Increased abdominal fat mass and high fat consumption in young school children with congenital heart disease: results from a case-control study.

BACKGROUND: We have previously found that infants with complex congenital heart disease (CHD) experience growth failure despite high-energy dietary supplementation. This is a follow-up and comparison with healthy controls at 9 years of age regarding body composition and macronutrient intake, especially in relationship to the diet provided during infancy. METHODS: Anthropometric changes in 10 children with CHD at 12 months and at 4 and 9 years of age were analysed as Z-scores. To assess body composition and food intake at 9 years of age, a dual-energy X-ray absorptiometry scan and a 3-day food diary were completed and compared with age- and gender-matched controls using Wilcoxon's signed-rank test for matched pairs. RESULTS: Growth changes from 12 months to 9 years, converted to Z-scores for weight for height and height for age, were significantly different within the group of children with complex CHD, although no growth differences were seen in comparison with healthy controls at 9 years of age. However, the children with CHD had statistically higher abdominal fat mass index and higher daily intake of fat, particularly from saturated fatty acid in g kg-1 compared to controls. CONCLUSIONS: At 9 years of age, children with complex CHD with growth failure and high fat intake in infancy have normalised growth but increased abdominal fat mass and higher intake of saturated fatty acid compared to their peers. Nutritional monitoring in early childhood may detect unhealthy diet quality and prevent later health risks in this group.

Dietary intake in infants with complex congenital heart disease: a case-control study on macro- and micronutrient intake, meal frequency and growth.

BACKGROUND: Children with severe congenital heart disease (CHD) need considerable nutritional support to reach normal growth. The actual intake of macro- and micronutrients in outpatient CHD infants over a 6-month period in infancy is not described in the literature. The present study aimed to prospectively investigate the distribution between macro- and micronutrient intake, meal frequency and growth in children with CHD. METHODS: At 6, 9 and 12 months of age, a 3-day food diary and anthropometric data were collected in 11 infants with severe CHD and 22 healthy age- and feeding-matched controls. Macro- and micronutrient intake, meal frequency and growth were calculated. RESULTS: Compared to the healthy controls, CHD infants had a statistically significantly higher intake of fat at 9 months of age (4.8 versus 3.6 g kg(-1) day(-1) ), a higher percentage energy (E%) from fat, (40.6% versus 34.5%) and a lower E% from carbohydrates (46.1% versus 39.6%) at 12 months of age, and a lower intake of iron (7.22 versus 9.28 mg day(-1) ) at 6 months of age. Meal frequency was significantly higher at 6 and 9 months of age (P < 0.01). Mean Z-score weight for height, weight for age and body mass index for age were significant lower (P < 0.01) at all time points. CONCLUSIONS: Despite a higher intake of energy from fat and a higher meal frequency, the intake does not meet the needs for growth, and the results may indicate a low intake of micronutrients in CHD infants.

Serum lipid and apolipoprotein levels in 4-year-old children are associated with parental levels and track over time.

BACKGROUND/OBJECTIVES: There are only a few studies linking dietary fat intake to serum lipid levels in young children. Our objective was to prospectively evaluate serum lipid levels from infancy to early childhood, and to explore their possible association with dietary, growth and parental factors. SUBJECTS/METHODS: Children (n=127) followed from early infancy were examined for serum lipid levels, anthropometry and dietary intake at 4 years of age. We also studied possible associations with parental anthropometric and blood biochemistry data collected from 122 mothers' and 118 fathers' when children were 4 years of age. RESULTS: Serum concentrations of total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC) and the apolipoprotein B/apolipoprotein A-1 ratio (apo B/apo A-1) showed significant tracking from infancy to 4 years. Furthermore, children's TC levels correlated with paternal TC level from 6 months to 4 years, but with maternal only at 4 years. In girls, both LDLC and HDLC correlated with parental LDLC and HDLC. In all children, intake of saturated fatty acids (SAFAs) was higher than recommended, and in 90% of the children polyunsaturated fatty acid (PUFA) intake was lower than recommended. CONCLUSIONS: Serum lipid levels values tracked from infancy to 4 years and were associated with parental values. Higher serum lipid levels at 4 years compared with 6-18 months of age may result from changes in the quality of dietary fat. We therefore suggest that intake of dietary fat in 4-year-old children should be more focused on quality. Furthermore, as there were strong associations between the child and parental serum lipid levels this supports the view that family-based rather than individual intervention is preferable.

Dietary shortcomings in children on a gluten-free diet.

