Association between glucose dips and the feeling of hunger in a dietary intervention study among students with early and late chronotype-secondary analysis of a randomized cross-over nutrition trial.

Consumption of foods with high glycaemic index (GI) can cause hyperglycemia, thus increasing postprandial hunger. Since circadian rhythm differs inter-individually, we describe glucose dips after breakfast/dinner with high/medium estimated meal GI among students with early (n = 22) and late chronotype (n = 23) and examine their relation to the feeling of hunger in a secondary analysis of a randomized cross-over nutrition trial. Glucose dips reflect the difference between the lowest glucose value recorded 2-3 h postprandially and baseline, presented as percentage of average baseline level. Associations between glucose dips and the feeling of hunger were analyzed using multilevel linear models. Glucose dips were lower after medium GI meals than after high GI meals among both chronotype groups (p = 0.03). Among early chronotypes, but not among late chronotypes, glucose dip values were lower after breakfast than after dinner (-4.9 % vs. 5.5 %, p = 0.001). Hunger increased throughout the day among both chronotypes but glucose dips were not related to the feeling of hunger at the meal following breakfast. Interestingly, lower glucose dip values 2-3 h postprandially occurred particularly after medium GI meals and were seen after breakfast among early chronotypes. These glucose dips did not predict hunger at meals after breakfast.

Associations of chronotype and social jetlag with eating jetlag and their changes among German students during the first COVID-19 lockdown. The Chronotype and Nutrition study.

Due to their biologically later chronotype, young students are vulnerable to a discrepant sleeping pattern between work- and free days, coined social jetlag (SJL). This study examined whether a later chronotype and/or a larger SJL are related to an analogous discrepancy in meal timing defined as eating jetlag (EJL) and whether chronotype and/or changes in SJL during the first COVID-19 related lockdown in Germany associated with changes in EJL. Baseline data were collected from September 2019-January 2020 among 317 students (58% females) aged 18-25 years of which a total of 156 students (67% females) completed an online follow-up survey in June-July 2020 (1st lockdown). Data were collected on daily routines, timing of meals/snacks, and physical activity. Chronotype was determined using the Munich ChronoType Questionnaire; SJL and EJL correspond to the difference in the daily midpoint of sleep/eating duration between work- and free days. Multivariable linear regression revealed that students with a later chronotype or a larger SJL experienced a larger EJL (padjusted = 0.0124 and padjusted<0.0001). A later chronotype at baseline and reductions in SJL during lockdown associated with concurrent reductions in EJL (padjusted = 0.027 and padjusted<0.0001). In conclusion, students with a later chronotype exhibit a more erratic meal pattern, which associates with SJL. During lockdown, flexible daily schedules allowed students to align the meal timing with their inner clock.

Breastfeeding trends in healthy infants since 1990-results of the DONALD study.

Exclusive breastfeeding is recommended for infants during the first 6 months of life. The aim of this analysis was to examine time trends in breastfeeding between 1990 and 2013 in Germany using data from the DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) Study. Although partial breastfeeding was observed to constantly increase over time in both 3-month and 6-month-old infants, fully breastfeeding rates did not further increase in 3-month-old infants since 2002, and even showed a tendency to decrease in 6-month-old infants. In conclusion, this finding emphasises the need for improvements in breastfeeding promotion in Germany, which currently seems to be ineffective in case of continuation of full breastfeeding until the age of 6 months.

Vegetarian diets in children: a systematic review.

PURPOSE: While the prevalence of children on vegetarian diets is assumed to be on the rise in industrialized countries, there are hardly any representative data available. In general, vegetarian diets are presumed to be healthy; nevertheless, there are concerns as to whether the dietary specifications required during infancy, childhood, and adolescence can be met. Therefore, the objective of this systematic review was to evaluate studies on the dietary intake and the nutritional or health status of vegetarian infants, children, and adolescents. METHODS: The database MEDLINE was used for literature search. In addition, references of reviews and expert opinions were considered. Inclusion criteria were (1) sufficient dietary information to define vegetarian type diet and (2) characteristics of nutritional or health status. Case reports and studies from non-industrialized countries were excluded. RESULTS: 24 publications from 16 studies published from 1988 to 2013 met our criteria. Study samples covered the age range from 0 to 18 years, and median sample size was 35. Five studies did not include a control group. With regard to biomarkers, anthropometry, and dietary or nutritional intake, the outcomes were diverse. Growth and body weight were generally found within the lower reference range. The intakes of folate, vitamin C, and dietary fiber were relatively high compared to reference values and/or control groups. Low status of vitamin B12 was reported in one study and low status of vitamin D in two studies. CONCLUSIONS: Due to the study heterogeneity, the small samples, the bias towards upper social classes, and the scarcity of recent studies, the existing data do not allow us to draw firm conclusions on health benefits or risks of present-day vegetarian type diets on the nutritional or health status of children and adolescents in industrialized countries.

