Background: Definitions and assessment methods of fussy/picky eating are heterogeneous and remain... more Background: Definitions and assessment methods of fussy/picky eating are heterogeneous and remain unclear. We aimed to identify an eating behavior profile reflecting fussy/picky eating in children and to describe characteristics of fussy eaters. Methods: Eating behavior was assessed with the Child Eating Behavior Questionnaire (CEBQ) in 4914 4-year olds in a population-based birth cohort study. Latent Profile Analysis (LPA) was used to identify eating behavior profiles based on CEBQ subscales. Results and discussion: We found a "fussy" eating behavior profile (5.6% of children) characterized by high food fussiness, slowness in eating, and satiety responsiveness in combination with low enjoyment of food and food responsiveness. Fussy eaters were more often from families with low household income than non-fussy eaters (42% vs. 31.8% respectively; Χ 2 (1) = 9.97, p < .01). When they were 14 months old, fussy eaters had a lower intake of vegetables (t [3008] = 2.42, p < .05) and fish (t [169.77] = 2.40, p < .05) but higher intake of savory snacks (t [153.69] = −2.03, p < .05) and sweets (t [3008] = −2.30, p < .05) compared to non-fussy eaters. Also, fussy eaters were more likely to be underweight at 4 years of age (19.3%) than non-fussy eaters (12.3%; Χ 2 (1) = 7.71, p < .01). Conclusions: A distinct fussy eating behavior profile was identified by LPA, which was related to family and child characteristics, food intake, and BMI. This behavior profile might be used in future research and the development of interventions.
To assess the relationship between diet and growth in infancy and socioeconomic background, all p... more To assess the relationship between diet and growth in infancy and socioeconomic background, all publications from the Avon Longitudinal Study of Parents and Children (ALSPAC) covering breastfeeding, diet and growth in infancy, and the associations of these factors with socioeconomic background and later health and developmental outcomes were reviewed. Diet was assessed by parent-completed food records and parent-completed food frequency questionnaires covering infant feeding practices. Infancy growth was monitored through routine screening and by standardized measurements. Indicators of socioeconomic background were obtained by parent-completed questionnaires. Childhood outcomes were measured by standardized procedures. Rapid early weight gain was associated with later obesity. Longer breastfeeding duration was associated with lower body fat, but not lower body mass index, and with higher IQ in mid-childhood. Breastfed infants were better at regulating their energy intake than bottle-fed infants. In bottle-fed infants, energy intake at 4 months was associated with greater weight gain up to 5 years of age. Feeding cow's milk as a main drink in infancy was associated with anemia and high salt intake. Maternal education was a strong determinant of dietary differences: low education was associated with never breastfeeding and not following feeding guidelines. ALSPAC has provided unique insights into the relationship between diet and growth in infancy and later developmental outcomes.
Background: There is controversy over whether a lack of breast-feeding is related to obesity deve... more Background: There is controversy over whether a lack of breast-feeding is related to obesity development. Objective: We examined the effects of feeding different types of milk in late infancy on childhood growth. Design: A cohort of 1112 term, singleton children (born in 1992) from the Avon Longitudinal Study of Parents and Children, United Kingdom, were studied prospectively. Food records collected at 8 mo of age were used to define the following 5 mutually exclusive feeding groups on the basis of the type and amount of milk consumed: breast milk (BM), ,600 mL formula milk/d (FM low), $600 mL formula milk/d (FM high), ,600 mL cow milk/d (CM low), and $600 mL cow milk/d (CM high). Weight, height, and BMI were measured at 14 time points from birth to 10 y of age, and SD scores (SDSs) were calculated. Dietary energy and macronutrient intakes were available at 7 time points. Results: CM high children were heavier than were BM children from 8 mo to 10 y of age with weight differences (after adjustment for maternal education, smoking, and parity) $0.27 SDSs and an average of 0.48 SDSs. The maximum weight difference was at 18 mo of age (0.70 SDS; 95% CI: 0.41, 1.00 SDS; P = ,0.0001). CM high children were taller at some ages (25-43 mo; P , 0.01) and had greater BMI SDSs from $8 mo of age (at 9 y of age; P = 0.001). FM high children were heavier and taller than were BM children from 8 to 37 mo of age. There were marked dietary differences between milk groups at 8 mo of age, some of which persisted to 18 mo of age. Adjustments for current energy and protein intakes did not attenuate the growth differences observed. Conclusions: The feeding of high volumes of cow milk in late infancy is associated with faster weight and height gain than is BM feeding. The feeding of bottle-fed infants with high volumes of cow milk in late infancy may have a persisting effect on body habitus through childhood.
Publications from the Avon Longitudinal Study of Parents and Children that used empirically deriv... more Publications from the Avon Longitudinal Study of Parents and Children that used empirically derived dietary patterns were reviewed. The relationships of dietary patterns with socioeconomic background and childhood development were examined. Diet was assessed using food frequency questionnaires and food records. Three statistical methods were used: principal components analysis, cluster analysis, and reduced rank regression. Throughout childhood, children and parents have similar dietary patterns. The " health-conscious " and " traditional " patterns were associated with high intakes of fruits and/or vegetables and better nutrient profiles than the " processed " patterns. There was evidence of tracking in childhood diet, with the " health-conscious " patterns tracking most strongly, followed by the " processed " pattern. An " energy-dense, low-fiber, high-fat " dietary pattern was extracted using reduced rank regression; high scores on this pattern were associated with increasing adiposity. Maternal education was a strong determinant of pattern score or cluster membership; low educational attainment was associated with higher scores on processed, energy-dense patterns in both parents and children. The Avon Longitudinal Study of Parents and Children has provided unique insights into the value of empirically derived dietary patterns and has demonstrated that they are a useful tool in nutritional epidemiology.
Publications from the Avon Longitudinal Study of Parents and Children covering diet, growth, and ... more Publications from the Avon Longitudinal Study of Parents and Children covering diet, growth, and obesity development during childhood are reviewed. Diet was assessed by food frequency questionnaires and food records. Growth data were collected by routine measurements, and in standardized clinics, body fatness was assessed by bioelectrical impedance and DXA (dual-energy X-ray absorptiometry) scans. Diets changed dramatically during the preschool period with an increase in the intake of free (added) sugars (12.3% rising to 16.4% of energy) that remained similar until adolescence. This was due to increased intake of energy-dense, nutrient-poor foods. Two periods of rapid growth were identified; infancy and mid-childhood (ages 7–11 y) and both were associated with obesity development. Diets with high energy density were associated with increasing fat mass from mid-childhood until adolescence. Genetic and dietary factors showed independent associations with increasing adiposity. At all ages studied, there were dietary inequalities related to maternal educational attainment that may influence inequalities found in obesity development. The Avon Longitudinal Study of Parents and Children has provided valuable insights into how disparities in diet and growth may affect the development of ill health in adulthood.
All publications covering diet during pregnancy that stemmed from the Avon Longitudinal Study of ... more All publications covering diet during pregnancy that stemmed from the Avon Longitudinal Study of Parents and Children were reviewed. Diet was assessed using a food frequency questionnaire. Socioeconomic background, maternal mental health, and the health and development of the offspring were assessed using a variety of methods, such as direct measurement, self-completion questionnaires, and assays of biological samples. Differences in diet, including specific food and nutrient intakes and dietary patterns, were associated with maternal educational attainment, smoking habits, and financial difficulty. There were marginal intakes, compared with recommendations, of the key nutrients iron, magnesium, potassium, and folate. Maternal diet during pregnancy was predictive of offspring diet during childhood. There were independent associations between prenatal fish consumption and lower frequency of maternal depressive and anxiety symptoms, as well as lower frequency of intrauterine growth retardation. Consistent evidence that fish consumption during pregnancy benefited the neurocognitive development of the child was also found. Two constituents of fish, n-3 polyunsaturated fatty acids and iodine, were associated with these benefits in children. The findings from the Avon Longitudinal Study of Parents and Children strengthen the recommendation to eat fish regularly during pregnancy.
