Maternal prepregnancy BMI or weight and offspring's blood pressure: Systematic review.

Emerging evidence suggests that maternal prepregnancy body mass index or weight (MPBW) may be associated with offspring's blood pressure (BP). Therefore, we conducted a systematic review-following the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement-to assess and judge the evidence for an association between MPBW with offspring's later BP. Five data bases were searched without limits. Risk of bias was assessed using the "Tool to Assess Risk of Bias in Cohort Studies," and an evidence grade was allocated following the World Cancer Research Fund criteria. Of 2,011 publications retrieved, 16 studies (all cohort studies) were included in the systematic review; thereof, 5 studies (31%) were rated as good-quality studies. Overall, data from 63,959 participants were enclosed. Systolic BP was analysed in 15 (5 good quality), diastolic BP in 12 (3 good quality), and mean arterial pressure in 3 (no good quality) studies. Five good-quality studies of MPBW with offspring's systolic BP as the outcome and 1 good-quality study with offspring's diastolic BP as the outcome observed a significant association. However, after adding offspring's anthropometry variables to the statistical model, the effect attenuated in 4 studies with systolic BP to nonsignificance, the study with diastolic BP remained significant. No good-quality studies were found with respect to offspring's later mean arterial pressure. In conclusion, this systematic review found suggestive, but still limited, evidence for an association between MPBW with offspring's later BP. The available data suggest that the effect might be mainly mediated via offspring's anthropometry.

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.

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.

Breastfeeding and its prospective association with components of the GH-IGF-Axis, insulin resistance and body adiposity measures in young adulthood--insights from linear and quantile regression analysis.

BACKGROUND: Breastfeeding may lower chronic disease risk by long-term effects on hormonal status and adiposity, but the relations remain uncertain. OBJECTIVE: To prospectively investigate the association of breastfeeding with the growth hormone- (GH) insulin-like growth factor- (IGF) axis, insulin sensitivity, body composition and body fat distribution in younger adulthood (18-37 years). DESIGN: Data from 233 (54% female) participants of a German cohort, the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study, with prospective data on infant feeding were analyzed. Multivariable linear as well as quantile regression were performed with full breastfeeding (not: ≤ 2, short: 3-17, long: >17 weeks) as exposure and adult IGF-I, IGF binding proteins (IGFBP) -1, -2, -3, homeostasis model assessment of insulin resistance (HOMA-IR), fat mass index, fat-free mass index, and waist circumference as outcomes. RESULTS: After adjustment for early life and socio-economic factors, women who had been breastfed longer displayed higher adult IGFBP-2 (p(trend) = 0.02) and lower values of HOMA-IR (p(trend) = 0.004). Furthermore, in women breastfeeding duration was associated with a lower mean fat mass index (p(trend) = 0.01), fat-free mass index (p(trend) = 0.02) and waist circumference (p(trend) = 0.004) in young adulthood. However, there was no relation to IGF-I, IGFBP-1 and IGFBP-3 (all p(trend) > 0.05). Associations for IGFBP-2 and fat mass index were more pronounced at higher, for waist circumference at very low or high percentiles of the distribution. In men, there was no consistent relation of breastfeeding with any outcome. CONCLUSIONS: Our data suggest that breastfeeding may have long-term, favorable effects on extremes of adiposity and insulin metabolism in women, but not in men. In both sexes, breastfeeding does not seem to induce programming of the GH-IGF-axis.

Animal protein intakes during early life and adolescence differ in their relation to the growth hormone-insulin-like-growth-factor axis in young adulthood.

