The development of food portion sizes suitable for 4-18-year-old children used in a theoretical meal plan meeting energy and nutrient requirements.

BACKGROUND: Healthy eating guidelines for school-aged children are available but without advice on portion sizes. This is a concern because consuming large portions is associated with an increased risk of overweight/obesity. The present study aimed to calculate recommended portion sizes for school-aged children based on weight for age and use them to develop a meal plan to meet nutritional needs within energy requirements. METHODS: Portion size data on foods consumed by school-aged children (4-18 years) were extracted from two sources: (i) British National Diet and Nutrition Survey (1997) and (ii) Avon Longitudinal Study of Parents and Children (1997-2006). Foods were allocated to groups based on the UK Eatwell Guide and the US My Plate Model. Portion sizes were developed for a variety of foods. A meal plan that included portion size guidance and met healthy eating guidelines was developed based on the number of portions of each food group needed to meet dietary requirements. RESULTS: Portion sizes were developed for 131 foods that were commonly eaten by children in age groups 4-6, 7-10, 11-14 and 15-18 years. The meal plan met requirements for energy and nutrients as specified by UK dietary reference values, except for vitamin D for which there are few dietary sources. CONCLUSIONS: Food portion sizes informed by usual intake in UK children can help inform dietary advice for a range of childhood settings and for parents. The meal plan included a wide variety of foods to encourage dietary diversity and meet energy and nutrient needs for school-aged children.

Prostate cancer risk related to foods, food groups, macronutrients and micronutrients derived from the UK Dietary Cohort Consortium food diaries.

BACKGROUND/OBJECTIVES: The influence of dietary factors remains controversial for screen-detected prostate cancer and inconclusive for clinically detected disease. We aimed to examine these associations using prospectively collected food diaries. SUBJECTS/METHODS: A total of 1,717 prostate cancer cases in middle-aged and older UK men were pooled from four prospective cohorts with clinically detected disease (n=663), with routine data follow-up (means 6.6-13.3 years) and a case-control study with screen-detected disease (n=1054), nested in a randomised trial of prostate cancer treatments (ISCTRN 20141297). Multiple-day food diaries (records) completed by men prior to diagnosis were used to estimate intakes of 37 selected nutrients, food groups and items, including carbohydrate, fat, protein, dairy products, fish, meat, fruit and vegetables, energy, fibre, alcohol, lycopene and selenium. Cases were matched on age and diary date to at least one control within study (n=3528). Prostate cancer risk was calculated, using conditional logistic regression (adjusted for baseline covariates) and expressed as odds ratios in each quintile of intake (±95% confidence intervals). Prostate cancer risk was also investigated by localised or advanced stage and by cancer detection method. RESULTS: There were no strong associations between prostate cancer risk and 37 dietary factors. CONCLUSIONS: Prostate cancer risk, including by disease stage, was not strongly associated with dietary factors measured by food diaries in middle-aged and older UK men.

Fish consumption in mid-childhood and its relationship to neuropsychological outcomes measured in 7-9 year old children using a NUTRIMENTHE neuropsychological battery.

BACKGROUND: Long-chain polyunsaturated fatty acids (LCPUFA), particularly n-3 LCPUFA, play a central role in neuronal growth and the development of the human brain. Fish is the main dietary source of n-3 LCPUFA. To assess the relation between fish consumption, estimated dietary n-3 LCPUFA intake and cognition and behaviour in childhood in a multi-centre European sample. METHODS: Children from 2 European studies, CHOP and NUHEAL, were assessed at 8 and 7.5 years of age, respectively. Different outcomes of neuropsychological development (assessed with the standardized NUTRIMENTHE Neuropsychological Battery (NNB) consisting of 15 subtests) were related with outcomes from a food-frequency questionnaire (FFQ) focussing on the consumption of fish. RESULTS: A total of 584 children completed the FFQ and the neuropsychological tests. We found no associations with calculated DHA or EPA intakes for any of the neuropsychological domains. Children who consumed 2 fish meals per week including one of fatty fish, showed no substantive differences in the cognitive domains from the children who did not. However negative associations with fatty fish consumption were found for social problems (p = 0.019), attention problems (p = 0.012), rule-breaking problems (p = 0.019) and aggressive behaviour problems (p = 0.032). No association was observed with internalizing problems. Higher levels of externalizing problems (p = 0.018) and total problems (p = 0.018) were associated with eating less fatty fish. CONCLUSIONS: Children who consumed 2 fish meals per week including one of fatty fish were less likely to show emotional and behavioural problems than those who did not.