BACKGROUND: Coeliac disease (CD), or permanent gluten intolerance, is one of the most common chronic food-related diseases among children in Europe and the USA. The treatment is lifelong gluten-free diet (GFD) (i.e. the exclusion of wheat, rye and barley from the diet, which are important sources particularly of iron, dietary fibre and vitamin B). The present study aimed to evaluate dietary intakes of energy and nutrients in children and adolescents on GFD and compare these with intake of comparable age groups on a normal diet as well as current recommendations. METHODS: Thirty children, 4-17 years of age with confirmed CD and on GFD were agreed to participate in this study at the Department of Pediatrics, Umeå University Hospital. Weight and height were used to calculate individual energy requirement according to Nordic Nutrition Recommendations 2004 (NNR-04). Dietary intake was assessed using 5-day food records and household measures were used for quantities. Twenty-five children completed their dietary record. RESULTS: Thirteen of the 25 children did not meet the recommended energy intake and the dietary intakes were inadequate regarding quality of macronutrients and quantity of minerals and vitamins. The mean intakes of sucrose and saturated fatty acids were above and the intakes of dietary fibre, vitamin D, magnesium and selenium below the NNR-04. High intakes of sucrose and saturated fat and a low intake of dietary fibre were also noted in a previous national survey on healthy children on a normal diet. The nutrient density of vitamin D, riboflavin, niacin, thiamine, magnesium and selenium were lower among CD children than healthy children but, for iron and calcium, it was higher in CD children. CONCLUSIONS: Children on GFD appear to follow the same trends as healthy children on a normal diet, with high intakes of saturated fat and sucrose and low intakes of dietary fibre, vitamin D and magnesium compared to recommendations.

BMI at 4 years of age is associated with previous and current protein intake and with paternal BMI.

OBJECTIVES: To evaluate possible associations between body mass index (BMI) at 4 years of age, current and previous dietary intakes and parental BMI. METHODS: A follow-up of dietary intake and anthropometry in 127 4-year-old children corresponding to 54% of children who completed an initial intervention study at 18 months of age. RESULTS: Fourteen percent of the girls and 13% of the boys were overweight (age-adjusted BMI> or =25) and 2% of the girls and 3% of the boys were obese (age-adjusted BMI> or =30). Thirty-four percent and 9% of the fathers and 19 and 7% of the mothers were overweight and obese, respectively. BMI at 6-18 months was a strong predictor of BMI at 4 years. Univariate regression analyses revealed that intake of protein in particular, and also of total energy and carbohydrates at 17/18 months and at 4 years, was positively associated with BMI at 4 years. Although BMI at 6-18 months was the strongest predictor of BMI at 4 years, in the final multivariate models of the child's BMI, protein intake at 17-18 months and at 4 years, energy intake at 4 years and the father's-but not the mother's-BMI were also independent contributing factors. CONCLUSIONS: Among these healthy children, BMI at 4 years of age tracked from 6 to 18 months of age and were associated with previous and current protein intake as well as parental BMI, particularly that of the father.

Dietary fat in infancy should be more focused on quality than on quantity.

OBJECTIVE: The primary aim was to assess, the association of the quantity and quality of dietary fat intake from 6 to 12 months of age and serum lipids at 12 months. SUBJECTS/METHODS: Three hundred healthy term Swedish infants were recruited in a longitudinal prospective study at the age of 6 months; 276 remained in the study at 12 months. Food records and anthropometric data were collected monthly from 6 to 12 months; serum lipids were analysed at 6 and 12 months. RESULTS: Swedish infants had a total fat intake within the Nordic recommendations, but intake of polyunsaturated fatty acids (PUFA) was low (5.6 percent of total energy (E%)) and intake of saturated fatty acids (SAFA) was high (15.1 E%). Higher PUFA intake was associated with lower total serum cholesterol (TC, B=-0.13, P=0.003), lower low-density-lipoprotein cholesterol (LDL-C, B=-0.12, P=0.004) and apolipoprotein B (B=-0.03) (P=0.034) in girls but not in boys. When data from the present study were compared to data from similar studies in Finland and Iceland, it appears that the quality of the dietary fat has greater impact on serum lipid levels than the quantity of fat in the diet. CONCLUSIONS: Higher PUFA and lower SAFA intakes may reduce TC and LDL-C early in life, particularly in girls. Further, with respect to lowering serum lipid concentrations in early childhood it seems appropriate to set focus on fat quality rather than the quantity. SPONSORSHIPS: Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning (Formas), Swedish Research Council, Medicine, Stiftelsen Oskar Foundation, Sven Jerring Foundation, Samariten Foundation, Stiftelsen Goljes minne and Semper AB.

Diet intake and caries prevalence in four-year-old children living in a low-prevalence country.

Preventive measures have dramatically decreased the prevalence of dental caries in children. However, risk factors for the disease in children living in low-prevalence areas remain elusive. In the present study we evaluated associations between dental caries, saliva levels of mutans streptococci and lactobacilli, and diet with special emphasis on the intake of fermentable carbohydrates and dairy products in 4-year-old children living in an area where the overall caries prevalence was low. Dietary intake was recorded in 234 infants as part of the Study of Infant Nutrition in Umeå, Sweden (SINUS). Of these the parents of 124 children gave consent to participate in a follow-up at 4 years of age. Dietary intake, height and weight, dental caries, oral hygiene, including tooth brushing habits, presence of plaque and gingival inflammation, fluoride habits and numbers of mutans streptococci and lactobacilli in saliva were recorded. Using multivariate stepwise logistic regression, caries experience was negatively associated with intake frequency of cheese (OR = 0.67; 95% CI = 0.44-0.98) and positively associated with the salivary level of mutans streptococci (OR = 1.57; 95% CI = 1.21-2.03). Caries experience was not correlated with intake frequency or amounts of carbohydrate-containing foods, with any other particular food, or with daily intake of energy, carbohydrate or any other macro- or micronutrient. We conclude that cheese intake may have a caries-protective effect in childhood populations where the overall caries prevalence and caries experience are low and the children are regularly exposed to fluoride from toothpaste.