Association between full breastfeeding, timing of complementary food introduction, and iron status in infancy in Germany: results of a secondary analysis of a randomized trial.

PURPOSE: Considering the low content in breast milk breastfed infants might be at particular risk for depleted iron stores after the first months of life. This study evaluates the association of the mode of milk feeding and the timing of complementary food (CF) introduction with parameters of iron status in term healthy infants in Germany. METHODS: In this secondary analysis of a randomized controlled trial, parents recorded all foods consumed by their infants from the age of 8 weeks onwards. Mothers were advised on the German food-based dietary guidelines for infants. Accordingly, CF was introduced between the fifth and seventh month of age. Blood samples were taken at 4 and at 10 months of age for analyses of iron status parameters. Iron depletion was defined as serum ferritin <12 ng/mL. RESULTS: The iron intake was lower in breastfed infants (n = 50) than in formula fed (n = 23) with decreasing differences during the course of infancy. At 10 months of age, most iron parameters were not associated with the mode of milk feeding or the timing of CF introduction. At this age, the iron depletion prevalence was >34% without general differences according to the mode of milk feeding or the timing of CF introduction. CONCLUSION: The high prevalence of depleted iron stores observed in both breastfed and formula-fed infants illustrates the need for further studies to improve our understanding of the optimal iron intake and sensitive parameters of iron status in infancy.

Prediction of human dietary δ15N intake from standardised food records: validity and precision of single meal and 24-h diet data.

Natural stable isotope ratios (δ15N) of humans can be used for nutritional analyses and dietary reconstruction of modern and historic individuals and populations. Information about an individual's metabolic state can be obtained by comparison of tissue and dietary δ15N. Different methods have been used to estimate dietary δ15N in the past; however, the validity of such predictions has not been compared to experimental values. For a total of 56 meals and 21 samples of 24-h diets, predicted and experimental δ15N values were compared. The δ15N values were predicted from self-recorded food intake and compared with experimental δ15N values. Predicted and experimental δ15N values were in good agreement for meals and preparations (r = 0.89, p < .001) as well as for the 24-h diets (r = 0.76, p < .001). Dietary δ15N was mainly determined by the amount of fish, whereas the contribution of meat to dietary δ15N values was less pronounced. Prediction of human dietary δ15N values using standardised food records and representative δ15N data sets yields reliable data for dietary δ15N intake. A differentiated analysis of the primary protein sources is necessary when relating the proportion of animal-derived protein in the diet by δ15N analysis.

Commercial complementary food consumption is prospectively associated with added sugar intake in childhood.

Given that commercial complementary food (CF) can contain high levels of added sugar, a high consumption may predispose to a preference for sweet taste later in life. This study examined cross-sectional associations between commercial CF consumption and added sugar intake in infancy as well as its prospective relation to added sugar intake in pre-school and primary-school age children. In all, 288 children of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study with 3-d weighed dietary records at 0·5 and 0·75 (infancy), 3 and 4 (pre-school age) and 6 and 7 years of age (primary-school age) were included in this analysis. Individual commercial CF consumption as percentage of total commercial CF (%cCF) was averaged at 0·5 and 0·75 years. Individual total added sugar intake (g/d, energy percentage/d) was averaged for all three age groups. Multivariable logistic and linear regression models were used to analyse associations between %cCF and added sugar intake. In infancy, a higher %cCF was associated with odds for high added sugar intake from CF and for high total added sugar intake (>75th percentile, P<0·033). Prospectively, a higher %cCF was related to higher added sugar intake in both pre-school (P<0·041) and primary-school age children (P<0·039), although these associations were attenuated in models adjusting for added sugar intake in infancy. A higher %cCF in infancy may predispose to higher added sugar intake in later childhood by virtue of its added sugar content. Therefore, offering home-made CF or carefully chosen commercial CF without added sugar might be one strategy to reduce sugar intake in infancy and later on.

Food neophobia in German adolescents: Determinants and association with dietary habits.

