Commercial complementary food consumption is prospectively associated with added sugar intake in childhood.

Given that commercial complementary food (CF) can contain high levels of added sugar, a high consumption may predispose to a preference for sweet taste later in life. This study examined cross-sectional associations between commercial CF consumption and added sugar intake in infancy as well as its prospective relation to added sugar intake in pre-school and primary-school age children. In all, 288 children of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study with 3-d weighed dietary records at 0·5 and 0·75 (infancy), 3 and 4 (pre-school age) and 6 and 7 years of age (primary-school age) were included in this analysis. Individual commercial CF consumption as percentage of total commercial CF (%cCF) was averaged at 0·5 and 0·75 years. Individual total added sugar intake (g/d, energy percentage/d) was averaged for all three age groups. Multivariable logistic and linear regression models were used to analyse associations between %cCF and added sugar intake. In infancy, a higher %cCF was associated with odds for high added sugar intake from CF and for high total added sugar intake (>75th percentile, P<0·033). Prospectively, a higher %cCF was related to higher added sugar intake in both pre-school (P<0·041) and primary-school age children (P<0·039), although these associations were attenuated in models adjusting for added sugar intake in infancy. A higher %cCF in infancy may predispose to higher added sugar intake in later childhood by virtue of its added sugar content. Therefore, offering home-made CF or carefully chosen commercial CF without added sugar might be one strategy to reduce sugar intake in infancy and later on.

Age and time trends in the diet of young children: results of the DONALD study.

PURPOSE: To describe age and time trends of energy and macronutrient intake during infancy and toddlerhood and to set a special focus on dietary practices with respect to milk, complementary food, and family food intake. METHODS: Three-day dietary records (n = 2241) collected at 3, 6, 9, 12, 18, 24, and 36 months (480 subjects) between 2004 and 2013 from the ongoing open cohort DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) study were evaluated using repeated-measures regression analyses for trend analysis. RESULTS: Significant age trends were found for macronutrients with a decrease in fat intake (% of energy intake, %E) and an increase in carbohydrates (%E) and protein (%E). Exclusive and partial breastfeeding rates at 3 and 6 months did not differ between 2004 and 2008 and 2009 and 2013 (p > 0.05). Macronutrient pattern was virtually stable over time, whereas food group intake (% of total food intake excluding beverages, % TFI) changed significantly during the study period. Breast/bottle milk (% TFI) intake increased over time in the toddler subgroup, whereas family food (% TFI) decreased. CONCLUSIONS: Our data demonstrate a period of stagnation in the last 10 years with respect to breastfeeding duration in infancy. Further breastfeeding promotion in Germany is needed to continue the favourable progress of the previous decades. In toddlerhood, breast/bottle milk remains a substantial part of the diet and has increased during the last 10 years. Parents should be encouraged to implement healthy eating habits during early toddlerhood and to facilitate their child's participation in appropriate family meals.

Factors associated with longitudinal food record compliance in a paediatric cohort study.

OBJECTIVE: Non-compliance with food record submission can induce bias in nutritional epidemiological analysis and make it difficult to draw inference from study findings. We examined the impact of demographic, lifestyle and psychosocial factors on such non-compliance during the first 3 years of participation in a multidisciplinary prospective paediatric study. DESIGN: The Environmental Determinants of Diabetes in the Young (TEDDY) study collects a 3 d food record quarterly during the first year of life and semi-annually thereafter. High compliance with food record completion was defined as the participating families submitting one or more days of food record at every scheduled clinic visit. SETTING: Three centres in the USA (Colorado, Georgia/Florida and Washington) and three in Europe (Finland, Germany and Sweden). SUBJECTS: Families who finished the first 3 years of TEDDY participation (n 8096). RESULTS: High compliance was associated with having a single child, older maternal age, higher maternal education and father responding to study questionnaires. Families showing poor compliance were more likely to be living far from the study centres, from ethnic minority groups, living in a crowded household and not attending clinic visits regularly. Postpartum depression, maternal smoking behaviour and mother working outside the home were also independently associated with poor compliance. CONCLUSIONS: These findings identified specific groups for targeted strategies to encourage completion of food records, thereby reducing potential bias in multidisciplinary collaborative research.