Journal of Epidemiology and Community Health, 2008
Objectives: To empirically test the impact of dietary intake at several time points in childhood ... more Objectives: To empirically test the impact of dietary intake at several time points in childhood on children's school attainment and to investigate whether any differences in school attainment between children who ate packed lunches or school meals was due to who these children were, their pre-school dietary patterns, or to what they ate at school. Design: Using longitudinal data available in the Avon Longitudinal Study of Parents and Children (ALSPAC), multivariate linear regression was used to assess the relative importance of diet at different ages for school attainment. Main outcome measures: Three indicators of school attainment were used: at ages 4-5 entry assessments to school, at ages 6-7 Key Stage 1 national tests and at ages 10-11 Key Stage 2 national tests. These outcome variables were measured in levels as well as in changes from the previous educational stage.
The complementary feeding period is an important stage of child development. The study aim was to... more The complementary feeding period is an important stage of child development. The study aim was to develop an index reflecting the degree of adherence to complementary feeding guidelines, evaluate its convergent validity, and explore associations with socio-demographic factors and dietary pattern scores in childhood. Data were analyzed from the Avon Longitudinal Study of Parents and Children (n = 6065) using parent-completed dietary questionnaires at 6 mo of age, socio-demographic information, and dietary patterns derived by principal component analysis at age 3 y. The Complementary Feeding Utility Index (CFUI) consists of 14 components: breastfeeding duration, feeding to appetite, timing of introduction to solids, exposure to iron-rich cereals, fruit and vegetable intake, exposure to high-fat/-salt/-sugar foods including sugary drinks, food texture, and meal/snack frequency. Regression analyses were undertaken to investigate associations between index scores, socio-demographic factors, food and nutrient intakes, and dietary pattern scores at age 3 y. Milk and food intake at 6 mo and nutrient intake at 8 mo of age varied across quintiles of index score in largely the expected directions. Associations were found among index score, maternal age, education, social class, maternal smoking history, and prepregnancy BMI. After adjustment for socio-demographic factors, the index score was associated with &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;processed&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; [β = -0.234 (95% CI = -0.260, -0.209)] and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;healthy&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; [β = 0.185 (95% CI = 0.155, 0.215)] dietary pattern scores at age 3 y. The CFUI is able to discriminate across food intake, nutrient intake, and socio-demographic factors and is associated with later dietary patterns.
A summary of the evidence pertaining to the association between methylenetetrahydrofolate reducta... more A summary of the evidence pertaining to the association between methylenetetrahydrofolate reductase ( MTHFR ) C677T and overall survival in pediatric acute lymphoblastic leukemia (ALL) is not currently available. We thus reviewed the literature on the association between MTFHR C677T and overall survival in pediatric ALL. We searched PubMed/MEDLINE, Scopus and ISI Web of Knowledge literature databases without language restrictions to identify observational studies among children diagnosed between ages 0 and 19 years that assessed MTHFR 677 polymorphisms in relation to ALL survival. We identifi ed six studies comprising 909 pediatric patients with ALL. The magnitude of relative risk (RR) for pediatric ALL mortality varied by genotype comparison and study population, ranging from RR ؍ 0.84 (95% confi dence limits [CL]: 0.24, 3.0) for a TT vs. CT/CC comparison to RR ؍ 7.0 (95% CL: 0.98, 49) for a TT vs. CC comparison. The current evidence suggests that individuals with MTHFR 677 variants (i.e. at least one T allele) may have a higher relative risk of pediatric ALL mortality, with greater statistical support for MTHFR 677TT. With more detailed supporting evidence, MTHFR 677 genotyping at diagnosis could provide an option for individualizing therapy and further reducing pediatric ALL mortality in certain populations.
Background: There is controversy over whether a lack of breastfeeding
is related to obesity devel... more Background: There is controversy over whether a lack of breastfeeding is related to obesity development. Objective: We examined the effects of feeding different types of milk in late infancy on childhood growth. Design: A cohort of 1112 term, singleton children (born in 1992) from the Avon Longitudinal Study of Parents and Children, United Kingdom, were studied prospectively. Food records collected at 8 mo of age were used to define the following 5 mutually exclusive feeding groups on the basis of the type and amount of milk consumed: breast milk (BM), ,600 mL formula milk/d (FMlow), $600 mL formula milk/d (FMhigh), ,600 mL cow milk/d (CMlow), and $600 mL cow milk/d (CMhigh). Weight, height, and BMI were measured at 14 time points from birth to 10 y of age, and SD scores (SDSs) were calculated. Dietary energy and macronutrient intakes were available at 7 time points. Results: CMhigh children were heavier than were BM children from 8 mo to 10 y of age with weight differences (after adjustment for maternal education, smoking, and parity) $0.27 SDSs and an average of 0.48 SDSs. The maximum weight difference was at 18 mo of age (0.70 SDS; 95% CI: 0.41, 1.00 SDS; P = ,0.0001). CMhigh children were taller at some ages (25-43 mo; P , 0.01) and had greater BMI SDSs from $8 mo of age (at 9 y of age; P = 0.001). FMhigh children were heavier and taller than were BM children from 8 to 37 mo of age. There were marked dietary differences between milk groups at 8 mo of age, some of which persisted to 18 mo of age. Adjustments for current energy and protein intakes did not attenuate the growth differences observed. Conclusions: The feeding of high volumes of cow milk in late infancy is associated with faster weight and height gain than is BM feeding. The feeding of bottle-fed infants with high volumes of cow milk in late infancy may have a persisting effect on body habitus through childhood
Publications from the Avon Longitudinal Study of Parents and Children covering
diet, growth, and ... more Publications from the Avon Longitudinal Study of Parents and Children covering diet, growth, and obesity development during childhood are reviewed. Diet was assessed by food frequency questionnaires and food records. Growth data were collected by routine measurements, and in standardized clinics, body fatness was assessed by bioelectrical impedance and DXA (dual-energy X-ray absorptiometry) scans. Diets changed dramatically during the preschool period with an increase in the intake of free (added) sugars (12.3% rising to 16.4% of energy) that remained similar until adolescence. This was due to increased intake of energy-dense, nutrient-poor foods. Two periods of rapid growth were identified; infancy and mid-childhood (ages 7–11 y) and both were associated with obesity development. Diets with high energy density were associated with increasing fat mass from mid-childhood until adolescence. Genetic and dietary factors showed independent associations with increasing adiposity. At all ages studied, there were dietary inequalities related to maternal educational attainment that may influence inequalities found in obesity development. The Avon Longitudinal Study of Parents and Children has provided valuable insights into how disparities in diet and growth may affect the development of ill health in adulthood. INTRODUCTION A balanced diet in childhood is very important to ensure optimum growth and development at a time of rapid growth. Poor diet has been associated with many adult health conditions, such as coronary heart disease, diabetes, and some cancers.1–3 Establishing and maintaining healthy eating habits is important because habits formed in early life are likely to continue into adulthood. 4 The Bogalusa Heart Study found that coronary atherosclerosis and
Publications from the Avon Longitudinal Study of Parents and Children that used
empirically deriv... more Publications from the Avon Longitudinal Study of Parents and Children that used empirically derived dietary patterns were reviewed. The relationships of dietary patterns with socioeconomic background and childhood development were examined. Diet was assessed using food frequency questionnaires and food records. Three statistical methods were used: principal components analysis, cluster analysis, and reduced rank regression. Throughout childhood, children and parents have similar dietary patterns. The “health-conscious” and “traditional” patterns were associated with high intakes of fruits and/or vegetables and better nutrient profiles than the “processed” patterns. There was evidence of tracking in childhood diet, with the “health-conscious” patterns tracking most strongly, followed by the “processed” pattern. An “energy-dense, low-fiber, high-fat” dietary pattern was extracted using reduced rank regression; high scores on this pattern were associated with increasing adiposity. Maternal education was a strong determinant of pattern score or cluster membership; low educational attainment was associated with higher scores on processed, energy-dense patterns in both parents and children. The Avon Longitudinal Study of Parents and Children has provided unique insights into the value of empirically derived dietary patterns and has demonstrated that they are a useful tool in nutritional epidemiology. INTRODUCTION The derivation of dietary patterns to describe diet, as opposed to investigating individual foods or nutrients, has become popular in nutritional epidemiology. Dietary patterns facilitate the study of the whole diet, recognizing that people consume foods in combination. They complement more traditional methods of examining diet– health relationships, which use individual foods or nutrients. Studies of dietary patterns and a particular disease outcome such
