Length of Exclusive Breastfeeding and Obesity Risk in Children at Risk for Type 1 Diabetes

Type 1 diabetes (T1D) is an autoimmune disease that occurs when T lymphocyte cells attack and destroy beta cells in the pancreas.1 The cause of T1D is considered to be a combination of genetic predisposition and environmental or lifestyle risk factors. Early introduction of diet is thought to play a role in the development of T1D as it is less common in people who were breastfed and who were introduced to solid foods at later ages. The protection that breastfeeding can offer against the development of childhood obesity and T1D in children at risk for T1D is unknown and may be related to many different factors. The purpose of this project is to review the literature on the association between infant diet, including breastfeeding and complementary foods, and the development of obesity and T1D. This information will be used to prepare a secondary analysis proposal to examine the association between length of exclusive breastfeeding and obesity risk in children at risk for T1D for submission to the Presentations and Publications Committee of the Trial to Reduce IDDM in the Genetically at Risk (TRIGR) study

The Relationship between the Source of Protein Intake and Obesity Risk in Children

Background: Previous research has reported a relationship between high protein intake (\u3e15% of energy) during early childhood and an increased risk of obesity later in life. However, few studies have investigated this relationship during middle childhood to early adolescence or examined the effects of different sources of protein. Objective: The aim of this study was to investigate the relationship between the source of protein intake (animal vs. plant) and body mass index (BMI) in children between the ages 6-14 years. Participants/setting: 285 healthy 6-14 year old (male n=154) Caucasian and African American (n=171) children from Pittsburgh, Pennsylvania completed a food frequency questionnaire. Main outcome measures: Median protein intake (grams) by total, animal, and plant protein and BMI-for-age classification. Statistical analysis: The Kruskal-Wallis test was used to evaluate differences in median protein intake (grams) by weight classification (normal weight [BMI 5th%ile to \u3c85th%ile], overweight [BMI 85th%tile to \u3c95th%tile], obese [BMI \u3e95th%tile]). Correlation statistics were also conducted to examine the relationship between protein intake and BMI. Results: The population used in the data analysis included 285 children/early adolescents (median age 9.8 ± 2.1 years; 53% boys; 40% Caucasian). Data from 11 children were excluded due to outliers or missing data. Girls had a significantly higher BMI than boys (20.1 vs. 18.2 kg/m2, respectively; P=P=P= Conclusions: We observed a significant curvilinear versus linear trend in total protein and animal and plant protein intake by weight classification in middle-aged children that may be due to under-reporting in overweight and obese children. Total percent protein intake was significantly higher in children of normal weight. Future longitudinal studies using multiple measures of body fatness should be conducted to determine the relationship between protein intake and BMI during middle childhood to early adolescence

The Effect of Intact Protein from Foods and Phenylalanine Free Medical Foods on Large Neutral Amino Acids in Patients with Phenylketonuria.

Objective: The primary aim of this retrospective cohort study was to determine the association between the source of dietary protein intake and the sum of plasma concentration of large neutral amino acids (LNAA) in patients with Phenylketonuria (PKU). A secondary aim of the study was to examine the effect of dietary compliance on plasma concentration of LNAA. Methods: The analysis included combined participant data from two previous studies conducted at the Emory University School of Medicine. Subjects are males (n=34) and females (n=43) with PKU ages 4-50 years. A Student t-test was used to compare total combined plasma LNAA (excluding tryptophan and phenylalanine) by dietary compliance status (alpha=0.05). Correlation statistics were used to determine the association between the ratio of reported intact food protein to medical food protein on plasma levels of LNAA. Multiple regression analysis was used to examine the contribution of intact protein to medical food protein ratio and other variables to plasma LNAA. Results: The median ratio of intact protein to medical food protein reported was 0.354 (IQR: 0.188, 0.914). Median percent of PHE intake over the PHE intake recommendation was 31.64 (Interquartile range [IQR]; 7.44, 104.98). Plasma concentration of LNAA did not differ significantly between those with plasma PHE levels within the therapeutic range μmol/L (compliant; 611.7 μmol/L [n=19]) vs levels above the therapeutic range (non-compliant; 595.3 μmol/L [n=47]); p=0.613). There was an inverse marginal correlation between the ratio of intact protein to medical food protein and plasma concentration of LNAA for those who were compliant (r = -0.436, r = 0.1) although the association was not statistically significant (p=0.08). No correlation was found for patients who were non-compliant. Regression analysis revealed that plasma concentration of LNAA was not significantly affected by the ratio of intact protein to medical food protein ratio, age, or gender. Conclusions: Although not statistically significant, a negative trend was observed between plasma LNAA concentration and the intact protein to medical food protein ratio in patients compliant with the PHE prescription. This suggests that the ratio of intact dietary protein to protein coming from medical food, as reported by patient diet records, may promote increased plasma LNAA levels in the effective treatment of PKU. The majority of the sample (74%) were non-compliant with diet based on plasma PHE levels. Future studies are needed to determine the consequences of non-compliance by decreased intake of medical food protein or increased intake of intact protein on plasma LNAA concentration and downstream health effects