Recent studies provide evidence that insulin-like-growth-factor I (IGF-I) and its binding proteins (IGFBP) IGFBP-2 and IGFBP-3 are related to the risk of several common cancers. It remains to be clarified whether their concentrations can be programmed by protein intake from different sources during growth. This study addressed the hypothesis that animal protein intakes during infancy, mid-childhood, and adolescence differ in their relevance for the growth-hormone (GH)-IGF-I axis in young adulthood. Data from the Dortmund Nutritional and Anthropometric Longitudinally Designed Study participants with at least 2 plausible 3-d weighed dietary records during adolescence (age: girls, 9-14 y; boys, 10-15 y; n = 213), around the adiposity rebound (age 4-6 y; n = 179) or early life (age 0.5-2 y; n = 130), and one blood sample in young adulthood were included in the study. Mean serum concentrations of IGF-I, IGFBP-1, IGFBP-2, and IGFBP-3 were compared between tertiles of habitual animal protein intake using multivariable regression analysis. Habitually higher animal protein intakes in females during puberty were related to higher IGF-I (P-trend = 0.005) and IGFBP-3 (P-trend = 0.01) and lower IGFBP-2 (P-trend = 0.04), but not to IGFBP-1 in young adulthood. In turn, IGF-I concentrations in young adulthood were inversely related to animal protein intakes in early life among males only (P-trend = 0.03), but not to animal protein intake around adiposity rebound (P-trend > 0.5). Our data suggest that, among females, a habitually higher animal protein intake during puberty may precipitate an upregulation of the GH-IGF-I axis, which is still discernible in young adulthood. By contrast, among males, higher animal protein intakes in early life may exert a long-term programming of the GH-IGF-I axis.

Current trends of 24-h urinary iodine excretion in German schoolchildren and the importance of iodised salt in processed foods.

Worldwide, the iodisation of salt has clearly improved iodine status. In industrialised countries, iodised salt added to processed food contributes most to iodine supply. Yet it is unclear as to what extent changes in the latter may affect the iodine status of populations. Between 2004 and 2009, 24-h urinary iodine excretions (UIE) were repeatedly measured in 278 German children (6 to 12 years old) of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study (n 707). Na excretion measurements and simultaneously collected 3-d weighed dietary records provided data on intakes of the most important dietary sources of iodine in the children's diet. Actual trends of UIE (2004-9) and contributions of relevant food groups were analysed by mixed linear regression models. Longitudinal regression analysis showed a plateau of UIE in 2004-6; afterwards, UIE significantly decreased till 2009 (P = 0·01; median 24-h UIE in 2004-6: 85·6 µg/d; 2009: 80·4 µg/d). Median urinary iodine concentration fell below the WHO criteria for iodine sufficiency of 100 µg/l in 2007-9. Salt, milk, fish and egg intake (g/d) were significant predictors of UIE (P < 0·005); and the main sources of iodine were salt and milk (48 and 38 %, respectively). The present data hint at a beginning deterioration in the iodine status of German schoolchildren. A decreased use of iodised salt in industrially produced foods may be one possible reason for this development. Because of the generally known risks for cognitive impairment due to even mild iodine deficits in children, a more widespread use of iodised salt, especially in industrially processed foods, has to be promoted.

Association of dietary energy density in childhood with age and body fatness at the onset of the pubertal growth spurt.

The aim of the present study was to examine the association of pre-pubertal dietary energy density (ED) with both age and body fatness at the start of the pubertal growth spurt (age at take-off, ATO). Analyses included 219 DOrtmund Nutritional and Anthropometric Longitudinally Designed Study participants with sufficient height measurements to estimate ATO who provided 3 d weighed dietary records at baseline, i.e. 2 and 3 years before ATO (mean age 6·9 (SD 1·2) years). Mean energy intakes and amounts of foods/drinks consumed at baseline were derived from the records. ED (kJ/g) was calculated based on (1) all foods and drinks (ED_all), (2) foods and energy-containing drinks (ED_energy), (3) foods and milk as a drink, but no other beverages (ED_milk) and (4) foods only, solid or liquid (ED_food). Using multiple regression analyses, the association between the ED variables and ATO was investigated. Furthermore, Z-scores of BMI and fat mass index (FMI) at ATO were considered as outcomes to reflect body fatness at puberty onset. The results showed that ED at baseline was not associated with ATO, regardless of the ED method used. For example, mean ATO in the lowest v. highest tertile of ED_food was 9·3 (95 % CI 9·0, 9·5) v. 9·4 (95 % CI 9·1, 9·7) years, P(trend) = 0·8 (adjusted for sex, maternal age, birth weight, dietary protein, dietary fibre, baseline BMI Z-score). Similarly, ED was not independently associated with BMI or FMI Z-score at ATO (P(trend) = 0·3-0·9). In conclusion, dietary ED in childhood did not influence timing or body fatness at ATO in this cohort of healthy, free-living children.

