Vitamin D and probiotics supplement use in young children with genetic risk for type 1 diabetes.

BACKGROUND/OBJECTIVES: Vitamin D and probiotics are nutrients of interest in the context of type 1 diabetes (T1D). We assessed the prevalence of and factors associated with vitamin D and probiotic supplementations among young children with genetic risk of T1D. SUBJECTS/METHODS: Use of supplements during the first 2 years of life was collected prospectively from 8674 children in The Environmental Determinants of Diabetes in the Young (TEDDY) study. RESULTS: Single and/or multivitamin/mineral (MVM) supplements were reported by 81% of the children. The majority of participants in Finland, Germany and Sweden (97-99%) and 50% in the United States received vitamin D supplements that were mostly MVMs. Probiotics use varied from 6% in the United States to 60% in Finland and was primarily from probiotics-only preparations. More than 80% of the vitamin D and probiotics supplementation was initiated during infancy, and more than half of the uses lasted longer than a year. Being the first child, longer duration of breastfeeding, born in a later year, older maternal age and higher maternal education level were associated with both vitamin D and probiotics use. Shorter gestational age and mother not smoking during pregnancy were associated with a higher likelihood of probiotics supplementation only. CONCLUSIONS: Vitamin D and probiotics supplementations are popular in children 0-2 years old and are associated with common factors. Data documented here will allow evaluation of the relationship between early childhood dietary intake and the development of islet autoimmunity and progression to T1D.

High consumption of pulses is associated with lower risk of abnormal glucose metabolism in women in Mauritius.

AIMS: To investigate if consumption of pulses was associated with a reduced risk of developing abnormal glucose metabolism, increases in body weight and increases in waist circumference in a multi-ethnic cohort in Mauritius. METHODS: Population-based surveys were performed in Mauritius in 1992 and in 1998. Pulse consumption was estimated from a food frequency questionnaire in 1992 and outcomes were measured in 1998. At both time points, anthropometry was undertaken and an oral glucose tolerance test was performed. RESULTS: Mauritian women with the highest consumption of pulses (highest tertile) had a reduced risk of developing abnormal glucose metabolism [odds ratio 0.52; 95% CI 0.27, 0.99) compared with those with the lowest consumption, and also after multivariable adjustments. In women, a high consumption of pulses was associated with a smaller increase in BMI. CONCLUSIONS: High consumption of pulses was associated with a reduced risk of abnormal glucose metabolism and a smaller increase in BMI in Mauritian women. Promotion of pulse consumption could be an important dietary intervention for the prevention of Type 2 diabetes and obesity in Mauritius and should be examined in other populations and in clinical trials.

Prevalence of obesity was related to HLA-DQ in 2-4-year-old children at genetic risk for type 1 diabetes.

OBJECTIVES: Body size is postulated to modulate type 1 diabetes as either a trigger of islet autoimmunity or an accelerator to clinical onset after seroconversion. As overweight and obesity continue to rise among children, the aim of this study was to determine whether human leukocyte antigen DQ (HLA-DQ) genotypes may be related to body size among children genetically at risk for type 1 diabetes. METHODS: Repeated measures of weight and height were collected from 5969 children 2-4 years of age enrolled in The Environmental Determinants of Diabetes in the Young prospective study. Overweight and obesity was determined by the International Obesity Task Force cutoff values that correspond to body mass index (BMI) of 25 and 30 kg m(-)(2) at age 18. RESULTS: The average BMI was comparable across specific HLA genotypes at every age point. The proportion of overweight was not different by HL A, but percent obesity varied by age with a decreasing trend among DQ2/8 carriers (P for trend=0.0315). A multivariable regression model suggested DQ2/2 was associated with higher obesity risk at age 4 (odds ratio, 2.41; 95% confidence interval, 1.21-4.80) after adjusting for the development of islet autoantibody and/or type 1 diabetes. CONCLUSIONS: The HLA-DQ2/2 genotype may predispose to obesity among 2-4-year-old children with genetic risk for type 1 diabetes.

