Sleep duration and problem behaviour in 8-year-old children in the Childhood Obesity Project

There is growing evidence that insufficient sleep has negative effects on the mental health of children. The aim of this study is to examine the associations between device-measured sleep duration and internalizing and externalizing problems in 8-year-old children. The study is a secondary analysis of data from the Childhood Obesity Project conducted in five European countries. Nocturnal sleep duration was measured with the SenseWear™ Armband 2. Parents rated their child’s internalizing and externalizing problems on the Child Behaviour Checklist. Behaviour scores were dichotomized at the 90th percentile based on sex- and country-specific z-scores. Logistic regression models were applied to test the associations between sleep duration and behaviour. Data were available for 406 8-year-old children. The average sleep duration was 9.25 h per night (SD: 0.67) with 1464 nights measured in total. The sleep duration recommendation of the American Academy of Sleep Medicine for school-aged children (9–12 h) was met by 66.7% of children. One hour of additional sleep per night significantly reduced the risk of having internalizing problems (adjusted OR = 0.51; 95% CI 0.29–0.91). Children who adhered to the sleep duration recommendation had a lower risk for internalizing problems (adjusted OR = 0.45; 95% CI 0.21–0.99). Sleep duration and externalizing problems showed no significant association. Longer sleep duration was associated with a reduced risk of having internalizing problems but not externalizing problems. Results highlight that it is important to ensure adequate sleep duration throughout primary-school years for the optimal emotional health of children. Trial registration number: NCT00338689. Registered: June 19, 2006

Effects of screen time and playing outside on anthropometric measures in preschool aged children

Objective: In view of the current obesity epidemic, studies focusing on the interplay of playing outside (PO), screen time (ST) and anthropometric measures in preschool age are necessary to guide evidence-based public health planning. We therefore investigated the relationship between average time spent PO and ST from the ages 3 to 6 years and anthropometric measures at 6 years of age. Methods PO and ST of 526 children of the European Childhood Obesity Project (CHOP) were annually assessed by questionnaire from 3 until 6 years of age. Body weight, waist circumference and height were measured at 3 and 6 years of age to calculate Body-Mass-Index z-Scores (zBMI) and waist-to-height ratio (WTH). Linear, logistic and quantile regressions were used to test whether average time spent PO and ST in the 4 year period had an effect on anthropometric measures at age 6 years. Results Longer daily ST was associated with a higher zBMI (P = 0.002) and WTH (P = 0.001) at 6 years of age. No significant associations were found for time spent PO. Each additional hour of average ST during the 4 year period resulted in a 66% higher risk of having a zBMI score over 1 (P < 0.001) and almost twice the risk (94% higher risk) of having an zBMI score over 2 (P < 0.001) at 6 years. Conclusions: Excessive ST during preschool age is a risk factor for increased zBMI at 6 years, regardless of time spent PO. Reducing high levels of ST during preschool age, for e.g. at least 1h per week, could help preventing childhood obesity

Mental performance in 8-year-old children fed reduced protein content formula during the 1st year of life: safety analysis of a randomised clinical trial

In humans, maximum brain development occurs between the third trimester of gestation and 2 years of life. Nutrition during these critical windows of rapid brain development might be essential for later cognitive functioning and behaviour. In the last few years, trends on protein recommendations during infancy and childhood have tended to be lower than that in the past. It remains to be demonstrated that lower protein intakes among healthy infants, a part of being able to reduce obesity risk, is safe in terms of mental performance achievement. Secondary analyses of the EU CHOP, a clinical trial in which infants from five European countries were randomised to be fed a higher or a lower protein content formula during the 1st year of life. Children were assessed at the age of 8 years with a neuropsychological battery of tests that included assessments of memory (visual and verbal), attention (visual, selective, focused and sustained), visual-perceptual integration, processing speed, visual-motor coordination, verbal fluency and comprehension, impulsivity/inhibition, flexibility/shifting, working memory, reasoning, visual-spatial skills and decision making. Internalising, externalising and total behaviour problems were assessed using the Child Behaviour Checklist 4\u201318. Adjusted analyses considering factors that could influence neurodevelopment, such as parental education level, maternal smoking, child\u2019s gestational age at birth and head circumference, showed no differences between feeding groups in any of the assessed neuropsychological domains and behaviour. In summary, herewith we report on the safety of lower protein content in infant formulae (closer to the content of human milk) according to long-term mental performance