All publications covering diet during pregnancy that stemmed from the Avon
Longitudinal Study of ... more All publications covering diet during pregnancy that stemmed from the Avon Longitudinal Study of Parents and Children were reviewed. Diet was assessed using a food frequency questionnaire. Socioeconomic background, maternal mental health, and the health and development of the offspring were assessed using a variety of methods, such as direct measurement, self-completion questionnaires, and assays of biological samples. Differences in diet, including specific food and nutrient intakes and dietary patterns, were associated with maternal educational attainment, smoking habits, and financial difficulty. There were marginal intakes, compared with recommendations, of the key nutrients iron, magnesium, potassium, and folate. Maternal diet during pregnancy was predictive of offspring diet during childhood. There were independent associations between prenatal fish consumption and lower frequency of maternal depressive and anxiety symptoms, as well as lower frequency of intrauterine growth retardation. Consistent evidence that fish consumption during pregnancy benefited the neurocognitive development of the child was also found. Two constituents of fish, n-3 polyunsaturated fatty acids and iodine, were associated with these benefits in children. The findings from the Avon Longitudinal Study of Parents and Children strengthen the recommendation to eat fish regularly during pregnancy. INTRODUCTION Maternal nutrition periconception and during pregnancy is important for the health, growth, and development of the fetus and the newborn infant. There is considerable interest in nutrition during pregnancy because of the fetal origins theory of adult disease. This theory hypothesizes that term infants who are small for gestational age have an increased risk of cardiovascular disease and type II diabetes in adulthood and that this is due to undernutrition of the fetus. The original work was based on the follow-up
Methods for the assessment of changes in dietary intake across the life course are underdeveloped... more Methods for the assessment of changes in dietary intake across the life course are underdeveloped. We demonstrate the use of linear-spline multilevel models to summarize energy-intake trajectories through childhood and adolescence and their application as exposures, outcomes, or mediators. The Avon Longitudinal Study of Parents and Children assessed children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s dietary intake several times between ages 3 and 13 years, using both food frequency questionnaires (FFQs) and 3-day food diaries. We estimated energy-intake trajectories for 12,032 children using linear-spline multilevel models. We then assessed the associations of these trajectories with maternal body mass index (BMI), and later offspring BMI, and also their role in mediating the relation between maternal and offspring BMIs. Models estimated average and individual energy intake at 3 years, and linear changes in energy intake from age 3 to 7 years and from age 7 to 13 years. By including the exposure (in this example, maternal BMI) in the multilevel model, we were able to estimate the average energy-intake trajectories across levels of the exposure. When energy-intake trajectories are the exposure for a later outcome (in this case offspring BMI) or a mediator (between maternal and offspring BMI), results were similar, whether using a two-step process (exporting individual-level intercepts and slopes from multilevel models and using these in linear regression/path analysis), or a single-step process (multivariate multilevel models). Trajectories were similar when FFQs and food diaries were assessed either separately, or when combined into one model. Linear-spline multilevel models provide useful summaries of trajectories of dietary intake that can be used as an exposure, outcome, or mediator.
Vitamin A is essential for growth and development. We investigated whether high consumption of en... more Vitamin A is essential for growth and development. We investigated whether high consumption of energy-dense nutrient-poor foods in the diets of pre-school children is detrimental to diet quality with respect to vitamin A. Data were collected from 755 children at 18-months and 3½-years, from the Avon Longitudinal Study of Parents and Children, using 3-day unweighed dietary records completed by parents in 1994 and 1996, respectively. Energy, carotene and retinol intakes were calculated. The quality of the diet declined from 18-months to 3½-years with respect to vitamin A. Preformed retinol intakes decreased by −54 μg/day on average (p = 0.003). Carotene intakes were similar at each age although there was a 23% increase in energy intake by 3½-years. Longitudinally those in the highest quartile of intake at 18-months were twice as likely to remain in the highest quartile at 3½-years for retinol (OR 2.21 (95% CI 1.48-3.28)) and carotene (OR 1.66 (95% CI 1.11-2.50)) than to change quartiles. Nutrient-rich core foods provided decreasing amounts of carotene and preformed retinol over time (both p < 0.001). Vegetables and milk contributed the highest proportion of carotene at both ages, but milk's contribution decreased over time. Milk and liver were the largest sources of retinol. Nutrient-poor foods provided an increased proportion of energy (p < 0.001) with low proportions of both nutrients; however fat spreads made an important contribution. It is recommended that pre-school children should take vitamin supplements; only 19% at 18-months did this, falling to 11% at 3½-years. Care should be taken to choose nutrient-rich foods and avoid energy-dense, nutrient-poor foods when feeding pre-school children.
Objective: To examine how the dietary patterns of children at various time points throughout chil... more Objective: To examine how the dietary patterns of children at various time points throughout childhood relate to estimated nutrient intakes. Design: FFQ at 3, 4, 7 and 9 years of age were completed by mothers. Dietary patterns were identified cross-sectionally using principal component analysis; 'processed', 'health conscious' and 'traditional' patterns were consistently obtained. Correlations between pattern scores and nutrient intakes and proportions of variance in nutrients explained by the patterns were calculated. Setting: Avon Longitudinal Study of Parents and Children (ALSPAC), Bristol, UK. Subjects: Children provided data between 3 and 9 years of age (n 8010 to 10 023). Results: Dietary patterns explained substantial proportions of the variance of the absolute intake for most nutrients (.25 % at 3 years of age, .40 % other ages). After energy adjustment, protein, fibre, K, Mg, Fe, Zn, folate, thiamin and vitamin B 6 continued to be well explained. Strong correlations were observed between the 'processed' pattern and macronutrients including energy (r 5 0?481-0?619), total fat (r 5 0?529-0?662) and total sugar (r 5 0?475-0?693). However correlations with most micronutrients were reversed after energy adjustment, suggesting that the 'processed' pattern is energy-dense but nutrient-poor. The 'health conscious' and 'traditional' patterns were strongly positively correlated with protein, fibre and most micronutrients, whether energy adjusted or not. Higher scores on these patterns were associated with a better nutrient profile. Conclusions: Dietary patterns explain a reasonable amount of the variation in the nutrient content of diets. Higher scores on the 'health conscious' and 'traditional' dietary patterns were related to better nutrient profiles; conversely, with higher scores on the 'processed' pattern the nutrient profile was poorer.
Objective: To examine the associations between maternal education level and diet in 10-year-old c... more Objective: To examine the associations between maternal education level and diet in 10-year-old children. Design: Three-day diet diaries (child completed with parental help) were collected. Height and weight were measured in research clinics. Maternal education level was derived from a questionnaire completed during pregnancy and classified into low, medium or high. One-way ANOVA was undertaken to compare maternal education groups for nutrient intakes and the Kruskal-Wallis test used for food consumption. Setting: Avon Longitudinal Study of Parents and Children (ALSPAC), Bristol, UK. Subjects: Children (n 7474) who provided dietary data at age 10 years. Results: A large proportion (60 %) of the sample was classified as plausible reporters, with under-reporting accounting for 36 %. No clear differences were found for intakes of energy or macronutrients between maternal education groups for plausible reporters. However, there were marked differences in micronutrient intakes especially for vitamin C, retinol equivalents and folate, highlighting lower diet quality with lower maternal education level. Intakes of fruit and vegetables showed a positive gradient with increasing maternal education (57 % v. 79 % consumed fresh fruit in low and high educational groups, respectively). A trend towards higher intake in the lower educated group was shown for less healthy foods (meat pies P , 0?001; sausages, burgers and kebabs P , 0?001).
