[Show abstract][Hide abstract] ABSTRACT: Severe acute malnutrition is a serious public health problem, and a challenge to clinicians. Why some children with malnutrition develop oedema (kwashiorkor) is not well understood. The objective of this study was to investigate socio-demographic, dietary and clinical correlates of oedema, in children hospitalised with severe acute malnutrition.
We recruited children with severe acute malnutrition admitted to Mulago Hospital, Uganda. Data was collected using questionnaires, clinical examination and measurement of blood haemoglobin, plasma c-reactive protein and α1-acid glycoprotein. Correlates of oedema were identified using multiple logistic regression analysis.
Of 120 children included, 77 (64%) presented with oedematous malnutrition. Oedematous children were slightly older (17.7 vs. 15.0 months, p = 0.006). After adjustment for age and sex, oedematous children were less likely to be breastfed (odds ratio (OR): 0.19, 95%-confidence interval (CI): 0.06; 0.59), to be HIV-infected (OR: 0.10, CI: 0.03; 0.41), to report cough (OR: 0.33, CI: 0.13; 0.82) and fever (OR: 0.22, CI: 0.09; 0.51), and to have axillary temperature > 37.5°C (OR: 0.28 CI: 0.11; 0.68). Household dietary diversity score was lower in children with oedema (OR: 0.58, CI: 0.40; 85). No association was found with plasma levels of acute phase proteins, household food insecurity or birth weight.
Children with oedematous malnutrition were less likely to be breastfed, less likely to have HIV infection and had fewer symptoms of other infections. Dietary diversity was lower in households of children who presented with oedema. Future research may confirm whether a causal relationship exists between these factors and nutritional oedema.
[Show abstract][Hide abstract] ABSTRACT: Background:
Evidence suggests that early life infections, presence of older siblings and furred pets in the household affect the risk of developing allergic diseases through altered microbial exposure. Recently, low gut microbial diversity during infancy has also been linked with later development of allergies. We investigated whether presence of older siblings, furred pets and early life infections affected gut microbial communities at 9 and 18 months of age and whether these differences were associated with the cumulative prevalence of atopic symptoms of eczema and asthmatic bronchitis at 3 years of age. Bacterial compositions and diversity indices were determined in fecal samples collected from 114 infants in the SKOT I cohort at age 9 and 18 months by 16S rRNA gene sequencing. These were compared to the presence of older siblings, furred pets and early life infections and the cumulative prevalence of diagnosed asthmatic bronchitis and self-reported eczema at 3 years of age.
The number of older siblings correlated positively with bacterial diversity (p = 0.030), diversity of the phyla Firmicutes (p = 0.013) and Bacteroidetes (p = 0.004) and bacterial richness (p = 0.006) at 18 months. Further, having older siblings was associated with increased relative abundance of several bacterial taxa at both 9 and 18 months of age. Compared to the effect of having siblings, presence of household furred pets and early life infections had less pronounced effects on the gut microbiota. Gut microbiota characteristics were not significantly associated with cumulative occurrence of eczema and asthmatic bronchitis during the first 3 years of life.
Presence of older siblings is associated with increased gut microbial diversity and richness during early childhood, which could contribute to the substantiation of the hygiene hypothesis. However, no associations were found between gut microbiota and atopic symptoms of eczema and asthmatic bronchitis during early childhood and thus further studies are required to elucidate whether sibling-associated gut microbial changes influence development of allergies later in childhood.
[Show abstract][Hide abstract] ABSTRACT: A New Nordic Diet (NND) was developed in the context of the Danish OPUS Study (Optimal well-being, development and health for Danish children through a healthy New Nordic Diet). Health, gastronomic potential, sustainability and Nordic identity were crucial principles of the NND. The aim of the present study was to investigate the effects of serving NND school meals compared with the usual packed lunches on the dietary intake of NND signature foods. For two 3-month periods, 834 Danish children aged 8-11 years received NND school meals or their usual packed lunches brought from home (control) in random order. The entire diet was recorded over 7 consecutive days using a validated Web-based Dietary Assessment Software for Children. The NND resulted in higher intakes during the entire week (% increase) of root vegetables (116 (95 % CI 1·93, 2·42)), cabbage (26 (95 % CI 1·08, 1·47)), legumes (22 (95 % CI 1·06, 1·40)), herbs (175 (95 % CI 2·36, 3·20)), fresh berries (48 (95 % CI 1·13, 1·94)), nuts and seeds (18 (95 % CI 1·02, 1·38)), lean fish and fish products (47 (95 % CI 1·31, 1·66)), fat fish and fish products (18 (95 % CI 1·02, 1·37)) and potatoes (129 (95 % CI 2·05, 2·56)). Furthermore, there was a decrease in the number of children with zero intakes when their habitual packed lunches were replaced by NND school meals. In conclusion, this study showed that the children increased their intake of NND signature foods, and, furthermore, there was a decrease in the number of children with zero intakes of NND signature foods when their habitual packed lunches were replaced by school meals following the NND principles.