Early Influences of Nutrition on Postnatal Growth

Health and nutrition modulate postnatal growth. The availability ofamino acids and energy, and insulin and insulin-like growth factor-I(IGF-I) regulates early growth through the mTOR pathway. Amino acids andglucose also stimulate the secretion of IGF-I and insulin. Postnatalgrowth induces lasting, programming effects on later body size andadiposity in animals and in human observational studies. Rapid weightgain in infancy and the first 2 years was shown to predict increasedobesity risk in childhood and adulthood. Breastfeeding leads to lesserhigh weight gain in infancy and reduces obesity risk in later life byabout 20%, presumably partly due to the lower protein supply with humanmilk than conventional infant formula. In a large randomized clinicaltrial, we tested the hypothesis that reduced infant formula proteincontents lower insulin-releasing amino acid concentrations and therebydecrease circulating insulin and IGF-I levels, resulting in lesser earlyweight gain and reduced later obesity risk (the ‘Early ProteinHypothesis’). The results demonstrate that lowered protein in infantformula induces similar - but not equal - metabolic and endocrineresponses and normalizes weight and BMI relative to breastfed controlsat the age of 2 years. The results available should lead to enhancedefforts to actively promote, protect and support breastfeeding. Forinfants that are not breastfed or not fully breastfed, the use of infantformulas with lower protein contents but high protein quality appearspreferable. Cows’ milk as a drink provides high protein intake andshould be avoided in infancy

BMI and recommended levels of physical activity in school children

Background: Physical activity (PA) and its health benefits are a continuous point of discussion. Recommendations for children's daily PA vary between guidelines. To better define the amount of PA necessary to prevent overweight and obesity in children, further research is needed. The present study investigates children's compliance to physical activity guidelines (PAGs) and the association between objectively measured PA and body mass index (BMI). Methods: Participating children were 11 years old (n = 419) and part of the European CHOP trial, which was conducted in Germany, Belgium, Poland, Spain, Italy. At least 2 days of PA measurements were collected from each child using a SenseWear (TM) armband. BMI was calculated from children's height and weight. Thresholds of min.day(-1) in PA needed to differentiate between normal and excess weight (overweight/obesity) were determined with Receiver Operator Characteristics (ROC) analysis. Additionally, adjusted linear and logistic regressions models were calculated for group differences and effects of a 5, 15 and 60 min.day(-1) increases in PA on BMI. Results: Median time spent in total PA was 462 min.day(-1) (25th percentile;75th percentile: 389;534) and 75 min . day(-1) (41;115) in moderate to vigorous PA (MVPA). Girls spent 36 min . day(-1) less in MVPA than boys and overweight/obese children 24 min . day(-1) less than normal weight children (linear regression, p < 0.001). 63.2% of the children met PAGs of 60 min.day(-1) in MVPA. The optimal threshold for min.day(-1) in MVPA determined with ROC analysis was 46 min.day(-1). Comparing 5, 15 and 60 min.day(-1) increases in PA revealed that an additional 15 min.day(-1) of vigorous PA had the same effect as 60 min.day(-1) of MVPA. Sedentary time and light PA showed contrary associations to one another, with light PA being negatively and sedentary time being positively associated with excessive weight. Conclusions: Current PAGs are met by 2/3 of children and seem appropriate to prevent excess weight in children. An official recommendation of daily 15-20 min of vigorous PA and further reduction of sedentary time could help to fight youth overweight and thus be of potential public health importance

Longitudinal analysis of physical activity, sedentary behaviour and anthropometric measures from ages 6 to 11 years

Background/Objective: The aim of this study was to examine the effect of physical activity (PA) and sedentary behaviour (SB) on body mass index (BMI) and fat mass index (FMI) in children over the course of five years and identify potential bi-directional associations.Subjects/Methods: Data were drawn from the EU Childhood Obesity Project (CHOP). PA and SB were measured with the SenseWear Armband 2 at the ages of 6 (T1), 8 (T2) and 11 (T3) years. Height and weight were measured and BMI was calculated at each time point, resulting in 1254 complete observations from 600 children. Bio impedance analysis was used to measure body fat mass and eventually calculate FMI. To examine the longitudinal association between PA/SB and BMI/FMI as well as to account for repeated measure on these children, mixed model analysis was employed.Results: Higher levels of total PA and moderate-to-vigorous PA (MVPA) were associated with lower BMI and FMI and higher SB with higher BMI and FMI over the five year period. When looking at the age dependent effects, negative associations of MVPA ((MVPA x age): -0.05, 95% confidence interval (CI): -0.09 - -0.01, p=0.007) and positive associations of SB ((SB x age): 0.04, 95% CI: 0.02-0.06, p<0.001) increased with each year of age. In a model combining these two effects, only SB x age interaction remained significant ((SB x age): 0.04, 95% CI: 0.03-0.06, p=0.01). No significant interaction between MVPA and SB could be discerned. Light Physical activity showed no significant associations with BMI or FMI. When reversing outcome and predictor;higher BMI or FMI showed a negative association with MVPA and a positive association with SB, but no age dependency.Conclusions: More time per day in SB was associated with a higher BMI over the course of five years, whereas higher MVPA had an inverse effect. In a combined model, only effects of higher SB remained significant, emphasizing the importance of SB in obesity prevention. Present bidirectional associations, where lower body size was associated with higher PA and lower SB, indicated the need for an integrated approach of activity and weight control for obesity prevention.Trial registrationClinicalTrials.gov Identifier: NCT00338689. Registered: June 19, 2006 (retrospectively registered)