Home-made and commercial complementary meals in German infants: results of the DONALD study.

BACKGROUND: Infant complementary food can be home-made or bought as ready-to-eat commercial products. The nutrient composition of commercial products is regularised in a European Commission guideline, whereas the preparation of home-made complementary meals is the responsibility of caregivers. In the present study, the composition of commercial and home-made complementary meals as eaten by healthy German infants was compared. METHODS: Of 8226 complementary meals (74% commercial and 26% home-made) recorded in 1083, 3-day weighed dietary records from 396 participants (6-12 months old) of the German DONALD (DOrtmund Nutritional and Anthropometric Longitudinally Designed) study were analysed. RESULTS: Median energy density (kcal 100 g(-1)) was highest in commercial and home-made cereal-milk meals (89 kcal 100 g(-1)). In home-made savoury and cereal-fruit meals, the energy density was significantly higher compared to their commercial counterparts. Median protein contents were highest in savoury and cereal-milk meals (>2.5 g 100 g(-1)) and dairy-fruit meals (2-4 g 100 g(-1)). Added sugars were found in less than a quarter of meals. Highest median sodium contents were found not only in commercial savoury meals (median 38 mg 100 g(-1)) and vegetable meals (32 mg 100 g(-1)), but also in home-made cereal-milk meals (36 mg 100 g(-1)). Both median fat and iron contents were higher in home-made meals compared to commercial savoury and cereal-fruit meals. CONCLUSIONS: With the exception of the higher sodium content in commercial savoury meals for older infants, the lower fat content in commercial savoury and cereal-fruit meals, and the added sugar content in some commercial dairy-fruit meals, a comparison of commercial and home-made complementary meals did not reveal any serious inadequacy.

Diet quality and diet costs in German children and adolescents.

We examined the association between diet costs and diet quality in a sample of children and adolescents using data from the ongoing longitudinal (open cohort) DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) study. Children and adolescents aged 4-18 years (255 boys and 239 girls) provided 1100 yearly collected 3-day weighted dietary records. Linear mixed (effects) models were used to analyze the association between diet costs ([euro ;[sol;day, estimated using retail food prices) and the Nutrient Quality Index (NQI) and the Healthy Nutrition Score for Kids and Youth (HuSKY). Analysis were stratified for low-quality records (scoremedian). No significant association was found in the low-quality records, whereas in the high-quality records the association was significantly positive for both scores (HuSKY P=0.016, NQI P<0.0001). In conclusion, a substantial part of our sample could increase their diet quality without a noteworthy increase of expenditure.

Development of an estimated food record for 9-36-month-old toddlers.

OBJECTIVES: Adequacy of dietary intake in the sensitive period of toddler development is a key determinant of health in a short- and long-term perspective. Therefore, studies focussing the nutrition of toddlers are of importance. For this purpose, tailored dietary record methods are an important prerequisite. The objective of this work is to develop a toddler-specific estimated food record (EFR) in a booklet providing photographs of age-specific foods and portion sizes that should be accurate and simple. SUBJECTS/METHODS: For a toddler study in Germany, a 7-day consecutive EFR was developed. Data were obtained from a sample of toddlers in Germany. The basis is an evaluation of 3-day weighing food records on food choice and portion size of the DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) study for 227 toddlers (118 boys) aged 9-36 months from January 2004 to March 2008. RESULTS: In the analysed food records, a total of 15.147 eating occasions with 24.820 dishes were reported and grouped in 17 food groups. To estimate the portion size, the median consumption amounts of the 194 most frequently consumed dishes were calculated and photographed. Formula and commercial complementary food are collected separately. EFR was structured into seven eating occasions of the day: before breakfast, breakfast, mid-morning, lunch, mid-afternoon, dinner, and before bed. CONCLUSIONS: The EFR booklet provides a simple, feasible and validated instrument that can be used to update information on dietary habits during the transition from infant to childhood diet for families in different social classes.

