Intake In Early Childhood Research Articles

Associations of protein intake in early childhood with body composition, height, and insulin-like growth factor I in mid-childhood and early adolescence

Early protein intake may program later body composition and height growth, perhaps mediated by insulin-like growth factor I (IGF-I). In infancy, higher protein intake is consistently associated with higher IGF-I concentrations and more rapid growth, but associations of protein intake after infancy with later growth and IGF-I are less clear. Our objective was to examine associations of protein intake in early childhood (median 3.2 y) with height, IGF-I, and measures of adiposity and lean mass in mid-childhood (median 7.7 y) and early adolescence (median 13.0 y), and with changes in these outcomes over time. We hypothesized that early childhood protein intake programs later growth. We studied 1165 children in the Boston-area Project Viva cohort. Mothers reported children's diet using food-frequency questionnaires. We stratified by child sex and examined associations of early childhood protein intake with mid-childhood and early adolescent BMI z score, skinfold thicknesses, dual-energy X-ray absorptiometry (DXA) fat mass, DXA lean mass, height z score, and IGF-I concentration. We adjusted linear regression models for race/ethnicity, family sociodemographics, parental and birth anthropometrics, breastfeeding status, physical activity, and fast food intake. Mean protein intake in early childhood was 58.3 g/d. There were no associations of protein intake in early childhood with any of the mid-childhood outcomes. Among boys, however, each 10-g increase in early childhood total protein intake was associated with several markers of early adolescent size, namely BMI z score (0.12 higher; 95% CI: 0.01, 0.23), DXA lean mass index (1.34% higher; 95% CI: -0.07%, 2.78%), and circulating IGF-I (5.67% higher; 95% CI: 0.30%, 11.3%). There were no associations with fat mass and no associations with any adolescent outcomes among girls. Early childhood protein intake may contribute to programming lean mass and IGF-I around the time of puberty in boys, but not to adiposity development. This study was registered at clinicaltrials.gov as NCT02820402.

Title: efficacy of a food parenting intervention for mothers with low income to reduce preschooler\u2019s solid fat and added sugar intakes: a randomized controlled trial

BackgroundFew interventions have shown efficacy to influence key energy balance behaviors during the preschool years.ObjectiveA randomized controlled trial (RCT) was used to evaluate the efficacy of Food, Fun, and Families (FFF), a 12 week authoritative food parenting intervention for mothers with low-income levels, to reduce preschool-aged children’s intake of calories from solid fat and added sugar (SoFAS).MethodsMothers were randomly assigned to receive FFF (n = 59) or to a delayed treatment control (n = 60). The primary outcome was children’s daily energy intake from SoFAS at the end of the 12 week intervention, controlling for baseline levels, assessed by 24-h dietary recalls. Secondary outcomes included children’s daily energy intake, children’s BMI z-scores, and meal observations of maternal food parenting practices targeted in FFF (e.g. providing guided choices).ResultsParticipating mothers were predominantly African American (91%), with 39% educated beyond high school and 66% unemployed. Baseline demographics and child SoFAS intakes did not differ by group. Lost to follow-up was 13% and did not differ between groups. At post-intervention, FFF children consumed ~ 94 kcal or 23% less daily energy from SoFAS than children in the control group, adjusting for baseline levels (307.8 (95%CI = 274.1, 341.5) kcal vs. 401.9 (95%CI = 369.8, 433.9) kcal, FFF vs. control; p < 0.001). FFF mothers also displayed a greater number of authoritative parenting practices when observed post-intervention with their child at a buffet-style meal (Wilcoxon z = − 2.54, p = 0.012). Neither child total daily energy intake nor BMI z-scores differed between groups post-intervention.ConclusionsFindings demonstrate the initial efficacy of an authoritative food parenting intervention for families with low-income to reduce SoFAS intake in early childhood. Additional research is needed to evaluate longer-term effects on diet and growth.Trial registrationRetrospectively registered at ClinicalTrials.gov: #NCT03646201.