Association of DASH diet with cardiovascular risk factors in youth with diabetes mellitus: the SEARCH for Diabetes in Youth study.

BACKGROUND: We have shown that adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is related to blood pressure in youth with type 1 and type 2 diabetes mellitus. We explored the impact of the DASH diet on other cardiovascular disease risk factors. METHODS AND RESULTS: Between 2001 and 2005, data on total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, low-density lipoprotein particle density, apolipoprotein B, body mass index, waist circumference, and adipocytokines were ascertained in 2130 youth aged 10 to 22 years with physician-diagnosed diabetes mellitus. Dietary intake was assessed by food frequency questionnaire, categorized into the DASH food groups, and assigned an adherence score. Among youth with type 1 diabetes mellitus, higher adherence to the DASH diet was significantly and inversely associated with low-density lipoprotein/high-density lipoprotein ratio and A(1c) in multivariable-adjusted models. Youth in the highest adherence tertile had an estimated 0.07 lower low-density lipoprotein/high-density lipoprotein ratio and 0.2 lower A(1c) levels than those in the lowest tertile adjusted for confounders. No significant associations were observed with triglycerides, low-density lipoprotein particle density, adipocytokines, apolipoprotein B, body mass index Z score, or waist circumference. Among youth with type 2 diabetes mellitus, associations were observed with low-density lipoprotein particle density and body mass index Z score. CONCLUSIONS: The DASH dietary pattern may be beneficial in the prevention and management of cardiovascular disease risk in youth with diabetes mellitus.

Body composition trajectories into adolescence according to age at pubertal growth spurt.

OBJECTIVE: To investigate whether the development of body composition into adolescence differs among children with an early, average, or late pubertal growth spurt (age at take-off [ATO]). METHODS: Mixed-effect polynomial models were applied to serial anthropometric measurements spanning from 4 years before to 4 years after ATO in 215 DONALD participants. Sex-specific trajectories of fat mass index (FMI, FM/m(2) ), fat-free mass index (FFMI, FFM/m(2) ), and their z-scores were compared among those with an early, average, or late ATO. RESULTS: Compared with girls with a late ATO (reference group), those with an early or average ATO experienced a significant increase in FFMI z-scores [ß (standard error) for linear trends in early and average ATO group: +0.15 (0.05) FFMI z-scores/year (P = 0.001) and +0.11 (0.04) FFMI z-scores/year (P = 0.005), respectively, adjusted for early life factors]. Similar differences were observed in boys [adjusted ß (standard error): +0.20 (0.06) FFMI z-scores/year (P = 0.0004) and +0.07 (0.05) FFMI z-scores/year (P = 0.1), respectively]. Graphical illustration of the predicted trajectories revealed that differences in relative FFMI emerged from ATO onward. For FMI, comparison with late maturers showed a more pronounced quadratic trend (kg/m(2) /years(2) ) (P = 0.01) among early-maturing girls and a reduced linear trend in FMI z-scores/year (P = 0.04) among early-maturing boys. CONCLUSIONS: This longitudinal study suggests that children who experience an early pubertal growth spurt accrue progressively more fat-free mass during the first years of puberty than late-maturing peers of the same age. Higher levels of adiposity commonly observed in adults with early puberty onset are, thus, likely to develop subsequently in later adolescence.

Validation of protein intake assessed from weighed dietary records against protein estimated from 24 h urine samples in children, adolescents and young adults participating in the Dortmund Nutritional and Longitudinally Designed (DONALD) Study.

