Maternal food consumption during pregnancy and risk of advanced ß-cell autoimmunity in the offspring.

BACKGROUND: Evidence for a putative role of maternal diet during pregnancy in the development of ß-cell autoimmunity in the child is scarce. The authors study the association of food consumption during pregnancy and the development of ß-cell autoimmunity in the offspring. SUBJECTS AND METHODS: A prospective Finnish birth cohort of 4297 infants with human leukocyte antigen (HLA)-DQB1-conferred susceptibility to type 1 diabetes and their mothers. Blood samples were collected from the children at 3-12 months intervals to measure type 1 diabetes-associated antibodies: antibodies against islet cells (ICA), insulin, glutamate dehydroxylase, and islet antigen 2. The mothers completed a validated food frequency questionnaire. The end-point was repeated positivity for ICA together with at least one of the other three antibodies. Piecewise-exponential survival models were used. The effective sample size was 3723, with 138 end-points. The median follow-up time was 4.4 years. RESULTS: Maternal consumption of butter, low-fat margarines, berries, and coffee were inversely associated with the development of advanced ß-cell autoimmunity in the offspring, adjusted for genetic risk group and familial diabetes. These associations for low-fat margarines (use vs. non-use HR 0.60, 95% CI: 0.38-0.93, p = 0.02), berries (continuous variable HR 0.90, 95% CI: 0.83-0.98, p = 0.02) and coffee (highest quarter vs. lowest HR 0.62, 95% CI: 0.40-0.97, p = 0.04), remained significant when adjusting for potential confounding sociodemographic, perinatal, and other dietary factors. CONCLUSIONS: In this study assessing total food consumption of the mother during pregnancy, only few among the 27 food groups tested were weakly related to the development of advanced ß-cell autoimmunity in Finnish children.

Maternal intake of vitamin D during pregnancy and risk of advanced beta cell autoimmunity and type 1 diabetes in offspring.

AIMS/HYPOTHESIS: We evaluated the intake of vitamin D by pregnant Finnish women and examined associations between maternal intake of vitamin D and the development of advanced beta cell autoimmunity and type 1 diabetes in their offspring. METHODS: The research was carried out within the Diabetes Prediction and Prevention study (DIPP), which is a population-based birth cohort of infants at genetic risk of type 1 diabetes. Mothers of 3,723 infants born between 1997 and 2002 completed a validated 181-item food frequency questionnaire, which included questions on dietary supplements. The offspring were observed at 3 to 12 month intervals for the appearance of autoantibodies associated with type 1 diabetes and for the development of clinical type 1 diabetes. RESULTS: Maternal mean daily intake of vitamin D was 5.1 microg from food and 1.3 microg from supplements. The maternal intake of vitamin D, either from food or from supplements, was not associated with the risk of advanced beta cell autoimmunity/type 1 diabetes in offspring (HR [95% CI] for intake of vitamin D from food 1.25 [0.80-1.95], for vitamin D intake from supplements 1.05 [0.95-1.16]), or with the risk of type 1 diabetes alone (HR [95% CI] for intake of vitamin D from food 0.84 [0.41-1.72], for vitamin D intake from supplements 1.09 [0.99-1.20]). CONCLUSIONS/INTERPRETATION: Maternal intake of vitamin D either from food or supplements during pregnancy is not associated with advanced beta cell autoimmunity/type 1 diabetes or with type 1 diabetes alone in Finnish offspring carrying increased genetic susceptibility to type 1 diabetes.

Accuracy in the estimation of food servings against the portions in food photographs.