Maternal food consumption during pregnancy and risk of advanced ß-cell autoimmunity in the offspring.

BACKGROUND: Evidence for a putative role of maternal diet during pregnancy in the development of ß-cell autoimmunity in the child is scarce. The authors study the association of food consumption during pregnancy and the development of ß-cell autoimmunity in the offspring. SUBJECTS AND METHODS: A prospective Finnish birth cohort of 4297 infants with human leukocyte antigen (HLA)-DQB1-conferred susceptibility to type 1 diabetes and their mothers. Blood samples were collected from the children at 3-12 months intervals to measure type 1 diabetes-associated antibodies: antibodies against islet cells (ICA), insulin, glutamate dehydroxylase, and islet antigen 2. The mothers completed a validated food frequency questionnaire. The end-point was repeated positivity for ICA together with at least one of the other three antibodies. Piecewise-exponential survival models were used. The effective sample size was 3723, with 138 end-points. The median follow-up time was 4.4 years. RESULTS: Maternal consumption of butter, low-fat margarines, berries, and coffee were inversely associated with the development of advanced ß-cell autoimmunity in the offspring, adjusted for genetic risk group and familial diabetes. These associations for low-fat margarines (use vs. non-use HR 0.60, 95% CI: 0.38-0.93, p = 0.02), berries (continuous variable HR 0.90, 95% CI: 0.83-0.98, p = 0.02) and coffee (highest quarter vs. lowest HR 0.62, 95% CI: 0.40-0.97, p = 0.04), remained significant when adjusting for potential confounding sociodemographic, perinatal, and other dietary factors. CONCLUSIONS: In this study assessing total food consumption of the mother during pregnancy, only few among the 27 food groups tested were weakly related to the development of advanced ß-cell autoimmunity in Finnish children.

Diet and weight gain characteristics of pregnant women with gestational diabetes.

BACKGROUND/OBJECTIVES: To determine if women with gestational diabetes (GD) modify their diet and nutrient intake in late pregnancy and gain more weight during pregnancy compared with women without GD. SUBJECTS/METHODS: Food and nutrient intake of 3613 pregnant women was studied using food frequency questionnaires from the Type I Diabetes Prediction and Prevention Nutrition Study. RESULTS: D was reported in 4.8% of the participating women (n=174). Women with GD gained less weight during pregnancy than those unaffected by GD (mean 9.4 vs 12.6 kg, P<0.001). Women with GD consumed more milk products (84 vs 76 g/MJ, P=0.002), cereal products (21 vs 18 g/MJ, P<0.001), vegetables (32 vs 22 g/MJ, P<0.001) and meat (16 vs 14 g/MJ, P<0.001) than unaffected women. The intake of protein (18 vs 16 percent of total daily energy intake, P<0.001) and dietary fibre (3.1 vs 2.4 g/MJ, P<0.001) was higher, whereas the intake of sugars (13.3 vs 15.0 g/MJ, P<0.001) and saturated fatty acids (3.49 vs 3.98 g/MJ, P<0.001) was lower among women with GD. The nutrient density of the diet was higher in women with GD with higher intakes of vitamins A and D, folate and iron. CONCLUSIONS: The late pregnancy diet of women with GD differed considerably from that of unaffected women. Women with GD had a higher body weight at the beginning of the pregnancy, but they gained less weight during pregnancy. These findings indicate that abnormal glucose tolerance during pregnancy encourages women to modify their dietary habits towards healthier food choices.

Maternal intake of vitamin D during pregnancy and risk of advanced beta cell autoimmunity and type 1 diabetes in offspring.