OBJECTIVE: To date, only a few nutritional assessment methods have been validated against the biomarker of urinary-N excretion for use in children and adolescents. The aim of the present study was to validate protein intake from one day of a weighed dietary record against protein intake estimated from a simultaneously collected 24 h urine sample. DESIGN: Cross-sectional analyses including 439 participants of the Dortmund Nutritional and Longitudinally Designed (DONALD) Study from four age groups (3-4, 7-8, 11-13 and 18-23 years). Mean differences, Pearson correlation coefficients (r), cross-classifications and Bland-Altman plots were used to assess agreement between methods. RESULTS: Weighed dietary records significantly underestimated mean protein intake by -6.4 (95 % CI -8.2, -4.7) g/d or -11 %, with the difference increasing across the age groups from -0.6 (95 % CI -2.7, 1.5) g/d at age 3-4 years to -13.5 (95 % CI -18.7, -8.3) g/d at age 18-23 years. Correlation coefficients were r = 0.7 for the total study sample and ranged from r = 0.5 to 0.6 in the different age groups. Both methods classified 85 % into the same/adjacent quartile for the whole study group (83-86 % for the different age groups) and 2.5 % into the opposite quartile (1.9-3.1 % for the different age groups). Bland-Altman plots for the total sample indicated that differences in protein intake increased across the range of protein intake, while this bias was not obvious within the age groups. CONCLUSIONS: Protein intake in children and adolescents can be estimated with acceptable validity by weighed dietary records. In this age-heterogeneous sample, validity was lower among adolescents and young adults.

Dietary protein intake throughout childhood is associated with the timing of puberty.

Early puberty onset is associated with hormone-related cancers, but whether diet in childhood influences pubertal timing is controversial. We examined the association of protein intake in early and mid-childhood with the ages at take-off of the pubertal growth spurt (ATO), peak height velocity (APHV), and menarche in girls and voice break in boys using data from the longitudinal Dortmund Nutritional and Anthropometric Longitudinally Designed Study. Among participants who provided 3-d weighed dietary records at 12 mo, 18-24 mo, 3-4 y, and 5-6 y, 112 had sufficient anthropometric measurements between 6 and 13 y to allow estimation of ATO. Life-course plots were used to identify critical periods of total, animal, and vegetable protein intake (percentage of total energy intake) for pubertal timing. At these ages, the association between tertiles of protein intake (T1-T3) and the outcomes was investigated using multiple linear regression analysis. A higher total and animal protein intake at 5-6 y was related to an earlier ATO. In the highest tertile of animal protein intake at 5-6 y, ATO occurred 0.6 y earlier than in the lowest [(mean, 95% CI) T1: 9.6, 9.4-9.9 vs. T2: 9.4, 9.1-9.7 vs. T3: 9.0, 8.7-9.3 y; P-trend = 0.003, adjusted for sex, total energy, breast-feeding, birth year, and paternal university degree]. Similar findings were seen for APHV (P-trend = 0.001) and the timing of menarche/voice break (P-trend = 0.02). Conversely, a higher vegetable protein intake at 3-4 and 5-6 y was related to later ATO, APHV, and menarche/voice break (P-trend = 0.02-0.04). These results suggest that animal and vegetable protein intake in mid-childhood might be differentially related to pubertal timing.

Diet quality in childhood is prospectively associated with the timing of puberty but not with body composition at puberty onset.

We examined whether the diet quality of healthy children prior to the pubertal growth spurt was associated with age and body composition at puberty onset. Multivariate regression analyses were performed using data from 222 Dortmund Nutritional and Anthropometric Longitudinally Designed Study participants (mean age +/- SD at baseline: 7.4 +/- 1.3 y) with 3-d weighed dietary records and anthropometric data at baseline, i.e. the visits 2 and 3 y before the onset of pubertal growth spurt [defined as age at take-off (ATO)]. Diet quality at baseline was determined using the nutrient density-based Nutritional Quality Index (NQI) and the food group and nutrient-based Revised Children's Diet Quality Index (RC-DQI). Based on their distribution, 3 NQI or RC-DQI categories were created to indicate lower, moderate, and higher diet quality. Parameters describing body composition at ATO were age- and gender-specific Z-scores of BMI, fat mass/height(2), and fat-free mass/height(2). Children with lower diet quality indicated by lower NQI scores entered puberty approximately 0.4 y earlier than children with higher NQI scores {ATO in lower and higher NQI categories were [mean (95% CI)] 9.2 y (9.0-9.4), and 9.6 y (9.4-9.9), adjusted for sex, maternal overweight, baseline energy intake, and baseline BMI Z-score} (P-value = 0.02). A similar association of the RC-DQI with ATO was largely explained by baseline energy intakes. Our data suggest that diet quality was not independently associated with body composition at ATO. Children with lower diet quality according to a nutrient density-based index appear to enter puberty at an earlier age, independently of prepubertal body composition.