Undernourished mothers are likely to have limited fat reserves to draw on during lactation. In or... more Undernourished mothers are likely to have limited fat reserves to draw on during lactation. In order to supply nutrition to her child the mother may therefore become more malnourished and suffer from bone resorption. Repeated or overlapping pregnancies with lactation are likely to compound the issue. Little research has been carried out into the health of mothers while breast feeding, or subsequently. There are theoretical reasons to think that the malnourished mother in the developing world may be particularly vulnerable, but no studies appear to have been undertaken. Investigations in the developed world have concentrated on cancers of the reproductive organs and shown consistent evidence in large case-control studies for a reduced risk of pre-menopausal breast cancer in mothers with a history of prolonged breast feeding. In contrast there have been a number of studies in the developed world concerned with emotional well-being with some indications that mothers who breast feed are more likely to be depressed and are less likely to be positive about their baby. 0 1997 Elsevier Science Ireland Ltd.
There is convincing evidence that breast-feeding is protective against gastro-enteritis and diaxr... more There is convincing evidence that breast-feeding is protective against gastro-enteritis and diaxrhoea, but for other infections the situation is less clear cut. There is evidence that breast-fed infants are at increased risk of one infection (infant botnlism). They are probably not significantly protected from upper respiratory tract infections (other than otitis media.), but they may be at a decreased risk of lower respiratory tract infections, particularly those associated with respiratory syncytial virus. There is strong evidence that Haemophilus infuenzae B infection is more likely in the bottie-fed infant, and consistent evidence of protection of young children from chronic otitis media with prolonged breast-feeding. 0 1997 Elsevier Science Ireland Ltd.
Background: Definitions and assessment methods of fussy/picky eating are heterogeneous and remain... more Background: Definitions and assessment methods of fussy/picky eating are heterogeneous and remain unclear. We aimed to identify an eating behavior profile reflecting fussy/picky eating in children and to describe characteristics of fussy eaters. Methods: Eating behavior was assessed with the Child Eating Behavior Questionnaire (CEBQ) in 4914 4-year olds in a population-based birth cohort study. Latent Profile Analysis (LPA) was used to identify eating behavior profiles based on CEBQ subscales. Results and discussion: We found a "fussy" eating behavior profile (5.6% of children) characterized by high food fussiness, slowness in eating, and satiety responsiveness in combination with low enjoyment of food and food responsiveness. Fussy eaters were more often from families with low household income than non-fussy eaters (42% vs. 31.8% respectively; Χ 2 (1) = 9.97, p < .01). When they were 14 months old, fussy eaters had a lower intake of vegetables (t [3008] = 2.42, p < .05) and fish (t [169.77] = 2.40, p < .05) but higher intake of savory snacks (t [153.69] = −2.03, p < .05) and sweets (t [3008] = −2.30, p < .05) compared to non-fussy eaters. Also, fussy eaters were more likely to be underweight at 4 years of age (19.3%) than non-fussy eaters (12.3%; Χ 2 (1) = 7.71, p < .01). Conclusions: A distinct fussy eating behavior profile was identified by LPA, which was related to family and child characteristics, food intake, and BMI. This behavior profile might be used in future research and the development of interventions.
To assess the relationship between diet and growth in infancy and socioeconomic background, all p... more To assess the relationship between diet and growth in infancy and socioeconomic background, all publications from the Avon Longitudinal Study of Parents and Children (ALSPAC) covering breastfeeding, diet and growth in infancy, and the associations of these factors with socioeconomic background and later health and developmental outcomes were reviewed. Diet was assessed by parent-completed food records and parent-completed food frequency questionnaires covering infant feeding practices. Infancy growth was monitored through routine screening and by standardized measurements. Indicators of socioeconomic background were obtained by parent-completed questionnaires. Childhood outcomes were measured by standardized procedures. Rapid early weight gain was associated with later obesity. Longer breastfeeding duration was associated with lower body fat, but not lower body mass index, and with higher IQ in mid-childhood. Breastfed infants were better at regulating their energy intake than bottle-fed infants. In bottle-fed infants, energy intake at 4 months was associated with greater weight gain up to 5 years of age. Feeding cow's milk as a main drink in infancy was associated with anemia and high salt intake. Maternal education was a strong determinant of dietary differences: low education was associated with never breastfeeding and not following feeding guidelines. ALSPAC has provided unique insights into the relationship between diet and growth in infancy and later developmental outcomes.
Background: There is controversy over whether a lack of breast-feeding is related to obesity deve... more Background: There is controversy over whether a lack of breast-feeding is related to obesity development. Objective: We examined the effects of feeding different types of milk in late infancy on childhood growth. Design: A cohort of 1112 term, singleton children (born in 1992) from the Avon Longitudinal Study of Parents and Children, United Kingdom, were studied prospectively. Food records collected at 8 mo of age were used to define the following 5 mutually exclusive feeding groups on the basis of the type and amount of milk consumed: breast milk (BM), ,600 mL formula milk/d (FM low), $600 mL formula milk/d (FM high), ,600 mL cow milk/d (CM low), and $600 mL cow milk/d (CM high). Weight, height, and BMI were measured at 14 time points from birth to 10 y of age, and SD scores (SDSs) were calculated. Dietary energy and macronutrient intakes were available at 7 time points. Results: CM high children were heavier than were BM children from 8 mo to 10 y of age with weight differences (after adjustment for maternal education, smoking, and parity) $0.27 SDSs and an average of 0.48 SDSs. The maximum weight difference was at 18 mo of age (0.70 SDS; 95% CI: 0.41, 1.00 SDS; P = ,0.0001). CM high children were taller at some ages (25-43 mo; P , 0.01) and had greater BMI SDSs from $8 mo of age (at 9 y of age; P = 0.001). FM high children were heavier and taller than were BM children from 8 to 37 mo of age. There were marked dietary differences between milk groups at 8 mo of age, some of which persisted to 18 mo of age. Adjustments for current energy and protein intakes did not attenuate the growth differences observed. Conclusions: The feeding of high volumes of cow milk in late infancy is associated with faster weight and height gain than is BM feeding. The feeding of bottle-fed infants with high volumes of cow milk in late infancy may have a persisting effect on body habitus through childhood.
Publications from the Avon Longitudinal Study of Parents and Children that used empirically deriv... more Publications from the Avon Longitudinal Study of Parents and Children that used empirically derived dietary patterns were reviewed. The relationships of dietary patterns with socioeconomic background and childhood development were examined. Diet was assessed using food frequency questionnaires and food records. Three statistical methods were used: principal components analysis, cluster analysis, and reduced rank regression. Throughout childhood, children and parents have similar dietary patterns. The " health-conscious " and " traditional " patterns were associated with high intakes of fruits and/or vegetables and better nutrient profiles than the " processed " patterns. There was evidence of tracking in childhood diet, with the " health-conscious " patterns tracking most strongly, followed by the " processed " pattern. An " energy-dense, low-fiber, high-fat " dietary pattern was extracted using reduced rank regression; high scores on this pattern were associated with increasing adiposity. Maternal education was a strong determinant of pattern score or cluster membership; low educational attainment was associated with higher scores on processed, energy-dense patterns in both parents and children. The Avon Longitudinal Study of Parents and Children has provided unique insights into the value of empirically derived dietary patterns and has demonstrated that they are a useful tool in nutritional epidemiology.