Food neophobia (FN) is described as the rejection to eat unknown foods. Because only little is known about the role of FN in adolescence the aim of this study was to examine potential determinants of FN and associations with dietary habits of DONALD study participants. FN was measured with Pliner's and Hobden's Food Neophobia Scale (FN Score (FNS): range 10-70) in 166 10-18-year-old adolescents. Participants' age, sex, body weight status and duration of breast-feeding as well as parents' FN and educational status were considered as determinants. Energy intake, distribution of macronutrients and two variety scores were calculated from 3-day weighed dietary records. Multivariable general linear models were performed for data analyses. Boys and girls did not differ in their FNS (median (Min-Max): boys 31 (10-58), girls 32 (14-59)). Increasing age (p = 0.010) and duration of total breast-feeding (p = 0.006) were associated with decreasing FNS in girls only. FN was further positively associated with parental FN in the total sample (p = 0.004). FN was negatively associated with protein intake in the total sample (p = 0.017). The overall low level of FN in the DONALD study can be ascribed to the low level of FN in adolescence in general. Congruently with other studies, age and breast-feeding duration were identified as determinants of girls' FN and parental FN was identified as determinant of FN in the total sample. Further, our results indicate that FN leads to reduced protein intakes. Dietary variety was not strongly affected, possibly because of a broad variety of food supply in Germany.

Age and time trends in the diet of young children: results of the DONALD study.

PURPOSE: To describe age and time trends of energy and macronutrient intake during infancy and toddlerhood and to set a special focus on dietary practices with respect to milk, complementary food, and family food intake. METHODS: Three-day dietary records (n = 2241) collected at 3, 6, 9, 12, 18, 24, and 36 months (480 subjects) between 2004 and 2013 from the ongoing open cohort DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) study were evaluated using repeated-measures regression analyses for trend analysis. RESULTS: Significant age trends were found for macronutrients with a decrease in fat intake (% of energy intake, %E) and an increase in carbohydrates (%E) and protein (%E). Exclusive and partial breastfeeding rates at 3 and 6 months did not differ between 2004 and 2008 and 2009 and 2013 (p > 0.05). Macronutrient pattern was virtually stable over time, whereas food group intake (% of total food intake excluding beverages, % TFI) changed significantly during the study period. Breast/bottle milk (% TFI) intake increased over time in the toddler subgroup, whereas family food (% TFI) decreased. CONCLUSIONS: Our data demonstrate a period of stagnation in the last 10 years with respect to breastfeeding duration in infancy. Further breastfeeding promotion in Germany is needed to continue the favourable progress of the previous decades. In toddlerhood, breast/bottle milk remains a substantial part of the diet and has increased during the last 10 years. Parents should be encouraged to implement healthy eating habits during early toddlerhood and to facilitate their child's participation in appropriate family meals.

Nutrient Adequacy and Associated Factors in a Nationwide Sample of German Toddlers.

OBJECTIVES: Nutrition in toddlerhood may have short- and long-term impacts on health and nutrition behavior. The objectives of the present article are to describe intake of energy and nutrients from the end of infancy to toddlerhood, and to examine dietary and socioeconomic factors (socioeconomic status [SES]) associated with total nutrient adequacy measured by a nutrient-based index (Nutrient Quality Index [NQI]). METHODS: In the German Representative Study of Toddler Alimentation from 2008, 7-day estimated dietary records were collected cross-sectionally from toddlers ages 10 to 36 months (n = 525). The study population was recruited in the TNS access panel. The intakes of energy and 18 nutrients were evaluated and the NQI was determined. Age trends in nutrient intake were tested with analysis of variance. Analysis of the association between SES and the NQI was performed by multiple linear regression analysis. RESULTS: In all of the age groups, energy intake was close to the reference value representing moderate physical activity. The mean intake of most vitamins and minerals reached the respective reference values, but nutrient density decreased with age. Dietary intakes of iron, iodine, and vitamin D are low in our study. The NQI reached approximately 80 points and was lower in older children than in younger children. NQI was not affected by SES but by formula use. CONCLUSIONS: Nutritional quality measured by total nutrient intake is altogether high in German toddlers, although NQI decreased with increasing age. The NQI is independent of social class. The positive association with formula intake can be explained by the general enrichment of vitamins and minerals of these products.