Pregnancy and Infants' Outcome: Nutritional and Metabolic Implications.

Pregnancy is a complex period of human growth, development, and imprinting. Nutrition and metabolism play a crucial role for the health and well-being of both mother and fetus, as well as for the long-term health of the offspring. Nevertheless, several biological and physiological mechanisms related to nutritive requirements together with their transfer and utilization across the placenta are still poorly understood. In February 2009, the Child Health Foundation invited leading experts of this field to a workshop to critically review and discuss current knowledge, with the aim to highlight priorities for future research. This paper summarizes our main conclusions with regards to maternal preconceptional body mass index, gestational weight gain, placental and fetal requirements in relation to adverse pregnancy and long-term outcomes of the fetus (nutritional programming). We conclude that there is an urgent need to develop further human investigations aimed at better understanding of the basis of biochemical mechanisms and pathophysiological events related to maternal-fetal nutrition and offspring health. An improved knowledge would help to optimize nutritional recommendations for pregnancy.

Point-of-care testing for HIV in an Irish prison setting: results from three major Irish prisons.

HIV is more prevalent in the prison population compared to the general population. Prison inmates are at an increased risk of blood-borne infections. Considerable stigma has been documented amongst inmates with HIV infection. In collaboration with the schools, healthcare facilities, prison authorities and inmate Irish Red Cross groups in Wheatfield, Cloverhill and Mountjoy prisons in Dublin, Ireland, the Department of Genito Urinary Medicine and Infectious Diseases at St James' Hospital in Dublin developed a campaign for raising awareness of HIV, educating inmates about HIV and tackling HIV stigma. Following this campaign, large-scale point-of-care testing for HIV was offered over a short period. In total, 741 inmates were screened for HIV. One inmate tested positive for HIV. We experienced a large number of invalid test results, requiring formal laboratory serum testing, and a small number of false positive results. Large-scale point-of-care testing in the Irish prison setting is acceptable and achievable.

Early problematic eating behaviours are associated with lower fruit and vegetable intake and less dietary variety at 4-5 years of age. A prospective analysis of three European birth cohorts.

Problematic eating behaviours during early childhood could be mediators of poor dietary habits. This study aims to prospectively relate early eating behaviours with fruit and vegetable (F&V) intake and a healthy diet variety score of children aged between 4 and 5 years. Eating behaviours were assessed in three European birth cohorts (Generation XXI from Portugal, ALSPAC from the UK and EDEN from France) at 4-6, 12-15, 24 and 48-54 months of age, based on the child's feeding difficulties, mother's perception of child's poor eating (eating small quantities at each meal, not eating enough or needing to be stimulated to eat), food refusal and difficulties in the establishment of daily food routines. Daily servings of F&V (>1 v. ≤1 serving/d, except in Generation XXI: >3 v. ≤3) and the Healthy Plate Variety Score (categorised by the median score of each sample) were calculated using FFQ. Associations were tested by logistic regressions adjusted for maternal age, education, smoking during pregnancy, any breast-feeding and the child's z-score BMI at 4-5 years of age. Children with more feeding difficulties, poor eating, food refusal/neophobia and difficulties in establishing a daily routine at 12-15, 24 and 48-54 months of age had in general lower F&V intake at 4-5 years of age. The association with vegetables was slightly stronger than with fruits. These early feeding problems were also inversely associated with the variety score at 4-5 years of age, particularly when eating behaviours were reported after 12-15 months of age. A better understanding of these early feeding difficulties may help define strategies to increase the dietary quality in children.

