Nutrition, body composition, and cardiometabolic health in children

In the research described in this thesis we studied nutrition in early life, particularly in early childhood, and its association with body composition and cardiometabolic health. Nutritional factors of interest were protein intake, fatty acid intake and blood levels, vitamin D status, and dietary patterns. Studies include systematic reviews of the literature and analyses in the Generation R Study, a population-based prospective cohort from fetal life onward in Rotterdam, the Netherlands. Overall, our results suggest that diet quality and vitamin D status in early childhood are suboptimal. Furthermore, our results show that a lower protein intake in early childhood, a fatty acid pattern characterized by high levels of n-3 fatty acids during fetal life, and an overall healthy dietary pattern in early childhood may be beneficial for later body composition and for certain cardiometabolic markers. Although effect sizes were small, our findings may be important for early prevention of obesity and cardiometabolic diseases on a population level. Public health interventions and future scientific research should therefore put more focus on nutrition quality in early childhood

Carbohydrate Intake in Early Childhood and Body Composition and Metabolic Health: Results from the Generation R Study

High sugar intake in childhood has been linked to obesity. However, the role of macronutrient substitutions and associations with metabolic health remain unclear. We examined associations of carbohydrate intake and its subtypes with body composition and metabolic health among 3573 children participating in a population-based cohort in the Netherlands. Intake of total carbohydrate, monosaccharides and disaccharides, and polysaccharides at age 1 year was assessed with a food-frequency questionnaire. We repeatedly measured children’s height and weight to calculate BMI between their ages of 1 and 10 years. At ages 6 and 10 years, fat and fat-free mass were measured with dual-energy X-ray-absorptiometry and blood concentrations of triglycerides, cholesterol, and insulin were obtained. For all outcomes, we calculated age and sexspecific SD-scores. In multivariable-adjusted linear mixed models, we found no associations of intake of carbohydrates or its subtypes with children’s BMI or body composition. A higher intake of monosaccharides and disaccharides was associated with higher triglyceride concentrations (0.02 SDS per 10 g/day, 95% CI: 0.01, 0.04). Higher monosaccharide and disaccharide intake was also associated with lower HDL-cholesterol (−0.03 SDS, 95% CI: −0.04; −0.01), especially when it replaced polysaccharides. Overall, our findings suggest associations of higher monosaccharide and disaccharide intake in early childhood with higher triglyceride and lower HDL-choleste

Reference values for white blood-cell-based inflammatory markers in the Rotterdam Study

Novel prognostic inflammatory markers of cancer survival and cardiovascular disease are; the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR) and the systemic immune-

Associations between Dietary Fiber Intake in Infancy and Cardiometabolic Health at School Age: The Generation R Study

Dietary fiber (DF) intake may be beneficial for cardiometabolic health. However, whether this already occurs in early childhood is unclear. We investigated associations between DF intake in infancy and cardiometabolic health in childhood among 2032 children participating in a population-based cohort in The Netherlands. Information on DF intake at a median age of 12.9 months was collected using a food-frequency questionnaire. DF was adjusted for energy intake using the residual method. At age 6 years, body fat percentage, high-density lipoprotein (HDL)-cholesterol, insulin, triglycerides, and blood pressure were assessed and expressed in age- and sex-specific standard deviation scores (SDS). These five factors were combined into a cardiometabolic risk factor score. In models adjusted for several parental and child cova

Associations of family feeding and mealtime practices with children's overall diet quality: Results from a prospective population-based cohort

Food parenting practices are considered to have a key influence on children's dietary habits, with potential long term effects. In this study, we explored the associations of parental feeding practices and family mealtime practices in early childhood with children's overall diet quality at school age among 3626 parents and their children in a population-based cohort study in Rotterdam, the Netherlands. Parental feeding practices (monitoring, pressure to eat, and restriction) and family mealtime practices (meal skipping behaviors and family meal frequency) at age 4 years were assessed by parental questionnaires. Children's dietary intake was assessed at age 8 years using a food-frequency questionnaire, from which diet quality scores (range 0–10) were calculated, reflecting adherence to age-specific dietary guidelines. Using multivariable linear regression models, we found that monitoring was associated with higher diet quality of children (β = 0.12; 95%CI: 0.08, 0.16), whereas pressure to eat was associated with lower diet quality (β = −0.08; 95%CI: −0.12, −0.04)), both independent of child BMI. Restriction was associated with a higher child diet quality, but this associati