Reducing stickiness in spray dried dairy emulsions

High-protein intake in early childhood may cause negative health effects in later life. However, low protein powdered follow-on milks are challenging to manufacture due to stickiness caused by increased free fat and lower glass transition points. Skim milk powder and palm oil emulsions, ranging from 0.25 to 5% w/w protein were assessed for their stability and subsequently spray dried to produce powders ranging from 1 to 20% w/w protein. Powders containing 2–8% w/w protein had high free fat levels despite the initial emulsion being stable, suggesting small adjustments in protein concentration can have a significant impact on emulsion stability during drying and atomisation. Reducing the protein content via substitution with lactose reduced the powders glass transition point (Tg) from 65 to 49 °C (powder contained 4%w/w protein, 67%w/w carbohydrate and 28%w/w fat). Substituting lactose with maltodextrin (DE6) at a 45%w/w level of inclusion increased the Tg of the powders from 50 to 113 °C, however, viscosity increased significantly. Interestingly, using glucose syrup (DE39) to substitute lactose at a 15%w/w level of inclusion, increased the powder Tg by 21 °C with no significant change in emulsion viscosity compared to a control with lactose as the sole carbohydrate. XPS analysis showed fat type (milk, palm, sunflower) influenced powder surface fat coverage. The inner fat contained increased levels of saturated fatty acids (palmitic and stearic) compared to the surface and encapsulated fat. In conclusion the Tg of low protein spray dried emulsions can be increased and the surface fat decreased, helping to reduce susceptibility to stickiness.

Child dietary intake of folate and vitamin B12 and their neurodevelopment at 24 and 30 months of age.

To evaluate whether child dietary intake of folate and vitamin B12, is associated with mental and psychomotor development in Mexican children, respectively, at 24 and 30 months of age. Information about neurodevelopment and dietary intake of folate and vitamin B12 at 24 and 30 months of age among 229 children belonging to a perinatal cohort was analyzed longitudinally. Dietary information was assessed using a semi-quantitative food frequency questionnaire, and neurodevelopment by Bayley Scale of Infant Development II. At 30 months of age, dietary folate intake was marginally associated with increased Mental Development Index (MDI) (b=8.33; 95%CI -0.48, 17.14; p=0.06). Nonsignificant positive associations of vitamin B12 with MDI were found. Psychomotor Development Index (PDI) was not associated with these nutrients. Dietary folate intake in early childhood may benefit the mental development of children.

Maternal intake of sugar during pregnancy and childhood respiratory andatopic outcomes.

The possible role of maternal consumption of free sugar during pregnancy in the inception of respiratory and atopic diseases has not been studied. We aimed to study the relationship between maternal intake of free sugar during pregnancy and respiratory and atopic outcomes in the offspring in a population-based birth cohort, the Avon Longitudinal Study of Parents and Children.We analysed associations between maternal intake of free sugar in pregnancy (estimated by a food frequency questionnaire), and current doctor-diagnosed asthma, wheezing, hay fever, eczema, atopy, serum total IgE and lung function in children aged 7–9 years (n=8956 with information on maternal diet in pregnancy and at least one outcome of interest).After controlling for potential confounders, maternal intake of free sugar was positively associated with atopy (OR for highest versus lowest quintile of sugar intake 1.38, 95% CI 1.06–1.78; per quintile p-trend=0.006) and atopic asthma (OR 2.01, 95% CI 1.23–3.29; per quintile p-trend=0.004). These associations were not confounded by intake of sugar in early childhood, which was unrelated to these outcomes.Our results suggest that a higher maternal intake of free sugar during pregnancy is associated with an increased risk of atopy and atopic asthma in the offspring, independently of sugar intake in early childhood.

Protein Intake in Early Childhood Is not Associated with Adiposity, Height, or IGF‐I in Mid‐Childhood among Well‐Nourished Children in a U.S. Cohort