Publications from the Avon Longitudinal Study of Parents and Children covering diet, growth, and ... more Publications from the Avon Longitudinal Study of Parents and Children covering diet, growth, and obesity development during childhood are reviewed. Diet was assessed by food frequency questionnaires and food records. Growth data were collected by routine measurements, and in standardized clinics, body fatness was assessed by bioelectrical impedance and DXA (dual-energy X-ray absorptiometry) scans. Diets changed dramatically during the preschool period with an increase in the intake of free (added) sugars (12.3% rising to 16.4% of energy) that remained similar until adolescence. This was due to increased intake of energy-dense, nutrient-poor foods. Two periods of rapid growth were identified; infancy and mid-childhood (ages 7–11 y) and both were associated with obesity development. Diets with high energy density were associated with increasing fat mass from mid-childhood until adolescence. Genetic and dietary factors showed independent associations with increasing adiposity. At all ages studied, there were dietary inequalities related to maternal educational attainment that may influence inequalities found in obesity development. The Avon Longitudinal Study of Parents and Children has provided valuable insights into how disparities in diet and growth may affect the development of ill health in adulthood.
All publications covering diet during pregnancy that stemmed from the Avon Longitudinal Study of ... more All publications covering diet during pregnancy that stemmed from the Avon Longitudinal Study of Parents and Children were reviewed. Diet was assessed using a food frequency questionnaire. Socioeconomic background, maternal mental health, and the health and development of the offspring were assessed using a variety of methods, such as direct measurement, self-completion questionnaires, and assays of biological samples. Differences in diet, including specific food and nutrient intakes and dietary patterns, were associated with maternal educational attainment, smoking habits, and financial difficulty. There were marginal intakes, compared with recommendations, of the key nutrients iron, magnesium, potassium, and folate. Maternal diet during pregnancy was predictive of offspring diet during childhood. There were independent associations between prenatal fish consumption and lower frequency of maternal depressive and anxiety symptoms, as well as lower frequency of intrauterine growth retardation. Consistent evidence that fish consumption during pregnancy benefited the neurocognitive development of the child was also found. Two constituents of fish, n-3 polyunsaturated fatty acids and iodine, were associated with these benefits in children. The findings from the Avon Longitudinal Study of Parents and Children strengthen the recommendation to eat fish regularly during pregnancy.
Journal of Epidemiology and Community Health, 2008
Objectives: To empirically test the impact of dietary intake at several time points in childhood ... more Objectives: To empirically test the impact of dietary intake at several time points in childhood on children's school attainment and to investigate whether any differences in school attainment between children who ate packed lunches or school meals was due to who these children were, their pre-school dietary patterns, or to what they ate at school. Design: Using longitudinal data available in the Avon Longitudinal Study of Parents and Children (ALSPAC), multivariate linear regression was used to assess the relative importance of diet at different ages for school attainment. Main outcome measures: Three indicators of school attainment were used: at ages 4-5 entry assessments to school, at ages 6-7 Key Stage 1 national tests and at ages 10-11 Key Stage 2 national tests. These outcome variables were measured in levels as well as in changes from the previous educational stage.
The complementary feeding period is an important stage of child development. The study aim was to... more The complementary feeding period is an important stage of child development. The study aim was to develop an index reflecting the degree of adherence to complementary feeding guidelines, evaluate its convergent validity, and explore associations with socio-demographic factors and dietary pattern scores in childhood. Data were analyzed from the Avon Longitudinal Study of Parents and Children (n = 6065) using parent-completed dietary questionnaires at 6 mo of age, socio-demographic information, and dietary patterns derived by principal component analysis at age 3 y. The Complementary Feeding Utility Index (CFUI) consists of 14 components: breastfeeding duration, feeding to appetite, timing of introduction to solids, exposure to iron-rich cereals, fruit and vegetable intake, exposure to high-fat/-salt/-sugar foods including sugary drinks, food texture, and meal/snack frequency. Regression analyses were undertaken to investigate associations between index scores, socio-demographic factors, food and nutrient intakes, and dietary pattern scores at age 3 y. Milk and food intake at 6 mo and nutrient intake at 8 mo of age varied across quintiles of index score in largely the expected directions. Associations were found among index score, maternal age, education, social class, maternal smoking history, and prepregnancy BMI. After adjustment for socio-demographic factors, the index score was associated with &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;processed&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; [β = -0.234 (95% CI = -0.260, -0.209)] and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;healthy&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; [β = 0.185 (95% CI = 0.155, 0.215)] dietary pattern scores at age 3 y. The CFUI is able to discriminate across food intake, nutrient intake, and socio-demographic factors and is associated with later dietary patterns.
A summary of the evidence pertaining to the association between methylenetetrahydrofolate reducta... more A summary of the evidence pertaining to the association between methylenetetrahydrofolate reductase ( MTHFR ) C677T and overall survival in pediatric acute lymphoblastic leukemia (ALL) is not currently available. We thus reviewed the literature on the association between MTFHR C677T and overall survival in pediatric ALL. We searched PubMed/MEDLINE, Scopus and ISI Web of Knowledge literature databases without language restrictions to identify observational studies among children diagnosed between ages 0 and 19 years that assessed MTHFR 677 polymorphisms in relation to ALL survival. We identifi ed six studies comprising 909 pediatric patients with ALL. The magnitude of relative risk (RR) for pediatric ALL mortality varied by genotype comparison and study population, ranging from RR ؍ 0.84 (95% confi dence limits [CL]: 0.24, 3.0) for a TT vs. CT/CC comparison to RR ؍ 7.0 (95% CL: 0.98, 49) for a TT vs. CC comparison. The current evidence suggests that individuals with MTHFR 677 variants (i.e. at least one T allele) may have a higher relative risk of pediatric ALL mortality, with greater statistical support for MTHFR 677TT. With more detailed supporting evidence, MTHFR 677 genotyping at diagnosis could provide an option for individualizing therapy and further reducing pediatric ALL mortality in certain populations.
Background: There is controversy over whether a lack of breastfeeding
is related to obesity devel... more Background: There is controversy over whether a lack of breastfeeding is related to obesity development. Objective: We examined the effects of feeding different types of milk in late infancy on childhood growth. Design: A cohort of 1112 term, singleton children (born in 1992) from the Avon Longitudinal Study of Parents and Children, United Kingdom, were studied prospectively. Food records collected at 8 mo of age were used to define the following 5 mutually exclusive feeding groups on the basis of the type and amount of milk consumed: breast milk (BM), ,600 mL formula milk/d (FMlow), $600 mL formula milk/d (FMhigh), ,600 mL cow milk/d (CMlow), and $600 mL cow milk/d (CMhigh). Weight, height, and BMI were measured at 14 time points from birth to 10 y of age, and SD scores (SDSs) were calculated. Dietary energy and macronutrient intakes were available at 7 time points. Results: CMhigh children were heavier than were BM children from 8 mo to 10 y of age with weight differences (after adjustment for maternal education, smoking, and parity) $0.27 SDSs and an average of 0.48 SDSs. The maximum weight difference was at 18 mo of age (0.70 SDS; 95% CI: 0.41, 1.00 SDS; P = ,0.0001). CMhigh children were taller at some ages (25-43 mo; P , 0.01) and had greater BMI SDSs from $8 mo of age (at 9 y of age; P = 0.001). FMhigh children were heavier and taller than were BM children from 8 to 37 mo of age. There were marked dietary differences between milk groups at 8 mo of age, some of which persisted to 18 mo of age. Adjustments for current energy and protein intakes did not attenuate the growth differences observed. Conclusions: The feeding of high volumes of cow milk in late infancy is associated with faster weight and height gain than is BM feeding. The feeding of bottle-fed infants with high volumes of cow milk in late infancy may have a persisting effect on body habitus through childhood
Publications from the Avon Longitudinal Study of Parents and Children covering
diet, growth, and ... more Publications from the Avon Longitudinal Study of Parents and Children covering diet, growth, and obesity development during childhood are reviewed. Diet was assessed by food frequency questionnaires and food records. Growth data were collected by routine measurements, and in standardized clinics, body fatness was assessed by bioelectrical impedance and DXA (dual-energy X-ray absorptiometry) scans. Diets changed dramatically during the preschool period with an increase in the intake of free (added) sugars (12.3% rising to 16.4% of energy) that remained similar until adolescence. This was due to increased intake of energy-dense, nutrient-poor foods. Two periods of rapid growth were identified; infancy and mid-childhood (ages 7–11 y) and both were associated with obesity development. Diets with high energy density were associated with increasing fat mass from mid-childhood until adolescence. Genetic and dietary factors showed independent associations with increasing adiposity. At all ages studied, there were dietary inequalities related to maternal educational attainment that may influence inequalities found in obesity development. The Avon Longitudinal Study of Parents and Children has provided valuable insights into how disparities in diet and growth may affect the development of ill health in adulthood. INTRODUCTION A balanced diet in childhood is very important to ensure optimum growth and development at a time of rapid growth. Poor diet has been associated with many adult health conditions, such as coronary heart disease, diabetes, and some cancers.1–3 Establishing and maintaining healthy eating habits is important because habits formed in early life are likely to continue into adulthood. 4 The Bogalusa Heart Study found that coronary atherosclerosis and
