Sweet treat consumption in school-aged children : Relationships to excess weight, dental caries and saliva microbiota

Globally excess weight and dental caries are highly prevalent chronic conditions both in children and adults, suggested as sharing risk factors, amongst them dietary sugar. Notably, sugar intake in children and adolescents appears high in many developed countries. The oral microbiota – that is, the microbial communities in the oral cavity – contribute to oral health as well as contributing to systemic health, and changes to the saliva microbiota might depend upon sugar consumption. This doctoral thesis aimed to 1) examine the relationship between the consumption frequency of foods and drinks generally high in added sugar (‘sweet treats’) and the risk of excess weight, 2) examine changes in sweet treat consumption patterns during early adolescence and whether these changes associate with changes in weight status and central obesity or the risk of developing excess weight or central obesity, 3) examine the relationship of sweet treat consumption frequency and other dietary factors to the risk of caries experience and 4) assess the diversity, composition and functional capacities of the saliva microbiota in children with low and high frequency levels of sweet treat consumption. The studies in this doctoral thesis consist of four original research publications and utilise material from the Finnish Health in Teens (Fin-HIT) study. The Fin-HIT is an ongoing prospective cohort of over 11 000 children aged mostly 9–12 years at enrolment. Baseline data collection was conducted between 2011 and 2014, and children were followed for nearly three years. Study I (n = 8461), study III (n = 6660) and study IV (n = 453) utilised cross-sectional data, whereas study II (n = 4237) was longitudinal. The research data includes self-reported questionnaire data on the consumption of indicative food items and other lifestyle factors, measured and self-reported anthropometrics as well as saliva samples. Sweet treats consisted of chocolate and sweets, sweet pastries, biscuits and cookies, ice cream, sugary soft drinks and sugary juice drinks. A sweet treat index (STI) was calculated to indicate the sum of the weekly consumption frequencies of sweet treats. Based on the STI and change in STI, children fell into low, medium and high as well as decreased, stable and increased STI groups, respectively. Weight status was defined as thin, normal weight, overweight or obese (that is, excess weight) using age- and sex-specific cut-offs, and as without central obesity and with central obesity based on the waist–height ratio (WHtR). The decayed, missing and filled teeth (DMFT) index for permanent teeth was used to indicate a history of cavitated caries lesions (caries experience). The saliva microbiota was characterised using 16S rRNA gene sequencing. We performed statistical analyses using the chi-square test, t-test, analysis of variance (ANOVA), logistic regression, Cox regression, permutational multivariate analysis of variance (PERMANOVA) and general linear model. Less than one in six children had excess weight. Children with a low consumption frequency of sweet treats were at an increased risk of having excess weight, whereas children with a high consumption were at an increased risk of thinness. On average, STI decreased during early adolescence, although the consumption frequency of chocolate and sweets increased in girls and boys, and that of sugar-sweetened soft drinks increased in boys. Similarly, decreasing trends in the mean STI were observed in groups of children who developed excess weight or central obesity. A decrease in the STI was associated with the risk of developing excess weight. Two-thirds of children had no caries experience. A high sweet treat consumption associated with an increased risk of a caries experience, whilst a low consumption associated with a decreased risk. Diversity in the saliva microbiota did not differ between a low and high sweet treat consumption, although differences in the composition and functional capacities were observed; several bacterial genera were differentially abundant, and pathways relating to nitrate reduction and gondoate biosynthesis were enriched in the saliva of children with the highest consumption frequency of sweet treats. The highest consumption frequency of sweet treats did not associate with excess weight cross-sectionally nor longitudinally, suggesting that sugary product consumption alone may not be relevant as a target of obesity prevention programmes amongst school-aged children. Although the overall sweet treat consumption frequency decreased during early adolescence, the increase in the consumption frequency of chocolate and sweets and sugary soft drinks requires attention. Specifically, we observed differences between girls’ and boys’ consumption patterns. A high consumption frequency of sweet treats associated positively with the risk of caries experience, highlighting the need to focus on sugar consumption to prevent caries even in an affluent Nordic country. Moreover, findings regarding the different saliva microbiota profiles in children with the