ObjectiveOur objective was to examine associations of protein intake in early childhood (~3y) with height, insulin‐like growth factor‐I (IGF‐I) levels, and measures of adiposity in mid‐childhood (~8y). In infancy, higher protein intake, typical of commercial formulas, has consistently been associated with higher IGF‐I levels and more rapid growth compared with intake of breast milk or lower protein formula. We aimed to test the hypothesis that protein intake in early childhood programs later growth.MethodsWe studied 1058 children in the Boston‐area Project Viva cohort. Mothers reported their children's early childhood diet using food frequency questionnaires. We adjusted protein intake for total energy and weight using residuals and categorized intake in g/d into quartiles. Using multivariable linear regression models adjusted for race/ethnicity, sex, family socioeconomic status, parental and birth anthropometrics, breastfeeding status, and certain mid‐childhood behaviors, we examined associations of early childhood protein intake with mid‐childhood adiposity (BMI z‐score, sum of subscapular and triceps (SS+TR) skinfolds and dual X‐ray absorptiometry (DXA) fat mass), height z‐score and IGF‐I levels.ResultsThe children were predominantly white (66%), and 70% had mothers with a college degree. Mean protein intake in early childhood was 58.2 g/d (3.78 g/kg/d), well above the U.S. recommendation of 13 g/d (1.1 g/kg/d) for ages 1–3y. There were no clear associations between protein intake in early childhood and adiposity, height, or IGF‐I levels in mid‐childhood in the overall sample or in separate analyses of boys and girls. In fully adjusted models, the βs (95% CIs) representing the difference in outcome corresponding to the highest vs. lowest quartile of protein intake were: 0.13 (−0.05, 0.30) for BMI z‐score; 0.02 (−1.66, 1.69) for SS+TR skinfolds (mm); −0.04 (−0.72, 0.63) for DXA fat mass (kg); 0.05 (−0.11, 0.21) for height z‐score; and −5.30 (−29.6, 19.0) for IGF‐I (ng/mL).ConclusionsOur results do not support a role for early childhood protein intake in programming later adiposity or height growth in a sample of children with relatively high protein intake.Support or Funding InformationSupported by the US National Institutes of Health (grant R01 HD034568, UG3 OD023286). Dr. Oken was supported by K24 HD069408 and P30 DK092924

Dietary Intake of Protein in Early Childhood Is Associated with Growth Trajectories between 1 and 9 Years of Age

Background: High protein intake in infancy might lead to a higher body mass index (BMI) in childhood. However, whether these associations differ between different sources of protein is unclear.Objective: We investigated associations between the intake of total protein, protein from different sources, and individual amino acids in early childhood and repeatedly measured height, weight, and BMI up to the age of 9 y.Methods: This study was performed in 3564 children participating in the Generation R Study, a population-based prospective cohort study in Rotterdam, Netherlands. Intakes of total protein, animal protein, vegetable protein, and individual amino acids (including methionine, arginine, lysine, threonine, valine, leucine, isoleucine, phenylalanine, tryptophan, histidine, cysteine, tyrosine, alanine, asparagine, glutamine, glycine, proline, and serine) at 1 y were assessed by using a food-frequency questionnaire. Height and weight were measured at the approximate ages of 14, 18, 24, 30, 36, and 45 mo and at 6 and 9 y, and BMI was calculated.Results: After adjustment for confounders, linear mixed models showed that a 10-g higher total protein intake/d at 1 y was significantly associated with a 0.03-SD greater height (95% CI: 0.00, 0.06), a 0.06-SD higher weight (95% CI: 0.03, 0.09), and a 0.05-SD higher BMI (95% CI: 0.03, 0.08) up to the age of 9 y. Associations were stronger for animal than for vegetable protein intake but did not differ between dairy and nondairy animal protein or between specific amino acids.Conclusions: A higher intake of protein, especially animal protein, at 1 y of age was associated with a greater height, weight, and BMI in childhood up to 9 y of age. Future studies should explore the role of growth hormones and investigate whether protein intake in early childhood affects health later in life.

Nutritional interventions or exposures in infants and children aged up to 3 years and their effects on subsequent risk of overweight, obesity and body fat: a systematic review of systematic reviews.

This study, performed as part of the international EarlyNutrition research project (http://www.project-earlynutrition.eu), provides a systematic review of systematic reviews on the effects of nutritional interventions or exposures in children (up to 3 years of age) on the subsequent risk of obesity, overweight and adiposity. Electronic databases (including MEDLINE, Embase and Cochrane Library) were searched up until September 2015. Forty systematic reviews were included. A consistent association of breastfeeding with a modest reduction in the risk of later overweight and obesity in childhood and adulthood was found (the odds decreased by 13% based on high-quality studies), but residual confounding cannot be excluded. Lowering the protein content of infant formula is a promising intervention to reduce the risk of later overweight and obesity in children. There is no consistent evidence of an association of the age of introducing complementary foods, sugar-sweetened beverage or energy intake in early childhood with later overweight/obesity, but there are some indications of an association of protein intake during the complementary feeding period with later overweight/obesity. There was inadequate evidence to determine the effects of other nutritional interventions or exposures, including modifications of infant formula composition, fat intake or consumption of different food groups.