Associations between commercial complementary food consumption and fruit and vegetable intake in children. Results of the DONALD study.

OBJECTIVES: Fruit and vegetable (FV) consumption is influenced by individual taste and food preferences that are developed early in life. Thus, the sensory properties of foods given during complementary feeding may shape later food acceptance and dietary intake. However, those experiences differ with respect to the preparation method of complementary food (CF), that is, homemade and commercial CF. The aim of this study therefore was to examine the association between the infant's consumption of commercial CF and FV intake and variety during infancy, preschool and school age. METHODS: In total, 281 children of the DONALD Study with 3-day weighed dietary records at 0.5 and 0.75 (infancy), 3 and 4 (preschool age), 6 and 7 years of age (school age) were included in this analysis. Percentage of commercial CF (%cCF) was averaged at 0.5 and 0.75 years. Individual FV intake (g/day) and FV variety scores were calculated and averaged separately for all three age groups. Multivariate linear regression was used to analyse associations between %cCF and FV intake and variety. Models were adjusted for early life and socioeconomic factors. RESULTS: For boys, higher %cCF was associated with lower vegetable intake in infancy (p < 0.0001) and preschool age (p = 0.036) as well as lower total FV intake in preschool and school age (p < 0.009). For girls, higher %cCF was associated with lower vegetable intake (p < 0.0001) in infancy. FV variety scores showed no clear associations with %cCF in girls and boys. CONCLUSION: The results of the DONALD Study suggest that the preparation method of CF is associated with FV consumption in infancy and at least for boys also in preschool and school age.

Food variety in commercial and homemade complementary meals for infants in Germany. Market survey and dietary practice.

INTRODUCTION: Already infants do not meet the recommendations for fruit and vegetable intake although the complementary feeding period offers the possibility to expose the infant to a variety of flavours from fruits and vegetables. The objective of the present analysis was to identify differences in the vegetable variety in commercial vs. homemade complementary meals and to describe fish and meat variety in these meals in dietary practice in Germany. A further objective was to provide an overview of the food variety in commercial complementary vegetable-potato-meat/fish meals available on the German baby food market in 2012. METHODS: 3-day weighed dietary records from the German DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study were used to describe the fish and meat variety and to compare the vegetable variety in commercial and homemade meals using a vegetable variety score (VegVS). The online data base 'Nutrichild' served to describe the food variety on the market. RESULTS AND CONCLUSION: The vegetable variety was low in homemade as well as in commercial meals without any differences in total variety at 6 and 9months of age. At 12months of age infants fed with commercial meals got a higher vegetable variety than those fed with homemade meals. In homemade and commercial meals most often carrot was used, whereas other vegetables were far below this frequency. In both meals, poultry and beef were most often used whereas fish meals were rarely offered. The market survey showed the same low vegetable variety and low fish offer as the results of the DONALD study. The data show that it is necessary to promote the advantages of a vegetable variety and fish consumption in Germany, already in early infancy.

Breast-feeding and weaning practices in the DONALD study: age and time trends.