lowest and highest sweet treat consumption frequencies can be utilised in future studies to further our knowledge about the influence of sugary diets on the saliva microbiota and, consequently, on oral and systemic health.Ylipaino ja hampaiden reikiintyminen eli karies ovat hyvin yleisiä kroonisia terveyshaasteita sekä lapsilla että aikuisilla ympäri maailman. Yhtenä niiden yhteisenä riskitekijänä on pidetty runsasta sokerinkäyttöä. Lasten ja nuorten liiallista sokerinsaantia on raportoitu useissa kehittyneissä maissa. Suun mikrobisto eli suussa elävät mikrobiyhteisöt osallistuvat sekä suun että koko elimistön terveyden ylläpitoon, ja sokerinkäyttö saattaa muokata syljen mikrobistoa. Tämän väitöskirjan tavoitteena oli 1) tutkia sokeristen ruokien ja juomien eli ns. makeiden herkkujen käyttötiheyden yhteyttä ylipainon riskiin kouluikäisillä lapsilla, 2) selvittää, muuttuuko lasten makeiden herkkujen käyttötiheys varhaisessa nuoruusiässä ja onko muutos yhteydessä painoindeksin ja pituus-vyötärösuhteen muutoksiin tai ylipainon tai keskivartalolihavuuden kehittymiseen, 3) tutkia makeiden herkkujen käyttötiheyden sekä muiden ruokavaliotekijöiden yhteyttä karieksen riskiin, ja 4) tutkia, eroaako syljen mikrobiston monimuotoisuus, koostumus ja toiminnallinen potentiaali lapsilla makeiden herkkujen käyttötiheyden mukaan. Väitöstutkimus koostuu neljästä osatyöstä, jotka pohjautuvat Hyvinvointi Teini-iässä (Fin-HIT) -tutkimuksen aineistoon. Fin-HIT on seurantatutkimus, johon kuuluu yli 11 000 lasta ympäri Suomen. Lapset olivat pääasiallisesti 9–12-vuotiaita osallistuessaan tutkimuksen ensimmäiseen vaiheeseen vuosina 2011–2014. Seuraavan kerran lapsilta kerättiin tietoa keskimäärin kolme vuotta myöhemmin. Osatyö I (n = 8461), osatyö III (n = 6660) ja osatyö IV (n = 453) ovat poikkileikkaustutkimuksia, kun taas osatyö II hyödynsi pitkittäisasetelmaa. Aineisto sisälsi itseraportoitua kyselytietoa ruoankäytöstä ja muista elintavoista, tutkimushenkilöstön mittaamia sekä itseraportoituja antropometrisiä mittoja ja sylkinäytteen. Pääaltiste herkkuindeksi (sweet treat index, STI) muodostettiin laskemalla yhteen makeiden herkkujen (=suklaa ja makeiset, makeat leivonnaiset, keksit, jäätelö, sokeroidut virvoitusjuomat ja sokeroidut mehut) viikoittaiset käyttötiheydet. Herkkuindeksin perusteella lapset luokiteltiin matalan, keskimmäisen ja korkean käytön sekä pienentyneen, stabiilin ja lisääntyneen käytön ryhmiin. Ikä- ja sukupuolivakioidun painoindeksin (BMI) perusteella lapset ryhmiteltiin ali-, normaali- tai vähintään ylipainoisiksi, sekä vyötärö-pituussuhteen perusteella niihin, joilla ei ollut keskivartalolihavuutta ja niihin, joilla oli keskivartalolihavuutta. Kariesta mitattiin DMFT-indeksillä (engl. decayed, missing or filled teeth eli reikiintynyt, poistettu tai paikattu hammas), jonka perusteella lapset luokiteltiin niihin, joilla ei ole ollut hoitoa vaativaa kariesta pysyvissä hampaissa ja niihin, joilla oli. Syljen mikrobisto sekvensoitiin käyttäen 16S rRNA-geenimenetelmää. Työssä käytettiin seuraavia tilastollisia menetelmiä: khiin neliötesti, t-testi, varianssianalyysi, logistinen regressio, Coxin regressio ja yleistetty lineaarinen malli. Ylipainoa esiintyi alle kuudesosalla lapsista. Matala herkkuindeksi oli yhteydessä ylipainon riskiin, kun taas korkea indeksi alipainon riskiin. Makeiden herkkujen yhteenlaskettu käyttötiheys keskimäärin pieneni seurannan aikana, mutta sokeristen virvoitusjuomien käyttötiheys suureni pojilla ja suklaan ja makeisten käyttötiheys suureni sekä tytöillä että pojilla. Korkean herkkuindeksin yhteyttä BMI:n tai vyötärö-pituussuhteen muutoksiin ei havaittu. Herkkuindeksin pieneneminen oli yhteydessä suurentuneeseen ylipainon kehittymisen riskiin. Kahdella kolmasosalla lapsista ei ollut kariesta. Korkea herkkuindeksi oli yhteydessä suurentuneeseen karieksen riskiin, kun taas matala herkkuindeksi yhdistyi pienentyneeseen riskiin. Syljen mikrobiston monimuotoisuus ei eronnut matalimman ja korkeimman käyttötiheyden ryhmien välillä, kun taas mikrobiston koostumuksessa ja toiminnallisessa potentiaalissa havaittiin eroja: useiden bakteerien runsaus erosi ryhmien välillä, ja lisäksi korkean käyttötiheyden ryhmässä nitraatin pelkistykseen ja gondoaatin biosynteesiin liittyvät aineenvaihduntareitit olivat aktivoituneempia kuin matalan käyttötiheyden ryhmässä. Makeiden herkkujen korkein käyttötiheys tai käytön tihentyminen ei ollut yhteydessä ylipainon tai sen kehittymisen riskiin. Täten kouluikäisten lasten ylipainon ehkäisyssä ei kannattane keskittyä pelkästään sokeristen tuotteiden käyttöön. Vaikka makeiden herkkujen kokonaiskäyttötiheys pieneni seurannan aikana, suklaan, makeisten ja virvoitusjuomien käyttötiheys lisääntyi. Tyttöjen ja poikien käyttötottumusten välillä havaittiin eroja. Makeiden herkkujen korkein käyttötiheys yhdistyi suurentuneeseen kariesriskiin, mikä kielii siitä, että rajoittamalla sokeristen tuotteiden käyttötiheyttä voidaan edistää hammasterveyttä. Syljen mikrobistoa koskevia löydöksiä voidaan hyödyntää tulevien tutkimusten kohdentamiseksi, jotta saadaan lisää tietoa sokeristen ruokavalioiden vaikutuksesta syljen mikrobistoon ja sitä kautta suun ja koko elimistön terveyteen

