Lasten D-vitamiinin saanti ja seerumin 25-hydroksi-D-vitamiinipitoisuus luomu- ja verrokkipäiväkodissa

Johdanto: D-vitamiinilla on keskeinen merkitys luuston terveydelle läpi elämän. Se osallistuu kalsiumtasa-painon säätelyyn sekä luuston muodostukseen ja ylläpitoon. D-vitamiinin vakavan puutoksen tiedetään aiheuttavan lapsille riisitautia. D-vitamiinin aktiivisella muodolla, 1,25-dihydroksi-D-vitamiinilla (1,25(OH)2D), on mahdollisesti muitakin kuin luustovaikutuksia. Matala 25-hydroksi-D-vitamiinipitoisuus (25(OH)D) on yhdistetty lapsilla esimerkiksi suurentuneeseen riskiin sairastua tyypin 1 diabetekseen ja aller-gioihin. Ennen vuotta 2010 tehdyissä tutkimuksissa D-vitamiinin saannin on todettu olevan riittämätöntä suurella osalla alle kouluikäisistä. Suomessa ravinnosta saatavalla D-vitamiinilla on suuri merkitys elimistön D-vitamiinitasapainolle, koska aurinko paistaa vain osan vuodesta D-vitamiinin saannin kannalta riittävästi. D-vitaminoidut maitovalmisteet ovat nykyään tärkeä D-vitamiinin lähde lasten ruokavaliossa. Luomumaitoa ei Suomessa kuitenkaan D-vitaminoida. Kiinnostus luomuruokaan on päiväkodeissa suurta, mutta luomu-maidon valinta päiväkoteihin on arveluttanut päättäjiä juuri D-vitamiinitäydennyksen puuttumisen vuoksi. Tavoitteet: Pro gradu -työn tavoitteena oli tutkia eroaako päiväkoti-ikäisten lasten seerumin 25(OH)D-pitoisuus ja D-vitamiinin saanti luomumaitoa tarjoavassa päiväkodissa ja tavanomaista D-vitaminoitua mai-toa tarjoavassa päiväkodissa. Aineisto ja menetelmät: Tutkittavia oli yhteensä 19 päiväkoti-ikäistä lasta, joista 11 luomumaitoa tarjoa-vista yksityisistä päiväkodeista ja 8 tavanomaista D-vitaminoitua maitoa tarjoavista kunnallisista päiväko-deista. Tutkittavilta mitattiin seerumin 25(OH)D-pitoisuus entsyymi-immunomääritysmenetelmällä, ja tut-kittavien D-vitamiinin saantia ravinnosta ja vitamiinivalmisteista selvitettiin vanhempien täyttämällä ruo-ankäytön frekvenssikyselylomakkeella. Päiväkotiruoan sisältämä D-vitamiiniin määrä laskettiin ruokalis-toista Aivo 2000 - Diet 32 -ravintolaskentaohjelmalla. Tilastoanalyysit tehtiin IBM SPSS -ohjelmistolla (ver-sio 21). Tulokset: Molempien ryhmien D-vitamiinin saanti oli suositusten mukaista, ja kaikki tutkittavat käyttivät D-vitamiinilisää. Luomupäiväkodin lapsilla oli kuitenkin verrokkeihin verrattuna pienempi D-vitamiinin kokonaissaanti ruoasta ja valmisteista (16 vs. 28,3 µg p=0,007), saanti ruoasta (3,5 vs. 14,0 µg p<0,001) sekä saanti erikseen kotiruoasta (3,0 vs. 7,5 µg p<0,001) ja päiväkotiruoasta (0,5 vs. 6,5 µg p<0,001). Tut-kittavien seerumin 25(OH)D-pitoisuudet olivat hyvät, ja vain yhdellä tutkittavista pitoisuus oli alle riittävänä pidettävän pitoisuuden (50 nmol/l). Luomupäiväkodissa 25(OH)D-pitoisuus oli keskimäärin 80,6 nmol/l (keskihajonta 24,7) ja verrokkipäiväkodissa 100,6 nmol/l (keskihajonta 13,8). Ryhmien välinen ero ei aivan yltänyt tilastollisesti merkitseväksi (p=0,054). Johtopäätökset: Molemmissa ryhmissä tutkittavien keskimääräinen seerumin 25(OH)D-pitoisuus oli hyvä ja D-vitamiinin kokonaissaanti suositusten mukaista. Luomupäiväkodin lapset saivat kuitenkin verrokkeihin verrattuna D-vitamiinia selvästi vähemmän koti- ja päiväkotiruoasta. D-vitamiinivalmiste kattoi heillä 80 % D-vitamiinin kokonaissaannista, ja ilman valmistetta saanti jäi alle puoleen suosituksesta. Luomumaidon käyttäjillä D-vitamiinilisän käyttö onkin erityisen tärkeää riittävän D-vitamiinin saannin turvaamiseksi. Vaikka aineisto jäi tavoiteltua pienemmäksi, voidaan tulosten katsoa olevan suuntaa-antavia