Dietary Intake, Nutrition Knowledge, and Body Composition of Collegiate Athletes: A Pilot Study

Background: Studies examining the dietary intake of collegiate athletes agree that common nutritional problems exists that put this population at high risk for nutrient and energy deficiencies. Additionally, nutrition knowledge deficit has been associated with improper dietary fueling in collegiate athletes. Furthermore, collegiate athletes often rely on coaches and athletic trainers for nutrition information, yet studies have shown that 64.1% of coaches and 28.6% of athletic trainers have inadequate nutrition knowledge. Objectives: To assess nutritional intake, body composition, sports nutrition knowledge, and nutrition sources knowledge of NCAA Division I female volleyball players. Methods: Nutritional intake was assessed using three-day food records during the pre-, during- and post-season while a 24-hour interview recall was used in the off-season. Daily average energy, carbohydrate, protein, fat, and specific vitamins and minerals intakes were analyzed using Food Processor 11.1. These values were compared to the recommendations from the American College of Sports Medicine (ACSM). Sports nutrition knowledge was assessed using an 87-question validated nutrition for sports knowledge questionnaire (NSKQ). Athletes were also asked to state their sources for nutrition knowledge. Body composition was assessed using bioelectrical impedance analysis. Results: Fourteen female volleyball players (age: 19.6 ± 1.3 y, height: 69 ± 3 in, weight: 73 ± 8.5 kg, BMI: 24.1 ± 3 kg/m2; body fat: 25 ± 3%) participated in this study in the pre-season with five having completed all four time-points. Athletes’ mean energy intake across all 14 participants in the pre-season was 25 ± 6.4 kcal/kg BW/day, while carbohydrate, protein and fat intake were 3 ± 0.9, 1.3 ± 0.4, and 0.9 ± 0.3 g/kg BW/day, respectively. Vitamin D intake was 137 ± 91 IU/day and calcium intake was 673 ± 353 mg/day. Energy and carbohydrate intake were lower than the ACSM recommendations (37-41 kcal/kg BW/day and 6-10 g/kg BW/day, respectively). Protein intake fell within the recommended ranges (1.2-1.7 g/kg BW/day). Additionally, vitamin D and calcium were lower than their established recommendations. Likewise, the off-season dietary intake followed similar trends. The average NSKQ score was 45 ± 9.6%, which is below the adequate score of 75%, and was found to be positively associated with pre-season weight (r = 0.738, p = 0.003) and vitamin D intake (r = 0.587, p = 0.03). Four athletes included a registered dietitian nutritionist (RDN) as a source of nutrition information. In contrast, twelve athletes listed athletic trainers as a source. Conclusions: The athletes in this study did not meet the established recommendations for adequate energy, carbohydrates, or select vitamins and minerals. Further, the athletes’ average NSKQ scores reflect inadequate sports nutrition knowledge. Taken together with the information that the athletes’ current nutrition knowledge is not wholly derived from professionals with the appropriate nutrition training, our team suggests that nutrition education provided by an expert in the field will improve dietary intake, health, and ultimately, sports performance. Funding Sources: There are no funding sources

Association between family history, early growth and the risk of beta cell autoimmunity in children at risk for type 1 diabetes