OBJECTIVE: In diet surveys, quantitative underestimation of food consumption may be due to intentional misreporting or false portion-size reporting. Perception of food photographs used as aids for assessing the actual amounts may have an effect. This study was carried out to assess the validity of food photographs. DESIGN: A real-time test protocol where 52 presented food servings were compared against photographed portions with similar food items. SUBJECTS: Volunteers from the Rehabilitation Company Petrea (in Turku) were recruited, 161 adults participated, and for 146 subjects, complete data were collected. METHODS: The proportions of correct estimations and reporting errors, in weights and percentages, are presented by gender and food group. Food descriptors, portion-size options and subject characteristics were studied as potential determinants of accuracy in portion-size estimation. RESULTS: The total proportion of exactly correct estimations was 51% in men and 49% in women. The overall reporting error was -10 g in men and +1 g in women for the 52 food servings. Underreporting was typical for bread, spread and cold cuts and dishes in both genders. Over-reporting was typical for cereals in both genders and for snacks, vegetables and fruit in women. The estimation error was associated with the portion-size options but not associated with the energy density of food items, education or body mass index. CONCLUSIONS: Food portions in photographs seem to be a useful aid for the quantification of most food items. However, validation studies are needed to test the applicability of photographs for estimating current portions and for searching better tools in dietary surveys.

Snacks as an element of energy intake and food consumption.

BACKGROUND: An increasing frequency of snacks has been observed in meal pattern studies. Snacks can alter the diet because of their high-energy density and low-nutrient content or on the contrary. OBJECTIVE: The prominence of snacks in energy intake and food consumption was assessed. DESIGN: Dietary data were collected for 2007 adults by using a computer-assisted 48-h dietary recall in the national FINDIET 2002 survey. Energy intakes and food consumption were aggregated for snacks and for main meals. RESULTS: Daily energy was mostly derived from main meals comprising traditional mixed dishes, milk and bread. However, a snack-dominating meal pattern was observed in 19% of men and 24% of women. This meal pattern was associated with urbanization in both genders and with physical work in men. Higher sucrose intake and lower intake of micronutrients were typical of the snack-dominating meal pattern compared to the others. CONCLUSIONS: As snacks appear to have a higher energy density and a lower content of micronutrients than main meals, a snack-dominating meal pattern is inadvisable. However, further studies are needed to examine the association between meal pattern and health status.

Gaps in dietary-survey methodology in Western Europe.

A national nutrition monitoring system, including regular dietary surveys of representative population samples exists in only a few Western European countries. Even though large surveys are carried out sporadically in most countries, variability in their objectives, population samples, methodology, and reporting limit their comparability. There are two main ways of building a survey program: either in connection with health status surveys or in connection with household budget surveys. Household budget surveys are the only possibility in many countries. However, the data collection method has to be modified from food-purchase recording to include proper description of all foods consumed by individuals during a certain time period. Comparability of food-composition data in software systems for nutrient conversion is another problem area.

Fatty acid composition of serum cholesterol esters, and erythrocyte and platelet membranes as indicators of long-term adherence to fat-modified diets.

Dietary adherence to four different fat-modified diets was examined in 160 subjects by determining the fatty acid composition of serum cholesterol esters (CEs) and erythrocyte (ER) and platelet (PT) membranes in addition to food records. Subjects were randomly assigned to one of the following diet groups: 1) high-sat--35/14:104 (% of energy from total/saturated:monounsaturated:polyunsaturated fatty acids in the actual diet) 2) AHA (American Heart Association) type--32/10:8:8 3) monoene-enriched--34/11:11:5, or 4) low-fat--30/12:8:3 for 6 mo. Decreases in the proportions of palmitic acid in CEs were found in the AHA-type and monoene-enriched-diet groups. An increased proportion of linoleic acid in CEs was found in the AHA-type group. The differences in the proportions of palmitic acid in CEs and linoleic and palmitoleic acids in PTs were significant in the AHA-type and monoene-enriched-diet groups compared with the high-sat group. An increase in alpha-linolenic acid in CEs was an indicator of the use of low erucic acid rapeseed oil, which was the main source of monoenes in the monoene-enriched-diet group.

Toenail selenium as an indicator of selenium intake among middle-aged men in an area with low soil selenium.