Lunch habits of German children and adolescents: composition and dietary quality.

BACKGROUND/AIMS: Data from the ongoing, open-cohort Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study were used to describe warm family lunch meals and the association of the lunch composition with total diet quality. METHODS: 2,095 three-day weighed dietary records, collected between 2004 and 2009, from a 4- to 18-year-old DONALD study subgroup were used. RESULTS: Warm lunch (eating occasions between 11.30 a.m. and 2.29 p.m. including at least one course that is typically consumed warm) was eaten on 68.8% of all record days. Meat lunch (>50%) was predominant, followed by vegetarian (25%), fish (13%) and sweet lunch meals (3%). The prevalence of desserts at lunch was high and beverages were drunk at 80% of lunch meals. A meat lunch was associated with a higher protein (+1.4% energy intake, %E) and fat intake (+1.7%E) than a sweet lunch; also densities of vitamin A, folate and iron were higher. A dessert at lunch decreased protein intake slightly (-0.2%E), but increased carbohydrate (+0.7%E) and added sugar intake (+1.4%E) as well as density of calcium (+18 mg/MJ). CONCLUSION: Our study proves the impact of lunch on daily dietary quality and yields valuable insights on the development of food and meal-based dietary guidelines.

Diet costs and energy density in the diet of German children and adolescents.

This study examined the association between energy density (ED, g/kJ) and diet costs (\[euro]/day) in a sample of 494 German children and adolescents aged 4-18 years using 1100 3-day-weighed dietary records from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study (open cohort study) and retail food prices of 341 empirically selected recorded food items including special brands. ED was negatively associated with diet costs (ß=-0.20 kJ/g, P<0.0007) with a non-linear term (ß=0.01 kJ/g*kJ/g, P=0.0440). Diet costs increased with age (ß=0.32 yr, P<0.0001) with a negative non-linear term (ß=-0.01 yr*yr; P<0.0001). In conclusion, the inverse association between diet costs and ED was more pronounced in the older than in the younger age groups and in low-ED diets than in high-ED diets. Higher % diet costs of fruit/vegetables could be compensated by lower % diet costs of meat/sausage to lower ED without increasing diet costs.

[The DONALD cohort. An updated overview on 25 years of research based on the Dortmund Nutritional and Anthropometric Longitudinally Designed study]. / Die DONALD Kohorte. Ein aktueller Überblick zu 25 Jahren Forschung im Rahmen der Dortmund Nutritional and Anthropometric Longitudinally Designed Study.

The DONALD study has been conducted in Dortmund, Germany since 1985 to examine the complex relations between nutritional intake, metabolism and growth from infancy to adulthood. Every year, approximately 40 infants are newly recruited into the open cohort study. Examinations conducted at ages 3, 6, 9, 12, 18, 24 months and then annually until young adulthood, comprise anthropometry, a 3 day weighed dietary record, a 24 h urine sample (from age 3-4 years onwards), medical examinations and parental interviews. Since 2005, participants are invited for follow-up visits during adulthood (including fasting blood samples). Approximately 1,400 children have been recruited into the study up to 2010. Recent findings revealed e.g. (i) the relevance of early life factors for subsequent development of body composition and puberty timing, (ii) the relation between pubertal hormonal status and puberty onset, (iii) age and time trends in iodine status and modern dietary habits and (iv) potential furan and benzol exposition by commercial weaning foods. Future analyses will provide insight into the extent to which health in young adulthood is receptive to diet, anthropometric pattern and hormonal status in distinct potentially critical periods during childhood.

Analysis and risk assessment of furan in coffee products targeted to adolescents.