Food neophobia in German adolescents: Determinants and association with dietary habits.

Food neophobia (FN) is described as the rejection to eat unknown foods. Because only little is known about the role of FN in adolescence the aim of this study was to examine potential determinants of FN and associations with dietary habits of DONALD study participants. FN was measured with Pliner's and Hobden's Food Neophobia Scale (FN Score (FNS): range 10-70) in 166 10-18-year-old adolescents. Participants' age, sex, body weight status and duration of breast-feeding as well as parents' FN and educational status were considered as determinants. Energy intake, distribution of macronutrients and two variety scores were calculated from 3-day weighed dietary records. Multivariable general linear models were performed for data analyses. Boys and girls did not differ in their FNS (median (Min-Max): boys 31 (10-58), girls 32 (14-59)). Increasing age (p = 0.010) and duration of total breast-feeding (p = 0.006) were associated with decreasing FNS in girls only. FN was further positively associated with parental FN in the total sample (p = 0.004). FN was negatively associated with protein intake in the total sample (p = 0.017). The overall low level of FN in the DONALD study can be ascribed to the low level of FN in adolescence in general. Congruently with other studies, age and breast-feeding duration were identified as determinants of girls' FN and parental FN was identified as determinant of FN in the total sample. Further, our results indicate that FN leads to reduced protein intakes. Dietary variety was not strongly affected, possibly because of a broad variety of food supply in Germany.

Associations between commercial complementary food consumption and fruit and vegetable intake in children. Results of the DONALD study.

OBJECTIVES: Fruit and vegetable (FV) consumption is influenced by individual taste and food preferences that are developed early in life. Thus, the sensory properties of foods given during complementary feeding may shape later food acceptance and dietary intake. However, those experiences differ with respect to the preparation method of complementary food (CF), that is, homemade and commercial CF. The aim of this study therefore was to examine the association between the infant's consumption of commercial CF and FV intake and variety during infancy, preschool and school age. METHODS: In total, 281 children of the DONALD Study with 3-day weighed dietary records at 0.5 and 0.75 (infancy), 3 and 4 (preschool age), 6 and 7 years of age (school age) were included in this analysis. Percentage of commercial CF (%cCF) was averaged at 0.5 and 0.75 years. Individual FV intake (g/day) and FV variety scores were calculated and averaged separately for all three age groups. Multivariate linear regression was used to analyse associations between %cCF and FV intake and variety. Models were adjusted for early life and socioeconomic factors. RESULTS: For boys, higher %cCF was associated with lower vegetable intake in infancy (p < 0.0001) and preschool age (p = 0.036) as well as lower total FV intake in preschool and school age (p < 0.009). For girls, higher %cCF was associated with lower vegetable intake (p < 0.0001) in infancy. FV variety scores showed no clear associations with %cCF in girls and boys. CONCLUSION: The results of the DONALD Study suggest that the preparation method of CF is associated with FV consumption in infancy and at least for boys also in preschool and school age.

Breast-feeding and weaning practices in the DONALD study: age and time trends.