Evidenced-based, practical food portion sizes for preschool children and how they fit into a well balanced, nutritionally adequate diet.

BACKGROUND: Healthy eating guidelines for 1-4-year-old children are available but evidence-based portion sizes have not been specified. Parents and early-years providers are concerned about under- or over-feeding young children. The present study aimed to report detailed information about appropriate average portion size ranges and suggest a practical food plan for feeding preschool children, providing adequate nutrient intakes within energy requirements. METHODS: Two sources of information were used to obtain an appropriate portion size range for the types of foods normally eaten by this age group. Median portions of a variety of foods were combined into a food plan fulfilling healthy eating guidelines regarding the number of servings from each food group. The nutrient and energy content of the plan was assessed and compared with recommended adequate nutrient intakes and percentage energy contributions from macronutrients. UK children, aged 1-4 years, taking part in Avon Longitudinal Study of Parents and Children and National Diet and Nutrition Survey, were used in the present study. RESULTS: Portion size ranges were developed for 164 foods. The theoretical food plan using foods with high to medium nutrient density was shown to provide an adequate intake of all nutrients, except vitamin D, for which there are very few food sources. CONCLUSIONS: These practical food portion size ranges could be used both in early years settings and in advice to parents. The food plan emphasises the need to include a variety of nutrient-dense foods if a balanced diet is to be achieved for preschool children.

Sources of vitamin D and calcium in the diets of preschool children in the UK and the theoretical effect of food fortification.

BACKGROUND: Dietary intakes of vitamin D are very low in the UK. Dietary calcium is also necessary to promote bone health. The fortification of foods with vitamin D could be a safe and effective way of increasing intake. METHODS: Diets of preschool children, 755 at 18 months and 3.5 years, from the Avon Longitudinal Study of Parents and Children were assessed using dietary records completed by parents. Energy, vitamin D and calcium intakes were calculated. Multinomial logistic regression was used to estimate the odds ratio for being in the highest/lowest quartile of intake. Intakes were recalculated to test different fortification regimes. RESULTS: Vitamin D intakes were low; all children were below the UK and US dietary recommendations. Calcium intakes decreased between the two ages as a result of reduced milk consumption. Children in the lowest quartile for vitamin D intake at 18 months were twice as likely to remain in that quartile at 3.5 years (odds ratio = 2.35; 95% confidence interval = 1.56-3.55). The majority of foods provide no vitamin D with fat spreads and milk as the main sources. The contribution from breakfast cereals increased, from 6% to 12%, as a result of the increased consumption of fortified cereals. Dairy foods provided the highest contribution to calcium at 18 months but were less important at 3.5 years. Theoretical intakes from different fortification regimens suggest that milk fortified at 2 µg 100 g(-1) vitamin D would provide most children with adequate but not excessive intakes. CONCLUSIONS: Dietary vitamin D intakes were very low and calcium intakes were mostly adequate. Fortification of milk with vitamin D could be a good way to boost intakes.

Comparison of childhood size and dietary differences at age 4 years between three European countries.

BACKGROUND/OBJECTIVES: Obesity in childhood is very common in Europe. It may be linked to diet, and intakes of protein and polyunsaturated fatty acids (PUFA) have been investigated. The study aims to investigate child size and dietary differences at the age of 4 years between three European countries and to assess dietary adequacy. SUBJECTS/METHODS: A total of 161 4-year-old children from Spain, Germany and Hungary, whose mothers participated in a pregnancy micronutrient supplementation trial, were included in this analysis. Child size was assessed by standardised anthropometry and diet calculated from parent-completed food frequency questionnaires. Adequacy of the diet was evaluated using US guidelines. RESULTS: The Spanish children had a higher mean body mass index (BMI) (16.4±1.5) compared with German (15.7±1.0) and Hungarian children (14.9±1.4, P<0.01). In Spanish children, dietary intakes were higher in animal protein density, particularly from dairy foods, were little different in total protein density and slightly lower in n-6 PUFA density compared with the intakes in the other groups. Dietary intakes of most children (% contribution to energy) were higher than those recommended for protein, saturated fat and added sugar. CONCLUSIONS: Spanish children had a higher mean BMI compared with German and Hungarian children. Diets taken by Spanish children may be more obesogenic than those taken by German or Hungarian children. In the present study, many children in all three countries were consuming diets that were high in protein, saturated fat and sugar.

