Determinants of a dietary pattern linked with greater metabolic risk and its tracking during adolescence

Background: Although growing evidence suggests that dietary patterns associated with noncommunicable diseases in adulthood may develop early in life, when these are established, as well as their determinants, remains unclear. Methods: We examined determinants and tracking of a dietary pattern (DP) associated with metabolic risk and its key food groups among 860 adolescents in the Western Australian Pregnancy (Raine) Cohort study. Food intake was reported using a food frequency questionnaire (FFQ) at 14 and 17 years. Z-scores for an 'energy-dense, high-fat, low-fibre' DP were estimated by applying reduced rank regression at both ages. Tracking was based on the predictive value (PV) of remaining in the DPZ-score or food intake quartile at 14 and 17 years. Early-life exposures included: maternal age; maternal pre-pregnancy body mass index; parent smoking status during pregnancy; and parent socio-economic position (SEP) at 14 and 17 years. Associations between the DPZ-scores, early-life factors and SEP were analysed using regression analysis. Results: Dietary tracking was strongest among boys with high DPZ-scores, high intakes of processed meat, low-fibre bread, crisps and savoury snacks (PV > 1) and the lowest intakes of vegetables, fruit and legumes. Lower maternal education (β = 0.09, P = 0.002 at 14 years; β = 0.14, P < 0.001 at 17 years) and lower maternal age at birth (β = 0.09, P = 0.003 at 14 years; β = 0.11, P = 0.004 at 17 years) were positively associated with higher DPZ-scores. Conclusions: An energy-dense, high-fat, low-fibre dietary pattern tracks more strongly among adolescent boys who have high scores for this pattern at 14 years of age. These findings highlight target foods and population subgroups for early interventions aiming to improve dietary behaviours

Life course dietary patterns and bone health in later life in a British birth cohort study

Evidence for the contribution of individual foods and nutrients to bone health is weak. Few studies have considered hypothesis-based dietary patterns and bone health. We investigated whether a protein, calcium and potassium-rich (PrCaK-rich) dietary pattern over the adult life course, was positively associated with bone outcomes at 60-64 years of age. Diet diaries were collected at ages 36, 46, 53 and 60-64 years in 1263 participants (661 women) from the MRC National Survey of Health and Development. DXA and pQCT measurements were obtained at 60-64y, including size-adjusted bone mineral content (SA-BMC) and volumetric bone mineral density (vBMD). A food-based dietary pattern best explaining dietary calcium, potassium and protein intakes (g/1000?kcal) was identified using reduced rank regression. Dietary pattern z-scores were calculated for each individual, at each time point. Individual trajectories in dietary pattern z-scores were modelled to summarise changes in z-scores over the study period. Regression models examined associations between these trajectories and bone outcomes at 60-64y, adjusting for baseline dietary pattern z-score and other confounders. A consistent PrCaK-rich dietary pattern was identified within the population, over time. Mean [SD] dietary pattern z-scores at age 36 and 60-64 years were -0.32[0.97], 2.2[1.5] (women) and -0.35[0.98], 1.7[1.6] (men). Mean trajectory in dietary pattern z-scores [SD] was 0.07[0.02]SD units/year. Among women, a 0.02 SD unit/year higher trajectory in dietary pattern z-score over time was associated with higher SA-BMC (spine 1.40% [95% CI: 0.30,2.51]; hip 1.35% [95% CI: 0.48,2.23]) and vBMD (radius 1.81% [95% CI: 0.13,3.50]) at 60-64 y. No statistically significant associations were found in men. During adulthood, an increasing score for a dietary pattern rich in protein, calcium and potassium was associated with greater SA-BMC at fracture-prone sites in women. This study emphasises the importance of these nutrients, within the context of the whole diet, to bone healt

The independent prospective associations of activity intensity and dietary energy density with adiposity in young adolescents.