Rapid growth and childhood obesity are strongly associated with lysoPC(14:0)

BACKGROUND: Despite the growing interest in the early-origins-of-later-disease hypothesis, little is known about the metabolic underpinnings linking infant weight gain and childhood obesity. OBJECTIVE: To discover biomarkers reflective of weight change in the first 6 months and overweight/obesity at age 6 years via a targeted metabolomics approach. DESIGN: This analysis comprised 726 infants from a European multicenter randomized trial (Childhood Obesity Programme, CHOP) for whom plasma blood samples at age 6 months and anthropometric data up to the age of 6 years were available. 'Rapid growth' was defined as a positive difference in weight within the first 6 months of life standardized to WHO growth standards. Weight change was regressed on each of 168 metabolites (acylcarnitines, lysophosphatidylcholines, sphingomyelins, and amino acids). Metabolites significant after Bonferroni's correction were tested as predictors of later overweight/obesity. RESULTS: Among the overall 19 significant metabolites, 4 were associated with rapid growth and 15 were associated with a less-than-ideal weight change. After adjusting for feeding group, only the lysophosphatidylcholine LPCaC14:0 remained significantly associated with rapid weight gain (\u3b2 = 0.18). Only LPCaC14:0 at age 6 months was predictive of overweight/obesity at age 6 years (OR 1.33; 95% CI 1.04-1.69). CONCLUSION: LPCa14:0 is strongly related to rapid growth in infancy and childhood overweight/obesity. This suggests that LPCaC14:0 levels may represent a metabolically programmed effect of infant weight gain on the later obesity risk. However, these results require confirmation by independent cohorts

Effects of infant feeding with goat milk formula or cow milk formula on atopic dermatitis: protocol of the randomised controlled Goat Infant Formula Feeding and Eczema (GIraFFE) trial

Atopic dermatitis (AD) is a chronic, inflammatory skin condition significantly affecting quality of life. A small randomised trial showed an approximately one-third lower incidence of AD in goat milk formula-fed compared with cow milk formula-fed infants. However, due to limited statistical power, AD incidence difference was not found to be significant. This study aims to explore a potential risk reduction of AD by feeding a formula based on whole goat milk (as a source of protein and fat) compared with a formula based on cow milk proteins and vegetable oils. Methods and analysis: This two-arm (1:1 allocation), parallel, randomised, double-blind, controlled nutritional trial shall enrol up to 2296 healthy term-born infants until 3 months of age, if parents choose to start formula feeding. Ten study centres in Spain and Poland are participating. Randomised infants receive investigational infant and follow-on formulas either based on whole goat milk or on cow milk until the age of 12 months. The goat milk formula has a whey:casein ratio of 20:80 and about 50% of the lipids are milk fat from whole goat milk, whereas the cow milk formula, used as control, has a whey:casein ratio of 60:40 and 100% of the lipids are from vegetable oils. The energy and nutrient levels in both goat and cow milk formulas are the same. The primary endpoint is the cumulative incidence of AD until the age of 12 months diagnosed by study personnel based on the UK Working Party Diagnostic Criteria. The secondary endpoints include reported AD diagnosis, measures of AD, blood and stool markers, child growth, sleep, nutrition and quality of life. Participating children are followed until the age of 5 years

Early Influences of Nutrition on Postnatal Growth

Health and nutrition modulate postnatal growth. The availability ofamino acids and energy, and insulin and insulin-like growth factor-I(IGF-I) regulates early growth through the mTOR pathway. Amino acids andglucose also stimulate the secretion of IGF-I and insulin. Postnatalgrowth induces lasting, programming effects on later body size andadiposity in animals and in human observational studies. Rapid weightgain in infancy and the first 2 years was shown to predict increasedobesity risk in childhood and adulthood. Breastfeeding leads to lesserhigh weight gain in infancy and reduces obesity risk in later life byabout 20%, presumably partly due to the lower protein supply with humanmilk than conventional infant formula. In a large randomized clinicaltrial, we tested the hypothesis that reduced infant formula proteincontents lower insulin-releasing amino acid concentrations and therebydecrease circulating insulin and IGF-I levels, resulting in lesser earlyweight gain and reduced later obesity risk (the ‘Early ProteinHypothesis’). The results demonstrate that lowered protein in infantformula induces similar - but not equal - metabolic and endocrineresponses and normalizes weight and BMI relative to breastfed controlsat the age of 2 years. The results available should lead to enhancedefforts to actively promote, protect and support breastfeeding. Forinfants that are not breastfed or not fully breastfed, the use of infantformulas with lower protein contents but high protein quality appearspreferable. Cows’ milk as a drink provides high protein intake andshould be avoided in infancy