AIMS/HYPOTHESIS: We evaluated the intake of vitamin D by pregnant Finnish women and examined associations between maternal intake of vitamin D and the development of advanced beta cell autoimmunity and type 1 diabetes in their offspring. METHODS: The research was carried out within the Diabetes Prediction and Prevention study (DIPP), which is a population-based birth cohort of infants at genetic risk of type 1 diabetes. Mothers of 3,723 infants born between 1997 and 2002 completed a validated 181-item food frequency questionnaire, which included questions on dietary supplements. The offspring were observed at 3 to 12 month intervals for the appearance of autoantibodies associated with type 1 diabetes and for the development of clinical type 1 diabetes. RESULTS: Maternal mean daily intake of vitamin D was 5.1 microg from food and 1.3 microg from supplements. The maternal intake of vitamin D, either from food or from supplements, was not associated with the risk of advanced beta cell autoimmunity/type 1 diabetes in offspring (HR [95% CI] for intake of vitamin D from food 1.25 [0.80-1.95], for vitamin D intake from supplements 1.05 [0.95-1.16]), or with the risk of type 1 diabetes alone (HR [95% CI] for intake of vitamin D from food 0.84 [0.41-1.72], for vitamin D intake from supplements 1.09 [0.99-1.20]). CONCLUSIONS/INTERPRETATION: Maternal intake of vitamin D either from food or supplements during pregnancy is not associated with advanced beta cell autoimmunity/type 1 diabetes or with type 1 diabetes alone in Finnish offspring carrying increased genetic susceptibility to type 1 diabetes.

Fat intake at midlife and risk of dementia and Alzheimer's disease: a population-based study.

BACKGROUND: Lifestyle and vascular factors have been linked to dementia and Alzheimer's disease (AD), but the role of dietary fats in the development of dementia is less clear. METHODS: Participants were derived from random, population-based samples initially studied in midlife (1972, 1977, 1982, or 1987). Fat intake from spreads and milk products was assessed using a structured questionnaire and an interview. After an average follow-up of 21 years, a total of 1,449 (73%) individuals aged 65-80 years participated in the re-examination in 1998. Altogether 117 persons had dementia. RESULTS: Moderate intake of polyunsaturated fats at midlife decreased the risk of dementia even after adjustment for demographic variables, other subtypes of fats, vascular risk factors and disorders, and apolipoprotein E (ApoE) genotype (OR 0.40, CI 0.17-0.94 for the 2nd quartile vs. 1st quartile), whereas saturated fat intake was associated with an increased risk (OR 2.45, CI 1.10-5.47 for the 2nd quartile). The associations were seen only among the ApoE epsilon4 carriers. CONCLUSIONS: Moderate intake of unsaturated fats at midlife is protective, whereas a moderate intake of saturated fats may increase the risk of dementia and AD, especially among ApoE epsilon4 carriers. Thus, dietary interventions may potentially modify the risk of dementia, particularly among genetically susceptible individuals.

Dietary Westernisation: conceptualisation and measurement in Mauritius.

OBJECTIVES: The aims of the study were to provide information that will contribute to conceptualising what is called "dietary Westernisation", and to provide an example of measuring it on an individual level. DESIGN: Food consumption frequency and demographic data on adults in Mauritius were examined in 1988, 1992 and 1998. In 1992, a 24-hour recall was also included. The cross-sectional samples consisted of 1115 (age 25-74 years) Mauritians in 1987/88, 1917 (age 30-74 years) in 1992 and 2239 (age 20-74 years) in 1998. Principal components analysis was carried out on daily consumption frequencies of 10 indicator foods (white rice, white bakery bread, pulses, processed meat, poultry, fresh/frozen fish, butter, margarine, whole milk and skimmed/low-fat milk). Correlations between dietary patterns and selected food consumption frequencies were examined in each survey year. RESULTS: Four dietary patterns were identified as being related to dietary Westernisation. The Traditional dietary pattern was characterised by higher consumption frequencies of Indian breads, salted/smoked fish and sugar-sweetened tea. The Western dietary pattern was characterised by higher consumption frequencies of cakes/pastries, meat and many Western fast foods like burgers, but, surprisingly, also by brown bread, breakfast cereals and salad. The Bread/butter dietary pattern predominantly described more frequent consumption of bread compared with rice. The Margarine/milk dietary pattern was inconsistently related with staple foods. Younger, educated and wealthier Mauritians appeared to adopt Western dietary patterns earlier. CONCLUSIONS: This study suggests that relatively few indicator foods are needed for measuring dietary Westernisation. Dietary Westernisation in a non-Western country may also include shifts towards voluntary consumption of healthier foods.