Associations between flavored milk consumption and changes in weight and body composition over time: differences among normal and overweight children.

BACKGROUND/OBJECTIVES: Few studies have investigated the associations between flavored milk consumption and body composition in children. We aimed to examine the prospective relationships between flavored milk consumption and body fat. SUBJECTS/METHODS: Subjects included 2270 children from the Avon Longitudinal Study of Parents and Children. Flavored milk consumption at age 10 years was assessed using dietary records; consumption was dichotomized as consumers and non-consumers. Percent body fat was measured using dual-energy X-ray absorptiometry at 11 and 13 years. Body weight at 11 and 13 years was included as a secondary outcome. Associations were also examined in a subset of plausible reporters to evaluate the influence of dietary reporting errors. There was an effect of interaction between flavored milk and baseline weight on body fat (P-interaction <0.02). RESULTS: In plausible reporters, overweight/obese children who consumed flavored milk had less favorable changes in body fat compared with non-consumers (adjusted means: -0.16%, 95% CI: -3.8, 3.5 vs -3.4%, 95% CI: -6.5, -0.42, P=0.02). Similar associations with body weight were observed. The adjusted mean percent body fat for overweight/obese girls who consumed flavored milk was greater at age 13 compared with 11 years (39.7%, 95% CI: 32, 47 vs 38.3%, 95% CI: 32, 44). The mean percent body fat for overweight/obese boys was similar between consumers and non-consumer is at 13 years (30.4%, 95% CI: 20, 41 vs 30.1%, 95% CI: 21, 40). CONCLUSIONS: Overweight/obese children who consumed flavored milk had less favorable changes in body composition over time. Although more research is needed, discouraging flavored milk consumption may be one beneficial strategy to address childhood obesity.

Identification of a dietary pattern prospectively associated with increased adiposity during childhood and adolescence.

BACKGROUND: Specific dietary risk factors for excess adiposity in young people are poorly understood. However, studies in adults suggest dietary energy density, fat and fibre are critical dietary factors. OBJECTIVE: To examine longitudinal relationships between a dietary pattern (DP) characterised by dietary energy density, % total energy from fat and fibre density and fat mass (FM) in children from 7 to 15 years of age. DESIGN: Subjects were 6772 children from the UK Avon Longitudinal Study of Parents and Children. Dietary intake was assessed using a 3-day food diary at 7, 10 and 13 years of age. An energy-dense, high-fat, low-fibre DP was identified using reduced rank regression and subjects scored for the DP at each age. FM was measured at 11, 13 and 15 years and FM index (FMI) calculated as FM/height((x)). Longitudinal models were adjusted for dietary misreporting, physical activity and maternal factors. RESULTS: DP z-scores at all ages were positively associated with later FMI. A 1 s.d. unit increase in DP z-score was longitudinally associated with an average increase in FMI z-score of 0.04 s.d. units (95% confidence interval (CI), 0.01-0.07). For each 1 s.d. unit increase in DP z-score, the odds of being in the highest quintile for FMI (as a marker of excess adiposity) increased by 13% (95% CI, 1-27%). CONCLUSIONS: Dietary habits during childhood are associated with increased adiposity in adolescence, with specific implications for dietary energy density, fat and fibre intake. Improving diet quality may reduce the risk of obesity in young people.

Associations between dietary patterns at 6 and 15 months of age and sociodemographic factors.