OBJECTIVES: Besides influencing short- and long-term health status, infant feeding practices are known to have an effect on later food preferences. This study aimed to identify present trends in breast-feeding duration and weaning practices with special focus on preparation methods of complementary food (CF), that is, homemade and commercial CF. METHODS: In total, 1419 three-day weighed diet records collected between 2004 and 2012 from 366 children of the German DOrtmund Nutritional and Anthropometric Longitudinally Designed study ages 6 to 24 months were analysed. Full (n = 339) and total breast-feeding duration (n = 344) was collected by questionnaire. To investigate age and time trends, logistic regression and polynomial mixed regression models were used. RESULTS: Infants born between 2008 and 2012 were 3.3-fold less likely to be fully breast-fed for ≥4 months than those born before 2004 (P < 0.0001). Overall, 59.3% commercial, 21.1% homemade, and 19.6% combined CF was consumed by the study sample. Subjects with high commercial CF consumption (percentage of commercial CF > median 62%) were significantly older (P < 0.0001), showed shorter full and total breast-feeding duration (P < 0.0001), and were more likely to have mothers with a lower educational status (P = 0.01). Both commercial and homemade CF showed opposing, nonlinear age trends. No time trends could be found. CONCLUSIONS: Decreasing duration of full breast-feeding should encourage health care providers to further promote longer breast-feeding duration. With the constantly high consumption of commercial CF at all ages, nutritional adequacy of both homemade and commercial CF needs to be investigated closer, as does their long-term influence on health and dietary habits, for example, fruit and vegetable intake.

Relative validity of a 3 d estimated food record in German toddlers.

OBJECTIVE: To determine the relative validity of a 3 d estimated food record (EFR) used to assess energy and nutrient intakes in toddlers, using a 3 d weighed food record (WDR) as the reference method. DESIGN: Parents reported the food and beverage intakes of their children using an EFR concurrently with a WDR over three consecutive days. Estimation of mean differences, Spearman correlation coefficients, cross-classifications and Bland-Altman plots were used to assess the agreement between the intakes of energy and fourteen nutrients obtained from the EFR and the WDR. SETTING: Data obtained from a representative sample of infants or toddlers in Germany. SUBJECTS: Sixty-seven toddlers aged 10-36 months who had completed an EFR for a 3 d recording period that corresponded to the WDR were included in the present analysis. RESULTS: Energy and nutrient intakes did not differ between the EFR and the WDR, except for linoleic acid and retinol. For all dietary intakes, Spearman rank correlation coefficients between the EFR and the WDR ranged from 0·35 to 0·80 (P ≤ 0·004). The proportion of participants correctly classified into quartiles ranged from 75 % for ascorbic acid intake to 96 % for Fe intake, and the percentage of misclassification was 9 % or less. The weighed κ values ranking the participants ranged from 0·23 for ascorbic acid intake to 0·59 for Fe intake. The Bland-Altman plots indicated a good agreement for all dietary intakes estimated from the EFR. CONCLUSIONS: Our study suggests that this EFR is a valid assessment instrument for estimating the energy and nutrient intakes among toddlers at the group level.

24 h-Sodium excretion and hydration status in children and adolescents--results of the DONALD Study.

BACKGROUND & AIMS: To describe actual data on intake, sources, age and time trends of urinary sodium excretion and to analyze the potential association between urinary sodium excretion and hydration status respective beverage consumption in a sample of healthy German children and adolescents. METHODS: Data of 1575 24 h-urine samples and weighed dietary records of 499 children (249 boys) aged 4-18 years of the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study collected in 2003-2009 were analyzed using linear mixed effects regression models. Free water reserve (FWR, measured urine volume (ml/24 h) minus the obligatory urine volume (ml/24 h)) was used as a marker for hydration status. RESULTS: Urinary sodium excretion was between 1.4 g/day and 3.2 g/day, showing a positive age trend but remained stable during the study period. In girls, there was a significant positive association between salt excretion and FWR (p = 0.04). Per g/MJ urinary sodium excretion, beverage intake increased by 0.05 g/MJ (boys) or 0.08 g/MJ (girls). CONCLUSION: Hydration status was not affected by salt intake in this sample of healthy children and adolescents in a western life style, due to a compensatory increase in beverage consumption.

Dietary exposure assessments for children in europe (the EXPOCHI project): rationale, methods and design.