Protein intake in early childhood and body composition at the age of 6 years: The Generation R Study.

Previous studies suggest that high protein intake in infancy leads to a higher body mass index (BMI) in later childhood. We examined the associations of total, animal and vegetable protein intake in early childhood with detailed measures of body composition at the age of 6 years. This study was performed in 2911 children participating in a population-based cohort study. Protein intake at the age of 1 year was assessed with a validated food-frequency questionnaire and was adjusted for total energy intake. At the children's age of 6 years, we measured their anthropometrics and body fat (with dual-energy X-ray absorptiometry). We calculated age- and sex-specific s.d. scores for BMI, fat mass index (FMI) and fat-free mass index (FFMI). After adjustment for confounders, a 10 g per day higher total protein intake at 1 year of age was associated with a 0.05 s.d. (95% confidence interval (CI) 0.00, 0.09) higher BMI at age 6. This association was fully driven by a higher FMI (0.06 s.d. (95%CI 0.01, 0.11)) and not FFMI (-0.01 s.d. (95%CI -0.06, 0.05)). The associations of protein intake with FMI at 6 years remained significant after adjustment for BMI at the age of 1 year. Additional analyses showed that the associations of protein intake with FMI were stronger in girls than in boys (P for interaction=0.03), stronger among children who had catch-up growth in the first year of life (P for interaction<0.01) and stronger for intake of animal protein (both dairy and non-dairy protein) than protein from vegetable sources. Our results suggest that high protein intake in early childhood is associated with higher body fat mass, but not fat-free mass. Future studies are needed to investigate whether these changes persist into adulthood and to examine the optimal range of protein intake for infants and young children.

Reducing discretionary food and beverage intake in early childhood: a systematic review within an ecological framework.

To systematically review the literature and map published studies on 4-8-year-olds' intake of discretionary choices against an ecological framework (ANalysis Grid for Environments Linked to Obesity; ANGELO). Articles were identified through database searches (PubMed, PyscINFO®, Web of Science) in February and March 2014 and hand-searching reference lists. Studies were assessed for methodological quality and mapped against the ANGELO framework by environment size (macro and micro setting) and type (physical, economic, policy and socio-cultural influences). Studies were conducted in the USA (n 18), Australia (n 6), the UK (n 3), the Netherlands (n 3), Belgium (n 1), Germany (n 1) and Turkey (n 1). Children aged 4-8 years, or parents/other caregivers. Thirty-three studies met the review criteria (observational n 23, interventions n 10). Home was the most frequently studied setting (67 % of exposures/strategies), with the majority of these studies targeting family policy-type influences (e.g. child feeding practices, television regulation). Few studies were undertaken in government (5·5 %) or community (11 %) settings, or examined economic-type influences (0 %). Of the intervention studies only four were categorised as effective. The present review is novel in its focus on mapping observational and intervention studies across a range of settings. It highlights the urgent need for high-quality research to inform interventions that directly tackle the factors influencing children's excess intake of discretionary choices. Interventions that assist in optimising a range of environmental influences will enhance the impact of future public health interventions to improve child diet quality.

Protein intake in early childhood and cardiometabolic health at school age: the Generation R Study.

PurposeHigh protein intake in infancy has been linked to obesity. We aimed to examine the associations of protein intake in early childhood with cardiovascular and metabolic outcomes at school age.MethodsThis study was performed in 2965 children participating in a population-based prospective cohort study. Protein intake at 1 year was assessed with a food frequency questionnaire and was adjusted for energy intake. At the children’s age of 6 years, we measured their body fat percentage (BF%), blood pressure (BP), and insulin, HDL cholesterol, and triglyceride serum levels. These measures were incorporated into a cardiometabolic risk factor score, using age- and sex-specific SD scores.ResultsIn covariate-adjusted models, higher protein intake was associated with a higher BF%, lower diastolic BP, and lower triglyceride levels. We observed a significant interaction of protein intake with child sex on metabolic outcomes. Stratified analyses showed that protein intake was positively associated with BF% [0.07 SD (95 % CI 0.02; 0.13) per 10 g/day] and insulin levels in girls, but not in boys. In boys, but not in girls, higher protein intake was associated with lower triglyceride levels [−0.12 SD (95 % CI −0.20; −0.04) per 10 g/day] and a lower cardiometabolic risk factor score. Protein intake was not consistently associated with systolic BP or HDL cholesterol levels.ConclusionProtein intake in early childhood was associated with a higher BF% and higher insulin levels at 6 years in girls and with lower triglyceride levels in boys. Further studies are needed to explore these sex differences and to investigate whether the observed changes persist into adulthood.Electronic supplementary materialThe online version of this article (doi:10.1007/s00394-015-1026-7) contains supplementary material, which is available to authorized users.