The aim of this work was to analyse the furan concentrations in coffee products targeted to adolescents and to estimate the health risk for those consumers by using the consumption data of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study (DONALD). Three different kinds of coffee beverages were analysed: 'coffee ready to drink' (i.e. industrially manufactured and packaged products available in cans or plastic cups), 'coffee instant' (i.e. soluble coffee in powder form) and 'coffee from coffee chains' (i.e. freshly prepared coffee sampled on-site). Furan was analysed according to the US Food and Drug Administration (USFDA) method using headspace-GC-MS and quantification with standard addition. The lowest furan concentrations were found within the category 'coffee instant', with an average of 4.6 µg kg(-1), followed by the category 'coffee ready to drink', with an average of 41.3 µg kg(-1), while the products from the coffee chains showed the highest concentrations, on average 100.5 µg kg(-1). According to the obtained furan contents, it seems that the highest furan exposure for adolescents is generally given in the consumption of products within the category 'coffee from coffee chains', while the lowest is given in the category 'coffee instant'. Risk assessment based on the margin of exposure (MOE) approach showed that in different consumption scenarios except for consumers of instant coffee, the MOE lay below 10,000, a range that is judged to be of public health relevance. The lowest MOE was found for consumers in the age group 10-12 years (especially females) and for both sexes in the age group 16-18 years.

Convenience foods in children's diet and association with dietary quality and body weight status.

BACKGROUND: Pre-prepared commercial foods (convenience foods, CFs) are one aspect of modern dietary habits. The present paper examines the association between CF consumption and dietary quality or body weight status in a sample of German children and adolescents. METHODS: Linear mixed-effect regression analyses using data from 586 participants (296 boys, 3-18 years) in the Dortmund Nutritional Anthropometric Longitudinally Designed Study, who yearly completed 1890 3-day dietary records and anthropometric measurements in 2004-2008, was used. RESULTS: CF intake (percent total food intake) showed no significant association with macronutrient intakes (%E), with exception of a significant positive association with polyunsaturated fatty acid (PUFA) intake (P<0.0001). Considering only high-energy-dense (ED)-CF (40% of the CF intake), there was a significant negative association with total protein, carbohydrate and saturated fatty acid intake (%E) (P<0.05), and a positive with total fat and PUFA (P<0.01). The nutrient quality index (harmonic mean of 10 vitamins and minerals as the percentage of the reference intakes) showed a significant negative trend with increased consumption of CF (P=0.0013). No significant association between baseline or change in consumption of CF and baseline or change in parameters of body weight (standard deviation score of body mass index (weight/height(2)) or percentage body fat (%BF) estimated from skinfolds) was found. Among boys, baseline consumption of high-ED-CF significantly predicted change in %BF during the study period (ß 0.104, P=0.0098). CONCLUSIONS: Our results point to an impairment of dietary quality with high consumption of CF and to a small but positive association between consumption of high-ED-CF in boys and weight.

Whole grain in children's diet: intake, food sources and trends.

OBJECTIVE: To quantify the intake of grain and whole grain, and their food sources, as well as to investigate the age and time trends over the last decade in a sample of German children and adolescents. METHODS: Dietary records from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study were used for conducting this work. A total of 5067 3-day weighed dietary records of 821 2- to 18-year-old children and adolescents collected between 1997 and 2008 were analysed using linear mixed-effect models, in which the means of the data and the covariance structure (children of the family, repeated measurements) were modelled. RESULTS: Mean whole-grain intake was between 20 and 33 g/day in the sample and highest in 13-18 year olds. No whole grain intake was recorded in 19% of all dietary records. Total grain intake increased significantly with age (P<0.0001), even after adjustment for energy intake. Whole-grain intake (g/day) increased significantly with age in the unadjusted model (P<0.0001). This increase disappeared after adjustment for energy intake (P>0.05) and became a negative trend after adjustment for grain intake (P<0.01). There were no significant time trends during the study period. Bread had the highest effect on grain intake in the total sample (50%), followed by rice/pasta (21%), cake (13%), grain (9%), RTECs (5%) and muesli (2%). CONCLUSIONS: The whole-grain intake in this sample of German children and adolescents was far below the FBDG. The decreasing percentage of whole grain per grain intake with age contradicts the common concept of stable dietary habits during childhood and adolescents.

PUFA and LC-PUFA intake during the first year of life: can dietary practice achieve a guideline diet?