The Contribution of Preschool Meals to the Diet of Finnish Preschoolers

Preschool meals may influence the formation of children’s dietary habits and health. We assessed the contribution of preschool meals to the diet of Finnish children. We used food record data from the cross-sectional DAGIS survey and selected recording days which included all three meals (breakfast, lunch, afternoon snack) at preschool. We analyzed the diet of three- to four-year-olds (n = 324) and five- to six-year-olds (n = 233). Preschool meals accounted for 54% of the weekday’s energy intake in both age groups, and provided ≥60% of total fiber, polyunsaturated fatty acids, and vitamins D and E. More than 60% of fish dishes but only one third of total daily fresh fruit were consumed at preschool. The mean (SD) percentages of energy from protein and fat at preschool were 17% (3%) and 30% (7%) in the younger and 17% (3%) and 31% (6%) in the older age group, respectively. The mean proportions of energy from added sugar at preschool were below 5% in both age groups. On average, salt intake exceeded recommendations and 60% of salt came from preschool food. Tackling high salt intake should be a future goal of guidance for early childhood education and care food services

Parents’ Reports of Preschoolers’ Diets: Relative Validity of a Food Frequency Questionnaire and Dietary Patterns

The accurate assessment of food consumption is crucial in nutritional studies. Since modern nutrition science has become more interested in diet as a whole, studies validating food frequency questionnaires (FFQs) and exploratory dietary patterns are needed. We aimed at examining the relative validity of a 47-item FFQ against three-day food records among three- to six-year-old Finnish children, as well as investigating the consistency of the dietary patterns derived using the principal component analysis (PCA), with food record and FFQ data as inputs. We conducted the PCA without forcing the food record data to match the FFQ items. Altogether, 75% or more of the participants were classified into the same or adjacent quarter of vegetables and fruits as well as sugary food consumption. Furthermore, the intake of folate and vitamin C increased linearly in the quarters of vegetable and fruit consumption, as did the intake of sucrose in quarters of sugary food consumption. Three fairly similar dietary patterns were identified from food records and FFQ data. Concerning the patterns, more than 70% of the participants were classified into the same or adjacent quarter. However, the Spearman correlation coefficients between the respective pattern scores were low (0.25–0.33). The FFQ showed acceptable validity when ranking food group consumption compared to food records. Additionally, the FFQ-derived dietary patterns were consistent with those derived using food record data

Effects of the DAGIS randomized controlled trial on home environment and children's food consumption according to the degree of implementation

Background Combining process evaluation data with effectiveness data and examining the possible mediators of intervention effects elicits valuable knowledge about how and for whom these interventions are effective. The aim of this study was to examine whether the parental degree of implementation (DOI) of a home-involving preschool intervention affected children's food consumption via home mediators. Methods The five-month Increased Health and Wellbeing in Preschools (DAGIS) intervention involved 476 participating children aged 3-6 years and was conducted in 2017-2018. Parents reported children's food consumption (g/day) outside childcare hours, the availability of foods at home, role modelling of food consumption, and the norms related to food consumption. In addition, parents reported the extent to which they had implemented the intervention program at home. Mediation analyses were conducted to examine the effect of low and high DOI compared to control group on the change in children's consumption of fruit and vegetables (FV), sugary everyday foods, sugary treats, and sugar-sweetened beverages (SSB) via food availability in the home, parental role modelling and parental norms. Results Compared to the control group, there was a direct effect of a high DOI on diminishing consumption of SSB (B -27.71, 95% CI -49.05, -4.80). No indirect effects were detected. In the high DOI group, a change in parental norm was associated with increased FV consumption showing an indirect effect (B 4.31, 95% CI 0.23, 10.59). In the low DOI group, there was an indirect effect via decreased food availability leading to decreased sugary everyday food consumption (B -2.17, 95% CI -5.09, -0.09). Conclusions Combining process evaluation and effectiveness data revealed a decrease in children's SSB consumption only in the high DOI group, as well as indirect effects on children's consumption of FV and sugary everyday foods. In order to gain more intervention effects, further studies are required in order to examine parental facilitators and barriers to the implementation of interventions and how to impact effectively the determinants of the targeted behavior.Peer reviewe

Sustainability analysis of Finnish pre-schoolers' diet based on targets of the EAT-Lancet reference diet