Factors influencing obesogenic dietary intake in young children (0–6 years): systematic review of qualitative evidence

BackgroundObesogenic dietary intake is prevalent in young children and is associated with obesity and other adverse health outcomes in childhood and later in life.ObjectiveTo describe the barriers to and facilitators...

First-trimester maternal protein intake and childhood kidney outcomes: the Generation R Study

Nutritional exposures during in utero development may have long-lasting consequences for postnatal renal health. Animal studies suggest that specifically maternal dietary protein intake during pregnancy influences childhood kidney function. We examined the associations of total, animal, and vegetable maternal protein intake during pregnancy with kidney volume and function in school-aged children. This study was conducted in 3650 pregnant women and their children who were participating in a population-based cohort study from early life onward. First-trimester energy-adjusted maternal protein intake was assessed with a food-frequency questionnaire. At the child's age of 6 y, we assessed kidney volume, estimated glomerular filtration rate (eGFR) using serum creatinine and cystatin C concentrations, and microalbuminuria using urine albumin:creatinine ratios. First-trimester maternal total protein intake was associated with a higher childhood creatinine-based eGFR (difference: 0.06 mL × min(-1) × 1.73 m(-2); 95% CI: 0.01, 0.12 mL · min(-1) · 1.73 m(-2) per gram of protein intake). This association was mainly driven by vegetable protein intake (0.22 mL × min(-1) × 1.73 m(-2); 95% CI: 0.10, 0.35 mL · min(-1) · 1.73 m(-2) per gram of vegetable protein intake). These associations were not explained by protein intake in early childhood. First-trimester maternal protein intake was not significantly associated with childhood kidney volume, cystatin C-based eGFR, or the risk of microalbuminuria. Our findings suggest that higher total and vegetable, but not animal, maternal protein intake during the first trimester of pregnancy is associated with a higher eGFR in childhood. Further follow-up studies are needed to investigate whether maternal protein intake in early pregnancy also affects the risk of kidney diseases in later life.

Protein intake in infancy and kidney size and function at the age of 6 years: The Generation R Study.

BackgroundHigh protein intake has been linked to kidney growth and function. Whether protein intake is related to kidney outcomes in healthy children is unclear.MethodsWe examined the associations between protein intake in infancy and kidney outcomes at age 6 years in 2968 children participating in a population-based cohort study. Protein intake at 1 year was assessed using a food-frequency questionnaire and was adjusted for energy intake. At age 6 years we measured the kidney volume and urinary albumin/creatinine ratio (ACR) of all participating children, and we estimated glomerular filtration rate (eGFR) using serum creatinine and cystatin C levels.ResultsIn models adjusted for age, sex, body surface area, and sociodemographic factors, a higher protein intake was associated with a lower ACR and a higher eGFR but was not consistently associated with kidney volume. However, after further adjustment for additional dietary and lifestyle factors, such as sodium intake, diet quality, and television watching, higher protein intake was no longer associated with kidney function. No differences in associations were observed between animal and vegetable protein intake.ConclusionsOur findings show that protein intake in early childhood is not independently associated with kidney size or function at the age of 6 years. Further study is needed on other early life predictors of kidney size and function in later life.Electronic supplementary materialThe online version of this article (doi:10.1007/s00467-015-3096-4) contains supplementary material, which is available to authorized users.