Association between the dietary approaches to hypertension diet and hypertension in youth with diabetes mellitus.

Among youth with diabetes mellitus, elevated blood pressure represents one of the most common comorbidities. Hence, exploring dietary factors that may help prevent or control hypertension in this population is of paramount importance. We investigated whether adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is associated with hypertension in youth with diabetes mellitus from the SEARCH for Diabetes in Youth Study. Between 2001 and 2005, 2830 youth aged 10 to 22 years (2440 with type 1 and 390 with type 2 diabetes mellitus) completed a study visit. For each of the 8 DASH food groups, a score of 10 was assigned when the DASH recommendation was met. Lower intakes were scored proportionately, and the 8 individual scores were summed. The association between the overall DASH score and hypertension was evaluated using multiple logistic regression. The crude prevalence of hypertension was 6.8% for youth with type 1 and 28.2% for youth with type 2 diabetes mellitus. In youth with type 1, a higher adherence to DASH was inversely related to hypertension, independent of demographic, clinical, and behavioral characteristics (tertile 2 versus 1: odds ratio: 0.7, 95% CI: 0.5 to 1.0; 3 versus 1: odds ratio: 0.6, 95% CI: 0.4 to 0.9; P(trend)=0.007). For type 2 diabetes mellitus, the DASH diet was not associated with hypertension (tertile 2 versus 1: odds ratio: 0.8, 95% CI: 0.5 to 1.4; 3 versus 1: odds ratio: 0.9, 95% CI: 0.5 to 1.5; P(trend)=0.6). Prospective observational studies or clinical trials are needed to investigate whether adherence to the DASH guidelines may help prevent hypertension in youth with type 1 diabetes mellitus. In type 2 diabetes mellitus, more research with a larger sample is necessary.

Renal net acid excretion capacity is comparable in prepubescence, adolescence, and young adulthood but falls with aging.

OBJECTIVES: To evaluate whether renal net acid excretion capacity (NAEC) varies across different age groups and, specifically, whether it falls in elderly people. DESIGN: Cross-sectional observational study. SETTING: Community-based. PARTICIPANTS: Young participants were from the DOrtmund Nutritional and Anthropometric Longitudinally Designed Study, Dortmund, Germany; elderly participants were from Gothenburg, Sweden. MEASUREMENTS: Twenty-four-hour urine pH, net acid excretion (NAE), urinary phosphorus, total nitrogen excretion, and anthropometric data were measured in healthy elderly people (aged 55-75; n=85), young adults (aged 18-22; n=117), adolescents (aged 13-14; n=112), and prepubescent children (aged 6-7; n=217). NAEC was determined as 24-hour NAE adjusted for urine pH using the residual method. RESULTS: In elderly participants 24-hour urinary pH (5.9+/-0.53) was lower (P<.05) and NAE (60+/-27 mEq/d) higher (P<.05) than in the three other groups. In a regression model adjusted for age, sex, and body surface area, NAEC showed a clear decrease with age, with highest values in prepubescents and lowest in elderly participants. However, NAEC remained significantly lower only in elderly participants (P<.001) after the inclusion of total nitrogen excretion, a protein intake index, which was included because protein intake is known to modulate renal function. NAEC was approximately 8 mEq/d lower in healthy elderly participants than in young adults. CONCLUSION: The capacity to excrete net endogenous acid does not vary markedly from childhood to young adulthood but falls significantly with age, implying that elderly people may require higher daily alkalizing mineral intake to compensate for renal function losses.

