Alignment between timing of 'highest caloric intake' and chronotype in relation to body composition during adolescence: the DONALD Study.

PURPOSE: Our aim was to assess alignment in timing of 'highest caloric intake' with individual chronotype and its association with body composition in adolescents. METHODS: We used repeatedly collected data from n = 196 adolescents (age 9-16 years, providing N = 401 yearly questionnaires) of the DONALD open cohort study. Chronotype was assessed by the Munich Chronotype Questionnaire from which midpoint of sleep (MSFsc) was derived. A sex- and age-specific diet-chrono-alignment score (DCAS) was calculated as the difference in hours between the chronotype-specific median timing of highest caloric intake of the studied population and the individual timing of 'highest caloric intake' or vice versa. Repeated-measures regression models were applied to study cross-sectional and longitudinal associations between the DCAS and body composition, e.g., Fat Mass Index (FMI) or Fat Free Mass Index (FFMI). RESULTS: DCAS ranged from -6:42 h to + 8:01 h and was not associated with body composition. Among adolescents with a later chronotype (N = 201) a 1 h increase in DCAS (later consumption of 'highest caloric intake' in comparison to the median intake of that group), increased FFMI by 1.92 kg/m2 (95% CI: 0.15, 3.69, p value = 0.04) over a median follow-up of 0.94 year. CONCLUSION: Alignment of energy intake with individual chronotype appears beneficial for FFMI among those with a late chronotype.

Multiple sclerosis by phenotype in Germany.

BACKGROUND: A diagnosis of multiple sclerosis (MS) can be categorized based on its disease course into the following phenotypes: relapsing-remitting MS (RRMS), primary progressive MS (PPMS), and secondary progressive MS (SPMS). With one exception, studies of MS by phenotype either provide only prevalence data or if describing drug utilization, the emphasis is on patients with RRMS; while drug utilization by phenotype tends to be examined over the course of a year. No recent studies have comprehensively evaluated MS phenotypes by prevalence, drug utilization, and comorbidities over time from a population-based perspective, which is essential for understanding the disease burden and identifying unmet needs in MS. Germany is one of the few countries where specific MS phenotypes are commonly recorded in routine clinical practice. The purpose of this study was to compare MS phenotypes with respect to changes in their population-based prevalence rates and the types of MS treatments prescribed over time, as well as the frequency of clinical conditions associated with MS based on data from a German health insurance database. METHODS: This retrospective, observational, cohort study used data from a German health insurance database for the period 2010 to 2017. Patients aged 18+ years with a specified phenotype of MS based on ICD-10 diagnosis coding were included in the analysis. RESULTS: In 2010, RRMS was reported in 73%, PPMS in 8%, and SPMS in 19% of patients with MS with a known phenotype. The mean ages of patients were 41.4, 53.6, and 52.8 years, respectively, and all phenotypes were associated with a female predominance (69%, 63% and 63%, respectively). The prevalence rate of each phenotype markedly increased during the study period (RRMS +113%, PPMS +40%, SPMS +54%; in 2017 the rates were 183, 14, and 34 per 100,000, respectively). The mean age of patients reporting each phenotype also increased (p<0.01), while the female:male proportion remained stable in RRMS and SPMS, the proportion of females significantly declined over time in the PPMS group. The overall percentage of patients prescribed a disease-modifying drug increased across the phenotypes from 51% to 57%. Prescription of interferon-based therapies declined in each phenotype, with the greatest declines observed in RRMS and PPMS. The PPMS and SPMS groups had significantly more prescriptions for symptom management than the RRMS group. Depression was the most prevalent clinical condition associated with each phenotype. There was a significant difference in the percentage of patients with depression across the phenotypes (p = 0.03), with the highest among SPMS (44%) compared with RRMS (35%) or PPMS (37%). Significant differences (p<0.05) across the phenotypes were also observed for the composite prevalence of cardiovascular conditions (highest in PPMS) and cognitive dysfunction (highest in SPMS). CONCLUSION: The increasing numbers of patients across each MS phenotype, aging population in patients with MS regardless of phenotype, gender differences and variations across the types of treatments prescribed, and clinical conditions associated with each MS phenotype present new insight into the disease burden and treatment strategies of MS. These should be considered when developing healthcare strategies and optimizing care for patients with MS.

Changes in chronotype and social jetlag during adolescence and their association with concurrent changes in BMI-SDS and body composition, in the DONALD Study.

BACKGROUND/OBJECTIVES: Adolescence is a critical period for both the development of overweight and the transition toward a later chronotype, often accompanied by an increase in social jetlag. This study assessed whether changes in chronotype and social jetlag, are linked to changes in body composition during adolescence. SUBJECTS/METHODS: We used data from the DONALD open cohort study, collected between 2014 and 2019, from 213 adolescents (9-17 years at baseline, 45% females) having at least two measures of chronotype and anthropometry (N = 572). Chronotype was assessed with the Munich Chronotype Questionnaire and defined as: midpoint of sleep corrected for sleep-debt (MSFsc) accumulated over the week (later MSFsc represents later chronotype). Social jetlag (SJL) defines the difference between midpoint of sleep during week and weekend. Calculations for Fat Free Mass Index (FFMI [kg/m2)]) and Fat Mass Index (FMI) [kg/m2)]) were based on body fat percentage, weight, and height. To analyze the associations, we used linear mixed-effect regression models. Finally, the total cohort was split into three biologically relevant age groups (cut-off set at <12 years, ≥12 to ≤15 years and >15 years). RESULTS: Median follow-up was 2.1 years. Overall, change toward a later chronotype was significantly related with an increase in FMI (ß: 0.05, 95% CI: 0.01-0.08). A 1 h increase in social jetlag predicted an increase in BMI-SDS of 0.08 SDS units (95% CI: 0.01-0.14) and in FMI of 0.04 kg/m2 (95% CI: 0.003-0.08). Associations were stronger for the age group ≥12 to ≤15 years (p for interaction: <0.001). No relationship was found with FFMI. CONCLUSIONS: Changes in MSFsc and SJL during adolescence were associated with concurrent changes in BMI-SDS and FMI. The age ≥12 to ≤15 years appears to be a sensitive period in which chronobiological changes were clearly associated with increasing body fatness.

