Micronutrient intake and prevalence of adequacy in european children, from birth to 8 years. Influence of calcium intake on bone mineral density

Antecedents: Els micronutrients són essencials per al desenvolupament. L’objectiu de la valoració de la ingesta és determinar l’adequació a les recomanacions. S’han descrit ingestes subòptimes en alguns micronutrients a nivell europeu. Cap estudi ha estudiat la ingesta de micronutrients en nens de diferents països europeus utilitzant metodologia estandarditzada. El calci influeix en la densitat mineral òssia (DMO) en adults i en nens. Una pobre mineralització condueix a la osteoporosis, que cal prevenir des de la infància. Objectiu: Descriure la ingesta de micronutrients i l’adequació en nens europeus durant la infància. Analitzar relacions entre ingesta de calci i DMO. Mètodes: Estudi observacional prospectiu secundari a l’European Childhood Obesity Project (EU-CHOP). La ingesta dietètica es valorà periòdicament amb registres de 3 dies. L’adequació dels micronutrients es calculà segons recomana l’American Institute of Medicine. Als 7 anys, es mesurà la DMO en una submostra amb Absorciometria de Rajos-X d’Energia-Dual. Resultats: L’EU-CHOP va reclutar 1679 nounats. Es recopilaren dades dietètiques de 904 nens als 3 mesos, disminuint fins a 396 als 8 anys. La DMO es mesurà en 179 nens. Es van determinar ingestes de sodi, potassi, calci, fòsfor, ferro, zinc, magnesi, iode, vitamina B12, folat, vitamina A i vitamina D a 7 edats. La prevalença d’adequació de calci, ferro i zinc fou de 60-90%, inferior al 20% per al folat, iode i vitamina D. Altes probabilitats d’adequació de calci mantingudes en el temps milloraren la DMO als 7 anys i reduïren més de 12 vegades el risc d’osteopenia. Conclusions: Les ingestes de calci, ferro zinc, folat, iode i vitamina D van ser inadequades. Altes probabilitats d’adequació de calci mantingudes en el temps milloren la DMO i redueixen el risc d’osteopenia.Antecedentes: Los micronutrientes son esenciales para el desarrollo. Valorar la ingesta tiene como objetivo determinar la adecuación a las recomendaciones. Se han descrito ingestas subóptimas de algunos micronutrientes en Europa. Ningún estudio ha valorado la ingesta de micronutrientes en niños de diferentes países europeos utilizando metodología estandarizada. El calcio influye en la densidad mineral ósea (DMO) en adultos y niños. Una pobre mineralización desencadena osteoporosis, requiriendo prevenirla desde la infancia. Objetivo: Describir la ingesta de micronutrientes y la adecuación en niños europeos durante la infancia. Analizar relaciones entre ingesta de calcio y DMO. Métodos: Estudio observacional prospectivo secundario al European Childhood Obesity Project (EU-CHOP). Ingesta dietética valorada periódicamente con registros de 3 días. La adecuación de los micronutrientes se calculó según recomienda el American Institute of Medicine. A los 7 años, se midió la DMO en una submuestra con Absorciometría de Rayos-X de Energia-Dual. Resultados: El EU-CHOP reclutó 1679 neonatos. Se recopilaron datos dietéticos de 904 niños a los 3 meses, disminuyendo hasta 396 a los 8 años. La DMO se midió en 179 niños. Se determinaron ingestas de sodio, potasio, calcio, fósforo, hierro, zinc, magnesio, iodo, vitamina B12, folato, vitamina A y vitamina D en 7 edades. La prevalencia de adecuación de calcio, hierro y zinc fue de 60-90%, inferior al 20% para folato, iodo y vitamina D. Altas probabilidades de adecuación de calcio mantenidas en el tiempo mejoraron la DMO a los 7 años y redujeron más de 12 veces el riesgo de osteopenia. Conclusiones: Las ingestas de calcio, hierro zinc, folato, iodo y vitamina D fueron inadecuadas. Altas probabilidades de adecuación de calcio mejoran la DMO y reducen el riesgo de osteopenia.Background: Micronutrients are essential for development. The objective of dietary intake evaluation is determining the adequacy to nutritional recommendations. Suboptimal intakes for calcium, iron, zinc, thiamine, riboflavin, niacin, folate and vitamin D have been previously described across Europe. No studies have assessed micronutrients intake of children from different European countries using the same methodology. Calcium intake influence on bone mass density (BMD) has been described in adults and children. Bone poor mineralization drives to osteoporosis, which might be prevented from childhood. Aim: To describe micronutrients intake and adequacy to dietary recommendations of European children during childhood. To analyse the relation between calcium intake and BMD. Methods: Prospective observational study secondary to the European Childhood Obesity Project (EU CHOP). Dietary intake was collected periodically with 3-day food records. Micronutrients adequacy was calculated following the American Institute of Medicine guidelines. At 7 years, BMD was measured by Dual-energy X-Ray Absorptiometry in a subsample of participants. Results: EU CHOP study recruited 1679 children at birth. Intake data was available for 904 children at 3 months, decreasing to 396 at 8 years. BMD was measured in 179 children. Sodium, potassium, calcium, phosphorus, iron, zinc, magnesium, iodine, vitaminB12, folate, vitamin A and vitamin D intakes were described at 7 time-points. Calcium, iron and zinc showed prevalence of adequacy between 60 and 90%; and folate, iodine and vitamin D under 20%. Maintained high probability of calcium adequacy improved BMD at 7 years and reduced more than 12 fold osteopenia risk. Conclusions: Calcium, iron, zinc, folate, iodine and vitamin D intakes were inadequate within European children. Maintained high probability of calcium adequacy improves lumbar and whole body BMD at 7 years and reduces osteopenia risk