There is limited evidence on the prospective association of time spent in activity intensity (sedentary (SED), moderate (MPA) or vigorous (VPA) physical activity) and dietary intake with adiposity indicators in young people. This study aimed to assess associations between (1) baseline objectively measured activity intensity, dietary energy density (DED) and 4-year change in adiposity and (2) 4-year change in activity intensity/DED and adiposity at follow-up. We conducted cohort analyses including 367 participants (10 years at baseline, 14 years at follow-up) with valid data for objectively measured activity (Actigraph), DED (4-d food diary), anthropometry (waist circumference (WC), %body fat (%BF), fat mass index (FMI), weight status) and covariates. Linear and logistic regression models were fit, including adjustment for DED and moderate-to-vigorous physical activity. Results showed that baseline DED was associated with change in WC (β for 1kJ/g difference: 0·71; 95% CI 0·26, 1·17), particularly in boys (1·26; 95% CI 0·41, 2·16 v. girls: 0·26; 95% CI -0·34, 0·87), but not with %BF, FMI or weight status. In contrast, baseline SED, MPA or VPA were not associated with any of the outcomes. Change in DED was negatively associated with FMI (β for 1kJ/g increase: -0·86; 95% CI -1·59, -0·12) and %BF (-0·86; 95% CI -1·25, -0·11) but not WC (-0·27; 95% CI -1·02, 0·48). Change in SED, MPA and VPA did not predict adiposity at follow-up. In conclusion, activity intensity was not prospectively associated with adiposity, whereas the directions of associations with DED were inconsistent. To inform public health efforts, future studies should continue to analyse longitudinal data to further understand the independent role of different energy-balance behaviours in changes in adiposity in early adolescence.We would like to thank the schools, children and parents for their participation in the SPEEDY study. The SPEEDY study is funded by the National Prevention Research Initiative (http://www.npri.org.uk), consisting of the following Funding Partners: British Heart Foundation; Cancer Research UK; Department of Health; Diabetes UK; Economic and Social Research Council; Medical Research Council; Health and Social Care Research and Development Office for the Northern Ireland; Chief Scientist Office, Scottish Government Health Directorates; Welsh Assembly Government and World Cancer Research Fund. This work was also supported by the Medical Research Council [Unit Programme numbers MC_UU_12015/3; MC_UU_12015/4; MC_UU_12015/7; U105960389] and the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research: Centre of Excellence. Funding from the British Heart Foundation, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. We also thank everyone who helped with the data collection and Norfolk Children’s Services for their invaluable input and support. In addition, we would like to Rebekah Steele, Kate Westgate and Stefanie Mayle from the physical activity technical team at the MRC Epidemiology Unit for their assistance in processing the accelerometer data. No authors declare a conflict of interest.This is the final version of the article. It first appeared from Cambridge University Press via http://dx.doi.org/10.1017/S000711451500509

A prospective investigation of dietary patterns and internalizing and externalizing mental health problems in adolescents

© 2016 The Authors. Food Science & Nutrition published by Wiley Periodicals, Inc.Investigating protective and risk factors that influence mental health in young people is a high priority. While previous cross-sectional studies have reported associations between diet and mental health among adolescents, few prospective studies exist. The aim of this study was to examine prospective relationships between dietary patterns and mental health among adolescents participating in the Western Australian Pregnancy Cohort (Raine) Study. Self-report questionnaires were used to assess indicators of mental health (Youth Self-Report externalizing/internalizing T-scores) and Western and Healthy dietary patterns (identified using factor analysis) at 14 (2003–2005) and 17 years (2006–2008). Multivariate linear and logistic regression were used to assess relationships between dietary patterns and mental health. Complete data were available for 746 adolescents. In females only, the Western dietary pattern z–score at 14 years was positively associated with greater externalizing behaviors at 17 years (ß = 1.91; 95% CI: 0.04, 3.78) and a greater odds of having clinically concerning externalizing behaviors at 17 years (OR = 1.90; 95% CI: 1.06, 3.41). No other statistically significant associations were observed. Overall our findings only lend partial support to a link between diet and mental health. We found it to be specific to females consuming a Western dietary pattern and to externalizing behaviors. Future research on dietary patterns and mental health needs to consider possible sex differences and distinguish between different mental health outcomes as well as between healthy and unhealthy dietary patterns

Adolescent dietary patterns are associated with lifestyle family psycho-social factors