The Characteristics of Young Children According to Dietary Supplement Use in Infancy: Data from the KNHANES IV and V (2009‐2012)

The interest of dietary supplement intake in early childhood is increasing. However, few studies have been conducted in Korea to examine the influence on health and growth. This study was conducted to assess the sociodemographic characteristics, health and growth outcomes, and dietary intakes of young children according to dietary supplement use in infancy. Data from 1,262 subjects aged 1‐3 years with 24hr diet recall data from Korea National Health and Nutrition Examination Survey IV and V (2009‐2012) were analyzed. We compared the differences of sociodemographic characteristics, health and growth outcomes including diagnosed disease, perceived health state, current health problem, weight‐for‐age, height‐for‐age, and weight‐for‐height, and dietary intakes between supplement users and non‐users. The prevalence of supplement use was 34.4%. The supplement use was significantly higher in older children and children of mothers with lower education level or supplement use. No significant differences between groups were observed in dietary intakes and most of health and growth outcomes, however, children without diagnosed disease or with weight‐for‐age less than 10 percentile used supplement more than the counterparts. Therefore, the early supplement use may be related to age, diagnosed disease, weight‐for‐age, and mother's education level and supplement use. Further studies are needed to assess the influence of dietary supplement on the long term growth and health in Korean children.This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT &amp; Future Planning (grant no. 2013R1A1A2057600)

Sleep and ultra‐processed intake in early childhood: a longitudinal analyses

ObjectiveTo assess whether shorter sleep at preschool age predicted the higher intake of energy and ultra‐processed food in childhood.MethodsCohort study conducted with 345 Brazilian children of low socioeconomic status aged 3‐4 years and 7‐8 years. Dietary data were collected through two 24‐hour recalls and children's ultra‐processed foods intake was assessed. Mothers reported the number of hours that the children had slept the past 24h.ResultsTotal energy intake at preschool and school‐age was significantly higher in shorter‐sleeping children, with children who slept &lt;10h/d consuming an average of 117 kcal/d (95% CI: 50–184) more than those sleeping for &gt;10 h/d at 3‐4 years; and an average difference of 62 kcal/d (7–117) at 7‐8 year. Regarding changes in diet from pre‐school to school‐age, total energy increased by 54 kcal/d (19–91) and 19 kcal/d (‐66–104) in children who slept 蠅10 and &lt;10 h/d at preschool age, respectively. Intake of energy from ultra‐processed foods increased only in those children who slept &lt;10 h/d. Energy provided by ultra‐processed foods remained constant in children who slept 蠅10 h/d. Dietary variables Sleep duration at 3‐4 years ≥10 hours/day &amp;lt;10 hours/day mean±SD At 3‐4 years Total energy intake (kcal) 1492±253 1610±372* % energy from ultra‐processed foodsa 45.1±6.1 31.4±4.9* At 7‐8 years Total energy intake (kcal) 1548±195 1611±513 % energy from ultra‐processed foodsa 47.7±9.2 48.5±8.8 mean difference (95% CI) Difference between 7‐8 years and 3‐4 years % energy from ultra‐processed foodsa 2.4 (0.9—3.9) 17.0 (14.6—19.4)** * p&amp;lt;0.05, Paired t test. ** p&amp;lt;0.01, Wilcoxon test. a Sweets, savory and biscuits, soft drink, processed meat, and bread. ConclusionEarly shorter sleep duration was associated with higher energy intake and increased consumption of ultra‐processed foods in children. These findings add new evidence to the limited literature available with children on the role that shorter sleep duration may play in relation to intake.CNPq, CAPES/Brazil.

Effects of protein intake on blood pressure, insulin sensitivity and blood lipids in children: a systematic review.

High protein intake in early childhood is associated with obesity, suggesting possible adverse effects on other cardiometabolic outcomes. However, studies in adults have suggested beneficial effects of protein intake on blood pressure (BP) and lipid profile. Whether dietary protein intake is associated with cardiovascular and metabolic health in children is unclear. Therefore, we aimed to systematically review the evidence on the associations of protein intake with BP, insulin sensitivity and blood lipids in children. We searched the databases Medline, Embase, Cochrane Central and PubMed for interventional and observational studies in healthy children up to the age of 18 years, in which associations of total, animal and/or vegetable protein intake with one or more of the following outcomes were reported: BP; measures of insulin sensitivity; cholesterol levels; or TAG levels. In the search, we identified 6636 abstracts, of which fifty-six studies met all selection criteria. In general, the quality of the included studies was low. Most studies were cross-sectional, and many did not control for potential confounders. No overall associations were observed between protein intake and insulin sensitivity or blood lipids. A few studies suggested an inverse association between dietary protein intake and BP, but evidence was inconclusive. Only four studies examined the effects of vegetable or animal protein intake, but with inconsistent results. In conclusion, the literature, to date provides insufficient evidence for effects of protein intake on BP, insulin sensitivity or blood lipids in children. Future studies could be improved by adequately adjusting for key confounders such as energy intake and obesity.