BACKGROUND/OBJECTIVES: Data from the Avon Longitudinal Study of Parents and Children (ALSPAC) have previously shown that dietary patterns are observable by 3 years. However, it is not clear when dietary patterns emerge. We aimed to describe dietary patterns in early life and their associations with maternal and infant sociodemographic characteristics. SUBJECTS/METHODS: Principal component analysis was applied to diet questionnaires of ALSPAC participants at 6 months (n = 7052) and 15 months (n = 5610) to extract dietary patterns. The sociodemographic factors associated with dietary patterns were investigated using regression analyses. RESULTS: Four dietary patterns were extracted at both 6 and 15 months. A traditional-style pattern characterized by home-prepared meats, vegetables and desserts, a second pattern characterized by ready-prepared baby foods and a third pattern characterized by discretionary foods such as biscuits, sweets and crisps were identified at both ages. At 6 months, the fourth pattern was characterized predominantly by breastfeeding and at 15 months, by contemporary-style foods including herbs, legumes, nuts, raw fruit and vegetables. Higher maternal age and education, number of siblings and lower body mass index (BMI) was associated with higher scores on the breastfeeding or meat, vegetables and desserts patterns, whereas higher discretionary food pattern scores were associated with younger maternal age, lower education, higher BMI and more siblings. Associations between sociodemographic factors and the ready-prepared baby food pattern scores were inconsistent across ages. CONCLUSIONS: Dietary patterns emerge from infancy and are associated with sociodemographic characteristics.

Contribution of inappropriate complementary foods to the salt intake of 8-month-old infants.

BACKGROUND/OBJECTIVE: Complementary feeding is a critical developmental time for establishing variety, and appropriate feeding practices are important. These include recommendations for a maximum intake of sodium (salt), because of the potential harmful effect of excessive intake on the developing kidneys and blood pressure in later life. Sodium intakes were examined to establish, if inappropriate complementary feeding practices were contributing to high intakes. SUBJECTS/METHODS: Data were collected from a cohort of 1178 8-month-old infants born in 1991/92, participating in the Avon Longitudinal Study of Parents and Children, using a 3-day dietary records completed by their mothers. Sodium and energy intakes were calculated and infants were categorised into quartiles of sodium intake. RESULTS: Majority of infants were first introduced to solids around 3-4 months, with plain baby rice, rusks and other cereals being the first foods consumed during complementary feeding. In the whole sample, 70% consumed in excess, of 400 mg sodium per day, the maximum UK recommendation for children up to age 12 months. The mean sodium intake for the highest quartile was 1060 mg per day. Infants in this quartile were often consuming cows' milk as a main drink; eating three times the amount of bread compared with the lowest quartile and used salty flavourings such as yeast extract and gravy. CONCLUSIONS: Sodium intakes in this cohort of infants were higher than recommendations. Clear and practical education is needed on complementary feeding practice for mothers highlighting what foods to introduce and when. Manufacturers have a responsibility to reduce the sodium content of food products.

A comparison of dietary patterns derived by cluster and principal components analysis in a UK cohort of children.

BACKGROUND/OBJECTIVES: The objective of this study was to identify dietary patterns in a cohort of 7-year-old children through cluster analysis, compare with patterns derived by principal components analysis (PCA), and investigate associations with sociodemographic variables. SUBJECTS/METHODS: The main caregivers in the Avon Longitudinal Study of Parents and Children (ALSPAC) recorded dietary intakes of their children (8279 subjects) using a 94-item food frequency questionnaire. Items were then collapsed into 57 food groups. Dietary patterns were identified using k-means cluster analysis and associations with sociodemographic variables examined using multinomial logistic regression. Clusters were compared with patterns previously derived using PCA. RESULTS: Three distinct clusters were derived: Processed (4177 subjects), associated with higher consumption of processed foods and white bread, Plant-based (2065 subjects), characterized by higher consumption of fruit, vegetables and non-white bread, and Traditional British (2037 subjects), associated with higher consumption of meat, vegetables and full-fat milk. Membership of the Processed cluster was positively associated with girls, younger mothers, snacking and older siblings. Membership of the Plant-based cluster was associated with higher educated mothers and vegetarians. The Traditional British cluster was associated with council housing and younger siblings. The three clusters were similar to the three dietary patterns obtained through PCA; each principal component score being higher on average in the corresponding cluster. CONCLUSIONS: Both cluster analysis and PCA identified three dietary patterns very similar both in the foods associated with them and sociodemographic characteristics. Both methods are useful for deriving meaningful dietary patterns.