BACKGROUND: An appropriate supply of n-3 long-chain polyunsaturated fatty acids (LC-PUFAs) during early childhood may enhance cognitive development. Little attention is paid to the fatty acid (FA) supply during the complementary feeding period. We examined the polyunsaturated fatty acids (PUFAs) and LC-PUFAs pattern in dietary practice of two study groups and evaluated the results against the present Dietary Guidelines in Germany. METHODS: The food consumption and FA pattern of dietary practice in subjects from two prospective studies (n=102 and n=184, respectively) at the age of 3, 6 and 9 months was assessed by weighed diet records, and changes during the first year of life were compared with the food-based dietary guidelines for the first year of life. RESULTS: Dietary practice in the complementary feeding period was clearly dominated by commercial food products. The FA composition in dietary practice was different from the Guideline Diet and the ratio of n-6/n-3 PUFAs was less favorable. Consumption of breast milk or formula was still of major importance for the intake of LC-PUFAs in the complementary feeding period. CONCLUSION: LC-PUFAs are predominantly provided by breast milk and formula during the first year of life and consequently decrease when milk consumption decreases. For compensation, commercial complementary food might come closer to the Guideline Diet by lowering the n-6/n-3 PUFA ratio through appropriate vegetable oil along with an increase in total fat content up to the legal limit.

Iodine intake in the youngest: impact of commercial complementary food.

Iodine is a nutrient contributing to the development of the central nervous system. To assure a sufficient iodine intake, iodine fortification of complementary food (CF) is recommended. We describe the current fortification practice of commercial CF and formula in Germany as an example for other European countries, based on a market survey conducted in autumn 2008. In addition, we estimated the iodine intake of an 8-month-old infant, fed one portion of milk and three complementary meals per day. All formulae were fortified with iodine, and half of CF products. Iodine concentration varied depending on product groups. A partially breast-fed infant getting homemade CF reached less than 50% of the recommended iodine intake. Using infant formula and commercial CF, the recommended intake was exceeded by 39 or 100%, depending on which products were chosen. A well-balanced fortification of commercial CF, including pure infant cereals, would be required to ensure an adequate iodine supply.

Evaluation of dietary fibre intake from infancy to adolescence against various references--results of the DONALD Study.

OBJECTIVE: To evaluate dietary fibre intake from infancy to adolescence against various reference standards expressed on a body weight, age or energy intake (EI) basis and to describe age and 15-year time trends. DESIGN AND SUBJECTS: The ongoing longitudinal (open cohort) Dortmund Nutritional and Anthropometric Longitudinally Designed Study with a total of 7810 3-day dietary records from 980 infants, children and adolescents aged 6 months to 18 years collected between 1990 and 2004. RESULTS: Absolute dietary fibre intakes (g/day) increased with age from infancy to adolescence; dietary fibre density (g/1000 kcal) reached a maximum at 1 year and remained constant after the transition to the family diet. Expressed as g/kg body weight, dietary fibre intake increased during infancy with a maximum at 1 year, but decreased thereafter during childhood and adolescence. Dietary fibre intake was low irrespective of the reference used and showed no time trends, with the exception of a small negative trend in 4-8-year olds and 9-13-year-old girls. CONCLUSION: As intake of dietary fibre in our sample was significantly associated with EI and fibre density remained constant after infancy, our data support an energy-based approach for establishing a reference value for children and adolescents.

Ghrelin levels before and after reduction of overweight due to a low-fat high-carbohydrate diet in obese children and adolescents.