BACKGROUND/PURPOSE: The number of dietary exposure assessment studies focussing on children is very limited. Children are however a vulnerable group due to their higher food consumption level per kg body weight. Therefore, the EXPOCHI project aims 1 to create a relational network of individual food consumption databases in children, covering different geographical areas within Europe, and 2 to use these data to assess the usual intake of lead, chromium, selenium and food colours. METHODS: EXPOCHI includes 14 food consumption databases focussed on children (1-14 y old). The data are considered representative at national/regional level: 14 regions covering 13 countries. Since the aim of the study is to perform long-term exposure assessments, only data derived from 24 hr dietary recalls and dietary records recorded on at least two non-consecutive days per individual were included in the dietary exposure assessments. To link consumption data and concentration data of lead, chromium and selenium in a standardised way, categorisation of the food consumption data was based on the food categorisation system described within the SCOOP Task report 3.2.11. For food colours, the food categorisation system specified in the Council Directive 94/36/EC was used. CONCLUSION: The EXPOCHI project includes a pan-European long-term exposure assessment of lead, chromium, selenium and food colours among children living in 13 different EU countries. However, the different study methods and designs used to collect the data in the different countries necessitate an in-depth description of these different methods and a discussion about the resulting limitations.

Dietary intake of nickel and zinc by young children--results from food duplicate portion measurements in comparison to data calculated from dietary records and available data on levels in food groups.

The daily dietary intake of nickel (Ni) and zinc (Zn) by 42 young children, 21 boys and 21 girls, from 4 to 7 years of age, living in urban and rural areas of Germany and having different food consumption behaviour, was determined by the duplicate method with a 7-day sampling period. Dietary records were also kept by the children's parents for the 7-day sampling period. Individual reported food items were identified, assigned to food groups and, together with known Ni and Zn concentrations of foodstuffs, daily intake rates were calculated. The same method was used for calculations of the energy, fat, protein and carbohydrate intake rates. The levels in the food duplicates, determined by atomic absorption spectrometry, were in the range of 69-2000 microg Ni/kg(dry weight) (geometric mean (GM): 348) and 7.1-43 mg Zn/kg(dry weight) (GM: 17.5). Daily intake rates based on the 294 individual food duplicate analyses were 12-560 microgNi/d (GM: 92.3) and 1.5-11 mgZn/d (GM: 4.63). The results from the dietary records were 35-1050 microg Ni/d (GM: 123) and 1.7-15 mg Zn/d (GM: 5.35). The results of the daily intake rates from both methods showed a correlation with regard to Zn (r=0.56), but no correlation was found between either the Ni intake rates determined with both methods or between the Ni intake rates measured by the duplicate method and calculated intake rates from the dietary records of energy, fat, protein, carbohydrates or drinking water. In the case of nickel, the discrepancies between the methods lead one to suppose that the main factors influencing Ni intake by food are not directly caused by easily assessable food ingredients themselves. It is possible that other factors, such as contaminated drinking water or the transition of Ni from kettles or other household utensils made from stainless steel into the food, may be more relevant. In addition there are some foodstuffs with great variations in concentrations, often influenced by the growing area and environmental factors. Further, some food groups naturally high in Nickel like nuts, cocoa or teas might not have been kept sufficient within the records. In summary, the dietary record method gave sufficient results for Zn, but is insufficient for Ni. Based on the food duplicate analysis, children living in urban areas with consumption of food products from a family-owned garden or the surrounding area and/or products from domestic animals of the surrounding area had about one-third higher Ni levels in their food than children either living in an urban area or children consuming products exclusively from the supermarket. Only slight differences were found with regard to Zn. Compared to the recommendations of the German Society of Nutrition (DGE) (25-30 microgNi/d and 5.0 mgZn/d), the participants of the study had a clearly increased Ni and, in view of the geometric mean value, a nearly adequate Zn intake. Health risks are especially given with regard to the influence of nickel intake by food on dermatitis for nickel-sensitive individuals.

Effects of age and time on energy and macronutrient intake in German infants and young children: results of the DONALD study.