Fall in total cholesterol concentration over five years in association with changes in fatty acid composition of cooking oil in Mauritius: cross sectional survey.

OBJECTIVE: To determine the extent to which reducing the saturated fatty acid composition of a ubiquitously used cooking oil influenced changes in cholesterol concentration in the population during a five year intervention programme in Mauritius. DESIGN: Cross sectional surveys in 1987 and 1992 determined mean total cholesterol concentrations in the population. A random sample of respondents in the 1992 survey completed a nutrition questionnaire that included questions on diet in the previous 24 hours. SETTING: Mauritius. INTERVENTION: In 1987 the government of Mauritius changed the composition of the commonly used cooking oil from being mostly palm oil (high in saturated fatty acids) to being wholly soya bean oil (high in unsaturated fatty acids). SUBJECTS: 5080 and 5162 subjects in 1987 and 1992 cross sectional surveys. 2059 subjects aged 30-64 years were randomly selected from the respondents of the 1992 survey to take part in the nutrition survey. MAIN OUTCOME MEASURES: Fatty acid composition of phospholipids in pooled serum samples from men and women from the two surveys; measured and predicted change in serum cholesterol concentration. RESULTS: From 1987 to 1992 total cholesterol concentrations fell significantly by 0.79 mmol/l (P < 0.001) in men and 0.82 mmol/l (P < 0.001) in women. The estimated intake of saturated fatty acids decreased by 3.5% of energy intake in men and by 3.6% in women, and the intake of polyunsaturated fatty acids increased by 5.5% and 5.6% of energy intake, respectively. These changes were reflected in changes in the fatty acid composition of serum phospholipids, and according to Keys' formula these changes explained much of the decrease in serum cholesterol concentrations (predicted decrease of 0.38 mmol/l in men and by 0.40 mmol/l in women). CONCLUSION: Dietary changes that entailed a reduction in the saturated fat content of a ubiquitous cooking oil explained most of the observed decrease in serum cholesterol concentration over five years in the population of Mauritius.

Fluoride and sugar intake among adults and youth in Mauritius: preliminary results.

The potential use of different vehicles for delivering fluoride to prevent dental caries has been discussed recently in Mauritius. Water fluoridation was found not to be feasible, and extending the fluoride tablet program would not be easy. Thus, sugar fluoridation as one possibility was considered. For these purposes, the average fluoride and sugar intake was estimated in Mauritius. The results are based on two studies--a Survey on Diet, Health and Lifestyle of Youth in Mauritius (1990) and the Mauritius Diet and Health Survey. Information was collected by trained interviewers using food-frequency and 24-hour-recall questionnaires. The daily total sugar intake, manufactured and natural, was found to be 62 g per day in young people and 50 g per day in adults. In the younger groups, daily frequencies of raw sugar, sweets, and biscuit (cookie) consumption were 1.5, 0.2, and 0.2 times a day, respectively. For adults, the mean daily frequency of consuming sugar-containing foods was 2.6 (SD = 1.3). The daily sucrose intake was rather high, representing about 10% of the daily energy intake. The fluoride levels of foods were calculated by use of Finnish and other available fluoride tables. The mean fluoride intakes per day were 0.64, 0.72, and 0.62 mg per day for 8-17-year-, 18-24-year-, and 30-64-year-old groups, respectively. The median fluoride intake for the oldest group was 0.62 mg/day. The estimated fluoride intake from food did not correspond with the proposed level for the prevention of caries (Murray, 1986) except for the 18-24-year-olds, where it might have been just above the lower recommended limit. However, further data based on analysis of the fluoride contents of Mauritian food samples, especially of whole daily diet, are needed.