102: Validation of a Vitamin D Dietary Intake Screening Questionnaire in Young Children

Vitamin D dietary intake is an important predictor of vitamin D status in young children; however, measuring vitamin D intake in early childhood is challenging in the pediatric office setting. To determine how well a simple, 1 min parent completed, dietary screening questionnaire (DSQ) completed in the pediatric office setting correlates with a detailed prospective three-day estimated food record (EFR) in measuring daily dietary vitamin D intake in children one to five years of age and to examine the correlation between the DSQ and EFR for assessing milk and vitamin D supplement intake. The mean vitamin D dietary intake values derived from the DSQ and EFR were compared using a paired two-tailed Student's t test and Spearman correlation coefficient. Seventy-four children consented to participate in this study and were included in the analysis. Mean age was 34 months, 60% were male, 55% were European, and median zBMI was 0.12. The mean calorie intake according to the EFR was 1257 calories. The mean vitamin D dietary intake according to the DSQ was 493 (SD 399) IU and EFR was 443 (SD 389) IU. Paired student t-test revealed a P value of 0.37. The Spearman correlation was 0.47 for total vitamin D intake, 0.56 for vitamin D supplement intake and 0.69 for cow's milk intake. A 1 min DSQ completed in the pediatric office setting, including cow's milk and supplement use correlates well with a detailed EFR. Future studies include determining whether the DSQ predicts 25-hydroxyvitmain D.

Breastfeeding and risk of obesity

The potential relationship between breastfeeding and development of future obesity has been controversial. Early studies suggested that breastfeeding was protective against obesity development. However, there was concern that some studies did not have adequate control of potential confounders and that the relationship reflected more about lifestyle factors that went with mothers who breastfed their babies, rather than breastfeeding itself. Subsequent studies with different designs and better control of confounders failed to find a relationship between breastfeeding and obesity. In this issue of The Journal, Péneau et al report data from a long term cohort study that examines the relationship between breastfeeding and adiposity 20 years later. They found that taking the usual confounders into account yielded no significant association. However, after adjusting for early nutrition beyond breastfeeding, a protective effect of breastfeeding emerged. The definitive answer to these questions would come from a randomized clinical trial, but such a trial of breastfeeding versus no breastfeeding would be unethical. Therefore, we must rely on observational studies. It appears that if breastfeeding is protective against future obesity, it is likely to be a complex relationship. Because there are so many other advantages to breastfeeding, pediatricians should continue to be strong advocates for it, whether or not it has an impact on obesity. Article page 1363▶ Breastfeeding, Early Nutrition, and Adult Body FatThe Journal of PediatricsVol. 164Issue 6PreviewTo examine the association between breastfeeding and adult body fatness, adjusting for nutritional intake in early childhood. Full-Text PDF

Sleep and energy intake in early childhood

Background And Objectives:Shorter sleep is associated with higher weight in children, but little is known about the mechanisms. The aim of this study was to test the hypothesis that shorter sleep was associated with higher energy intake in early childhood.Methods:Participants were 1303 families from the Gemini twin birth cohort. Sleep duration was measured using the Brief Infant Sleep Questionnaire when the children were 16 months old. Total energy intake (kcal per day) and grams per day of fat, carbohydrate and protein were derived from 3-day diet diaries completed by parents when children were 21 months old.Results:Shorter nighttime sleep was associated with higher total energy intake (P for linear trend=0.005). Children sleeping <10 h consumed around 50 kcal per day more than those sleeping 11–<12 h a night (the optimal sleep duration for children of this age). Differences in energy intake were maintained after adjustment for confounders. As a percentage of total energy intake, there were no significant differences in macronutrient intake by sleep duration. The association between sleep and weight was not significant at this age (P=0.13).Conclusions:This study provides the first evidence that shorter nighttime sleep duration has a linear association with higher energy intake early in life. That the effect is observed before emergence of associations between sleep and weight indicates that differences in energy intake may be a mechanism through which sleep influences weight gain.