Methodology for longitudinal assessment of nutrient intake and dietary habits in early childhood in a transnational multicenter study.

OBJECTIVES: The aim of this study was to describe developed methods for repeated longitudinal assessment of feeding habits and nutrient intakes of children in a multicenter trial in different European countries and to assess feasibility. PATIENTS AND METHODS: Nutrient intake and dietary habits of formula-fed and breast-fed infants were assessed in 5 European countries (Belgium, Germany, Italy, Poland, and Spain). Prospective age-adapted 3-day weighed food records were used from birth to 2 years of age (1, 2, 3, 4, 5, 6, 7, 8, 9, 12, 18, and 24 months). Standard operating procedures were developed to check each day's food record for quality. Dietitians were trained by using standardized food records. Data entry and nutrient analyses were performed with a dedicated software developed for this project. RESULTS: Of 1368 study participants, at least one 3-day food record was available; of 25,367 1-day food records, data on quality could be evaluated. Overall, between 81% and 97% (depending on the country) of the food records had been completed with high accuracy. The implementation of solid foods and regular family foods decreased the recording quality significantly during the 2-year time course (P < 0.001). The standardized training shows coefficients of variation up to a maximum of about 41%, indicating differences in data entry. CONCLUSIONS: The experiences gathered indicate that collecting dietary and behavioral data in a large number of infants from different cultures is a challenging but feasible task in which permanent supervision and training is vital. However, we conclude that the established methodology is suitable to obtain valuable results on current infant nutrition practice in Europe.

Protein intake in the first year of life: a risk factor for later obesity? The E.U. childhood obesity project.

Effective strategies for primary prevention are urgently needed to combat the rapidly increasing prevalence of childhood obesity. Evidence accumulates that early nutrition programmes later obesity risk. Breast feeding reduces the odds ratio for obesity at school age, adjusted for biological and sociodemographic confounding variables, by some 20-25%. We propose that the protective effect of breast feeding is related in part by the induction of a lower weight gain in infancy, which is related to differences in substrate intake. Protein intake per kg bodyweight is some 55-80% higher in formula fed than in breast fed infants. We hypothesize that high early protein intakes in excess of metabolic requirements enhance weight gain in infancy and increase later obesity risk (the "early protein hypothesis"). The European Childhood Obesity Programme tests this hypothesis in a randomized double blind intervention trial in 1150 infants in five European centres. Infants that are not breast fed are randomized to formulae with higher or lower protein content and followed up to school age. If an effect of infant feeding habits on later obesity risk should be established, there is great potential for effective preventive intervention with a significant potential health benefit for the child and adult population.

Height and weight of German primary school children in the Family Intervention Trial (FIT) Erlangen.

Many anthropometric reference data for children are based on studies conducted up to 40 years ago. We assessed height and weight distribution of a population of German primary school children and compared the results with national and international reference data. In February 1998 weight and height were measured in 427 first grade school children (195 boys, 232 girls) aged 6 to 7 years who participated in the family intervention trial Erlangen. Compared to studies in the 1980s, weight showed a marked but height only a minimal increase. Mean weight-for-height is similar to previously published reference data, but upper percentile values are much higher. Mean weight-for-height and the proportion of overweight children are similar for children of German and of foreign origin. We conclude that overweight and obesity have clearly increased in primary school children in recent years.