Background/ Objectives: Dietary intake during adolescence contributes to lifelong eating habits and the development of early risk factors for disease in adulthood. Few studies have examined the dietary patterns of adolescents and the social and environmental factors that may affect them during this life stage. The present study describes dietary patterns in a cohort of adolescents and examines their associations with socioeconomic factors, as well as parental and adolescent risk factor behaviours. Design: A semi quantitative FFQ was used to assess study adolescents’ usual dietary intake over the previous year. Information was collected on family functioning and various socio economic and risk factor variables via questionnaire. Adolescents visited the clinic for anthropometric measurements. Setting: The Western Australian Pregnancy Cohort Study (Raine Study), Perth, Western Australia. Subjects: Adolescents (n 1631) aged 14 years from a pregnancy cohort study. Results: Factor analysis identified two distinct dietary patterns that differed predominantly in fat and sugar intakes. The ‘Western’ pattern consisted of high intakes of take away foods, soft drinks, confectionery, French fries, refined grains, full fat dairy products and processed meats. The ‘Healthy’’ pattern included high intakes of whole grains, fruit, vegetables, legumes and fish. ANOVA showed that the ‘Western’ dietary pattern was positively associated with greater television viewing and having a parent that smoked, and was inversely associated with family income. The ‘Healthy’’ pattern was positively associated with female gender, greater maternal education, better family functioning and being in a two parent family, and was inversely associated with television viewing. Conclusions: This study suggests that both lifestyle factors and family psycho social environment are related to eating patterns in Australian adolescents

Plasma retinol, carotene and vitamin E concentrations and lung function in a crocidolite-exposed cohort from Wittenoom, Western Australia: a cohort study

BACKGROUND: Increased rates of death from asbestos related diseases have been reported for people previously employed in the mining and milling operations at Wittenoom (Western Australia), and people who lived in the nearby town, where they were environmentally exposed to crocidolite. METHODS: Annual measurements of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) and plasma concentrations of retinol, carotene and vitamin E have been made since 1992. Mixed effects models were used to examine the associations between lung function and the plasma vitamin levels of retinol, carotene and vitamin E. RESULTS: After adjusting for potential confounders, higher plasma retinol and carotene concentrations were significantly associated with higher levels of lung function at entry into the study, while vitamin E concentrations were associated with lower entry lung function. Retinol was associated with a less steep decline of lung function over time, while carotene concentrations were associated with an increased decline of lung function over time and vitamin E levels were not associated with changes of lung function over time. CONCLUSION: These results support a beneficial relationship between plasma concentrations of retinol on the levels and rates of change of lung function, while showing no such consistent beneficial effect for plasma levels of beta-carotene or vitamin E

Sources and pattern of protein intake and risk of overweight or obesity in young UK twins

High protein intake in young children is associated with excess gains in weight and body fat, but the specific role of different protein sources has yet to be described. The study aimed to investigate the role of different types of protein in the post-weaning stage on weight, BMI and overweight/obesity at 60 months. Intakes of animal, dairy and plant protein and a dietary pattern characterising variation in protein types at 21 months of age were estimated using a 3-d diet diary in a cohort of 2154 twins; weight and height were recorded every 3 months from birth to 60 months. Longitudinal mixed-effect models investigated the associations between sources of protein intake or dietary pattern scores and BMI, weight and overweight/obesity from 21 months up to 60 months. Adjusting for confounders, dairy protein intake at 21 months was positively associated with greater weight (46 (95 % CI 21, 71) g and BMI up to 60 months (0·04 (95 % CI 0·004, 0·070) kg/m2) and the odds of overweight/obesity at 3 years (OR 1·12; 95 % CI 1·00, 1·24). Milk showed associations of similar magnitude. A dietary pattern low in dairy protein and high in plant protein was associated with lower weight gain up to 60 months, but not overweight/obesity. Intake of dairy products in early childhood is most strongly associated with weight gain, compared with other protein sources. A dietary pattern characterised by lower protein intake and greater protein source diversity at 2 years may confer a lower risk of excess weight gain

Greater improvements in diet quality among overweight participants following a group-based commercial weight loss programme than those receiving support to lose weight in primary care.

