With the exception of vitamin E, significant time trends in the proportions of nutrient intakes from fortification were observed. The fortification of food with vitamins A, C, B1, B2 and B6 and niacin raised the already adequate intakes from non-fortified food (100% to 150% of reference intake values) by 20-50%. The fortification of food with vitamin E and folate raised the low intakes from non-fortified food (about 50% of reference intake values) to about 80% (folate) and 100% (vitamin E) of the references. Fortification of food with calcium and iron was not significant (<10%), but while total intake of calcium was adequate, total intake of iron remained critical. CONCLUSIONS: Since the nutrient intake of the population of children and adolescents studied is adequate with respect to vitamins A, C, B1, B2 and B6, niacin and calcium, fortification seems inefficient, while fortification of food with vitamin E and folate, but not iron, improves an inadequate intake. SPONSORSHIP: The DONALD study is supported by the German Federal Ministry of Health and the North-Rhine-Westphalian Ministry of Science and Research. European Journal of Clinical Nutrition (2000) 54, 81-86

Vitamin intake of 1- to 18-year-old German children and adolescents in the light of various recommendations.

Data on the vitamin intake during childhood and adolescence are rare in Europe. Here, age and sex specific percentiles of the absolute intakes and relative densities (per MJ) of retinol, carotenoids, vitamins A, E, C, B1, B2, B6, niacin and folate in a sample of 627 subjects between the age of 1 and 18 years are reported and compared to the actual recommendations from Germany, the EC and the USA. The evaluation of the intakes clearly depends on the reference value chosen. In total, the vitamin intake can be assessed to range between satisfactory and generous with the exception of folate which ranged consistently below the references.

Vitamin intake of 3- to 36-month-old German infants and children--results of the DONALD-Study.

Infants and young children are a vulnerable group with regard to nutrition. However, there is a lack of information about the dietary composition of healthy German infants and children. Therefore, the intake of vitamins (A, C, E, B1, B2, B6, folate, niacin) was assessed in 354 healthy German infants and children aged 3 to 36 months from 3-day-weighed diet records and compared with German, European and US reference values. Intake of all B-vitamins (B1, B2, B6, folate, niacin) increased during the first 3 years of life, whereas intake of vitamin E decreased. Intake of vitamin A and C varied between age groups. The highest levels of the nutrient densities of most vitamins were found at the end of the first year of life. Depending on the reference values chosen, the vitamin supply of the study population ranged between sufficient and very good. The reported satisfactory intake of vitamins in infants and young children in this study gives rise to the question of whether the current extent of fortification of commercial infant food in Germany is necessary.

Diet quality and diet costs in German children and adolescents.

We examined the association between diet costs and diet quality in a sample of children and adolescents using data from the ongoing longitudinal (open cohort) DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) study. Children and adolescents aged 4-18 years (255 boys and 239 girls) provided 1100 yearly collected 3-day weighted dietary records. Linear mixed (effects) models were used to analyze the association between diet costs ([euro ;[sol;day, estimated using retail food prices) and the Nutrient Quality Index (NQI) and the Healthy Nutrition Score for Kids and Youth (HuSKY). Analysis were stratified for low-quality records (scoremedian). No significant association was found in the low-quality records, whereas in the high-quality records the association was significantly positive for both scores (HuSKY P=0.016, NQI P<0.0001). In conclusion, a substantial part of our sample could increase their diet quality without a noteworthy increase of expenditure.

Development of an estimated food record for 9-36-month-old toddlers.

OBJECTIVES: Adequacy of dietary intake in the sensitive period of toddler development is a key determinant of health in a short- and long-term perspective. Therefore, studies focussing the nutrition of toddlers are of importance. For this purpose, tailored dietary record methods are an important prerequisite. The objective of this work is to develop a toddler-specific estimated food record (EFR) in a booklet providing photographs of age-specific foods and portion sizes that should be accurate and simple. SUBJECTS/METHODS: For a toddler study in Germany, a 7-day consecutive EFR was developed. Data were obtained from a sample of toddlers in Germany. The basis is an evaluation of 3-day weighing food records on food choice and portion size of the DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) study for 227 toddlers (118 boys) aged 9-36 months from January 2004 to March 2008. RESULTS: In the analysed food records, a total of 15.147 eating occasions with 24.820 dishes were reported and grouped in 17 food groups. To estimate the portion size, the median consumption amounts of the 194 most frequently consumed dishes were calculated and photographed. Formula and commercial complementary food are collected separately. EFR was structured into seven eating occasions of the day: before breakfast, breakfast, mid-morning, lunch, mid-afternoon, dinner, and before bed. CONCLUSIONS: The EFR booklet provides a simple, feasible and validated instrument that can be used to update information on dietary habits during the transition from infant to childhood diet for families in different social classes.

Diet costs and energy density in the diet of German children and adolescents.

This study examined the association between energy density (ED, g/kJ) and diet costs (\[euro]/day) in a sample of 494 German children and adolescents aged 4-18 years using 1100 3-day-weighed dietary records from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study (open cohort study) and retail food prices of 341 empirically selected recorded food items including special brands. ED was negatively associated with diet costs (ß=-0.20 kJ/g, P<0.0007) with a non-linear term (ß=0.01 kJ/g*kJ/g, P=0.0440). Diet costs increased with age (ß=0.32 yr, P<0.0001) with a negative non-linear term (ß=-0.01 yr*yr; P<0.0001). In conclusion, the inverse association between diet costs and ED was more pronounced in the older than in the younger age groups and in low-ED diets than in high-ED diets. Higher % diet costs of fruit/vegetables could be compensated by lower % diet costs of meat/sausage to lower ED without increasing diet costs.