Prevalence of overweight and metabolic syndrome, and associated sociodemographic factors among adult Ecuadorian populations: the ENSANUT-ECU study

Background: Obesity and metabolic syndrome (MetS) are key risk factors for type 2 diabetes and cardiovascular disease. Little information exists on the prevalence of obesity and MetS in Latin America and specifically in Ecuador. We aimed to estimate the prevalence of overweight, obesity, and MetS among adults in Ecuador. Methods: We analyzed data from a nation-wide population-based survey in Ecuador (ENSANUT-ECU) among 10,318 participants (3684 men, 6634 women; age range: 18–59 years) conducted in 2012. Data related to residential location (urban versus rural), altitude ( 1500 m above sea level (MASL)), region (highland, coast, amazon, or Galápagos), and socioeconomic status were collected. BMI, waist circumference, blood lipids, glucose, and blood pressure were measured by trained fieldworkers following standardized procedures. Results: The age-standardized prevalence of overweight was 39.5%; 22.3% was obese; and 31.2% had MetS. The prevalence of obesity, low HDL-cholesterol, and abdominal obesity were higher in women than in men, whereas men had a higher prevalence of hypertension (p < 0.05). Sex differences were not observed regarding the prevalence of combined MetS. Prevalence of both obesity and MetS was higher in urban areas, at low altitude regions (coast and Galapagos), and at high socioeconomic status (all p < 0.05). Conclusions: Prevalence of obesity and MetS in Ecuador are high. There are important demographic differences in the prevalence of MetS between Ecuadorian subpopulations that requires targeted research and prevention efforts, to hold and reduce the current public health problem of metabolic disorders

Diet quality in childhood: the Generation R Study

Purpose: We aimed to evaluate diet quality of 8-year-old children in the Netherlands, to identify sociodemographic and lifestyle correlates of child diet quality, and to examine tracking of diet quality from ea

Determinants of the Presence and Size of Intracranial Aneurysms in the General Population The Rotterdam Study

BACKGROUND AND PURPOSE: The prevalence of unruptured intracranial aneurysms (UIAs) in the adult population is ≈3%. Rupture of an intracranial aneurysm can have devastating consequences, which emphasizes the importance of identification of potentially modifiable determinants for the presence and size of UIAs. Our aim was to study the association of a broad spectrum of potential determinants with the presence and size of UIAs in a general adult population. METHODS: Between 2005 and 2015, 5841 participants from the population-based Rotterdam Study (mean age, 64.4 years, 45.0% male) underwent brain magnetic resonance imaging (1.5T). These scans were evaluated for the presence of incidental UIAs. We determined number and volume of the UIAs. Using logistic and linear regression models, we assessed the association of cardiovascular, lifestyle and emerging inflammatory and hormonal determinants with the presence and volume of UIAs. RESULTS: In 134 (2.3%) participants, ≥1 UIAs were detected (149 UIAs in total), with a median volume of 61.1 mm3 (interquartile range, 33.2–134.0). In multivariable models, female sex (odds ratio, 1.92 [95% CI, 1.33–2.84]), hypertension (odds ratio, 1.73 [95% CI, 1.13–2.68]), and current smoking (odds ratio, 3.75 [95% CI, 2.27–6.33]) were associated with the presence of UIAs. We found no association of alcohol use, physical activity, or diet quality with UIA presence. Finally, we found white blood cell count to relate to larger aneurysm volume (difference in volume of 33.6 mm3 per 109/L increase in white blood cell [95% CI, 3.92–63.5]). CONCLUSIONS: In this population-based study, female sex, hypertension, and smoking, but no other lifestyle determinants, were associated with the presence of UIAs. White blood cell count is associated with size of UIAs. Preventive strategies should focus on treating hypertension and promoting cessation of smoking