Tracking of obesity and body fatness through mid-childhood.

OBJECTIVES: To explore how fat, lean and body mass index (BMI) track in childhood and how this relates to parental obesity. DESIGN AND SETTING: Prospective population-based cohort study: Avon Longitudinal Study of Parents and Children, UK. METHOD: Height, weight and leg-to-leg bioelectrical impedance (BIA) were collected at ages 7 and 11 years, as well as pre-pregnancy parental heights and weights. For BMI International Obesity Task Force thresholds of obesity and overweight were used. Impedance data were expressed as separate lean and fat z scores, internally standardised for gender, height and age and a child was defined as over-fat if fat z score was >85th and very over-fat if >95th internal centile. RESULTS: Data were available for 7723 and 7252 children at ages 7 and 11 years, respectively (6066 at both time points). Of those obese at age 7, 75% were still obese at age 11, while of those who had been overweight 16% had become obese and 20% now had normal BMI. Both fat and lean z scores showed moderate levels of tracking (correlation coefficients 0.70 and 0.73, respectively). Children with one or two obese parents had higher fat z scores at age 7 and showed greater increases in fat thereafter. They were more likely to be very over-fat at age 7 and, of these, 69% remained so at age 11 compared to only 45% with non-obese parents (p <0.001). CONCLUSIONS: Children of obese parents already have high fat levels at age 7 and are more likely to remain very over-fat.

Dietary patterns of men in ALSPAC: associations with socio-demographic and lifestyle characteristics, nutrient intake and comparison with women's dietary patterns.

OBJECTIVE: The aim of this study is to obtain distinct dietary patterns using principal components analysis (PCA) in men taking part in the Avon Longitudinal Study of Parents and Children and to determine the associations with (a) the patterns derived in the study women (the men's partners), (b) socio-demographic and lifestyle factors and (c) estimated nutrient intakes. DESIGN AND METHODS: A total of 4681 men taking part in a population-based cohort study recorded their current frequency of food consumption through questionnaire. Dietary patterns were identified using PCA, and scores were calculated for each pattern. A wide variety of social and demographic characteristics and lifestyle factors were also collected through self-completion questionnaire. RESULTS: Four dietary patterns were established: 'health conscious', 'traditional', 'processed/confectionery' and 'semi-vegetarian'. There were relatively strong correlations and levels of agreement between the 'health conscious' and 'vegetarian' style patterns in men and women (P<0.001). Strong associations were evident between several socio-demographic variables and the dietary patterns, similar to those earlier reported in women. Finally, nutrient intakes were plausibly associated with dietary pattern scores. CONCLUSIONS: Distinct dietary patterns in men have been identified using PCA that are similar, but not identical to those obtained in their partners at the same time point. Researchers should always consider stratifying by gender when examining dietary patterns. This study will form the basis for further work investigating the associations between parental and child dietary patterns.

Obesogenic diet and physical activity: independent or associated behaviours in adolescents?

