Early Diet and Later Cancer Risk: Prospective Associations of Dietary Patterns During Critical Periods of Childhood with the GH-IGF Axis, Insulin Resistance and Body Fatness in Younger Adulthood.

Early life, adiposity rebound, and puberty represent critical growth periods when food choices could have long-term relevance for cancer risk. We aimed to relate dietary patterns during these periods to the growth hormone-insulin-like-growth-factor (GH-IGF) axis, insulin resistance, and body fatness in adulthood. Data from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study participants with outcome data at 18-37 years, and ≥2 dietary records during early life (1-2 yr; n = 128), adiposity rebound (4-6 years, n = 179), or puberty (girls 9-14, boys 10-15 yr; n = 213) were used. Dietary patterns at these ages were derived by 1) reduced rank regression (RRR) to explain variation in adult IGF-I, IGF-binding protein-3 (IGFBP-3), homoeostasis model assessment for insulin resistance (HOMA-IR) and fat-mass index; 2) principal component analysis (PCA). Regarding RRR, the patterns "cake/canned fruit/cheese & eggs" (early life), "sweets & dairy" (adiposity rebound) and "high-fat foods" (pubertal boys) were independently associated with higher adult HOMA-IR. Furthermore, the patterns "favorable carbohydrate sources" (early life), "snack & convenience foods" (adiposity rebound), and "traditional & convenience carbohydrates" (pubertal boys) were related to adult IGFBP-3 (P trend < 0.01). PCA identified "healthy" patterns for all periods, but none was associated with the outcomes (P trend > 0.1). In conclusion, dietary patterns during sensitive growth periods may be of long-term relevance for adult insulin resistance and IGFBP-3.

Food packaging cues influence taste perception and increase effort provision for a recommended snack product in children.

Food marketing research shows that child-directed marketing cues have pronounced effects on food preferences and consumption, but are most often placed on products with low nutritional quality. Effects of child-directed marketing strategies for healthy food products remain to be studied in more detail. Previous research suggests that effort provision explains additional variance in food choice. This study investigated the effects of packaging cues on explicit preferences and effort provision for healthy food items in elementary school children. Each of 179 children rated three, objectively identical, recommended yogurt-cereal-fruit snacks presented with different packaging cues. Packaging cues included a plain label, a label focusing on health aspects of the product, and a label that additionally included unknown cartoon characters. The children were asked to state the subjective taste-pleasantness of the respective food items. We also used a novel approach to measure effort provision for food items in children, namely handgrip strength. Results show that packaging cues significantly induce a taste-placebo effect in 88% of the children, i.e., differences in taste ratings for objectively identical products. Taste ratings were highest for the child-directed product that included cartoon characters. Also, applied effort to receive the child-directed product was significantly higher. Our results confirm the positive effect of child-directed marketing strategies also for healthy snack food products. Using handgrip strength as a measure to determine the amount of effort children are willing to provide for a product may explain additional variance in food choice and might prove to be a promising additional research tool for field studies and the assessment of public policy interventions.

Overweight in adolescence can be predicted at age 6 years: a CART analysis in German cohorts.

OBJECTIVE: To examine, whether overweight in adolescents can be predicted from the body mass index (BMI) category, at the age of 6, the mother's education level and mother's obesity and to quantify the proportion of overweight at the age of 14 that can be explained by these predictors. METHOD: Pooled data from three German cohorts providing anthropometric and other relevant data to a total of 1 287 children. We used a classification and regression tree (CART) approach to identify the contribution of BMI category at the age of 6 (obese: BMI > 97th percentile (P97); overweight: P90 < BMI ≤ P97; high normal weight: P75P90) at the age of 14. RESULTS: While 4.8% [95%CI: 3.2;7.0] of 651 boys and 4.1% [95%CI: 2.6;6.2] of 636 girls with a BMIP97 (similar results for girls). BM I ≥ P75 at the age of 6 explained 63.5% [95%CI: 51.1;74.5]) and 72.0% [95%CI: 60.4;81.8] of overweight/obesity at the age of 14 in boys and girls, respectively. CONCLUSIONS: Overweight/obesity in adolescence can be predicted by BMI category at the age of 6 allowing for parent counselling or risk guided interventions in children with BMI ≥ P75, who accounted for >2/3 of overweight/obesity in adolescents.

Prospective relevance of dietary patterns at the beginning and during the course of primary school to the development of body composition.