Frequent use of selected sugary products associates with thinness, but not overweight during preadolescence : a cross-sectional study

Convincing evidence suggests that diets laden with added sugar, specifically sugar-sweetened beverages, associate with excess weight in children. The relationships between sugar consumption frequency and BMI remain less well studied. We, therefore, evaluated children's consumption frequency of selected sugary products (n8461; mean age 11 center dot 1 (sd0 center dot 9) years) selected from the Finnish Health in Teens cohort study. Using a sixteen-item FFQ including six sugary products (chocolate/sweets, biscuits/cookies, ice cream, sweet pastry, sugary juice drinks and sugary soft drinks), we calculated a Sweet Treat Index (STI) for the frequency of weekly sugary product consumption and categorised children based on quartiles (Q) into low (Q1, cut-off 10 center dot 5), and as thin, normal and overweight/obese based on the measured BMI. Through multinomial logistic regression analyses, we found that subjects with a high STI exhibited a higher risk of being thin (OR 1 center dot 20, 95 % CI 1 center dot 02, 1 center dot 41) and lower risk of being overweight (OR 0 center dot 79, 95 % CI 0 center dot 67, 0 center dot 92), while subjects with a low STI were at higher risk of being overweight (OR 1 center dot 32, 95 % CI 1 center dot 14, 1 center dot 53). High consumption frequencies of salty snacks, pizza and hamburgers most closely were associated with a high STI. Our findings suggest that consuming sugary products at a high frequency does not associate with being overweight. The relationship between a low consumption frequency and being overweight suggests that overweight children's consumption frequency of sugary products may be controlled, restricted or underreported.Peer reviewe

Children’s Eating Attitudes Test (ChEAT) : a validation study in Finnish children