Purpose The EAT-Lancet reference diet is a healthy plant-based diet produced within planetary boundaries. To inform the food system transformation, we compared Finnish pre-schoolers' food consumption with the reference diet's food group targets. Methods Food record data for 3- to 6-year-old pre-schoolers were collected in the cross-sectional DAGIS survey. Ingredients of composite dishes were available in the data. In addition, we manually decomposed industrial products such as sausages and biscuits by estimating the shares of ingredients. We also estimated the consumption of added sugars and converted the consumption of dairy products into milk equivalents. We used usual intake modelling to estimate the mean consumption and the proportion of children who met the reference diet's targets. We set the target amounts separately for 3- to 4-year-olds and 5- to 6-year-olds in grams by proportioning the published target amounts (assuming a 2500 kcal diet) to the children's mean reported energy intake. Results For both age groups (3- to 4-year-olds, n = 460; 5- to 6-year-olds, n = 402), the daily mean consumption of whole grains, vegetables, legumes, nuts, and unsaturated oils was below targets, whereas the consumption of red meat, dairy foods, tubers, and added sugars was above targets. The consumption of fruit and fish was in line with targets. Conclusion To comply with the reference diet's targets, major changes in the diets of Finnish children are needed. The key food groups targeted for higher consumption are whole grains and legumes and targeted for lower consumption red meat and dairy products.Peer reviewe

Vitamin D intake, serum 25-hydroxyvitamin D status and response to moderate vitamin D3 supplementation: a randomised controlled trial in East African and Finnish women

Insufficient vitamin D status (serum 25-hydroxyvitamin D (S-25(OH)D)0·05 for differences between ethnic groups). In conclusion, high prevalence of vitamin D insufficiency existed among East African women living in Finland, despite higher vitamin D intake than their Finnish peers. Moderate vitamin D3 supplementation was effective in increasing S-25(OH)D in both groups of women, and no ethnic differences existed in the response to supplementation.Peer reviewe

Dietary patterns and their associations with home food availability among Finnish pre-school children : a cross-sectional study

Objective: To study the associations between home food availability and dietary patterns among pre-school children. Design: Cross-sectional study in which parents of the participating children filled in an FFQ and reported how often they had certain foods in their homes. We derived dietary pattern scores using principal component analysis, and composite scores describing the availability of fruits and vegetables as well as sugar-enriched foods in the home were created for each participant. We used multilevel models to investigate the associations between availability and dietary pattern scores. Setting: The DAGIS study, Finland. Subjects: The participants were 864 Finnish 3-6-year-old children recruited from sixty-six pre-schools. The analyses included 711 children with sufficient data. Results: We identified three dietary patterns explaining 16.7% of the variance. The patterns were named 'sweets-and-treats' (high loadings of e.g. sweet biscuits, chocolate, ice cream), 'health-conscious' (high loadings of e.g. nuts, natural yoghurt, berries) and 'vegetables-and-processed meats' (high loadings of e.g. vegetables, cold cuts, fruit). In multivariate models, the availability of fruits and vegetables was inversely associated with the sweets-and-treats pattern (beta = -0.05, P <0.01) and positively associated with the health-conscious (beta = 0.07, P <0.01) and vegetables-and-processed meats patterns (beta = 0.06, P <0.01). The availability of sugar-enriched foods was positively associated with the sweets-and-treats pattern (beta = 0.10, P <0.01) and inversely associated with the health-conscious pattern (beta = -0.03, P <0.01). Conclusions: Considering dietary patterns, the availability of sugar-enriched foods in the home seems to have a stronger role than that of fruits and vegetables. Parents should restrict the availability of unhealthy foods in the home.Peer reviewe

Vegan diet in young children remodels metabolism and challenges the statuses of essential nutrients

Vegan diets are gaining popularity, also in families with young children. However, the effects of strict plant-based diets on metabolism and micronutrient status of children are unknown. We recruited 40 Finnish children with a median age 3.5 years-vegans, vegetarians, or omnivores from same daycare centers-for a cross-sectional study. They enjoyed nutritionist-planned vegan or omnivore meals in daycare, and the full diets were analyzed with questionnaires and food records. Detailed analysis of serum metabolomics and biomarkers indicated vitamin A insufficiency and border-line sufficient vitamin D in all vegan participants. Their serum total, HDL and LDL cholesterol, essential amino acid, and docosahexaenoic n-3 fatty acid (DHA) levels were markedly low and primary bile acid biosynthesis, and phospholipid balance was distinct from omnivores. Possible combination of low vitamin A and DHA status raise concern for their visual health. Our evidence indicates that (i) vitamin A and D status of vegan children requires special attention; (ii) dietary recommendations for children cannot be extrapolated from adult vegan studies; and (iii) longitudinal studies on infant-onset vegan diets are warranted.Peer reviewe

Perheen tulojen ja koetun toimeentulon yhteys lapsen ruokavalioon

Peer reviewe