Publications from the Avon Longitudinal Study of Parents and Children that used
empirically deriv... more Publications from the Avon Longitudinal Study of Parents and Children that used empirically derived dietary patterns were reviewed. The relationships of dietary patterns with socioeconomic background and childhood development were examined. Diet was assessed using food frequency questionnaires and food records. Three statistical methods were used: principal components analysis, cluster analysis, and reduced rank regression. Throughout childhood, children and parents have similar dietary patterns. The “health-conscious” and “traditional” patterns were associated with high intakes of fruits and/or vegetables and better nutrient profiles than the “processed” patterns. There was evidence of tracking in childhood diet, with the “health-conscious” patterns tracking most strongly, followed by the “processed” pattern. An “energy-dense, low-fiber, high-fat” dietary pattern was extracted using reduced rank regression; high scores on this pattern were associated with increasing adiposity. Maternal education was a strong determinant of pattern score or cluster membership; low educational attainment was associated with higher scores on processed, energy-dense patterns in both parents and children. The Avon Longitudinal Study of Parents and Children has provided unique insights into the value of empirically derived dietary patterns and has demonstrated that they are a useful tool in nutritional epidemiology. INTRODUCTION The derivation of dietary patterns to describe diet, as opposed to investigating individual foods or nutrients, has become popular in nutritional epidemiology. Dietary patterns facilitate the study of the whole diet, recognizing that people consume foods in combination. They complement more traditional methods of examining diet– health relationships, which use individual foods or nutrients. Studies of dietary patterns and a particular disease outcome such
All publications covering diet during pregnancy that stemmed from the Avon
Longitudinal Study of ... more All publications covering diet during pregnancy that stemmed from the Avon Longitudinal Study of Parents and Children were reviewed. Diet was assessed using a food frequency questionnaire. Socioeconomic background, maternal mental health, and the health and development of the offspring were assessed using a variety of methods, such as direct measurement, self-completion questionnaires, and assays of biological samples. Differences in diet, including specific food and nutrient intakes and dietary patterns, were associated with maternal educational attainment, smoking habits, and financial difficulty. There were marginal intakes, compared with recommendations, of the key nutrients iron, magnesium, potassium, and folate. Maternal diet during pregnancy was predictive of offspring diet during childhood. There were independent associations between prenatal fish consumption and lower frequency of maternal depressive and anxiety symptoms, as well as lower frequency of intrauterine growth retardation. Consistent evidence that fish consumption during pregnancy benefited the neurocognitive development of the child was also found. Two constituents of fish, n-3 polyunsaturated fatty acids and iodine, were associated with these benefits in children. The findings from the Avon Longitudinal Study of Parents and Children strengthen the recommendation to eat fish regularly during pregnancy. INTRODUCTION Maternal nutrition periconception and during pregnancy is important for the health, growth, and development of the fetus and the newborn infant. There is considerable interest in nutrition during pregnancy because of the fetal origins theory of adult disease. This theory hypothesizes that term infants who are small for gestational age have an increased risk of cardiovascular disease and type II diabetes in adulthood and that this is due to undernutrition of the fetus. The original work was based on the follow-up
Methods for the assessment of changes in dietary intake across the life course are underdeveloped... more Methods for the assessment of changes in dietary intake across the life course are underdeveloped. We demonstrate the use of linear-spline multilevel models to summarize energy-intake trajectories through childhood and adolescence and their application as exposures, outcomes, or mediators. The Avon Longitudinal Study of Parents and Children assessed children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s dietary intake several times between ages 3 and 13 years, using both food frequency questionnaires (FFQs) and 3-day food diaries. We estimated energy-intake trajectories for 12,032 children using linear-spline multilevel models. We then assessed the associations of these trajectories with maternal body mass index (BMI), and later offspring BMI, and also their role in mediating the relation between maternal and offspring BMIs. Models estimated average and individual energy intake at 3 years, and linear changes in energy intake from age 3 to 7 years and from age 7 to 13 years. By including the exposure (in this example, maternal BMI) in the multilevel model, we were able to estimate the average energy-intake trajectories across levels of the exposure. When energy-intake trajectories are the exposure for a later outcome (in this case offspring BMI) or a mediator (between maternal and offspring BMI), results were similar, whether using a two-step process (exporting individual-level intercepts and slopes from multilevel models and using these in linear regression/path analysis), or a single-step process (multivariate multilevel models). Trajectories were similar when FFQs and food diaries were assessed either separately, or when combined into one model. Linear-spline multilevel models provide useful summaries of trajectories of dietary intake that can be used as an exposure, outcome, or mediator.
Vitamin A is essential for growth and development. We investigated whether high consumption of en... more Vitamin A is essential for growth and development. We investigated whether high consumption of energy-dense nutrient-poor foods in the diets of pre-school children is detrimental to diet quality with respect to vitamin A. Data were collected from 755 children at 18-months and 3½-years, from the Avon Longitudinal Study of Parents and Children, using 3-day unweighed dietary records completed by parents in 1994 and 1996, respectively. Energy, carotene and retinol intakes were calculated. The quality of the diet declined from 18-months to 3½-years with respect to vitamin A. Preformed retinol intakes decreased by −54 μg/day on average (p = 0.003). Carotene intakes were similar at each age although there was a 23% increase in energy intake by 3½-years. Longitudinally those in the highest quartile of intake at 18-months were twice as likely to remain in the highest quartile at 3½-years for retinol (OR 2.21 (95% CI 1.48-3.28)) and carotene (OR 1.66 (95% CI 1.11-2.50)) than to change quartiles. Nutrient-rich core foods provided decreasing amounts of carotene and preformed retinol over time (both p < 0.001). Vegetables and milk contributed the highest proportion of carotene at both ages, but milk's contribution decreased over time. Milk and liver were the largest sources of retinol. Nutrient-poor foods provided an increased proportion of energy (p < 0.001) with low proportions of both nutrients; however fat spreads made an important contribution. It is recommended that pre-school children should take vitamin supplements; only 19% at 18-months did this, falling to 11% at 3½-years. Care should be taken to choose nutrient-rich foods and avoid energy-dense, nutrient-poor foods when feeding pre-school children.
Objective: To examine how the dietary patterns of children at various time points throughout chil... more Objective: To examine how the dietary patterns of children at various time points throughout childhood relate to estimated nutrient intakes. Design: FFQ at 3, 4, 7 and 9 years of age were completed by mothers. Dietary patterns were identified cross-sectionally using principal component analysis; 'processed', 'health conscious' and 'traditional' patterns were consistently obtained. Correlations between pattern scores and nutrient intakes and proportions of variance in nutrients explained by the patterns were calculated. Setting: Avon Longitudinal Study of Parents and Children (ALSPAC), Bristol, UK. Subjects: Children provided data between 3 and 9 years of age (n 8010 to 10 023). Results: Dietary patterns explained substantial proportions of the variance of the absolute intake for most nutrients (.25 % at 3 years of age, .40 % other ages). After energy adjustment, protein, fibre, K, Mg, Fe, Zn, folate, thiamin and vitamin B 6 continued to be well explained. Strong correlations were observed between the 'processed' pattern and macronutrients including energy (r 5 0?481-0?619), total fat (r 5 0?529-0?662) and total sugar (r 5 0?475-0?693). However correlations with most micronutrients were reversed after energy adjustment, suggesting that the 'processed' pattern is energy-dense but nutrient-poor. The 'health conscious' and 'traditional' patterns were strongly positively correlated with protein, fibre and most micronutrients, whether energy adjusted or not. Higher scores on these patterns were associated with a better nutrient profile. Conclusions: Dietary patterns explain a reasonable amount of the variation in the nutrient content of diets. Higher scores on the 'health conscious' and 'traditional' dietary patterns were related to better nutrient profiles; conversely, with higher scores on the 'processed' pattern the nutrient profile was poorer.