Purpose To validate the Children's Eating Attitudes Test (ChEAT) in the Finnish population. Materials and methods In total 339 children (age 10-15 years) from primary schools in Southern Finland were evaluated at two time points. They answered the ChEAT and SCOFF test questions, and had their weight, height and waist circumference measured. Retesting was performed 4-6 weeks later. Test-retest reliability was evaluated using intra-class correlation (ICC), and internal consistency was examined using Cronbach's alpha coefficient (C-alpha). ChEAT was cross-calibrated against SCOFF and background variables. Factor analysis was performed to examine the factor structure of ChEAT. Results The 26-item ChEAT showed high internal consistency (C-alpha 0.79), however, a 24-item ChEAT showed even better internal consistency (C-alpha 0.84) and test-retest reliability (ICC 0.794). ChEAT scores demonstrated agreement with SCOFF scores (p <0.01). The mean ChEAT score was higher in overweight children than normal weight (p <0.001). Exploratory factor analysis yielded four factors (concerns about weight, limiting food intake, pressure to eat, and concerns about food), explaining 57.8% of the variance. Conclusions ChEAT is a valid and reliable tool for measuring eating attitudes in Finnish children. The 24-item ChEAT showed higher reliability than the 26-item ChEAT.Peer reviewe

Central obesity in school-aged children increases the likelihood of developing paediatric autoimmune diseases

Background The incidences of both paediatric obesity and autoimmune diseases have been increasing, but their relationship with one another is unclear. Objective To determine whether obesity or particular dietary patterns in school-aged children are potential risk factors for autoimmune diseases during adolescence. Methods This matched case-control study included 525 children, followed up from a median age of 11.3 to 16.7 years. Of them, 105 children received primary autoimmune diagnoses (diabetes, thyroiditis, arthritis, or inflammatory bowel diseases) after baseline and generated the case group. Four children with matching age, sex, and residential area generated the control group of 420 children. At baseline, age- and sex-specific body mass index categories were acquired and waist-to-height ratio (WHTR) was calculated. Central obesity was present when WHTR >= 0.5. Dietary patterns were analysed using a food frequency questionnaire (FFQ). Results School-aged children with central obesity were 2.11 (OR, 95% CI 1.11-3.98) times more likely to develop autoimmune diseases before age of 19 years than those without central obesity. Being overweight was not related to the onset of these diseases (OR 1.60, 95% CI 0.89-2.87, nor were dietary patterns. Conclusion Central obesity in school-aged children was related to the development of autoimmune diseases, while being overweight and dietary patterns were not.Peer reviewe

High abundance of sugar metabolisers in saliva of children with caries

Dental caries is a biofilm-mediated, dynamic disease with early onset. A balanced salivary microbiota is a foundation of oral health, while dysbiosis causes tooth decay. We compared the saliva microbiota profiles in children with and without caries. The study consisted of 617 children aged 9-12 years from the Finnish Health in Teens (Fin-HIT) study with available register data on oral health. Caries status was summarised based on Decayed, Missing, and Filled Teeth (DMFT) index in permanent dentition. The children were then classified into the following two groups: DMFT value >= 1 was considered as cavitated caries lesions (hereafter called 'caries') (n=208) and DMFT=0 as 'cavity free' (n=409). Bacterial 16S rRNA gene (V3-V4 regions) was amplified using PCR and sequenced by Illumina HiSeq. The mean age (SD) of the children was 11.7 (0.4) years and 56% were girls. The children had relatively good dental health with mean DMFT of 0.86 (1.97). Since sex was the key determinant of microbiota composition (p=0.014), we focused on sex-stratified analysis. Alpha diversity indexes did not differ between caries and cavity free groups in either sexes (Shannon: p=0.40 and 0.58; Inverse Simpson: p=0.51 and 0.60, in boys and girls, respectively); neither did the composition differ between the groups (p=0.070 for boys and p=0.230 for girls). At the genus level, Paludibacter and Labrenzia had higher abundances in the caries group compared to cavity free group in both sexes (pPeer reviewe

Prevalence of Thinness, Overweight, Obesity, and Central Obesity in Finnish School-Aged Children : A Comparison of National and International Reference Values