Dietary flavonoids among children and adolescents in the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study: intake, food sources and trends from 1985 until 2016.

Flavonoids are suggested to reduce disease risk. Since dietary habits are acquired during early life, describing age and time trends of flavonoid intake and major food sources are important for monitoring and disease prevention in later life. We aimed to describe total flavonoid intake and food sources and to investigate age and time trends of flavonoid intake in 3-18-year-olds, from the Dortmund Nutritional and Anthropometric Longitudinally Designed study from 1985 to 2016. Intake was assessed annually using 3-d weighed food records (WFR). Flavonoid values were assigned using the United States Department of Agriculture database. Foods contributing to intake were determined. Age and time trends in total flavonoid and isoflavone density were analysed by sex with PROC MIXED. In total, 1312 children completed 10 758 WFR. Across all ages, daily mean total flavonoid density was lower in boys compared with girls (134 v. 146 mg/4184 kJ) and no difference in median isoflavone density (0·04 mg/4184 kJ per d) was found. The top five foods contributing to total flavonoid intake were apple with peel (15·0/17·1 %), strawberries (5·9/6·1 %), chocolate spread (3·9/3·5 %), orange juice (3·5/3·4 %) and pasta (3·5/3·4 %) for boys and girls, respectively. Overall, in boys, total flavonoid density decreased over the course of age and time. In girls, there was no association with age or time. In both sexes, isoflavone density followed a U-shaped age trend with no change over time. From a public health perspective, the overall observed downwards trend of flavonoid intake in boys deserves attention. Future initiatives should be tailored at maintaining a high flavonoid density as children age, specifically among boys.

Age and time trends in sugar intake among children and adolescents: results from the DONALD study.

PURPOSE: To describe age and time trends in added sugar, free sugar and total sugar intake among German 3-18-year-olds. METHODS: Overall, 10,761 3-day dietary records kept between 1985 and 2016 by 1312 DONALD participants (660 boys, 652 girls) were analysed (%E) using polynomial mixed-effects regression models. RESULTS: TS intake decreased with age (♂: linear, quadratic and cubic trend all p < 0.0098; ♀: linear trend p < 0.0001). While the oldest children had the lowest FS intake (linear, quadratic trend: p < 0.0001), the youngest children had the lowest AS intake (linear, quadratic trend p < 0.0001, cubic trend p = 0.0004). In terms of time trends, TS (♂: cubic trend p = 0.0052; ♀: quadratic trend p = 0.0608, cubic trend p = 0.0014) and FS (quadratic trend p = 0.0163, cubic trend p < 0.0001) intake increased between 1985 and 2005 and decreased thereafter, most notably since 2010. AS intake decreased between 1985 and 1995, increased slightly until 2005 and decreased thereafter, most notably since 2010 (linear, quadratic, cubic trend p < 0.0001). FS intake exceeded 10%E/day throughout the 30-year study period. CONCLUSION: Our results do not support the common assumptions that sugar intake is on the rise and generally higher among adolescents than among younger children. Of note, TS, AS and FS intakes have decreased in the last decade among all age groups. Nevertheless, FS intake still exceeds the intake level recommended by the WHO.

Time and Age Trends in Free Sugar Intake from Food Groups among Children and Adolescents between 1985 and 2016.

Trend analyses suggest that free sugar (FS) intake-while still exceeding 10%E-has decreased among German children and adolescents since 2005, yet that intakes may shift from sugars naturally occurring in foods to added sugars as children age. Thus, we analysed time and age trends in FS intake (%E) from food groups among 3-18 year-olds (1985-2016) using 10,761 3-day dietary records from 1312 DONALD participants (660 boys, 652 girls) by use of polynomial mixed-effects regression models. Among girls, FS from sugar & sweets decreased from 1985 to 2016 (linear trend p < 0.0001), but not among boys (p > 0.05). In the total sample, FS intake from juices increased until 2000 and decreased since 2005 (linear, quadratic trend p < 0.0001). FS from sugar sweetened beverages (SSB) decreased non-linearly from 1985 to 2016 (girls: linear, quadratic, cubic trend p < 0.0001; boys: linear, quadratic, cubic trend p < 0.02). Younger children consumed more FS from juices than older ones, who had a higher FS intake from SSB. FS intake from sugar & sweets increased until early adolescence and decreased afterwards. Since sugar & sweets represent the main source of FS intake and the source with the least pronounced decline in intake, public health measures should focus on these products.