Urinary excretion of polyamines: importance of circadian rhythm, age, sex, menstrual cycle, weight, and creatinine excretion.

The urinary excretion of putrescine, spermidine, spermine, and N1- and N8-acetylspermidines was measured in 95 volunteers. The 24-h excretion, split in four consecutive periods, was analyzed for circadian rhythm in eight volunteers. Circadian rhythm was observed in total polyamine and in N1- and N8-acetylspermidine excretions. The excretion rates of these polyamines were highest in the morning. The normal values for 24-h urinary excretion of polyamines were determined in 87 volunteers. Men excreted significantly more spermidine (P less than 0.001), N8-acetylspermidine (P less than 0.05), and spermine (P less than 0.001) than did women; putrescine excretion was higher in women (P less than 0.001). This variation was only partially explained by differences between sexes in body or muscle mass because most differences remained significant even after normalization for creatinine excretion and body weight. No correlation between the polyamine excretions and age or menstrual cycle was found.

Consumption of boiled coffee is correlated with serum cholesterol in Finland.

The association between coffee consumption and serum cholesterol concentration was studied in a cross-sectional epidemiological study among 5704 men and women in Finland. The mean serum cholesterol values of those consuming boiled coffee (24% of the subjects) was significantly higher than that of drinkers of filtered coffee (69% of the subjects) in both sexes after adjusting for age, body mass index, smoking, serum gamma-glutamyltransferase, index of saturated fat intake, and physical activity: in men 6.37 versus 6.02 mmol/l, in women 6.22 versus 5.84 mmol/l, both significant at p less than 0.001. A significant dose-dependent effect was observed between the consumption of boiled coffee both in men and in women. For filter coffee drinkers a weak coffee dose-cholesterol association was found only for women. The magnitude of the effect of boiled coffee, 0.3-0.4 mmol/l in serum cholesterol values, is in accordance with the results from controlled trials carried out among both hyper- and normocholesterolaemic subjects.

Variation and modifying factors of the exposure to lead and cadmium based on an epidemiological study.

Exposure to cadmium and lead was studied using a dietary survey. Data for 1348 individuals aged 25-64 years were collected using 3-day food records. In addition to the dietary intake of heavy metals, the effect of the following were also analyzed: smoking frequency, place of residence, occupation and age. Total cadmium and lead exposure was estimated by calculating intake from food plus that from inhalation, i.e. from urban air and smoking. Heavy smoking increased the cadmium exposure three-fold. The distribution curve of total cadmium exposure was bimodal due to the additional exposure caused by smoking. The distribution curve of the lead and cadmium exposure from food was also skewed, being mostly influenced by food intake. Contaminated urban air slightly increased the total exposure to lead. Occupation had a minor effect on the exposure to both metals. Housewives and retired persons were the least exposed groups. The distribution pattern and wide range of heavy metal exposure should be taken into account in risk assessment for contaminants in food. The additional exposure to cadmium and lead from smoking and from air and water should be considered.

Coffee and tea consumption, dietary fat intake and serum cholesterol concentration of Finnish men and women.

The association between the consumption of coffee and tea and serum cholesterol concentration was studied in a population sample of 653 men and 695 women from east and south-west Finland. Cholesterol and high density lipoprotein (HDL) cholesterol were determined from fresh serum samples. Smoking and the intake of coffee, tea and alcohol were assessed by a questionnaire, and nutrient intake was determined from 3-day food records. Serum cholesterol and non-HDL cholesterol showed a positive and linear association with coffee consumption in men. In women, no such significant linear association was evident, although the highest mean serum cholesterol levels were found in subjects consuming seven to nine cups of coffee daily. Both in men and in women coffee consumption was positively associated with smoking and the intake of saturated and monounsaturated fatty acids and cholesterol. Serum cholesterol values, adjusted for age, body mass index, smoking, dietary cholesterol, fatty acids, alcohol and physical activity, showed a significant linear association with coffee consumption in men but not in women. Although coffee consumption and high intake of saturated fatty acids and cholesterol were related both in men and in women, adjustment for dietary and other confounding factors did not remove the association between coffee consumption and serum cholesterol concentration in men.