Introduction: The global epidemic of obesity concerns children, and monitoring the prevalence is of highest priority. Body mass index (BMI) with age- and sex-specific cutoff values determines weight status in children, although multiple reference systems exist. Our aim was to compare the prevalence for thinness, normal weight, overweight, and obesity in Finnish school-aged children according to national and international reference values, as well as to determine which cutoff values for overweight agree with the criteria for central obesity. Methods: This study includes 10,646 children aged 9-12 years from the Finnish Health in Teens cohort. Height, weight, and waist circumference were measured in 2011-2014. BMI (weight [kg]/height [m](2)) and the waist-to-height ratio (WHtR; waist [cm]/height [cm]) were calculated. The WHtR cutoff of >0.5 indicated central obesity. We compared the sex-specific prevalence of thinness, overweight, and obesity using the International Obesity Task Force (IOTF), World Health Organization (WHO) and Finnish (FIN) BMI-for-age reference values, as well as these three against central obesity based on the WHtR. Results: The prevalence of thinness, overweight, and obesity were 11.0%, 12.7%, and 2.6%, respectively, using IOTF; 2.6%, 15.9%, and 5.2% using WHO; and 5.1%, 11.4%, and 2.2% using FIN. Overweight and obesity were more common in boys than girls using WHO and FIN, while thinness was more common in girls using IOTF and FIN. IOTF versus WHO exhibited moderate agreement (kappa = 0.59), which improved for IOTF versus FIN (kappa = 0.74). Of those classified as overweight by WHO, 37% and 47% were regarded as normal weight according to IOTF and FIN, respectively. The prevalence of central obesity was 8.7%, and it was more common in boys than girls. WHO provided the highest sensitivity: 95% of individuals with central obesity were classified with overweight or obesity. Using FIN provided the highest specificity (93%). Conclusion: Our findings show that WHO overestimates the prevalence of overweight and obesity, while IOTF overrates thinness. Thus, comparing prevalence rates between studies requires caution. The novelty of this study is the comparison of the cutoff values for overweight with central obesity. The choice of reference system affects the generalizability of the research results. (C) 2021 The Author(s) Published by S. Karger AG, BaselPeer reviewe

The Composition and Functional Capacities of Saliva Microbiota Differ Between Children With Low and High Sweet Treat Consumption

Excess sugar consumption—common in youth—is associated with poor health. Evidence on the relationship between sugar consumption and the oral microbiome, however, remains scarce and inconclusive. We explored whether the diversity, composition, and functional capacities of saliva microbiota differ based on the consumption of select sugary foods and drinks (“sweet treats”). Using 16S rRNA gene sequencing, we characterized saliva microbiota from 11 to 13-year-old children who participated in the Finnish Health in Teens (Fin-HIT) cohort study. The sample comprised children in the lowest (n = 227) and highest (n = 226) tertiles of sweet treat consumption. We compared differences in the alpha diversity (Shannon, inverse Simpson, and Chao1 indices), beta diversity (principal coordinates analysis based on Bray–Curtis dissimilarity), and abundance (differentially abundant operational taxonomic units (OTUs) at the genus level) between these low and high consumption groups. We performed PICRUSt2 to predict the metabolic pathways of microbial communities. No differences emerged in the alpha diversity between low and high sweet treat consumption, whereas the beta diversity differed between groups (p = 0.001). The abundance of several genera such as Streptococcus, Prevotella, Veillonella, and Selenomonas was higher in the high consumption group compared with the low consumption group following false discovery rate correction (p < 0.05). Children with high sweet treat consumption exhibited higher proportions of nitrate reduction IV and gondoate biosynthesis pathways compared with the low consumption group (p < 0.05). To conclude, sweet treat consumption shapes saliva microbiota. Children who consume a high level of sweet treats exhibited different compositions and metabolic pathways compared with children who consume low levels of sweet treats. Our findings reveal novel insights into the relationship between sugary diets and oral microbiota.Peer reviewe

Ahmintahäiriö ja ahmintaoireet nuorilla suomalaisilla kaksosilla FinnTwin16-aineistossa