Objective: To examine the associations between maternal education level and diet in 10-year-old c... more Objective: To examine the associations between maternal education level and diet in 10-year-old children. Design: Three-day diet diaries (child completed with parental help) were collected. Height and weight were measured in research clinics. Maternal education level was derived from a questionnaire completed during pregnancy and classified into low, medium or high. One-way ANOVA was undertaken to compare maternal education groups for nutrient intakes and the Kruskal-Wallis test used for food consumption. Setting: Avon Longitudinal Study of Parents and Children (ALSPAC), Bristol, UK. Subjects: Children (n 7474) who provided dietary data at age 10 years. Results: A large proportion (60 %) of the sample was classified as plausible reporters, with under-reporting accounting for 36 %. No clear differences were found for intakes of energy or macronutrients between maternal education groups for plausible reporters. However, there were marked differences in micronutrient intakes especially for vitamin C, retinol equivalents and folate, highlighting lower diet quality with lower maternal education level. Intakes of fruit and vegetables showed a positive gradient with increasing maternal education (57 % v. 79 % consumed fresh fruit in low and high educational groups, respectively). A trend towards higher intake in the lower educated group was shown for less healthy foods (meat pies P , 0?001; sausages, burgers and kebabs P , 0?001).
Undernourished mothers are likely to have limited fat reserves to draw on during lactation. In or... more Undernourished mothers are likely to have limited fat reserves to draw on during lactation. In order to supply nutrition to her child the mother may therefore become more malnourished and suffer from bone resorption. Repeated or overlapping pregnancies with lactation are likely to compound the issue. Little research has been carried out into the health of mothers while breast feeding, or subsequently. There are theoretical reasons to think that the malnourished mother in the developing world may be particularly vulnerable, but no studies appear to have been undertaken. Investigations in the developed world have concentrated on cancers of the reproductive organs and shown consistent evidence in large case-control studies for a reduced risk of pre-menopausal breast cancer in mothers with a history of prolonged breast feeding. In contrast there have been a number of studies in the developed world concerned with emotional well-being with some indications that mothers who breast feed are more likely to be depressed and are less likely to be positive about their baby. 0 1997 Elsevier Science Ireland Ltd.
There is convincing evidence that breast-feeding is protective against gastro-enteritis and diaxr... more There is convincing evidence that breast-feeding is protective against gastro-enteritis and diaxrhoea, but for other infections the situation is less clear cut. There is evidence that breast-fed infants are at increased risk of one infection (infant botnlism). They are probably not significantly protected from upper respiratory tract infections (other than otitis media.), but they may be at a decreased risk of lower respiratory tract infections, particularly those associated with respiratory syncytial virus. There is strong evidence that Haemophilus infuenzae B infection is more likely in the bottie-fed infant, and consistent evidence of protection of young children from chronic otitis media with prolonged breast-feeding. 0 1997 Elsevier Science Ireland Ltd.
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Papers by Pauline Emmett
is related to obesity development.
Objective: We examined the effects of feeding different types of
milk in late infancy on childhood growth.
Design: A cohort of 1112 term, singleton children (born in 1992) from
the Avon Longitudinal Study of Parents and Children, United Kingdom,
were studied prospectively. Food records collected at 8 mo of age
were used to define the following 5 mutually exclusive feeding groups
on the basis of the type and amount of milk consumed: breast milk
(BM), ,600 mL formula milk/d (FMlow), $600 mL formula milk/d
(FMhigh), ,600 mL cow milk/d (CMlow), and $600 mL cow milk/d
(CMhigh). Weight, height, and BMI were measured at 14 time points
from birth to 10 y of age, and SD scores (SDSs) were calculated. Dietary
energy and macronutrient intakes were available at 7 time points.
Results: CMhigh children were heavier than were BM children from
8 mo to 10 y of age with weight differences (after adjustment for
maternal education, smoking, and parity) $0.27 SDSs and an average
of 0.48 SDSs. The maximum weight difference was at 18 mo
of age (0.70 SDS; 95% CI: 0.41, 1.00 SDS; P = ,0.0001). CMhigh
children were taller at some ages (25-43 mo; P , 0.01) and had
greater BMI SDSs from $8 mo of age (at 9 y of age; P = 0.001).
FMhigh children were heavier and taller than were BM children from
8 to 37 mo of age. There were marked dietary differences between
milk groups at 8 mo of age, some of which persisted to 18 mo of
age. Adjustments for current energy and protein intakes did not
attenuate the growth differences observed.
Conclusions: The feeding of high volumes of cow milk in late
infancy is associated with faster weight and height gain than is
BM feeding. The feeding of bottle-fed infants with high volumes
of cow milk in late infancy may have a persisting effect on body
habitus through childhood
diet, growth, and obesity development during childhood are reviewed. Diet was
assessed by food frequency questionnaires and food records. Growth data were
collected by routine measurements, and in standardized clinics, body fatness was
assessed by bioelectrical impedance and DXA (dual-energy X-ray absorptiometry)
scans. Diets changed dramatically during the preschool period with an increase in
the intake of free (added) sugars (12.3% rising to 16.4% of energy) that remained
similar until adolescence. This was due to increased intake of energy-dense,
nutrient-poor foods. Two periods of rapid growth were identified; infancy and
mid-childhood (ages 7–11 y) and both were associated with obesity development.
Diets with high energy density were associated with increasing fat mass from
mid-childhood until adolescence. Genetic and dietary factors showed independent
associations with increasing adiposity. At all ages studied, there were dietary
inequalities related to maternal educational attainment that may influence
inequalities found in obesity development. The Avon Longitudinal Study of Parents
and Children has provided valuable insights into how disparities in diet and
growth may affect the development of ill health in adulthood.
INTRODUCTION
A balanced diet in childhood is very important to ensure
optimum growth and development at a time of
rapid growth. Poor diet has been associated with many
adult health conditions, such as coronary heart disease,
diabetes, and some cancers.1–3 Establishing and maintaining
healthy eating habits is important because habits
formed in early life are likely to continue into adulthood.
4 The Bogalusa Heart Study found that coronary
atherosclerosis and
empirically derived dietary patterns were reviewed. The relationships of dietary patterns
with socioeconomic background and childhood development were examined.
Diet was assessed using food frequency questionnaires and food records. Three
statistical methods were used: principal components analysis, cluster analysis, and
reduced rank regression. Throughout childhood, children and parents have similar
dietary patterns. The “health-conscious” and “traditional” patterns were associated
with high intakes of fruits and/or vegetables and better nutrient profiles than the
“processed” patterns. There was evidence of tracking in childhood diet, with the
“health-conscious” patterns tracking most strongly, followed by the “processed”
pattern. An “energy-dense, low-fiber, high-fat” dietary pattern was extracted using
reduced rank regression; high scores on this pattern were associated with increasing
adiposity. Maternal education was a strong determinant of pattern score or
cluster membership; low educational attainment was associated with higher scores
on processed, energy-dense patterns in both parents and children. The Avon
Longitudinal Study of Parents and Children has provided unique insights into the
value of empirically derived dietary patterns and has demonstrated that they are a
useful tool in nutritional epidemiology.