The British journal of nutrition 07/2015; 114:1-8. DOI:10.1017/S0007114515002299 · 3.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Third trimester fetal growth is partially regulated by C-peptide and insulin-like growth factor I (IGF-I). Prenatal exposures including maternal obesity and high gestational weight gain as well as high birth weight have been linked to subsequent metabolic disease. We evaluated the associations between newborn regional body composition and cord blood levels of C-peptide and IGF-I.
We prospectively included obese and normal-weight mothers and their newborns; cord blood was collected and frozen. Analyses of C-peptide and IGF-I were performed simultaneously, after recruitment was completed. Newborn regional body composition was assessed with dual-energy X-ray absorptiometry scanning (DXA) within 48 hours of birth.
Three hundred thirty-six term infants were eligible to participate in the study; of whom 174 (52%) infants had cord blood taken. Total, abdominal and arm and leg fat mass were positively associated with C-peptide (p < 0.001). Arm and leg fat mass was associated with IGF-I concentration: 28 g [95% confidence interval: 4, 53] per doubling of IGF-I. There was no association between total or abdominal fat mass and IGF-I. Fat-free mass was positively associated with both C-peptide (p < 0.001) and IGF-I (p = 0.004).
Peripheral fat tissue accumulation was associated with cord blood C-peptide and IGF-I. Total and abdominal fat masses were related to C-peptide but not to IGF-I. Thus, newborn adiposity is partially mediated through C-peptide and early linear growth is associated with IGF-I.
PLoS ONE 07/2015; 10(7):e0121350. DOI:10.1371/journal.pone.0121350 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Early excessive weight gain is positively associated with later obesity, and yet the effect of weight gain during specific periods and the impact of infant feeding practices are debated. The objective of the present study was to examine the impact of weight gain in periods of early childhood on body composition at 3 years, and whether infant feeding modified the relationship between early growth and body composition at 3 years. We studied 233 children from the prospective cohort study, SKOT (in Danish: Småbørns Kost og Trivsel). Birth weight
-scores (BWZ) and change in weight-for-age
-scores (WAZ) from 0 to 5, 5 to 9, 9 to 18 and 18 to 36 months were analysed for relations with body composition (anthropometry and bioelectrical impedance) at 3 years by multivariate regression analysis. BWZ and change in WAZ from 0 to 5 months were positively associated with BMI, fat mass index (FMI) and fat-free mass index (FFMI) at 3 years. Full breastfeeding for 6 months (compared to less than 1 month) eliminated the effect of early growth (
= 0·01). Full breastfeeding for 6 months (compared to less than 1 month) also eliminated the positive relation between BWZ and FMI (
= 0·009). No effect modification of infant feeding was found for FFMI. In conclusion, high birth weight and rapid growth from 0 to 5 months were associated with increased FMI and FFMI at 3 years. Longer duration of full breastfeeding reduced the effect of birth weight and early weight gain on fat mass.
The British journal of nutrition 07/2015; DOI:10.1017/S0007114515001427 · 3.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: It is important to increase the awareness of indicators associated with adverse infant dietary patterns to be able to prevent or to improve dietary patterns early on.
The aim of this study was to investigate the association between a wide range of possible family and child indicators and adherence to dietary patterns for infants aged 9 months.
The two dietary patterns 'Family Food' and 'Health-Conscious Food' were displayed by principal component analysis, and associations with possible indicators were analysed by multiple linear regressions in a pooled sample (n=374) of two comparable observational cohorts, SKOT I and SKOT II. These cohorts comprised infants with mainly non-obese mothers versus infants with obese mothers, respectively.
A lower Family Food score indicates a higher intake of liquid baby food, as this pattern shows transition from baby food towards the family's food. Infants, who were younger at diet registration and had higher body mass index (BMI) z-scores at 9 months, had lower Family Food pattern scores. A lower Family Food pattern score was also observed for infants with immigrant/descendant parents, parents who shared cooking responsibilities and fathers in the labour market compared to being a student, A lower Health-Conscious Food pattern score indicates a less healthy diet. A lower infant Health-Conscious Food pattern score was associated with a higher maternal BMI, a greater number of children in the household, a higher BMI z-score at 9 months, and a higher infant age at diet registration.