Toenail selenium concentration has been proposed as a long-term (6-12 mo) indicator of human selenium status. This study investigated the association between toenail selenium concentration and selenium intake and other dietary factors among 166 urban men aged 55-69 y. The dietary information was collected by food records covering a 6-mo period. Toenail clippings were collected by mail 9-10 mo after food recording. The mean selenium intake from food was 42.5 micrograms/d and the dietary intake was equal to that of users and nonusers of selenium supplements. The mean toenail selenium concentration was 0.47 mg/kg. The mean selenium intake from supplements was 29.7 micrograms/d among supplement users. In the analysis of covariance the best predictors of toenail selenium concentration were selenium intake from supplements and food, and among supplement users dietary beta-carotene also.

Liberal fortification of foods: the risks. A study relating to Finland.

STUDY OBJECTIVE: The free circulation of goods in the European Union (EU) has increased the number of fortified foods available to consumers in Finland. Fortification of foodstuffs with calcium is currently widespread. To assist decision making relating to fortification, the object of this study was to determine whether there might be a risk of excessive levels of calcium. The study was done using the dietary data of adult population by sex and calcium intake deciles, taking account of intakes of calcium from normal diets and from fortified foods. STUDY DESIGN: Calcium intakes for deciles were calculated from dietary data of the population involved in the 1992 FINDIET survey. Calcium fortification was evaluated by considering foodstuffs to which calcium has already been added or which producers might wish to fortify and market in Finland. Situations in which a fortified product replaced its unfortified equivalent were envisaged. Daily calcium intakes (mg) from particular foodstuffs were calculated based on known amounts of calcium (mg) per 100 g of each foodstuff and amounts of each product consumed per day. Total calcium intakes of people in different deciles were calculated by adding amounts of calcium contributed by each fortified product to normal dietary intakes. Calcium intakes were also calculated for consumption by persons of all foodstuffs that are or intended to be fortified with calcium. STUDY PARTICIPANTS: Adults aged 25 to 64 representing populations in four regions of Finland, who recorded food consumption over three day periods in spring 1992. STUDY SETTING: North Karelia, Kuopio Province, Turku-Loimaa, and the capital area Helsinki-Vantaa, Finland. MAIN STUDY RESULTS: The results indicate that the highest 10% of Finnish adult men receive on average 2315 mg calcium per day from diets that do not include fortified foodstuffs. These people whose energy consumption was high consumed substantial amounts of dairy products. Consumption of fortified foods would increase the calcium intake further to levels exceeding the tolerable upper intake level (2500 mg/d). CONCLUSIONS: Liberal addition of calcium to various groups of foodstuffs could increase the calcium intake in the highest decile to levels with potentially untoward health effects. In assessing benefits and possible disadvantages of fortification of foodstuffs, the dietary habits of the population concerned, probable consumption of fortified products and nutritional intakes, especially at extremes, need to be taken into account, by total risk assessment.

Reported alcohol intake, diet and body mass index in male smokers.

OBJECTIVE: The study was carried out to determine associations of reported alcohol intake with diet and body mass index. Type and frequency of consumed alcohol were also considered. DESIGN: A cross-sectional study. SETTING: The baseline examination of the participants of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study in 1985-1988. SUBJECTS: 27215 middle-aged Finnish male smokers. INTERVENTIONS: The diet was assessed by a self-administered food use questionnaire: Subject's habitual diet and alcohol intake over the previous 12 months were asked. Body mass index was used as the measure of adiposity. RESULTS: Energy intake from food was not related to alcohol intake. Although alcohol consumption was associated with food selection (eg berry and coffee consumption), this only slightly influenced daily nutrient intakes. Intake of spirits was more consistently related to higher body mass index than that of other alcoholic beverages. Daily alcohol intake had a much smaller association with body mass index than less frequent use, independently of the total consumption. CONCLUSIONS: The differences in nutrient intake between abstainers, light and moderate alcohol consumers were small although the consumption of many foods varied with alcohol consumption. Even if alcohol consumption is one noteworthy factor associated with weight, the energy from alcohol increases body weight less than expected; both the type and frequency of consumed alcohol may explain why energy from alcohol is utilized less efficiently than non-alcoholic energy.