Primary school years seem to represent a critical period for the development of overweight and obesity. However, only a few studies have analysed the prospective relationship between dietary patterns and weight status in children. The aims of the present study were to identify dietary patterns at the beginning of and during the primary school period and to examine their relevance to the development of body composition. Nutritional and anthropometric data from 371 participants of the Dortmund Nutritional and Longitudinally Designed (DONALD) Study at the beginning (ages 6 and 7 years) and end (ages 10 and 11 years) of the primary school period were used. Principal component analyses (PCA) were conducted to identify dietary patterns, which were regressed on changes in BMI and fat mass index (FMI) between ages 6 and 7 years and ages 10 and 11 years. Reduced rank regression (RRR) was used to directly extract patterns explaining variation in changes in BMI and FMI between ages 6 and 7 years and ages 10 and 11 years. PCA yielded interpretable patterns of dietary changes at the beginning of and during the primary school period, which were not related to changes in body composition. Conversely, RRR allowed identifying predictive patterns: higher baseline intakes of white bread and lower baseline intakes of whole-grain products as well as increases in the consumption of savoury snacks, sausages and cheese during primary school years independently predicted increases in BMI and FMI during the primary school period. In conclusion, selection of unfavourable carbohydrate sources at the beginning of the primary school period and increases in the consumption of processed savoury foods during primary school years may adversely affect the development of body composition during the course of primary school.

Nutrient intake of European adolescents: results of the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study.

OBJECTIVE: An adequate nutritional intake in childhood and adolescence is crucial for growth and the prevention of youth and adult obesity and nutrition-related morbidities. Improving nutrient intake in children and adolescents is of public health importance. The purpose of the present study was to describe and evaluate the nutrient intake in a European sample using the D-A-CH nutrient intake recommendations and the Nutritional Quality Index (NQI). DESIGN: The HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study is a cross-sectional study, the main objective of which is to obtain comparable data on a variety of nutritional and health-related parameters in adolescents aged 12·5-17·5 years. SETTING: Eight cities in Europe. SUBJECTS: The initial sample consisted of 3528 European adolescents. Among these, 1590 adolescents (54% female) had sufficient and plausible dietary data on energy and nutrient intakes from two 24 h recalls using the HELENA-DIAT software. RESULTS: The intakes of most macronutrients, vitamins and minerals were in line with the D-A-CH recommendations. While the intakes of SFA and salt were too high, the intake of PUFA was too low. Furthermore, the intakes of vitamin D, folate, iodine and F were less than about 55% of the recommendations. The median NQI was about 71 (of a maximum of 100). CONCLUSIONS: The intakes of most nutrients were adequate. However, further studies using suitable criteria to assess nutrient status are needed. Public health initiatives should educate children and adolescents regarding balanced food choices.

Lunch at school, at home or elsewhere. Where do adolescents usually get it and what do they eat? Results of the HELENA Study.

Considering the lack of uniformity regarding school meals in Europe, information on adolescents' school lunch patterns is of public health importance. Thus, the aim of this analysis was to describe and evaluate lunchtime energy and food intake of European adolescents at different lunch locations. Data on nutritional and health-related parameters were derived from the HEalthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS). A sub-sample of 891 adolescents (47% male) with plausible data on total and lunchtime energy intake (2 × 24 h recall) as well as usual lunch location was considered. Food intake was compared to lunch of the Optimized Mixed Diet (OMD) for children and adolescents. Although energy intake was nearly in line with the recommendations, food intake was suboptimal compared to the OMD regardless of usual lunch location. Adolescents had more potatoes and less sweets at school, and more drinks (water, coffee and tea) and vegetables at home when each compared with the other locations. Food intake of adolescents getting their lunch elsewhere was characterized by the smallest amounts of potatoes and the highest amounts of sweets. Although lunch patterns may differ among countries, schools in Europe do not seem to reveal all their potential to offer access to a healthy lunch for adolescents yet.

Association between self-reported sleep duration and dietary quality in European adolescents.

Evidence has grown supporting the role for short sleep duration as an independent risk factor for weight gain and obesity. The purpose of the present study was to examine the relationship between sleep duration and dietary quality in European adolescents. The sample consisted of 1522 adolescents (aged 12.5-17.5 years) participating in the European multi-centre cross-sectional 'Healthy Lifestyle in Europe by Nutrition in Adolescence' study. Sleep duration was estimated by a self-reported questionnaire. Dietary intake was assessed by two 24 h recalls. The Diet Quality Index for Adolescents with Meal index (DQI-AM) was used to calculate overall dietary quality, considering the components dietary equilibrium, dietary diversity, dietary quality and a meal index. An average sleep duration of ≥ 9 h was classified as optimal, between 8 and 9 h as borderline insufficient and < 8 h as insufficient. Sleep duration and the DQI-AM score were positively associated (ß = 0.027, r 0.130, P< 0.001). Adolescents with insufficient (62.05 (sd 14.18)) and borderline insufficient sleep (64.25 (sd 12.87)) scored lower on the DQI-AM than adolescents with an optimal sleep duration (64.57 (sd 12.39)) (P< 0.001; P= 0.018). The present study demonstrated in European adolescents that short sleep duration was associated with a lower dietary quality. This supports the hypothesis that the health consequences of insufficient sleep may be mediated by the relationship of insufficient sleep to poor dietary quality.