Associations between infant dietary patterns and maternal, paternal, household, and child characteristics were identified. This may improve the possibility of identifying infants with an increased risk of developing unfavourable dietary patterns and potentially enable an early targeted preventive support.
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to compare total food intake, total and relative edible plate waste and self-reported food likings between school lunch based on the new Nordic diet (NND) and packed lunch from home. In two 3-month periods in a cluster-randomised controlled unblinded cross-over study 3rd- and 4th-grade children (
187) from two municipal schools received lunch meals based on NND principles and their usual packed lunch (control). Food intake and plate waste (
1558) were calculated after weighing lunch plates before and after the meal for five consecutive days and self-reported likings (
905) assessed by a web-based questionnaire. Average food intake was 6 % higher for the NND period compared with the packed lunch period. The quantity of NND intake varied with the menu (
< 0·0001) and was positively associated with self-reported likings. The edible plate waste was 88 (
80) g for the NND period and 43 (
60) g for the packed lunch period whereas the relative edible plate waste was no different between periods for meals having waste (
1050). Edible plate waste differed between menus (
< 0·0001), with more waste on soup days (36 %) and vegetarian days (23 %) compared with the packed lunch period. Self-reported likings were negatively associated with percentage plate waste (
< 0·0001). The study suggests that portion sizes need to be considered in new school meal programmes. New strategies with focus on reduction of plate waste, children's likings and nutritious school meals are crucial from both a nutritional, economic and environmental point of view.
[Show abstract][Hide abstract] ABSTRACT: It is widely assumed that nutrition can improve school performance in children; however, evidence remains limited and inconclusive. In the present study, we investigated whether serving healthy school meals influenced concentration and school performance of 8- to 11-year-old Danish children. The OPUS (Optimal well-being, development and health for Danish children through a healthy New Nordic Diet) School Meal Study was a cluster-randomised, controlled, cross-over trial comparing a healthy school meal programme with the usual packed lunch from home (control) each for 3 months (NCT 01457794). The d2 test of attention, the Learning Rating Scale (LRS) and standard tests on reading and mathematics proficiency were administered at baseline and at the end of each study period. Intervention effects were evaluated using hierarchical mixed models. The school meal intervention did not influence concentration performance (CP; primary outcome,
693) or processing speed; however, the decrease in error percentage was 0·18 points smaller (
< 0·001) in the intervention period than in the control period (medians: baseline 2·03 %; intervention 1·46 %; control 1·37 %). In contrast, the intervention increased reading speed (0·7 sentence,
= 0·009) and the number of correct sentences (1·8 sentences,
< 0·001), which corresponded to 11 and 25 %, respectively, of the effect of one school year. The percentage of correct sentences also improved (
< 0·001), indicating that the number correct improved relatively more than reading speed. There was no effect on overall math performance or outcomes from the LRS. In conclusion, school meals did not affect CP, but improved reading performance, which is a complex cognitive activity that involves inference, and increased errors related to impulsivity and inattention. These findings are worth examining in future trials.
The British journal of nutrition 03/2015; 113(08):1-12. DOI:10.1017/S0007114515000033 · 3.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There is a need for trials on the effects of food aid products for children with moderate acute malnutrition, to identify how best to restore body tissues and function. The choice of control intervention is a major challenge, with both ethical and scientific implications. While randomized trials are needed, special designs, such as cluster-randomized, stepped-wedged or factorial designs may offer advantages. Anthropometry is widely used as the primary outcome in such trials, but anthropometric traits do not refer directly to specific organs, tissues, or functions. Thus, it is difficult to understand what components of health might be impacted by public health programs, or the underlying mechanisms whereby improved nutritional status might benefit short- and long-term health. Measurement of body composition, specific growth markers and functional outcomes may provide greater insight into the nature and implications of growth failure and recovery. There are now several methodologies suitable for application in infants and young children, e.g., measuring body composition with deuterium dilution, physical activity with accelerometers and linear growth with knemometers. To evaluate the generalizability of the findings from nutrition trials, it is important to collect data on baseline nutritional status.