Johdanto: Ahmintahäiriö on syömishäiriö, jonka oireita ovat toistuvat ahmintakohtaukset. Niiden aikana syödään suuri määrä ruokaa lyhyessä ajassa ja menetetään syömisen hallinta. Tyypillistä on, että ahmija syö pitkin päivää, eikä syömiseen välttämättä liity nälkää. Koska ahminta tuottaa häpeää, ahmija syö yksin. Ahmintaan liittyy itsehalveksunnan ja syyllisyyden tunteita, ja se aiheuttaa voimakasta ahdistuneisuutta. Ahmintahäiriöön ei kuulu tyhjentäytymistä tai muita kompensaatiokeinoja painonnousun estämiseksi kuten bulimia nervosassa. Ahmintahäiriö voi johtaa lihavuuteen, joka on riskitekijä mm. tyypin 2 diabetekselle. Tavoite: Ahmintahäiriön ja ahmintaoireiden esiintyvyydestä suomalaisilla nuorilla naisilla ja miehillä ei ole tietoa. Tämän tutkimuksen tavoitteena oli selvittää, miten yleisiä ahmintahäiriö ja ahmintaoireet ovat tutkittavassa aineistossa oirekyselyn (Eating Disorder Inventory, EDI) ja puolistrukturoidun haastattelun (Semistructured Clinical Interview, SCID) perusteella. Lisäksi selvitettiin masennuksen ja muiden syömishäiriöiden esiintyvyyttä sekä lihavuuden tai ylipainon riskiä ahmintahäiriöisillä naisilla. Samalla selvitettiin diagnostisten tunnuslukujen avulla EDI-oirekyselyn soveltuvuutta ahmintahäiriön tunnistamiseen riskiryhmistä. Aineisto ja menetelmät: Nuorten Kaksosten Terveystutkimuksen (FinnTwin16) osanottajat eli Suomessa vuosina 1975‒ 1975 syntyneet kaksoset (N=5258, 2835 naista, 2423 miestä, vastausprosentti naisilla 87 ja miehillä 83) täyttivät syömishäiriöitä seulovan kyselylomakkeen, joka sisälsi kysymyksiä painosta ja syömiskäyttäytymisestä sekä syömishäiriöiden oireita mittaavan EDI-osion. Seulontapositiiviset naiset, heidän kaksossiskonsa ja satunnaisotos seulontanegatiivisia naisia kutsuttiin puhelinhaastatteluun, jossa diagnosoitiin puolistrukturoidun SCID-haastattelun avulla anoreksia nervosa, bulimia nervosa, ahmintahäiriö ja masennus DSM-IV-tautiluokituskriteereihin perustuen. Miehiä ei haastateltu. Epidemiologisten tunnuslukujen ja logistisen regression avulla kuvattiin ahmintahäiriön ja ahmintaoireiden esiintyvyyttä ja ahmintahäiriön kliinistä kuvaa. Lisäksi EDI-kyselyn soveltuvuutta ahmintahäiriön tunnistamiseen riskiryhmistä selvitettiin herkkyyden ja tarkkuuden receiver operator curve (ROC) -analyysin avulla. Tulokset: Haastattelun perusteella 15 naista sai ahmintahäiriön DSM-IV-diagnoosin (esiintyvyys 0,5 %, ilmaantuvuus 30/100000 henkilövuotta). Muu syömishäiriötausta ahmintahäiriöisillä oli epätavallinen, mutta masennusta esiintyi noin kolmanneksella. Ahmintahäiriöisillä naisilla oli yli 10-kertainen riski (95 %:n luottamusväli 3,0–35,0) ylipainoon tai lihavuuteen (painoindeksi > 25kg/m2) verrattuna kohortin terveisiin. Yksittäisistä ahmintaoireista naisilla yleisimmät olivat tunnen syyllisyyttä ylensyötyäni (20 %), ahdan itseni täyteen ruokaa (13 %) ja syön silloin, kun olen poissa tolaltani (13 %). Miehillä yleisin ahmintaoire oli ahdan itseni täyteen ruokaa (17 %). Paras ahmintahäiriön seula ROC-analyysin perusteella oli EDI:n kolmen ala-asteikon kokonaispistemäärä (AUC-arvo 0,9, herkkyys 86 % ja tarkkuus 82 %). Johtopäätökset: Tulosten perusteella ahmintahäiriö oli harvinainen naiskaksosilla, mutta erilaiset ahmintaoireet olivat melko yleisiä sekä naisilla että miehillä. Masennuksen esiintyvyys sekä lihavuuden tai ylipainon riski ahmintahäiriöisillä olivat suurempia kuin terveillä. EDI-kysely soveltui hyvin ahmintahäiriön seulomiseen. Ahmintahäiriön matalan esiintyvyyden ja EDI-kyselyn seulontaominaisuuksien takia ahmintahäiriön seulominen kannattaa keskittää tiettyihin riskiryhmiin kuten masentuneet tai ylipainoiset nuoret naiset. Ravitsemusepidemiologisesta näkökulmasta ahmintahäiriön ja ahmintaoireilun välinen raja voidaan nähdä liian tiukkana, sillä ahminnan terveydelle aiheuttamia epäedullisia vaikutuksia esiintyy epäilemättä jo paljon ennen varsinaista ahmintahäiriödiagnoosia. Ahmintahäiriön tunnistaminen ja ehkäisy varhaisessa vaiheessa on tärkeää, jotta sen aiheuttamia terveyshaittoja voidaan ehkäistä