OBJECTIVES: Besides influencing short- and long-term health status, infant feeding practices are known to have an effect on later food preferences. This study aimed to identify present trends in breast-feeding duration and weaning practices with special focus on preparation methods of complementary food (CF), that is, homemade and commercial CF. METHODS: In total, 1419 three-day weighed diet records collected between 2004 and 2012 from 366 children of the German DOrtmund Nutritional and Anthropometric Longitudinally Designed study ages 6 to 24 months were analysed. Full (n = 339) and total breast-feeding duration (n = 344) was collected by questionnaire. To investigate age and time trends, logistic regression and polynomial mixed regression models were used. RESULTS: Infants born between 2008 and 2012 were 3.3-fold less likely to be fully breast-fed for ≥4 months than those born before 2004 (P < 0.0001). Overall, 59.3% commercial, 21.1% homemade, and 19.6% combined CF was consumed by the study sample. Subjects with high commercial CF consumption (percentage of commercial CF > median 62%) were significantly older (P < 0.0001), showed shorter full and total breast-feeding duration (P < 0.0001), and were more likely to have mothers with a lower educational status (P = 0.01). Both commercial and homemade CF showed opposing, nonlinear age trends. No time trends could be found. CONCLUSIONS: Decreasing duration of full breast-feeding should encourage health care providers to further promote longer breast-feeding duration. With the constantly high consumption of commercial CF at all ages, nutritional adequacy of both homemade and commercial CF needs to be investigated closer, as does their long-term influence on health and dietary habits, for example, fruit and vegetable intake.

Food variety in commercial and homemade complementary meals for infants in Germany. Market survey and dietary practice.

INTRODUCTION: Already infants do not meet the recommendations for fruit and vegetable intake although the complementary feeding period offers the possibility to expose the infant to a variety of flavours from fruits and vegetables. The objective of the present analysis was to identify differences in the vegetable variety in commercial vs. homemade complementary meals and to describe fish and meat variety in these meals in dietary practice in Germany. A further objective was to provide an overview of the food variety in commercial complementary vegetable-potato-meat/fish meals available on the German baby food market in 2012. METHODS: 3-day weighed dietary records from the German DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study were used to describe the fish and meat variety and to compare the vegetable variety in commercial and homemade meals using a vegetable variety score (VegVS). The online data base 'Nutrichild' served to describe the food variety on the market. RESULTS AND CONCLUSION: The vegetable variety was low in homemade as well as in commercial meals without any differences in total variety at 6 and 9months of age. At 12months of age infants fed with commercial meals got a higher vegetable variety than those fed with homemade meals. In homemade and commercial meals most often carrot was used, whereas other vegetables were far below this frequency. In both meals, poultry and beef were most often used whereas fish meals were rarely offered. The market survey showed the same low vegetable variety and low fish offer as the results of the DONALD study. The data show that it is necessary to promote the advantages of a vegetable variety and fish consumption in Germany, already in early infancy.

Dietary intake of soluble fiber and risk of islet autoimmunity by 5 y of age: results from the TEDDY study.

BACKGROUND: Deficient soluble fiber intake has been suggested to dysregulate the immune response either directly or through alterations of the microbial composition in the gut. OBJECTIVE: We hypothesized that a high intake of dietary soluble fiber in early childhood decreases the risk of type 1 diabetes (T1D)-associated islet autoimmunity. DESIGN: We analyzed 17,620 food records collected between age 9 and 48 mo from 3358 children from the United States and Germany prospectively followed in the TEDDY (The Environmental Determinants of Diabetes in the Young) study. HRs for the development of any/multiple islet autoantibodies (242 and 151 events, respectively) and T1D (71 events) by soluble fiber intake were calculated in Cox regression models and adjusted for potential confounders. RESULTS: There were no statistically significantly protective associations observed between a high intake of soluble fiber and islet autoimmunity or T1D. For example, the adjusted HRs (95% CIs) for high intake (highest compared with lowest quintile) at age 12 mo were 0.90 (0.55, 1.45) for any islet autoantibody, 1.20 (0.69, 2.11) for multiple islet autoantibodies, and 1.24 (0.57, 2.70) for T1D. In analyzing soluble fiber intake as a time-varying covariate, there were also no short-term associations between soluble fiber intake and islet autoimmunity development, with adjusted HRs of 0.85 (0.51, 1.42) for high intake and development of any islet autoantibody, for example. CONCLUSION: These results indicate that the intake level of dietary soluble fiber is not associated with islet autoimmunity or T1D in early life.