[Show abstract][Hide abstract] ABSTRACT: Objective
The aim of this study was to investigate whether indicators of metabolic health fluctuate during the week in a group of children posing unhealthier physical activity, sedentary time, and sleep during weekends compared to weekdays.MethodsA total of 807 eight- to eleven-year-old children had valid metabolic health markers from one, two, or three measurements contributing 2190 to 2240 observations of metabolic health markers. The weekly variation was tested using linear mixed models.ResultsHomeostatic model assessment of insulin resistance (HOMAIR), triglycerides, leptin (all P < 0.001), and adiponectin (P = 0.03) decreased from Monday to Friday, whereas ghrelin increased (P < 0.001). HOMAIR, triglycerides, and leptin were 35%, 28%, and 33% higher on Mondays compared to Fridays, respectively, and ghrelin was 7% lower on Mondays compared to Fridays (all P < 0.001).Conclusions
The large weekly variation in HOMAIR, triglycerides, and leptin was likely the result of unhealthier behaviors during weekends. These findings have public health relevance and raise methodological issues that should ideally be taken into account in future studies.
[Show abstract][Hide abstract] ABSTRACT: BackgroundsDairy proteins may support muscle protein synthesis and improve satiety in adults. However, there are limited studies using exact measures of body composition, especially in adolescents.Objectives
This study investigates the effect of milk proteins and water on body composition and leptin in overweight adolescents.Methods
Subjects (n = 193) aged 12–15 years were randomized to drink 1 L d−1 of skimmed milk, whey, casein (all milk-based drinks 35 g protein L−1) or water for 12 weeks. Twenty participants dropped out. A pre-test control group of 32 adolescents was examined 12 weeks before start of intervention. Outcomes included leptin and dual-energy X-ray absorptiometry scanning. The effects of the milk-based drinks on body composition and leptin were compared with baseline, pre-test control and water.ResultsLean mass index (LMI) increased compared to baseline (all 95% confidence intervals 0.05–0.50 kg m−2, all P ≤ 0.009) and the pre-test control group (0.044–0.247 kg m−2, P ≤ 0.002) for all four test drinks. Fat mass index (FMI) increased only for milk-based drink groups compared with baseline (0.15–0.67 kg m−2, P < 0.001) and also compared with water (0.029–0.255 kg m−2, P ≤ 0.011). For pre-test control, there was no change in FMI or LMI. Leptin increased in the casein (1.016–3.246 ng mL−1, P < 0.001; 0.952–3.294 ng mL−1, P < 0.001) and whey groups (0.135–2.273 ng mL−1, P = 0.027; 0.069–2.322, P = 0.038) compared with water and pre-test control group, respectively.Conclusions
Although milk proteins increased LMI in overweight adolescents, there was a concurrent increase in FMI and leptin, whereas water only resulted in increased LMI. Thus, increased water intake may be beneficial for body composition in overweight adolescents.
[Show abstract][Hide abstract] ABSTRACT: Children's vitamin D intake and status can be optimised to meet recommendations. We investigated if nutritionally balanced school meals with weekly fish servings affected serum 25-hydroxyvitamin D (25(OH)D) and markers related to bone in 8-to 11-year-old Danish children. We conducted an explora-tive secondary outcome analysis on data from 784 children from the OPUS School Meal Study, a cluster-randomised cross-over trial where children received school meals for 3 months and habitual lunch for 3 months. At baseline, and at the end of each dietary period, 25(OH)D, parathyroid hormone (PTH), osteocalcin (OC), insulin-like growth factor-1 (IGF-1), bone mineral content (BMC), bone area (BA), bone mineral density (BMD), dietary intake and physical activity were assessed. School meals increased vitamin D intake by 0·9 (95 % CI 0·7, 1·1) μg/d. No consistent effects were found on 25(OH) D, BMC, BA, BMD, IGF-1 or OC. However, season-modified effects were observed with 25(OH)D, i.e. children completing the school meal period in January/February had higher 25(OH)D status (5·5 (95 % CI 1·8, 9·2) nmol/l; P = 0·004) than children completing the control period in these months. A similar tendency was indicated in November/December (4·1 (95 % CI –0·12, 8·3) nmol/l; P = 0·057). However, the effect was opposite in March/April (–4·0 (95 % CI –7·0, –0·9) nmol/l; P = 0·010), and no difference was found in May/June (P = 0·214). Unexpectedly, the school meals slightly increased PTH (0·18 (95 % CI 0·07, 0·29) pmol/l) compared with habitual lunch. Small increases in dietary vitamin D might hold potential to mitigate the winter nadir in Danish children's 25(OH)D status while higher increases appear necessary to affect status throughout the year. More trials on effects of vitamin D intake from natural foods are needed.