BACKGROUND: There are conflicting results for ghrelin changes in reduction of overweight. Increasing ghrelin levels in weight reduction are considered to be responsible for compensatory mechanisms that make the reduction of overweight unlikely to be sustained. METHODS: We have analyzed fasting serum ghrelin levels, weighed dietary record and, as biochemical markers of clinically relevant reduction of overweight, leptin, adiponectin and insulin levels and insulin resistance measured by homeostasis model assessment (HOMA) at baseline and after a 1-y outpatient weight reduction program based on a high-carbohydrate and low-fat diet in 37 obese children (median age 10 y). We divided these children into two subgroups according to their degree of weight loss (substantial reduction of overweight: decrease in SDS-BMI > or = 0.5). Furthermore, we analyzed ghrelin levels in 16 normal-weight children. RESULTS: Obese children demonstrated significant (P<0.001) lower ghrelin levels compared to normal-weight children. Daily caloric intake (P = 0.004) and percentage fat content decreased significantly (P<0.001), while percentage carbohydrate content increased significantly (P = 0.003) between baseline and 1-y follow-up in the obese children. The substantial reduction of overweight in 16 children (median SDS-BMI = -0.7) was associated with significant changes in insulin resistance (median decrease of HOMA 27%; P = 0.013), insulin (median decrease 25%, P = 0.036), adiponectin (median increase 15%; P = 0.003), and leptin levels (median decrease 19%; P = 0.023), while there were no significant changes in ghrelin levels (median increase 4%; P = 0.326). In the 21 children without substantial reduction of overweight (median SDS-BMI = -0.3), there were no significant changes in insulin resistance and in insulin, adiponectin, leptin and ghrelin levels. CONCLUSIONS: We conclude that in obese children, low-fat high-carbohydrate diet-induced weight loss does not change ghrelin secretion, but significantly decreases leptin levels, increases adiponectin levels and improves insulin resistance determined by significantly decreased insulin resistance indices as well as lowered serum insulin levels.

[Evaluation of the training program "OBELDICKS" for obese children and adolescents]. / Evaluation der Schulung "OBELDICKS" für adipöse Kinder und Jugendliche.

UNLABELLED: The evaluation of treatment programs in obese children and adolescents is uncommon but necessary to prove effectiveness and to improve treatment modalities. We studied the effectiveness of the a one-year structured outpatient training programme "OBELDICKS" consisting of physical exercise, nutrition education and behaviour therapy in 132 participants based on the criterions developed by the Institute of Medicine and German Obesity Group (degree of weight reduction, improvement of comorbidity and health behaviour, minimising of side effects). Furthermore, we analysed degree of overweight (SDS-BMI) two years after the end of the outpatient training (n = 60). - 74 % of participants reduced their overweight (intention to treat). The mean reduction of SDS-BMI was 0.43. 34 % of the participants was not obese any more at end of the training. The degree of overweight was significantly (p < 0.001) lower two years after intervention compared to baseline. The comorbidity was improved (significant reduction of the frequencies of hypertension, dyslipidaemia and hyperuricaemia). The nutrition, exercise and eating habits (cognitive control and disinhibition of control) were significantly improved. Side effects were not found. CONCLUSION: The effectiveness based on the criterions of the Institute of Medicine and the German Obesity Group was proven for the outpatient training "OBELDICKS". Long-term weight reduction can be achieved in most of the obese participating children due to this long-term, specialised treatment.

Pattern of long-term fat intake and BMI during childhood and adolescence--results of the DONALD Study.

OBJECTIVE: Adverse dietary habits have been discussed as being conducive to the increased prevalence of obesity in children and adolescents. No single dietary factor has been clearly identified so far. We analyzed long-term fat intake patterns during childhood and adolescence and their influence on body fatness. METHODS: Four clusters with different patterns of percent energy from fat were found in 228 individuals from the age of 2-18 y participating in the DONALD Study (Dortmund Nutritional Anthropometric Longitudinally Designed Study) with at least 10 yearly weighed dietary records between 1985 and 2002. Clusters were evaluated with regard to macronutrient and food group intakes and body mass index (BMI). RESULTS: The mean energy density and the ratio of energy intake to estimated basal metabolic rate per subject differed significantly between clusters. All calculated macronutrients (per energy intake) with the exception of dietary fiber differed significantly as well as intakes of Meat/Fish/Eggs, Fats/Oils and Fruit/Vegetables. Although these differences in dietary characteristics persisted during the study period, no differences of BMI (calculated as standard deviation score) were found either at the first or last examination per subject. The mean BMI during the study period differed significantly, with the highest BMI in the low fat intake cluster. CONCLUSION: BMI could not be explained by different dietary patterns during childhood and adolescence in this long-term evaluation of dietary records. Underreporting especially in obese subjects, the problem of detecting minor overconsumption of energy intake that favors the development of obesity over long periods, and the small study sample may explain these conflicting results.