How early dietary factors modify the effect of rapid weight gain in infancy on subsequent body-composition development in term children whose birth weight was appropriate for gestational age.

BACKGROUND: It is not clear whether the adverse effects of rapid weight gain in infancy are modified by nutrition during the first 2 y of life in term children whose birth weight was appropriate for gestational age (AGA). OBJECTIVE: We examined the interaction between rapid weight gain and nutrition in infancy and early childhood and their effect on body fat percentage (BF%) trajectories between 2 and 5 y of age. DESIGN: The study population comprised 249 (51.4% female) term AGA participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study, for whom repeated anthropometric measurements until 5 y of age and information on breastfeeding status and on diet at 12 and 18-24 mo of age were available. RESULTS: Multilevel model analyses showed that, among rapid growers, those who had been fully breastfed for > or =4 mo had a lower BF% at 2 y of age than did those who had not been fully breastfed for > or =4 mo (beta +/- SE: -1.53 +/- 0.59%; P = 0.009). This difference persisted until 5 y. Furthermore, those rapid growers who had a consistently high fat intake at both 12 and 18-24 mo did not show the expected physiologic decrease in BF% between 2 and 5 y seen in those rapid growers with an inconsistent or consistently low fat intake at these time points (0.73 +/- 0.26%/y; P = 0.006). CONCLUSIONS: Among rapid growers, full breastfeeding for > or =4 mo is protective against a high BF% at 2 y of age, whereas a consistently high fat intake in the second year of life "inhibits" the physiologic decrease in BF% between 2 and 5 y.

Early protein intake and later obesity risk: which protein sources at which time points throughout infancy and childhood are important for body mass index and body fat percentage at 7 y of age?

BACKGROUND: A high early protein intake has been proposed to increase obesity risk. OBJECTIVE: We examined whether a critical period of protein intake for later obesity may exist early in childhood and investigated the relation between protein intake from different sources and body mass index SD score and body fat percentage (BF%) at 7 y of age. DESIGN: The study population included 203 participants of the Dortmund Nutritional and Longitudinally Designed Study with information on diet at 6 mo, 12 mo, 18-24 mo, 3-4 y, and 5-6 y. Life-course plots were constructed to assess when protein intake (% of energy) was associated with body mass index SD score and BF% at 7 y. Mean values were then compared among tertiles (T1-T3) of protein from different sources at the important time points. RESULTS: The ages of 12 mo and 5-6 y were identified as critical ages at which higher total and animal, but not vegetable, protein intakes were positively related to later body fatness. In fully adjusted models, animal protein intake at 12 mo was associated with BF% at 7 y as follows [x (95% CI) BF%]: T1, 16.20 (15.23, 17.25); T2, 17.21 (16.24, 18.23); T3, 18.21 (17.12, 19.15); P for trend = 0.008. With respect to food groups, dairy, but not meat or cereal protein intake, at 12 mo was related to BF% at 7 y (P for trend = 0.07). Animal protein at 5-6 y yielded similar results (P for trend = 0.01), but food group associations were less consistent. CONCLUSION: A higher animal, especially dairy, protein intake at 12 mo may be associated with an unfavorable body composition at 7 y. The age of 5-6 y might represent another critical period of protein intake for later obesity risk.

Breakfast glycemic index affects subsequent daily energy intake in free-living healthy children.