[Show abstract][Hide abstract] ABSTRACT: A child's diet is an important determinant for later health, growth and development. In Denmark, most children in primary school bring their own packed lunch from home and attend an after-school care institution. The aim of the present study was to evaluate the food, energy and nutrient intake of Danish school children in relation to dietary guidelines and nutrient recommendations, and to assess the food intake during and outside school hours. In total, 834 children from nine public schools located in the eastern part of Denmark were included in this cross-sectional study and 798 children (95·7 %) completed the dietary assessment sufficiently (August–November 2011). The whole diet was recorded during seven consecutive days using the Web-based Dietary Assessment Software for Children (WebDASC). Compared with the food-based dietary guidelines and nutrient recommendations, 85 % of the children consumed excess amounts of red meat, 89 % consumed too much saturated fat, and 56 % consumed too much added sugar. Additionally 35 or 91 % of the children (depending on age group) consumed insufficient amounts of fruits and vegetables, 85 % consumed insufficient amounts of fish, 86 % consumed insufficient amounts of dietary fibre, 60 or 84 % had an insufficient Fe intake (depending on age group), and 96 % had an insufficient vitamin D intake. The study also showed that there is a higher intake of fruits and bread during school hours than outside school hours; this is not the case with, for example, fish and vegetables, and future studies should investigate strategies to increase fish and vegetable intake during school hours.
[Show abstract][Hide abstract] ABSTRACT: Background: Regulation of body composition during childhood is complex. Numerous hormones are potentially involved. Leptin has been proposed to restrain weight gain, but results are inconsistent. Objectives: We examined if baseline fasting levels of ghrelin, adiponectin, leptin, insulin, insulin-like growth factor I (IGF-1), osteocalcin and intact parathyroid hormone (iPTH) were associated with body composition cross-sectionally and longitudinally in 633 8-11-year-olds. Design: Data on hormones and body composition by Dual-energy X-ray absorptiometry from OPUS School Meal Study were used. We looked at baseline hormones as predictors of baseline fat mass index (FMI) or fat-free mass index (FFMI), and also subsequent changes (three and six months) in FMI or FFMI using models with hormones individually or combined. Results: Cross-sectionally, baseline leptin was positively associated with FMI in girls (0.211 kg/m(2) pr. μg/ml (0.186; 0.236), p<0.001) and boys (0.231 kg/m(2) pr. μg/ml (0.200; 0.261), p<0.001). IGF-1 in both genders and iPTH in boys were positively associated with FMI. An inverse association between adiponectin and FFMI in boys and a positive association between IGF-1 and FFMI in girls were found. In longitudinal models, baseline leptin was inversely associated with subsequent changes in FMI (-0.018 kg/m(2) pr. μg/ml (-0.034; -0.002), p=0.028) and FFMI (-0.014 kg/m(2) pr. μg/ml (-0.024; -0.003), p=0.006) in girls. Conclusions: Cross-sectional findings support that leptin is produced in proportion to body fat mass, but the longitudinal observations support that leptin inhibits gains in FMI and FFMI in girls, a finding which may reflect preserved leptin sensitivity in this predominantly normal weight population.
[Show abstract][Hide abstract] ABSTRACT: Background/objectives:
A nutritionally adequate diet in childhood is important for health and resistance of allergies and infections. This study explored the effects of school meals rich in fish, vegetables and fibre on school attendance, asthma, allergies and illness in 797 Danish 8- to 11-year-old children. No comparable studies conducted in high-income settings have been identified.
The OPUS School Meal Study was a cluster-randomised cross-over trial. Children from third and fourth grades at nine Danish schools received school meals or usual packed lunch (control) for two 3-month periods. Occurrence and duration of illnesses, asthma and allergies during the last 14 days were recorded by parental questionnaires at baseline and after each 3-month period. Self-reported well-being was assessed by visual analogue scales.
The school meals did not affect school attendance, parent-reported occurrence or duration of asthma and allergies or self-reported well-being. The most common symptoms of illness were stomach pain (24%), headache (28%) and cold (24%). A slightly higher number of children experienced headaches in the school meal (27%) compared with the control period (22%) (P=0.02). However, subgroup analyses showed that this effect was only seen in children eating school meals in the classroom (P=0.007), and not in common dining areas (P=0.2). No effect was found on other symptoms of illness.
Provision of nutritionally balanced school meals did not affect school attendance, asthma, allergies, illness or well-being in 8- to 11-year-old children. The slight increase in occurrence of headaches seems to be related to the physical eating environment.
European Journal of Clinical Nutrition 12/2014; 69(5). DOI:10.1038/ejcn.2014.263 · 2.71 Impact Factor