OBJECTIVE: Associations between diet and physical activity may identify behaviours that could be changed together to prevent childhood obesity. The present study examines associations between physical activity and obesogenic dietary behaviours in a large UK adolescent cohort. DESIGN: Cross-sectional analysis of a UK cohort. Adolescents aged 10-11 years completed three 1 d diet diaries. Average daily energy consumption, percentage energy from fat and carbohydrate, energy density and grams of fruit and vegetables were estimated. To assess physical activity participants wore an accelerometer for three or more days. Regression models were run by sex to examine the extent to which dietary variables predicted physical activity before and after controlling for pubertal status, maternal education and adiposity. SETTING: The Avon Longitudinal Study of Parents and Children (ALSPAC), south-west England. SUBJECTS: Adolescents who provided diet data at age 10 years and physical activity data at age 11 years. RESULTS: Among boys, percentage energy from fat was consistently negatively associated with accelerometer-determined indicators of physical activity (standardized beta (beta) = -0.055 to -0.101, P < 0.05) while total energy (beta = 0.066 to 0.091, P < 0.05) and percentage energy from carbohydrate (beta = 0.054 to 0.106, P < 0.05) were positively associated before and after adjustment for confounders. For girls fruit and vegetable intake was consistently positively associated with physical activity (beta = 0.056 to 0.074, P < 0.005). However all associations were weak. Associations were broadly comparable when participants with non-plausible dietary reports were included or excluded from the analyses. CONCLUSIONS: Obesogenic diet and physical activity behaviours were weakly associated, suggesting that interventions should focus on implementing strategies that are independently successful at changing diet or physical activity behaviours either separately or in combination.

Dietary patterns in pregnancy and respiratory and atopic outcomes in childhood.

BACKGROUND: Studies of the relation between maternal diet in pregnancy and respiratory and atopic outcomes in the offspring have focused on the effects of individual nutrients and foods rather than dietary patterns. A study was undertaken to determine whether dietary patterns in pregnancy are related to childhood asthma and related outcomes. METHODS: In a population-based birth cohort, the Avon Longitudinal Study of Parents and Children (ALSPAC), dietary patterns in pregnancy previously identified using principal components analysis ("health conscious", "traditional", "processed", "vegetarian" and "confectionery") were related to early wheezing phenotypes and eczema; wheezing, hay fever, eczema, doctor-diagnosed asthma, atopy and total IgE at 7 years; lung function and bronchial responsiveness at 8-9 years. In regression models, confounders were controlled for using propensity scores. RESULTS: Univariately, the "health conscious" pattern was positively associated with eczema, total IgE, forced expiratory volume in 1 s and forced expiratory flow and negatively associated with early wheezing and asthma (unadjusted odds ratios per standard deviation increase in pattern score for early persistent wheeze and asthma: 0.78 (95% CI 0.70 to 0.87), p = 7.3x10(-6), N = 8886 and 0.90 (95% CI 0.84 to 0.97), p = 0.007, N = 7625, respectively). The "processed" pattern was positively associated with early wheezing and negatively associated with atopy and forced vital capacity. On controlling for confounders, the effects were substantially attenuated and became non-significant (adjusted odds ratios for the associations of the "health conscious" pattern with early persistent wheeze and asthma: 1.00 (0.86 to 1.16), p = 0.99 and 0.95 (0.86 to 1.04), p = 0.27, respectively). CONCLUSIONS: In this cohort, dietary patterns in pregnancy did not predict asthma and related outcomes in the offspring after controlling for confounders.

Dietary assessment in the Avon Longitudinal Study of Parents and Children.

OBJECTIVES: To describe the use of dietary assessment methods in a cohort study. SUBJECTS: The Avon Longitudinal Study of Parents and Children (ALSPAC) based in Bristol, UK, a cohort of children born in 1991/1992 and their parents. METHODS AND RESULTS: Data were collected about maternal and paternal diet, breastfeeding, weaning and childhood diet by both food frequency questionnaire (FFQ) and unweighed diet records (children only). Other questionnaires have covered socioeconomic background and eating behaviours. Nutrient and food group intakes were calculated from both FFQ and diet records. These were used singly and in combination to assess the contribution of diet to various growth and development outcomes in the children and in relation to socioeconomic position and other behaviours. Both methods provided important contributions to knowledge and have enhanced each other, allowing the development of the assessment instruments as experience in their use was gained. Statistical analysis methods such as the use of dietary patterns to summarize the diet were explored. CONCLUSIONS: Longitudinal cohort studies are greatly enhanced if dietary assessment methods are built into their design. The use of more than one method of dietary assessment can increase the scientific usefulness of a study.