Reduced bone mass in 7-year-old children with asymptomatic idiopathic hypercalciuria

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Idiopathic hypercalciuria (IHC), i.e. an elevated urinary calcium excretion without concomitant hypercalcemia, is a common disorder in children and can have a range of urinary clinical presentations and decreased bone mineral density (BMD). &lt;b&gt;&lt;i&gt;Aim:&lt;/i&gt;&lt;/b&gt; To assess the effect of IHC on bone mineral content in children without urological symptoms. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; Calcium excretion, BMD (by dual-energy X-ray absorptiometry), and anthropometry were assessed in 175 seven-year-old children who were classified as IHC or controls. Calcium intake and physical activity were measured as confounding factors. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; The prevalence of IHC was 17.7%. Both groups (controls and IHC) showed similar baseline characteristics in terms of their anthropometry, gender distribution, and protein and calcium dietary intakes as well as physical activity scores. Urinary calciuria was independent of the calcium dietary intake and anthropometry. BMD correlated with anthropometry and physical activity but not with calcium dietary intake. IHC children had lower whole-body BMD z-scores compared to controls. The role of IHC in reducing the whole-body BMD z-score was still significant even when anthropometry, physical activity, and calcium intake were included as confounders in multivariate analyses. &lt;b&gt;&lt;i&gt;Conclusions:&lt;/i&gt;&lt;/b&gt; The prevalence of IHC in this population of 7-year-old children was about 17%. IHC diagnosis was associated with lower BMD z-scores and osteopenia in 22% of them.</jats:p

The Obemat2.0 Study: A Clinical Trial of a Motivational Intervention for Childhood Obesity Treatment.

The primary aim of the Obemat2.0 trial was to evaluate the efficacy of a multicomponent motivational program for the treatment of childhood obesity, coordinated between primary care and hospital specialized services, compared to the usual intervention performed in primary care. This was a cluster randomized clinical trial conducted in Spain, with two intervention arms: motivational intervention group vs. usual care group (as control), including 167 participants in each. The motivational intervention consisted of motivational interviewing, educational materials, use of an eHealth physical activity monitor and three group-based sessions. The primary outcome was body mass index (BMI) z score increments before and after the 12 (+3) months of intervention. Secondary outcomes (pre-post intervention) were: adherence to treatment, waist circumference (cm), fat mass index (z score), fat free mass index (z score), total body water (kg), bone mineral density (z score), blood lipids profile, glucose metabolism, and psychosocial problems. Other assessments (pre and post-intervention) were: sociodemographic information, physical activity, sedentary activity, neuropsychological testing, perception of body image, quality of the diet, food frequency consumption and foods available at home. The results of this clinical trial could open a window of opportunity to support professionals at the primary care to treat childhood obesity. The clinicaltrials.gov identifier was NCT02889406