Dietary changes in the North Karelia Project (1972-1982).

The North Karelia Project is a community-based program to reduce the high cardiovascular disease rates in the province of North Karelia in eastern Finland. Dietary changes aimed at reducing serum cholesterol levels were among the main objectives. The evaluation of the program was based on examinations of independent cross-sectional population samples in 1972, 1977, and 1982 in North Karelia and in a matched reference area. A questionnaire was used to measure changes in dietary habits during the program. A major shift from whole to low-fat milk took place in both areas as well as a reduction in the amount of butter used on bread. The net reduction in North Karelia (difference in change compared with the reference area) in the intake of saturated fatty acids from milk and fat spreads used on bread was 20% in men and 14% in women. This reduction was similar in different age, education, and occupational groups suggesting that the dietary intervention had reached the whole community. The validity of the reported dietary changes was confirmed by parallel changes in serum cholesterol levels.

Dietary survey of the FINMONICA project in 1982.

A dietary survey concerning 1348 persons aged 25-64 was carried out in connection with the first FINMONICA risk factor survey in the three monitoring areas, North Karelia and Kuopio in the east, and Turku-Loimaa in the south-west in 1982. Three-day food records were used in the dietary assessment. The fat content of the diet in men was 38-39% of energy in all areas, whereas in women it was about 36% in the east compared to 38% in the south-west. The ratio of polyunsaturated to saturated fat of the diet was lower in the east than in the south-west in both sexes (0.25 vs. 0.31). This seemed to be the result of higher milk and butter consumption in the east. The regional differences in the quality of dietary fats seemed to be the result of both different occupational structures and different dietary habits within each occupational group, especially among women.

No effect on serum lipids by moderate and high doses of vitamin C in elderly subjects with low plasma ascorbic acid levels.

The influence of dietary supplementation with moderate (200 mg/day) and high (2,000 mg/day) doses of vitamin C on serum lipid levels was studied in 27 female long-stay hospital patients characterized by low plasma ascorbic acid levels during the preceding year. The two doses of vitamin C were compared with placebo in a double-blind, cross-over design during randomly determined 6-week periods followed by 2-week washout intervals. No effect was observed on serum cholesterol, HDL cholesterol, and triglyceride levels. Plasma ascorbic acid levels were highly significantly increased (p less than 0.001) by both doses of vitamin C. It is concluded that dietary supplementation with moderate or high doses of vitamin C does not affect serum lipids of persons who have low plasma ascorbic acid levels suggestive of possible marginal deficiency of vitamin C.

Boiled coffee increases serum low density lipoprotein concentration.

The effects of boiled coffee, filtered coffee, and tea on serum lipoprotein lipids and apoproteins were compared in 42 middle-aged hypercholesterolemic subjects (21 men and 21 women). The subjects consumed the beverages, eight cups a day, in random order during successive 4-week periods with 2-week run-in intervals in a crossover design. The diet was kept unchanged. Statistically significant differences were found between the periods in serum total cholesterol (P less than .0001 ANOVA), LDL cholesterol (P less than .01), and apoprotein B (P less than .01) levels. All differences were due to significantly higher levels during boiled coffee as compared with filtered coffee and tea. No statistically significant differences were found between the filtered coffee and tea periods. There were no differences in serum VLDL cholesterol or triglyceride, HDL cholesterol, and apoprotein A-I concentrations between the periods. Consumption of boiled coffee thus increased the concentration of low density lipoprotein in the serum without affecting its lipid-protein composition. The effect seemed to be determined by the method of brewing.