Validation of the Diet Quality Index for Adolescents by comparison with biomarkers, nutrient and food intakes: the HELENA study.

Food-based dietary guidelines (FBDG) aim to address the nutritional requirements at population level in order to prevent diseases and promote a healthy lifestyle. Diet quality indices can be used to assess the compliance with these FBDG. The present study aimed to investigate whether the newly developed Diet Quality Index for Adolescents (DQI-A) is a good surrogate measure for adherence to FBDG, and whether adherence to these FBDG effectively leads to better nutrient intakes and nutritional biomarkers in adolescents. Participants included 1804 European adolescents who were recruited in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study. Dietary intake was assessed by two, non-consecutive 24 h recalls. A DQI-A score, considering the components' dietary quality, diversity and equilibrium, was calculated. Associations between the DQI-A and food and nutrient intakes and blood concentration biomarkers were investigated using multilevel regression analysis corrected for centre, age and sex. DQI-A scores were associated with food intake in the expected direction: positive associations with nutrient-dense food items, such as fruits and vegetables, and inverse associations with energy-dense and low-nutritious foods. On the nutrient level, the DQI-A was positively related to the intake of water, fibre and most minerals and vitamins. No association was found between the DQI-A and total fat intake. Furthermore, a positive association was observed with 25-hydroxyvitamin D, holo-transcobalamin and n-3 fatty acid serum levels. The present study has shown good validity of the DQI-A by confirming the expected associations with food and nutrient intakes and some biomarkers in blood.

Food intake of European adolescents in the light of different food-based dietary guidelines: results of the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study.

OBJECTIVE: Since inadequate food consumption patterns during adolescence are not only linked with the occurrence of obesity in youth but also with the subsequent risk of developing diseases in adulthood, the establishment and maintenance of a healthy diet early in life is of great public health importance. Therefore, the aim of the present study was to describe and evaluate the food consumption of a well-characterized sample of European adolescents against food-based dietary guidelines for the first time. DESIGN: The HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study is a cross-sectional study, whose main objective was to obtain comparable data on a variety of nutritional and health-related parameters in adolescents aged 12·5-17·5 years. SETTING: Ten cities in Europe. SUBJECTS: The initial sample consisted of more than 3000 European adolescents. Among these, 1593 adolescents (54 % female) had sufficient and plausible dietary data on energy and food intakes from two 24 h recalls using the HELENA-DIAT software. RESULTS: Food intake of adolescents in Europe is not optimal compared with the two food-based dietary guidelines, Optimized Mixed Diet and Food Guide Pyramid, examined in this study. Adolescents eat half of the recommended amount of fruit and vegetables and less than two-thirds of the recommended amount of milk (and milk products), but consume much more meat (and meat products), fats and sweets than recommended. However, median total energy intake may be estimated to be nearly in line with the recommendations. CONCLUSION: The results urge the need to improve the dietary habits of adolescents in order to maintain health in later life.

Associations between the macronutrient composition of the evening meal and average daily sleep duration in early childhood.

BACKGROUND & AIMS: Short sleep duration in early childhood may increase the risk for chronic diseases in later life. Strategies to improve sleep duration are thus of interest. We investigated whether the nutritional composition of the evening meal is associated with children's sleep duration in the 2nd year of life. METHODS: Multivariable regression models included 594 participants of the DONALD Study with 3-days weighed dietary records and average daily sleep duration at age 1.5 and 2 years. RESULTS: Higher energy intakes with the evening meal were associated with a longer sleep duration (1 min/10 kcal, p = 0,01). With respect to absolute intakes, carbohydrates (0.8 min/g, p < 0.0001), especially from high GI foods (1.3 min/g, p < 0.01), and a higher GL (1.5 min/g GL, p < 0.01) were accompanied by longer sleeping time. A qualitative exchange of energy from protein by energy from carbohydrates from high GI foods was only associated with increased sleep duration in toddlers without (1.9 min/%E, p < 0.05), but not with nightly eating occasions (p > 0.4). CONCLUSIONS: The observed associations are in line with suggested sleep-improving effects of carbohydrates. Effect sizes suggest that the clinical relevance of nutritional composition for sleep duration is limited in healthy young toddlers. These observations and their possible importance for more vulnerable groups need to be confirmed in clinical trials.