Aims/hypothesis The aim of this work was to examine the relationship between family history of type 1 diabetes, birthweight, growth during the first 2 years and development of multiple beta cell autoantibodies in children with a first-degree relative with type 1 diabetes and HLA-conferred disease susceptibility. Methods In a secondary analysis of the Trial to Reduce IDDM in the Genetically at Risk (TRIGR), clinical characteristics and development of beta cell autoantibodies were compared in relation to family history of type 1 diabetes (mother vs father vs sibling) in 2074 children from families with a single affected family member. Results Multiple autoantibodies (>= 2 of 5 measured) developed in 277 (13%) children: 107 (10%), 114 (16%) and 56 (18%) born with a mother, father or sibling with type 1 diabetes, respectively (p <0.001). The HR for time to multiple autoimmunity was 0.54 (95% CI 0.39, 0.75) in offspring of affected mothers (n = 107/1046,p <0.001) and 0.81 (95% CI 0.59, 1.11) (n = 114/722,p = 0.19) in offspring of affected fathers, compared with participants with a sibling with type 1 diabetes (comparator groupn = 56/306). The time to the first autoantibody present (to insulin, GAD, tyrosine phosphatase-related insulinoma-associated 2 molecules, islet cell or zinc transporter 8) was similar in the three groups. Height velocity (zscore/year) in the first 24 months was independently associated with developing multiple antibodies in the total cohort (HR 1.31 [95% CI 1.01, 1.70],p = 0.04). A higher birthweight in children born to an affected mother vs affected father or an affected sibling was not related to the risk of multiple autoimmunity. Conclusions/interpretation The risk of developing multiple autoantibodies was lower in children with maternal type 1 diabetes. For the whole group, this risk of developing multiple autoantibodies was independent of birthweight but was greater in those with increased height velocity during the first 2 years of life. However, the risk associated with paternal type 1 diabetes was not linked to differences in birthweight or early growth.Peer reviewe

Survey of Nutrition Management Practices in Centers for Pediatric Intestinal Rehabilitation

Background: Nutrition management of pediatric intestinal failure (IF) requires interdisciplinary coordination of parenteral nutrition (PN) and enteral nutrition (EN) support. Nutrition strategies used by specialists in pediatric intestinal rehabilitation to promote gut adaptation and manage complications have not been previously summarized. Methods: A practice survey was distributed to members of the dietitian subgroup of the American Society for Parenteral and Enteral Nutrition Pediatric Intestinal Failure Section. The survey included 24 open‐ended questions related to PN and enteral feeding strategies, nutrition management of PN‐associated liver disease, and laboratory monitoring. Results: Dietitians from 14 centers completed the survey. Management components for patients at risk for cholestasis were consistent and included fat minimization, trace element modification, avoiding PN overfeeding, and providing EN. Parenteral amino acid solutions designed for infants/young children are used in patients <1 or 2 years of age. Trace minerals are dosed individually in 10 of 14 centers. Eleven centers prescribe a continuous infusion of breast milk or elemental formula 1–2 weeks after resection while 3 centers determine the formula type by the extent of resection. Most (86%) centers do not have a protocol for initiating oral/motor therapy. Laboratory panel composition varied widely by center. The selection and frequency of use depended on clinical variables, including cholestatic status, exclusive vs partial PN dependence, postrepletion verification vs routine monitoring, intestinal anatomy, and acuity of care. Conclusion: EN and PN management strategies are relatively consistent among U.S. centers. Collaborative initiatives are necessary to define better practices and establish laboratory monitoring guidelines.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145220/1/ncp10040_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145220/2/ncp10040.pd

Serum 25-hydroxyvitamin D concentration in childhood and risk of islet autoimmunity and type 1 diabetes : the TRIGR nested case-control ancillary study

Aims/hypothesis Our aim was to study the association between serum 25-hydroxyvitamin D (25OHD) concentration and islet autoimmunity and type 1 diabetes in children with an increased genetic risk of type 1 diabetes. Methods Serum samples for 25OHD measurements were obtained in the Trial to Reduce IDDM in the Genetically at Risk (TRIGR) ancillary study (Divia) from children in 15 countries. Case children (n = 244) were defined as having positivity for at least two out of four diabetes-associated autoantibodies measured at any one sample. For each case child, two control children were selected matched for country and date of birth (+/- 1 year) (n = 488). Of the case children, 144 developed type 1 diabetes. Serum 25OHD was measured repeatedly in infancy and childhood and was compared according to age at the first seroconversion (at 6, 12 and 18 months prior to and at seroconversion) and calendar age (0, 6, 12 and 18 months). Results In children with islet autoimmunity, mean serum 25OHD concentration was lower 18 months prior to the age of first seroconversion of the case children compared with the control children (57.7 vs 64.8 nmol/l, p = 0.007). In children with type 1 diabetes (n = 144), mean serum 25OHD concentration was lower 18 months prior to the age of the first seroconversion (58.0 vs 65.0 nmol/l, p = 0.018) and at the calendar age of 12 months (70.1 vs 75.9 nmol/l, p = 0.031) than in their control counterparts. Analyses were adjusted for month of sample collection, human leucocyte antigen genotype, maternal type 1 diabetes and sex. Conclusions/interpretation The results suggest that early postnatal vitamin D may confer protection against the development of type 1 diabetes.Peer reviewe