BACKGROUND: Relatively little is known about dietary changes and their relationships with weight change during behavioural weight loss interventions. In a secondary analysis of data from a multicentre RCT, we investigated whether greater improvements in diet would be achieved by overweight adults following a 12 month group-based commercial weight loss programme (CP) than those receiving standard care (SC) in primary practice, and if these dietary changes were associated with greater weight loss. METHODS: Adults with a BMI 27-35 kg/m2 and >1 risk factor for obesity-related disorders were recruited in study centres in Australia and the UK during 2007-2008. Dietary intake and body weight were measured at baseline, 6 and 12 months. Linear mixed effects models compared mean changes in dietary macronutrient intake, fibre density and energy density over time between groups, and their relationships with weight loss. RESULTS: The CP group demonstrated greater mean weight loss than the SC group at 6 months (3.3 kg, 95% CI: 2.2, 4.4) and 12 months (3.3 kg, 95% CI: 2.1, 4.5). Diet quality improved in both intervention groups at 6 and 12 months. However, the CP group (n = 228) achieved significantly greater mean reductions in energy intake (mean difference; 95% CI: - 503 kJ/d; - 913, - 93), dietary energy density (- 0.48 MJ/g; - 0.81, - 0.16), total fat (- 6.9 g/d; - 11.9, - 1.8), saturated fat (- 3.3 g/d; - 5.4, - 1.1), and significantly greater mean increases in fibre density (0.30 g/MJ; 0.15, 0.44) at 6 months than the SC group (n = 239). Similar differences persisted at 12 months and the CP group showed greater mean increases in protein density (0.65 g/MJ). In both groups, weight loss was associated with increased fibre density (0.68 kg per g/MJ, 95% CI: 0.08, 1.27) and protein density (0.26 kg per g/MJ, 95% CI: 0.10, 0.41). CONCLUSIONS: Following a group-based commercial program led to greater improvements in diet quality than standard care. Increases in dietary protein and fibre density were independently associated with weight loss in both behavioural weight loss interventions. Greater increases in protein and fibre density in the commercial program likely contributed to their greater weight loss. TRIAL REGISTRATION: ISRCTN: ISRCTN85485463 Registered 03/08/2007 Retrospectively Registered

Dietary patterns and markers for the metabolic syndrome in Australian adolescents

Background and Aims: Overweight and other risk factors for cardiovascular disease (CVD) as well as their clustering, or the metabolic syndrome, are increasingly prevalent among children and adolescents. We examined dietary patterns, CVD risk factors, and the clustering of these risk factors, in 1139 14 year olds living in Western Australia. Methods and Results: Usual dietary intake was assessed with a food frequency questionnaire. Two dietary patterns, ‘Western’ and ‘Healthy’, were identified using factor analysis. Associations between these dietary patterns and BMI, waist circumference, systolic blood pressure, fasting levels of serum glucose, insulin, total cholesterol, HDL C, LDL C, triglycerides and insulin resistance were assessed using ANOVA. Cluster analysis identified a high risk group (the “high risk metabolic cluster’) with features akin to adult metabolic syndrome. Belonging to the high risk metabolic cluster was examined in relation to dietary patterns using logistic regression, adjusting for aerobic fitness and socio demographic factors. Higher ‘Western’ dietary pattern scores were associated with greater odds for the ‘high risk metabolic cluster’ (p for trend =0.02) and greater mean values for total cholesterol (p for trend=0.03), waist circumference (p for trend=0.03) and BMI (p for trend =0.02) in girls, but not boys. Scores for the ‘Healthy’ dietary pattern were not related to the ‘high risk metabolic cluster but were inversely associated with serum glucose in boys and girls (p for trend=0.01 and 0.04, respectively) and were positively associated with HDL C in boys (p for trend=0.02). Conclusions: Dietary patterns are associated with CVD risk factors and the clustering of these risk factors in adolescence

Free Sugars and Total Fat Are Important Characteristics of a Dietary Pattern Associated with Adiposity across Childhood and Adolescence

Background The importance of dietary sugar versus fat in the development of obesity is currently a topic of debate. Objective We aimed to identify dietary patterns (DPs) characterized by high sugar and/or high fat content and their longitudinal associations with adiposity during childhood and adolescence. Methods Participants were 6722 children from the Avon Longitudinal Study of Parents and Children (born 1991-92). DPs were characterized by % total energy intake (%E) from free sugars, %E from total fat, dietary energy density (DED) and fiber density, using reduced rank regression at 7, 10 and 13 years of age. Total body fat mass was measured at 11, 13 and 15 years of age. Regression analyses adjusted for dietary misreporting, physical activity and maternal class. Results Two major DPs were identified: higher z scores for DP1 were associated with greater DED, %E from sugars and fat, and lower fiber density; higher z scores for DP2 were associated with greater %E from sugars but lower %E from fat and DED. A 1 SD increase in z score for DP1 was associated with a mean increase in fat mass index z score of 0.04 SD units (95%CI 0.01, 0.07; P=0.017) and greater odds of excess adiposity (OR:1.12, 95%CI: 1.0, 1.25; P=0.038). DP2 was not associated with adiposity. Conclusions An energy-dense DP high in %E from fat and sugars is associated with greater adiposity in childhood and adolescence. This confirms the role of both fat and sugar and provides a basis for food based dietary guidelines to prevent obesity in children.</p