The LifeCycle Project-EU Child Cohort Network : a federated analysis infrastructure and harmonized data of more than 250,000 children and parents

Early life is an important window of opportunity to improve health across the full lifecycle. An accumulating body of evidence suggests that exposure to adverse stressors during early life leads to developmental adaptations, which subsequently affect disease risk in later life. Also, geographical, socio-economic, and ethnic differences are related to health inequalities from early life onwards. To address these important public health challenges, many European pregnancy and childhood cohorts have been established over the last 30 years. The enormous wealth of data of these cohorts has led to important new biological insights and important impact for health from early life onwards. The impact of these cohorts and their data could be further increased by combining data from different cohorts. Combining data will lead to the possibility of identifying smaller effect estimates, and the opportunity to better identify risk groups and risk factors leading to disease across the lifecycle across countries. Also, it enables research on better causal understanding and modelling of life course health trajectories. The EU Child Cohort Network, established by the Horizon2020-funded LifeCycle Project, brings together nineteen pregnancy and childhood cohorts, together including more than 250,000 children and their parents. A large set of variables has been harmonised and standardized across these cohorts. The harmonized data are kept within each institution and can be accessed by external researchers through a shared federated data analysis platform using the R-based platform DataSHIELD, which takes relevant national and international data regulations into account. The EU Child Cohort Network has an open character. All protocols for data harmonization and setting up the data analysis platform are available online. The EU Child Cohort Network creates great opportunities for researchers to use data from different cohorts, during and beyond the LifeCycle Project duration. It also provides a novel model for collaborative research in large research infrastructures with individual-level data. The LifeCycle Project will translate results from research using the EU Child Cohort Network into recommendations for targeted prevention strategies to improve health trajectories for current and future generations by optimizing their earliest phases of life.Peer reviewe

Micronutrient intake and prevalence of adequacy in european children, from birth to 8 years. Influence of calcium intake on bone mineral density

