EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA); Scientific Opinion on Dietary Reference Values for energy

Following a request from the European Commission, the Panel on Dietetic Products, Nutrition and Allergies (NDA) derived dietary reference values for energy, which are provided as average requirements (ARs) of specified age and sex groups. For children and adults, total energy expenditure (TEE) was determined factorially from estimates of resting energy expenditure (REE) plus the energy needed for various levels of physical activity (PAL) associated with sustainable lifestyles in healthy individuals. To account for uncertainties inherent in the prediction of energy expenditure, ranges of the AR for energy were calculated with several equations for predicting REE in children (1-17 years) and adults. For practical reasons, only the REE estimated by the equations of Henry (2005) was used in the setting of the AR and multiplied with PAL values of 1.4, 1.6, 1.8 and 2.0, which approximately reflect low active (sedentary), moderately active, active and very active lifestyles. For estimating REE in adults, body heights measured in representative national surveys in 13 EU Member States and body masses calculated from heights assuming a body mass index of 22 kg/m2 were used. For children, median body masses and heights from the WHO Growth Standards or from harmonised growth curves of children in the EU were used. Energy expenditure for growth was accounted for by a 1 % increase of PAL values for each age group. For infants (7-11 months), the AR was derived from TEE estimated by regression equation based on doubly labelled water (DLW) data, plus the energy needs for growth. For pregnant and lactating women, the additional energy for the deposition of newly formed tissue, and for milk output, was derived from data obtained by the DLW method and from factorial estimates, respectively. The proposed ARs for energy may need to be adapted depending on specific objectives and target populations

Anthropometry‐based prediction of body composition in early infancy compared to air‐displacement plethysmography

Funder: Danone Nutricia ResearchFunder: EU Commission for JPI HDHL program ‘Call III Biomarkers’ for project: BioFN ‐ Biomarkers for Infant Fat Mass Development and Nutrition; Grant(s): 696295Summary: Background: Anthropometry‐based equations are commonly used to estimate infant body composition. However, existing equations were designed for newborns or adolescents. We aimed to (a) derive new prediction equations in infancy against air‐displacement plethysmography (ADP‐PEA Pod) as the criterion, (b) validate the newly developed equations in an independent infant cohort and (c) compare them with published equations (Slaughter‐1988, Aris‐2013, Catalano‐1995). Methods: Cambridge Baby Growth Study (CBGS), UK, had anthropometry data at 6 weeks (N = 55) and 3 months (N = 64), including skinfold thicknesses (SFT) at four sites (triceps, subscapular, quadriceps and flank) and ADP‐derived total body fat mass (FM) and fat‐free mass (FFM). Prediction equations for FM and FFM were developed in CBGS using linear regression models and were validated in Sophia Pluto cohort, the Netherlands, (N = 571 and N = 447 aged 3 and 6 months, respectively) using Bland–Altman analyses to assess bias and 95% limits of agreement (LOA). Results: CBGS equations consisted of sex, age, weight, length and SFT from three sites and explained 65% of the variance in FM and 79% in FFM. In Sophia Pluto, these equations showed smaller mean bias than the three published equations in estimating FM: mean bias (LOA) 0.008 (−0.489, 0.505) kg at 3 months and 0.084 (−0.545, 0.713) kg at 6 months. Mean bias in estimating FFM was 0.099 (−0.394, 0.592) kg at 3 months and −0.021 (−0.663, 0.621) kg at 6 months. Conclusions: CBGS prediction equations for infant FM and FFM showed better validity in an independent cohort at ages 3 and 6 months than existing equations

Study protocol : optimized complementary feeding study (OTIS): a randomized controlled trial of the impact of a protein-reduced complementary diet based on Nordic foods

Background: What we eat as infants and children carries long-term consequences. Apart from breastfeeding, the composition of the complementary diet, i.e. the foods given to the infant during the transition from breast milk/infant formula to regular family foods affects the child's future health. A high intake of protein, a low intake of fruits, vegetables and fish and an unfavorable distribution between polyunsaturated and saturated fats are considered to be associate with health risks, e.g. obesity, type 2 diabetes and dyslipidemia later in life. Methods: In a randomized, controlled study from 6 to 18months of age we will compare the currently recommended, Swedish complementary diet to one based on Nordic foods, i.e. an increased intake of fruits, berries, vegetables, tubers, whole-grain and game, and a lower intake of sweets, dairy, meat and poultry, with lower protein content (30% decrease), a higher intake of vegetable fats and fish and a systematic introduction of fruits and greens. The main outcomes are body composition (fat and fat-free mass measured with deuterium), metabolic and inflammatory biomarkers (associated with the amount of body fat) in blood and urine, gut microbiota (thought to be the link between early diet, metabolism and diseases such as obesity and insulin resistance) and blood pressure.We will also measure the participants' energy and nutrient intake, eating behavior and temperament through validated questionnaires, acceptance of new and unfamiliar foods through video-taped test meals and assessment of cognitive development, which we believe can be influenced through an increased intake of fish and milk fats, notably milk fat globule membranes (MFGM). Discussion: If the results are what we expect, i.e. improved body composition and a less obesogenic, diabetogenic and inflammatory metabolism and gut microbiota composition, a more sustainable nutrient intake for future health and an increased acceptance of healthy foods, they will have a profound impact on the dietary recommendations to infants in Sweden and elsewhere, their eating habits later in life and subsequently their long-term health. Trial registration: NCT02634749. Registration date 18 December 2015

Effects of weaning cereals with different phytate contents on hemoglobin, iron stores, and serum zinc: a randomized intervention in infants from 6 to 12 mo of age.