Plant sterol and stanol intake in Finland: a comparison between users and nonusers of plant sterol- and plant stanol-enriched foods.

UNLABELLED: BACKGROUND/ OBJECTIVES: We evaluated plant sterol and stanol (PS) intakes from natural sources and enriched foods in the Finnish population-based national FINDIET 2007 Survey. In addition, we compared the users and nonusers of PS-enriched foods in terms of their characteristics and dietary intake. SUBJECTS/METHODS: This was a cross-sectional population-based study on 958 men and 1080 women aged 25-74. Users and nonusers of PS-enriched products were compared with respect to sex, age, education, region, cholesterol-lowering medication and cholesterol-lowering diet. Intakes of PS, energy, energy nutrients, fat composition, cholesterol and dietary fibre were calculated on the basis of a 48-h dietary recall. The distribution of PS intake was assessed for the users of enriched products. RESULTS: PS-enriched foods were used by 9.5% of all subjects. The usage increased significantly with age (P<0.001) and level of education (P=0.01). The usage of enriched products was more common among those following a cholesterol-lowering medication or diet (P<0.001 for both). Among users, the mean intake of PS was 2.2 g/d for men and 1.6 g/d for women, and among nonusers it was 363 mg/d for men and 286 mg/d for women. The majority of users received less than 2 g/d of PS from enrichment, but 20% of users obtained more than 3 g of PS per day. CONCLUSIONS: The intake of PS can reach several grams in a subgroup of subjects consuming PS-enriched foods. The manufacturers' recommendations on PS-enriched food consumption are not consistently followed, and customer guidance needs to be improved.

Are serum α- and ß-carotene concentrations associated with the development of advanced beta-cell autoimmunity in children with increased genetic susceptibility to type 1 diabetes?

AIM: Reactive oxygen intermediates have been implicated in mediating the destruction of insulin-producing beta cells and antioxidant nutrients thought to protect against such a process. This study aimed to assess the associations between serum α- and ß-carotene concentrations, and the risk of advanced beta-cell autoimmunity, in children with HLA-conferred susceptibility to type 1 diabetes. METHODS: This case-control study, comprising 108 case children with advanced beta-cell autoimmunity and 216 matched control children, was nested within the nutrition study of the Type 1 Diabetes Prediction and Prevention (DIPP) birth cohort. Serum α- and ß-carotene samples were collected each year from the age of 1 to 6 years. For each case-control group, serum samples were analyzed up to the time of seroconversion in the case children. Associations were studied using a conditional logistic-regression model. RESULTS: Neither serum α- nor ß-carotene concentration was significantly associated with the risk of advanced beta-cell autoimmunity. There was marginal evidence (P=0.049) of an inverse association between serum ß-carotene concentration and the risk of developing advanced beta-cell autoimmunity at a time closest to seroconversion after adjusting for parental education, maternal age, duration of gestation, diabetes in first-degree relatives, number of earlier deliveries and maternal smoking during pregnancy. CONCLUSION: The present study data provided no clear evidence to support an association between serum α- or ß-carotene concentration and advanced beta-cell autoimmunity.

Inverse association between dietary and serum conjugated linoleic acid and risk of breast cancer in postmenopausal women.

Conjugated linoleic acid (CLA) is anticarcinogenic in experimental animal studies. We studied dietary and serum CLA in Finnish patients with breast cancer in 1992-1995. Participants were consecutive women with breast cancer (68 premenopausal and 127 postmenopausal) and population-based control women (75 premenopausal and 133 postmenopausal), matched for age and area of residence. Diet was assessed by a validated food frequency questionnaire and the fatty acid composition of serum by gas-liquid chromatography. In postmenopausal women, dietary CLA, serum CLA, myristic acid, and trans-vaccenic acid were significantly lower in cases than in controls. The odds ratio for breast cancer in the highest quintile vs. the lowest was 0.4 [95% confidence interval (CI) = 0.2-0.9]for CLA, 0.3 (95% CI = 0.1-0.7) for myristic acid, and 0.3 (95% CI = 0.1-0.7) for trans-vaccenic acid in serum. The odds ratios remained similar after adjustment for known risk factors of breast cancer. A diet composed of CLA-rich foods, particularly cheese, may protect against breast cancer in postmenopausal women, but it is impossible to assess the independent effects of CLA in this study. The findings may be of relevance for food production, inasmuch as it is possible to increase CLA and its precursor trans-vaccenic acid in foods by modifying the feeding of ruminants.