INTRODUCTION
The derivation of dietary patterns to describe diet, as opposed
to investigating individual foods or nutrients, has
become popular in nutritional epidemiology. Dietary patterns
facilitate the study of the whole diet, recognizing
that people consume foods in combination. They complement
more traditional methods of examining diet–
health relationships, which use individual foods or nutrients.
Studies of dietary patterns and a particular disease
outcome such
Longitudinal Study of Parents and Children were reviewed. Diet was assessed using
a food frequency questionnaire. Socioeconomic background, maternal mental
health, and the health and development of the offspring were assessed using a
variety of methods, such as direct measurement, self-completion questionnaires,
and assays of biological samples. Differences in diet, including specific food and
nutrient intakes and dietary patterns, were associated with maternal educational
attainment, smoking habits, and financial difficulty. There were marginal intakes,
compared with recommendations, of the key nutrients iron, magnesium, potassium,
and folate. Maternal diet during pregnancy was predictive of offspring diet during
childhood. There were independent associations between prenatal fish consumption
and lower frequency of maternal depressive and anxiety symptoms, as well as
lower frequency of intrauterine growth retardation. Consistent evidence that fish
consumption during pregnancy benefited the neurocognitive development of the
child was also found. Two constituents of fish, n-3 polyunsaturated fatty acids and
iodine, were associated with these benefits in children. The findings from the Avon
Longitudinal Study of Parents and Children strengthen the recommendation to eat
fish regularly during pregnancy.
INTRODUCTION
Maternal nutrition periconception and during pregnancy
is important for the health, growth, and development of
the fetus and the newborn infant. There is considerable
interest in nutrition during pregnancy because of the fetal
origins theory of adult disease. This theory hypothesizes
that term infants who are small for gestational age
have an increased risk of cardiovascular disease and type
II diabetes in adulthood and that this is due to undernutrition
of the fetus. The original work was based on the
follow-up
is related to obesity development.
Objective: We examined the effects of feeding different types of
milk in late infancy on childhood growth.
Design: A cohort of 1112 term, singleton children (born in 1992) from
the Avon Longitudinal Study of Parents and Children, United Kingdom,
were studied prospectively. Food records collected at 8 mo of age
were used to define the following 5 mutually exclusive feeding groups
on the basis of the type and amount of milk consumed: breast milk
(BM), ,600 mL formula milk/d (FMlow), $600 mL formula milk/d
(FMhigh), ,600 mL cow milk/d (CMlow), and $600 mL cow milk/d
(CMhigh). Weight, height, and BMI were measured at 14 time points
from birth to 10 y of age, and SD scores (SDSs) were calculated. Dietary
energy and macronutrient intakes were available at 7 time points.
Results: CMhigh children were heavier than were BM children from
8 mo to 10 y of age with weight differences (after adjustment for
maternal education, smoking, and parity) $0.27 SDSs and an average
of 0.48 SDSs. The maximum weight difference was at 18 mo
of age (0.70 SDS; 95% CI: 0.41, 1.00 SDS; P = ,0.0001). CMhigh
children were taller at some ages (25-43 mo; P , 0.01) and had
greater BMI SDSs from $8 mo of age (at 9 y of age; P = 0.001).
FMhigh children were heavier and taller than were BM children from
8 to 37 mo of age. There were marked dietary differences between
milk groups at 8 mo of age, some of which persisted to 18 mo of
age. Adjustments for current energy and protein intakes did not
attenuate the growth differences observed.
Conclusions: The feeding of high volumes of cow milk in late
infancy is associated with faster weight and height gain than is
BM feeding. The feeding of bottle-fed infants with high volumes
of cow milk in late infancy may have a persisting effect on body
habitus through childhood
diet, growth, and obesity development during childhood are reviewed. Diet was
assessed by food frequency questionnaires and food records. Growth data were
collected by routine measurements, and in standardized clinics, body fatness was
assessed by bioelectrical impedance and DXA (dual-energy X-ray absorptiometry)
scans. Diets changed dramatically during the preschool period with an increase in
the intake of free (added) sugars (12.3% rising to 16.4% of energy) that remained
similar until adolescence. This was due to increased intake of energy-dense,
nutrient-poor foods. Two periods of rapid growth were identified; infancy and
mid-childhood (ages 7–11 y) and both were associated with obesity development.
Diets with high energy density were associated with increasing fat mass from
mid-childhood until adolescence. Genetic and dietary factors showed independent
associations with increasing adiposity. At all ages studied, there were dietary
inequalities related to maternal educational attainment that may influence
inequalities found in obesity development. The Avon Longitudinal Study of Parents
and Children has provided valuable insights into how disparities in diet and
growth may affect the development of ill health in adulthood.
INTRODUCTION
A balanced diet in childhood is very important to ensure
optimum growth and development at a time of
rapid growth. Poor diet has been associated with many
adult health conditions, such as coronary heart disease,
diabetes, and some cancers.1–3 Establishing and maintaining
healthy eating habits is important because habits
formed in early life are likely to continue into adulthood.
4 The Bogalusa Heart Study found that coronary
atherosclerosis and
empirically derived dietary patterns were reviewed. The relationships of dietary patterns
with socioeconomic background and childhood development were examined.
Diet was assessed using food frequency questionnaires and food records. Three
statistical methods were used: principal components analysis, cluster analysis, and
reduced rank regression. Throughout childhood, children and parents have similar
dietary patterns. The “health-conscious” and “traditional” patterns were associated
with high intakes of fruits and/or vegetables and better nutrient profiles than the
“processed” patterns. There was evidence of tracking in childhood diet, with the
“health-conscious” patterns tracking most strongly, followed by the “processed”
pattern. An “energy-dense, low-fiber, high-fat” dietary pattern was extracted using
reduced rank regression; high scores on this pattern were associated with increasing
adiposity. Maternal education was a strong determinant of pattern score or
cluster membership; low educational attainment was associated with higher scores
on processed, energy-dense patterns in both parents and children. The Avon
Longitudinal Study of Parents and Children has provided unique insights into the
value of empirically derived dietary patterns and has demonstrated that they are a
useful tool in nutritional epidemiology.
INTRODUCTION
The derivation of dietary patterns to describe diet, as opposed
to investigating individual foods or nutrients, has
become popular in nutritional epidemiology. Dietary patterns
facilitate the study of the whole diet, recognizing
that people consume foods in combination. They complement
more traditional methods of examining diet–
health relationships, which use individual foods or nutrients.
Studies of dietary patterns and a particular disease
outcome such
Longitudinal Study of Parents and Children were reviewed. Diet was assessed using
a food frequency questionnaire. Socioeconomic background, maternal mental
health, and the health and development of the offspring were assessed using a
variety of methods, such as direct measurement, self-completion questionnaires,
and assays of biological samples. Differences in diet, including specific food and
nutrient intakes and dietary patterns, were associated with maternal educational
attainment, smoking habits, and financial difficulty. There were marginal intakes,
compared with recommendations, of the key nutrients iron, magnesium, potassium,
and folate. Maternal diet during pregnancy was predictive of offspring diet during
childhood. There were independent associations between prenatal fish consumption
and lower frequency of maternal depressive and anxiety symptoms, as well as
lower frequency of intrauterine growth retardation. Consistent evidence that fish
consumption during pregnancy benefited the neurocognitive development of the
child was also found. Two constituents of fish, n-3 polyunsaturated fatty acids and
iodine, were associated with these benefits in children. The findings from the Avon
Longitudinal Study of Parents and Children strengthen the recommendation to eat
fish regularly during pregnancy.
INTRODUCTION
Maternal nutrition periconception and during pregnancy
is important for the health, growth, and development of
the fetus and the newborn infant. There is considerable
interest in nutrition during pregnancy because of the fetal
origins theory of adult disease. This theory hypothesizes
that term infants who are small for gestational age
have an increased risk of cardiovascular disease and type
II diabetes in adulthood and that this is due to undernutrition
of the fetus. The original work was based on the
follow-up