Association between family history, early growth and the risk of beta cell autoimmunity in children at risk for type 1 diabetes

Aims/hypothesisThe aim of this work was to examine the relationship between family history of type 1 diabetes, birthweight, growth during the first 2 years and development of multiple beta cell autoantibodies in children with a first-degree relative with type 1 diabetes and HLA-conferred disease susceptibility.MethodsIn a secondary analysis of the Trial to Reduce IDDM in the Genetically at Risk (TRIGR), clinical characteristics and development of beta cell autoantibodies were compared in relation to family history of type 1 diabetes (mother vs father vs sibling) in 2074 children from families with a single affected family member.ResultsMultiple autoantibodies (>= 2 of 5 measured) developed in 277 (13%) children: 107 (10%), 114 (16%) and 56 (18%) born with a mother, father or sibling with type 1 diabetes, respectively (p Conclusions/interpretationThe risk of developing multiple autoantibodies was lower in children with maternal type 1 diabetes. For the whole group, this risk of developing multiple autoantibodies was independent of birthweight but was greater in those with increased height velocity during the first 2 years of life. However, the risk associated with paternal type 1 diabetes was not linked to differences in birthweight or early growth.</div

Serum fatty acids and risk of developing islet autoimmunity : A nested case-control study within the TRIGR birth cohort

Background Circulating fatty acids have been linked to development of type 1 diabetes. Objectives To study the prospective associations of serum fatty acids with the risk of islet autoimmunity in high-risk children. Methods A nested case-control selection was carried out within the TRIGR cohort, which included infants with HLA (DQB1 or DQA1)-conferred disease susceptibility and a first-degree relative with type 1 diabetes, born between 2002 and 2007 in 15 countries and followed-up until 2017. The present study included 244 case children positive for at least two islet autoantibodies (ICA, IAA, GADA, and IA-2A) and two control children were matched for country and age. Proportions of 26 serum fatty acids at cord blood and at 6, 12, and 18 months of age were assessed using gas-chromatography. Results The average proportions of the following fatty acids were associated with an increased risk of islet autoimmunity, adjusted for sex, HLA risk, and maternal type 1 diabetes: pentadecanoic acid (15:0) (OR 3.41: 95% CI 1.70, 6.85), heptadecanoic acid (iso 17:0) (2.64: 1.62, 4.28) and (anteiso 17:0) (2.27: 1.39, 3.70), stearic acid (18:0) (23.8: 2.32, 244.6), and conjugated linoleic acid (18:2n-7) (2.60: 1.47, 4.59). Breastfeeding and not having maternal type 1 diabetes were positively associated with levels of the above-mentioned fatty acids. N-3 fatty acids were not consistently associated with islet autoimmunity. Conclusions We found direct associations of pentadecanoic acid, heptadecanoic acid, stearic acid, and conjugated linoleic acid with the risk of islet autoimmunity. Further studies are needed to understand the complex role of fatty acids in the development of type 1 diabetes.Peer reviewe

Growth differences between North American and European children at risk for type 1 diabetes

AIM: To evaluate the relationships between early growth and regional variations in type 1 diabetes (T1D) incidence in an international cohort of children with familial and genetic risk for T1D. METHODS: Anthropometric indices between birth to 5 yr of age were compared among regions and T1D proband in 2160 children participating in the Trial to Reduce Insulin-dependent diabetes mellitus in the Genetically at Risk study. RESULTS: Children in Northern Europe had the highest weight z-score between birth to 12 months of age, while those in Southern Europe and U.S.A. had the lowest weight and length/height z-scores at most time points (p < 0.005 to p < 0.001). Few differences in z-score values for weight, height, and body mass index were found by maternal T1D status. Using International Obesity Task Force criteria, the obesity rates generally increased with age and at 5 yr were highest in males in Northern Europe (6.0%) and in females in Canada (12.8%). However, no statistically significance difference was found by geographic region. In Canada, the obesity rate for female children of mothers with and without T1D differed significantly at 4 and 5 yr (6.0 vs. 0.0% and 21.3 vs. 1.9%, respectively; p < 0.0125) but no differences by maternal T1D status were found in other regions. CONCLUSIONS: There are regional differences in early childhood growth that are consistent with the higher incidence of T1D in Northern Europe and Canada as compared to Southern Europe. Our prospective study from birth will allow evaluation of relationships between growth and the emerging development of autoimmunity and progression to T1D by region in this at-risk population of childre