Sex- and weight-specific changes in the frequency of sweet treat consumption during early adolescence : a longitudinal study

The transition from childhood to adolescence is a sensitive period, triggering changes in health- and weight-related behaviours including eating habits which likely vary between girls and boys. We aimed to characterise the changes in the frequency of consumption of select sugary foods and drinks ('sweet treats') among 4237 Finnish girls and boys during a 2-year follow-up period. Additionally, we examined four subgroups: children whose weight or waist normalised as well as children whose weight or waist circumference increased during follow-up. An FFQ was completed at 11 center dot 1 (sd 0 center dot 9) and again at 13 center dot 4 (sd 1 center dot 1) years of age. A sum variable sweet treat index (STI, range 0-84) captured the weekly consumption frequencies of sweet treats. From baseline to follow-up, the mean STI decreased among girls from 7 center dot 1 (95 % CI 6 center dot 9, 7 center dot 3) to 6 center dot 0 (95 % CI 5 center dot 9, 6 center dot 2) (P < 0 center dot 001) and boys from 8 center dot 5 (95 % CI 8 center dot 3, 8 center dot 8) to 7 center dot 8 (95 % CI 7 center dot 6, 7 center dot 8) (P < 0 center dot 001), although both sexes increased their chocolate/sweets consumption: girls from 1 center dot 3 (95 % CI 1 center dot 3, 1 center dot 4) to 1 center dot 6 (95 % CI 1 center dot 5, 1 center dot 6) (P < 0 center dot 001) and boys from 1 center dot 4 (95 % CI 1 center dot 3, 1 center dot 4) to 1 center dot 6 (95 % CI 1 center dot 6, 1 center dot 7) (P < 0 center dot 001), and boys increased their soft drink consumption from 1 center dot 4 (95 % CI 1 center dot 3, 1 center dot 4) to 1 center dot 5 (95 % CI 1 center dot 4, 1 center dot 5) (P = 0 center dot 020). We found similar decreases in both the weight and waist subgroups. To conclude, the total frequency of consumption of sweet treats decreased during early adolescence. A similar trend across subgroups suggests that the frequency of consumption of sweet treats is unrelated to becoming overweight.Peer reviewe

Delayed bedtime on non-school days associates with higher weight and waist circumference in children : Cross-sectional and longitudinal analyses with Mendelian randomisation

Sleep duration has been linked with obesity in population-based studies. Less is known about bedtimes and, especially, if discrepancy between bedtimes on school and non-school days associate with adiposity in children. The associations of self-reported bedtimes with the body mass index z-score (BMIz) and waist-to-height ratio (WtHr) were examined among children with a mean (SD) age of 11.2 (0.85) years in cross-sectional (n = 10,245) and longitudinal (n = 5085) study settings. The causal relationship of whether BMIz contributes to bedtimes, was further examined in a subset of 1064 participants by exploiting Mendelian randomisation (MR). After adjusting for sleep duration and other confounders, every 0.5 h later bedtime on non-school nights and a delay in bedtime in non-school nights compared with school nights associated with 0.048 (95% CI 0.027; 0.069) and 0.08 (95% CI 0.056; 0.105) higher BMIz as well as 0.001 (95% CI 0; 0.002) and 0.004 (95% CI 0.003; 0.005) with higher WtHr, respectively. Moreover, every 0.5-h delay in bedtime in non-school nights compared with school nights associated with 0.001 (95% CI 0; 0.002) greater increase in WtHr in the 2.5 years follow-up. Thus, a 2-h delay in bedtime at the age of 11 years corresponds with a 0.6 cm increase in waist circumference. The MR analysis did not indicate an opposite causal relationship: higher BMIz was not causing delayed bedtimes. Later bedtime on non-school days and discrepancy in bedtimes associated with increased BMIz and WtHr, while longitudinally these predicted higher WtHr, independently of sleep duration. Promoting early bedtimes, especially on weekends, should be considered in obesity prevention among school-aged children.Peer reviewe