OBJECTIVES: To describe effects of age and time on the intake of energy and macronutrients in infants and young children. PATIENTS AND METHODS: The energy and macronutrient intake of 720 DONALD study participants between 1989 and 2003 was evaluated by analysing 3027 three-day weighed dietary records (including test weighing of breast milk consumption) at 3, 6, 9, 12, 18, 24 and 36 months. Mixed models and logistic regression analyses were used to investigate the effects of age and time on intake. RESULTS: Age affected macronutrient patterns (percentage of energy intake, E%) more often in infants than in young children. The percentage of full and partial breast-fed infants increased between 1989 and 2003. Almost no time trends were found for energy intake. Macronutrient patterns changed with time; for example, protein intake decreased throughout infancy (between -0.05 and -0.17 E%/y). An increase in fat intake (0.23 and 0.40 E%/y) was compensated by a decrease in carbohydrates (-0.18 and -0.29 E%/y) in young infants (3 and 6 months). Opposite trends in macronutrient patterns were observed in infants and young children. CONCLUSIONS: Increasing breast milk consumption over time was the most obvious factor influencing long-term trends in macronutrient patterns. In all of the age groups examined here, macronutrient patterns have come closer to the references over time.

Consumption of homegrown products does not increase dietary intake of arsenic, cadmium, lead, and mercury by young children living in an industrialized area of Germany.

The dietary intake of arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb) was studied among young German children with different food consumption behaviour (consumption of own grown foodstuffs and of products from the supermarket). The study area comprised an industrialized and a rural area of West Germany. Dietary intake of contaminants was measured by the duplicate method according to the WHO guideline. A total 588 duplicate portions were collected daily from 84 individuals between May and September 1998. Intake of food groups was calculated from dietary records. Determination of As, Cd, Hg, and Pb was performed following high-pressure digestion of lyophilized samples by atomic absorption spectrometry (AAS). Geometric mean weekly intake [microg/(kgbw x week)] was as follows: As 1.4, Cd 2.3, Hg 0.16, and Pb 5.3. Geometric mean intake corresponded to the percentage of the provisional tolerable weekly intake (PTWI) as follows: As 9.7%, Cd 32%, Hg 3.3%, Pb 21%. As and Hg intake were mainly influenced by fish consumption. The amount of cereals and bakery wares mainly determined the Cd and Pb intake. Children living in the industrialized area with a substantial food consumption of own grown vegetables or products from domestic animals products had no increased dietary intake of the metals.

Estimation of the dietary intake of acrylamide by German infants, children and adolescents as calculated from dietary records and available data on acrylamide levels in food groups.

Dietary intakes of acrylamide for the general population were estimated by FAO/WHO to be in the range of 0.3 to 0.8 microg/(kg(bw) *d). It was supposed that children and adolescents would generally have intakes twice to three times higher than adults. However, relevant data is rare. Therefore, 3- or 7-day dietary records (n = 2956) from infants, children and adolescents aged 0.5 to 18 years from the DONALD study (2001) and other studies (RUB studies) were evaluated to estimate the potential dietary intake of acrylamide. Statistical data of the intake of 6 food groups relevant for acrylamide exposure were combined with available data for ranges of acrylamide concentrations in more than 1500 foods in Germany. Scenarios were calculated assuming minimum, median and maximum acrylamide concentration in food groups. Assuming median (minimum; maximum) acrylamide concentrations in foods and mean consumed food amounts, the calculated intake of acrylamide ranged from 0.21-0.43 (0.12-0.19; 0.98-1.79) microg/(kg(bw) *d) between the age groups from <1 to <19 years in the DONALD study and was 0.61 (0.21; 2.58) microg/(kg(bw) *d) from 1 to <7 years in the RUB studies. The highest intake was calculated for children aged 1-<7 years. The highest proportions of total intake of acrylamide came from the intake of commercial baby food (86-91%) in infants, and bread (18-46%), pastries (16-35%), and potato products (7-35%) in children and adolescents, depending on scenario and age. Our estimated data are in the range of reports from the literature for adolescents and adults in Germany and other European countries and lower than reports for infants. Our results do not confirm that children and adolescents will have higher exposures to acrylamide than adults. Practical suggestions to lower the risk of acrylamide exposure by food without decreasing the quality of the nutrition in the diet are given.