Analysis and risk assessment of furan in coffee products targeted to adolescents.

The aim of this work was to analyse the furan concentrations in coffee products targeted to adolescents and to estimate the health risk for those consumers by using the consumption data of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study (DONALD). Three different kinds of coffee beverages were analysed: 'coffee ready to drink' (i.e. industrially manufactured and packaged products available in cans or plastic cups), 'coffee instant' (i.e. soluble coffee in powder form) and 'coffee from coffee chains' (i.e. freshly prepared coffee sampled on-site). Furan was analysed according to the US Food and Drug Administration (USFDA) method using headspace-GC-MS and quantification with standard addition. The lowest furan concentrations were found within the category 'coffee instant', with an average of 4.6 µg kg(-1), followed by the category 'coffee ready to drink', with an average of 41.3 µg kg(-1), while the products from the coffee chains showed the highest concentrations, on average 100.5 µg kg(-1). According to the obtained furan contents, it seems that the highest furan exposure for adolescents is generally given in the consumption of products within the category 'coffee from coffee chains', while the lowest is given in the category 'coffee instant'. Risk assessment based on the margin of exposure (MOE) approach showed that in different consumption scenarios except for consumers of instant coffee, the MOE lay below 10,000, a range that is judged to be of public health relevance. The lowest MOE was found for consumers in the age group 10-12 years (especially females) and for both sexes in the age group 16-18 years.

Convenience foods in children's diet and association with dietary quality and body weight status.

BACKGROUND: Pre-prepared commercial foods (convenience foods, CFs) are one aspect of modern dietary habits. The present paper examines the association between CF consumption and dietary quality or body weight status in a sample of German children and adolescents. METHODS: Linear mixed-effect regression analyses using data from 586 participants (296 boys, 3-18 years) in the Dortmund Nutritional Anthropometric Longitudinally Designed Study, who yearly completed 1890 3-day dietary records and anthropometric measurements in 2004-2008, was used. RESULTS: CF intake (percent total food intake) showed no significant association with macronutrient intakes (%E), with exception of a significant positive association with polyunsaturated fatty acid (PUFA) intake (P<0.0001). Considering only high-energy-dense (ED)-CF (40% of the CF intake), there was a significant negative association with total protein, carbohydrate and saturated fatty acid intake (%E) (P<0.05), and a positive with total fat and PUFA (P<0.01). The nutrient quality index (harmonic mean of 10 vitamins and minerals as the percentage of the reference intakes) showed a significant negative trend with increased consumption of CF (P=0.0013). No significant association between baseline or change in consumption of CF and baseline or change in parameters of body weight (standard deviation score of body mass index (weight/height(2)) or percentage body fat (%BF) estimated from skinfolds) was found. Among boys, baseline consumption of high-ED-CF significantly predicted change in %BF during the study period (ß 0.104, P=0.0098). CONCLUSIONS: Our results point to an impairment of dietary quality with high consumption of CF and to a small but positive association between consumption of high-ED-CF in boys and weight.

Whole grain in children's diet: intake, food sources and trends.

OBJECTIVE: To quantify the intake of grain and whole grain, and their food sources, as well as to investigate the age and time trends over the last decade in a sample of German children and adolescents. METHODS: Dietary records from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study were used for conducting this work. A total of 5067 3-day weighed dietary records of 821 2- to 18-year-old children and adolescents collected between 1997 and 2008 were analysed using linear mixed-effect models, in which the means of the data and the covariance structure (children of the family, repeated measurements) were modelled. RESULTS: Mean whole-grain intake was between 20 and 33 g/day in the sample and highest in 13-18 year olds. No whole grain intake was recorded in 19% of all dietary records. Total grain intake increased significantly with age (P<0.0001), even after adjustment for energy intake. Whole-grain intake (g/day) increased significantly with age in the unadjusted model (P<0.0001). This increase disappeared after adjustment for energy intake (P>0.05) and became a negative trend after adjustment for grain intake (P<0.01). There were no significant time trends during the study period. Bread had the highest effect on grain intake in the total sample (50%), followed by rice/pasta (21%), cake (13%), grain (9%), RTECs (5%) and muesli (2%). CONCLUSIONS: The whole-grain intake in this sample of German children and adolescents was far below the FBDG. The decreasing percentage of whole grain per grain intake with age contradicts the common concept of stable dietary habits during childhood and adolescents.

PUFA and LC-PUFA intake during the first year of life: can dietary practice achieve a guideline diet?

BACKGROUND: An appropriate supply of n-3 long-chain polyunsaturated fatty acids (LC-PUFAs) during early childhood may enhance cognitive development. Little attention is paid to the fatty acid (FA) supply during the complementary feeding period. We examined the polyunsaturated fatty acids (PUFAs) and LC-PUFAs pattern in dietary practice of two study groups and evaluated the results against the present Dietary Guidelines in Germany. METHODS: The food consumption and FA pattern of dietary practice in subjects from two prospective studies (n=102 and n=184, respectively) at the age of 3, 6 and 9 months was assessed by weighed diet records, and changes during the first year of life were compared with the food-based dietary guidelines for the first year of life. RESULTS: Dietary practice in the complementary feeding period was clearly dominated by commercial food products. The FA composition in dietary practice was different from the Guideline Diet and the ratio of n-6/n-3 PUFAs was less favorable. Consumption of breast milk or formula was still of major importance for the intake of LC-PUFAs in the complementary feeding period. CONCLUSION: LC-PUFAs are predominantly provided by breast milk and formula during the first year of life and consequently decrease when milk consumption decreases. For compensation, commercial complementary food might come closer to the Guideline Diet by lowering the n-6/n-3 PUFA ratio through appropriate vegetable oil along with an increase in total fat content up to the legal limit.