Dietary intakes of polychlorinated dibenzo-p-dioxins, dibenzofurans and polychlorinated biphenyls in Finland.

Samples of cow milk, pork, beef eggs, rainbow trout, flours and vegetables were analysed for 17 polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/F) and 36 polychlorinated biphenyls (PCB). Daily dietary intake of PCDD/Fs as toxic equivalent (I-TEq) and PCBs (PCB-TEq) was assessed using food consumption data from a 24-h dietary recall study for 2862 Finnish adults. The calculated intake of PCDD/F was 46 pg I-TEq day(-1). The current level was about half of the earlier estimation of intake in Finland made in 1992. The assessed PCB intake was 53 pg PCB-TEq day(-1). Thus, the total intake of PCDD/Fs and PCBs was 100 pg TEqday(-1) (1.3pg TEqkg(-1) b.w. day(-1)), which is within the range of tolerable daily intake (TDI) proposed by the WHO (1-4pg TEqkg(-1) b.w. day(-1)).

Estimation of plant sterol and cholesterol intake in Finland: quality of new values and their effect on intake.

The Finnish national food composition database Fineli was updated with recent analytical values for plant sterols (PS) (sitosterol, campesterol, stigmasterol, avenasterol, brassicasterols and stanols) and cholesterol. The quality of the new analytical data was assessed. The aims of the present study were: (1) to compare the effect of old and new database values on PS and cholesterol intakes based on average per capita food consumption data; (2) to estimate the current intake and major sources of these compounds in various population groups according to the national FINDIET 1997 survey data. The intake of total PS was 305 mg/d for men and 237 mg/d for women. The respective intakes for cholesterol were 284 mg/d and 201 mg/d. Women had a higher density of PS in their diets than men, whereas the cholesterol density in the diets did not differ between genders. Cereals, margarine, vegetables and vegetable oils were the main food sources of PS. Meat, meat products and eggs were the main sources of cholesterol. A 9 % greater PS intake estimate was obtained with the new PS database compared with the old PS database, probably due to minor methodological differences between the new and old analyses. Notable changes in analytical methods suggest a lower value (-19 %) for cholesterol intake calculated from the new database compared with the old one. We conclude that researchers can have confidence in the new values for PS and cholesterol, because systematic evaluation of the new analytical values showed them to be of high quality.

Intake of flavonols and flavones and risk of coronary heart disease in male smokers.

Flavonols and flavones are antioxidant polyphenolic compounds found in tea, vegetables, fruits, and wine. In experimental studies they have been effective free radical scavengers, metal chelators, and antithrombotic agents. In the few epidemiologic studies of these agents, some have suggested an inverse association between intake of flavonols and flavones and the risk of cardiovascular disease. Our study population comprised 25,372 male smokers, 50-69 years of age, with no previous myocardial infarction. They were participants of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, which was a randomized, double-blind, placebo-controlled trial with daily supplementation of alpha-tocopherol (50 mg per day) and/or beta-carotene (20 mg per day). The men completed a validated dietary questionnaire at baseline. After 6.1 years of follow-up, there were 1,122 nonfatal myocardial infarctions and 815 coronary deaths. In the multivariate model, the relative risk of nonfatal myocardial infarction was 0.77 (95% confidence interval = 0.64-0.93) among men in the highest (median 18 mg per day) compared with the lowest (median 4 mg per day) quintile of flavonol and flavone intake. The respective relative risk for coronary death was 0.89 (95% confidence interval = 0.71-1.11). Thus, intake of flavonols and flavones was inversely associated with nonfatal myocardial infarction, whereas there was a weaker association with coronary death.