BACKGROUND: Experimental studies have reported that the effect of a meal's glycemic index (GI) on subsequent energy intake depends on the timing of the subsequent meal. OBJECTIVE: We examined whether the timing of the next meal after breakfast modifies the effect of the breakfast GI (GI(br)) on subsequent daytime energy intake of healthy free-living children. DESIGN: Analyses included 381 participants of the DOrtmund Nutritional and Anthropometrical Longitudinally Designed (DONALD) Study who had provided weighed dietary records at ages 2, 4-5, and 7 y. RESULTS: At all ages, among children who consumed their next meal in the early postprandial phase (after 3-4 h), children with a lower GI(br) consumed more calories throughout the remainder of the day than did children with a higher GI(br), independent of major dietary confounders. For the age groups 2, 4-5, and 7 y, energy intakes in tertiles 1 and 3 were 785 kcal (95% CI: 743-830 kcal) and 717 kcal (678-758 kcal), P for trend = 0.2; 993 kcal (941-1047 kcal) and 949 kcal (900-1000 kcal), P for trend = 0.05; 1255 (1171-1344) and 1166 (1090-1247 kcal), P for trend = 0.03, respectively. Conversely, among children consuming their next meal in the late postprandial phase (>3-4 h), subsequent daytime energy intake was not associated with GI(br). CONCLUSION: This study confirms differential early and late postprandial effects of the GI(br) on subsequent daytime energy intake for free-living children at different ages. Interestingly, the apparent short-term satiating effect of a higher GI(br), in particular, persisted throughout the day, if a second breakfast was consumed midmorning.

Protein intake during the period of complementary feeding and early childhood and the association with body mass index and percentage body fat at 7 y of age.

BACKGROUND: A high protein intake during infancy and early childhood has been proposed to increase the risk of subsequent obesity. OBJECTIVE: We analyzed the association of different protein intakes during 6-24 mo with body mass index (BMI; in kg/m2) and percentage body fat (%BF) at 7 y of age. DESIGN: The analyses included 203 participants of the DOrtmund Nutritional and Longitudinally Designed (DONALD) Study with complete information on early diet (6, 12, and 18-24 mo) and anthropometric data at the age of 7 y. The median of energy-adjusted protein intakes (in g/d) was used to distinguish different patterns of low and high protein intakes throughout the first 2 y of life, which were then related to BMI SD scores (SDSs), %BF, and the risk of overweight and overfatness at 7 y of age. RESULTS: Although protein intake at 6 mo of age was not associated with the outcomes, a consistently high protein intake at the ages of 12 and 18-24 mo was independently related to a higher mean BMI SDS and %BF at the age of 7 y [BMI SDS: 0.37 (95% CI: 0.12, 0.61) compared with 0.08 (95% CI: -0.09, 0.26), P = 0.04; %BF: 18.37 (95% CI: 17.29, 19.51%) compared with 16.91 (95% CI: 16.19, 17.66%), P = 0.01] and a higher risk of having a BMI or %BF above the 75th percentile at that age [odds ratio for BMI: 2.39 (95% CI: 1.14, 4.99), P = 0.02); odds ratio for %BF: 2.28 (95% CI: 1.06, 4.88), P = 0.03]. CONCLUSIONS: High protein intakes during the period of complementary feeding and the transition to the family diet are associated with an unfavorable body composition at the age of 7 y.

Maternal perceptions of her child's body weight in infancy and early childhood and their relation to body weight status at age 7.

INTRODUCTION: Maternal perception of her child's weight status has been hypothesised to affect a child's weight development. OBJECTIVE: The aim of this analysis was to determine in how far the maternal weight perception of her child's weight at different ages is related to its future body weight status. MATERIALS AND METHODS: Longitudinal data on body weight, height and skinfolds from the Dortmund Nutritional and Anthropometric Longitudinally Designed Study were used to determine the risk of being overweight at age 7. Complete data on anthropometry, maternal weight perception and confounding variables were available for 253 children. RESULTS AND DISCUSSION: Maternal weight perception assessments at age 6 months, 12 months, 2 years and 4 years of age were related to body weight status as well as changes in body mass index standard deviation score (BMI-SDS) and skinfold SDS between age at assessment and age 7. With respect to the risk of being overweight at age 7, no independent effect of maternal perception was found. When changes in anthropometric measures were considered, it could be observed that children whose weight was considered too low gained more weight until age 7, and those who were considered to be too heavy lost more weight as compared to the children whose weight was considered to be just right. Among infants aged 6 months who were above the 85th percentile, maternal misperception appeared to promote an unfavourable weight development. These latter results support the hypothesis that maternal weight perception might affect a child's weight development. CONCLUSION: As our data suggest, this effect might begin to operate already in infancy.