Longitudinal associations between reported sleep duration in early childhood and the development of body mass index, fat mass index and fat free mass index until age 7.

OBJECTIVE: Epidemiological studies in children and adolescents have revealed short sleep duration as a risk factor for weight gain. However, only few studies have addressed sleep in early childhood. Our aim was to determine whether sleep in the second year of life is associated with the development of body composition throughout childhood. METHODS: Analysis included 481 DONALD participants with parental reported data on sleep duration and annually measured body composition until age 7. Using median splits of sleeping time at 1.5 and 2 years we defined sleep duration categories: consistently short (CS, n = 122), inconsistent (I, n = 143) and consistently long (CL, n = 216). Polynomial mixed effects regression models were used to analyze differences in the trajectories of body mass index (BMI, kg/m(2)), fat mass index (FMI, kg/m(2)) and fat free mass index (FFMI, kg/m(2)) from ages 2-7 years between the sleep duration categories. RESULTS: Compared to CL-children, CS-sleepers differed in their FMI development with respect to linear, quadratic and cubic trend (all p < 0.04), resulting in progressively higher FMI levels until age 7 independently of early life or socioeconomic factors. Trajectories of BMI and FFMI did not differ between the sleep duration categories. CONCLUSION: Consistently short sleep duration in the critical window of early childhood appears to exert a moderate but sustained adverse effect on the development of fat mass - but not fat free mass - until age 7.

Direction of associations between added sugar intake in early childhood and body mass index at age 7 years may depend on intake levels.

Dietary factors, especially during early childhood, have been discussed as potentially critical for the development of childhood overweight. This study evaluated associations between added sugar intake during early childhood and BMI and body fat at age 7 y. Analysis was based on data from 216 participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study. Life-course plots were constructed to evaluate the association between added sugar intake at different ages (0.5, 1, 1.5, and 2 y) and BMI SD score (BMI-SDS) and % body fat (%BF) at age 7 y. Multivariable analyses were performed for the periods identified as critical for later BMI and body fat. Added sugar intake at age 1 y and the change in intake levels during the second year of life emerged as potentially critical. At age 1 y, a higher total added sugar intake was related to a lower BMI-SDS at age 7 y [adjusted ß ± SE: -0.116 ± 0.057 BMI-SDS/percent energy (%En) added sugar; P = 0.04]. Conversely, an increase in total added sugar in the second year of life (Δ%En between age 1 and 2 y) tended to be associated with a higher BMI-SDS (adjusted ß ± SE: 0.074 ± 0.043 BMI-SDS/Δ%En added sugar; P = 0.09). No associations were observed with %BF. In conclusion, added sugar intake at low intake levels during early childhood does not appear to be critical for BMI and body fat at age 7 y. However, detrimental effects on BMI development may emerge when added sugar intakes are increased to higher levels.

Longitudinal associations between endogenous melatonin production and reported sleep duration from childhood to early adulthood.

BACKGROUND/AIMS: The study objective was to assess longitudinal associations between melatonin secretion and reported sleep duration from childhood to early adulthood. METHODS: In the frame of the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study, 24-hour melatonin secretion and average daily sleep duration were determined once during childhood (4-< 11 years), adolescence (11-<16 years) and early adulthood (16-19 years) in 52 participants (23 males/29 females) aged 4-19 years. The associations between (1) melatonin secretion and sleep duration in childhood (cross-sectional); (2) melatonin secretion in childhood and sleep duration in early adulthood (prospective), and (3) changes in melatonin secretion and concurrent changes in sleep duration from childhood to early adulthood (concurrent) were analyzed. RESULTS: Melatonin secretion was associated with sleep duration in childhood (cross-sectional, 3.5 min/day/10 µg 6-hydroxymelatonin sulfate (6-OHMS)/day, p = 0.009) and tended to predict sleep duration in early adulthood (prospective, 9.8 min/day/10 µg 6-OHMS/day, p = 0.09). An individual increase in melatonin secretion between childhood and early adulthood was associated with a concurrent increase in sleep duration (concurrent, 6.9 min/day/10 µg 6-OHMS/day, p = 0.046). CONCLUSION: Our observational data suggest that pineal production of melatonin in childhood is correlated with alterations in sleep duration until early adulthood. Nevertheless, this observational evidence needs to be verified in clinical studies.