BACKGROUND: Weaning foods frequently contain phytate, an inhibitor of iron and zinc absorption, which may contribute to the high prevalence of iron and zinc deficiency seen in infancy. OBJECTIVE: The objective was to investigate whether either an extensive reduction in the phytate content of infant cereals or the use of milk-based, iron-fortified infant formula would improve iron and zinc status in infants. DESIGN: In a double-blind design, infants (n = 300) were randomly assigned to 3 cereal groups from 6 to 12 mo of age: commercial milk-based cereal drink (MCD) and porridge (CC group), phytate-reduced MCD and phytate-reduced porridge (PR group), or milk-based infant formula and porridge with the usual phytate content (IF group). Venous blood samples were collected at 6 and 12 mo. Dietary intake was recorded monthly. After the intervention, 267 infants remained in the analysis. RESULTS: Hemoglobin concentrations of < 110 g/L, serum ferritin concentrations of < 12 microg/L, and serum zinc concentrations of < 10.7 micromol/L had overall prevalences at baseline and 12 mo of 28% and 15%, 9% and 18%, and 22% and 27%, respectively. After the intervention, there were no significant differences in any measure of iron or zinc status between the CC and the PR groups. However, hemoglobin was significantly higher (120 g/L compared with 117 g/L; P = 0.012) and the prevalence of anemia was lower (13% compared with 23%; P = 0.06) in the PR group than in the IF group, which could be explained by differences in daily iron intake between the 2 groups. CONCLUSION: Extensive reduction in the phytate content of weaning cereals had little long-term effect on the iron and zinc status of Swedish infants

Validation of a pre-coded food record for infants and young children.

International audienceBackground/Objectives: To assess the validity of a 7-day pre-coded food record (PFR) method in 9-month-old infants against metabolisable energy intake (MEDLW) measured by doubly labelled water (DLW); additionally to compare PFR with a 7-day weighed food record (WFR) in 9-month-old infants and 36-month-old children. Subjects/Methods: The study population consisted of 36 infants (age: 9.03±0.2 months) and 36 young children (age: 36.1±0.3 months) enrolled in a cross-over design of 7 consecutive days PFR vs. 7 consecutive days WFR. Children were randomly assigned to one method during Week 1, crossing over to the alternative method in Week 2. Total energy expenditure (TEE) and MEDLW was obtained in the 9-month-old infants using the DLW technique for 7 days while recording with PFR. Results: For the 9-month-old group, PFR showed a mean bias of +726 kJ/day, equivalent to 24 %, (P<0.0001) compared to MEDLW (n=29). Using WFR as the reference in this group no between-method differences were found for energy, fat and carbohydrate. Energy intake in the 36-month-old children was 12% higher in the PFR vs. WFR (P<0.0001) and protein plus total fat intake were overestimated with the PFR (P=0.008, P<0.0001, respectively). Conclusions: The study indicates that the PFR may be a valuable tool for measuring energy, energy-yielding nutrients and foods in groups of 9-month-olds infants and 36-month-olds young children. Keywords: Pre-coded food record; validation; energy intake; doubly labelled water; energy expenditure; dietary assessmen

Association of physical activity with body-composition indexes in children aged 6-8 y at varied risk of obesity.

BACKGROUND: Physical inactivity increases the risk of obesity, but the relations between reported levels of physical activity (PA) and measures of body fatness (BF) in children are remarkably inconsistent. OBJECTIVE: We examined the relation between objective measures of PA and body-composition indexes in nonobese children. DESIGN: A cross-sectional study was conducted in 100 children aged 6-8 y who were recruited according to their risk of future obesity: high-risk children had >/=1 obese parent [body mass index (BMI; in kg/m(2)): >30] and low-risk children had 2 nonobese biological parents (BMI: <30). Free-living activity energy expenditure (AEE) and PA level were calculated from 7-d doubly labeled water measurements, time spent in light-intensity activity was assessed by heart rate monitoring, and body composition was determined from isotopic dilution. To adjust for body size, fat mass and fat-free mass were normalized for height and expressed as fat mass index (FMI) and lean mass index (LMI), respectively. RESULTS: High-risk children had significantly higher BMI, LMI, and FMI than did low-risk children, but no group differences in PA were found. AEE and PA level were positively associated with LMI and, after adjustment for sex and fat-free mass, negatively associated with FMI but not with BMI. Boys who spent more than the median time in light-intensity activities had significantly higher FMI than did less sedentary boys. This difference was not observed in girls. CONCLUSIONS: AEE and PA level were negatively associated with BF in nonobese children. Accurate measures of body composition are essential to appropriate assessment of relations between PA and obesity risk