Antecedents: Els micronutrients són essencials per al desenvolupament. L’objectiu de la valoració de la ingesta és determinar l’adequació a les recomanacions. S’han descrit ingestes subòptimes en alguns micronutrients a nivell europeu. Cap estudi ha estudiat la ingesta de micronutrients en nens de diferents països europeus utilitzant metodologia estandarditzada. El calci influeix en la densitat mineral òssia (DMO) en adults i en nens. Una pobre mineralització condueix a la osteoporosis, que cal prevenir des de la infància. Objectiu: Descriure la ingesta de micronutrients i l’adequació en nens europeus durant la infància. Analitzar relacions entre ingesta de calci i DMO. Mètodes: Estudi observacional prospectiu secundari a l’European Childhood Obesity Project (EU-CHOP). La ingesta dietètica es valorà periòdicament amb registres de 3 dies. L’adequació dels micronutrients es calculà segons recomana l’American Institute of Medicine. Als 7 anys, es mesurà la DMO en una submostra amb Absorciometria de Rajos-X d’Energia-Dual. Resultats: L’EU-CHOP va reclutar 1679 nounats. Es recopilaren dades dietètiques de 904 nens als 3 mesos, disminuint fins a 396 als 8 anys. La DMO es mesurà en 179 nens. Es van determinar ingestes de sodi, potassi, calci, fòsfor, ferro, zinc, magnesi, iode, vitamina B12, folat, vitamina A i vitamina D a 7 edats. La prevalença d’adequació de calci, ferro i zinc fou de 60-90%, inferior al 20% per al folat, iode i vitamina D. Altes probabilitats d’adequació de calci mantingudes en el temps milloraren la DMO als 7 anys i reduïren més de 12 vegades el risc d’osteopenia. Conclusions: Les ingestes de calci, ferro zinc, folat, iode i vitamina D van ser inadequades. Altes probabilitats d’adequació de calci mantingudes en el temps milloren la DMO i redueixen el risc d’osteopenia.Antecedentes: Los micronutrientes son esenciales para el desarrollo. Valorar la ingesta tiene como objetivo determinar la adecuación a las recomendaciones. Se han descrito ingestas subóptimas de algunos micronutrientes en Europa. Ningún estudio ha valorado la ingesta de micronutrientes en niños de diferentes países europeos utilizando metodología estandarizada. El calcio influye en la densidad mineral ósea (DMO) en adultos y niños. Una pobre mineralización desencadena osteoporosis, requiriendo prevenirla desde la infancia. Objetivo: Describir la ingesta de micronutrientes y la adecuación en niños europeos durante la infancia. Analizar relaciones entre ingesta de calcio y DMO. Métodos: Estudio observacional prospectivo secundario al European Childhood Obesity Project (EU-CHOP). Ingesta dietética valorada periódicamente con registros de 3 días. La adecuación de los micronutrientes se calculó según recomienda el American Institute of Medicine. A los 7 años, se midió la DMO en una submuestra con Absorciometría de Rayos-X de Energia-Dual. Resultados: El EU-CHOP reclutó 1679 neonatos. Se recopilaron datos dietéticos de 904 niños a los 3 meses, disminuyendo hasta 396 a los 8 años. La DMO se midió en 179 niños. Se determinaron ingestas de sodio, potasio, calcio, fósforo, hierro, zinc, magnesio, iodo, vitamina B12, folato, vitamina A y vitamina D en 7 edades. La prevalencia de adecuación de calcio, hierro y zinc fue de 60-90%, inferior al 20% para folato, iodo y vitamina D. Altas probabilidades de adecuación de calcio mantenidas en el tiempo mejoraron la DMO a los 7 años y redujeron más de 12 veces el riesgo de osteopenia. Conclusiones: Las ingestas de calcio, hierro zinc, folato, iodo y vitamina D fueron inadecuadas. Altas probabilidades de adecuación de calcio mejoran la DMO y reducen el riesgo de osteopenia.Background: Micronutrients are essential for development. The objective of dietary intake evaluation is determining the adequacy to nutritional recommendations. Suboptimal intakes for calcium, iron, zinc, thiamine, riboflavin, niacin, folate and vitamin D have been previously described across Europe. No studies have assessed micronutrients intake of children from different European countries using the same methodology. Calcium intake influence on bone mass density (BMD) has been described in adults and children. Bone poor mineralization drives to osteoporosis, which might be prevented from childhood. Aim: To describe micronutrients intake and adequacy to dietary recommendations of European children during childhood. To analyse the relation between calcium intake and BMD. Methods: Prospective observational study secondary to the European Childhood Obesity Project (EU CHOP). Dietary intake was collected periodically with 3-day food records. Micronutrients adequacy was calculated following the American Institute of Medicine guidelines. At 7 years, BMD was measured by Dual-energy X-Ray Absorptiometry in a subsample of participants. Results: EU CHOP study recruited 1679 children at birth. Intake data was available for 904 children at 3 months, decreasing to 396 at 8 years. BMD was measured in 179 children. Sodium, potassium, calcium, phosphorus, iron, zinc, magnesium, iodine, vitaminB12, folate, vitamin A and vitamin D intakes were described at 7 time-points. Calcium, iron and zinc showed prevalence of adequacy between 60 and 90%; and folate, iodine and vitamin D under 20%. Maintained high probability of calcium adequacy improved BMD at 7 years and reduced more than 12 fold osteopenia risk. Conclusions: Calcium, iron, zinc, folate, iodine and vitamin D intakes were inadequate within European children. Maintained high probability of calcium adequacy improves lumbar and whole body BMD at 7 years and reduces osteopenia risk

Association of Protein Intake during the Second Year of Life with Weight Gain-Related Outcomes in Childhood: A Systematic Review

There is accumulating evidence that early protein intake is related with weight gain in childhood. However, the evidence is mostly limited to the first year of life, whereas the high-weight-gain-velocity period extends up to about 2 years of age. We aimed to investigate whether protein intake during the second year of life is associated with higher weight gain and obesity risk later in childhood. We conducted a systematic review with searches in both PubMed®/MEDLINE® and the Cochrane Central Register of Controlled Trials. Ten studies that assessed a total of 46,170 children were identified. We found moderate-quality evidence of an association of protein intake during the second year of life with fat mass at 2 years and at 7 years. Effects on other outcomes such as body mass index (BMI), obesity risk, or adiposity rebound onset were inconclusive due to both heterogeneity and low evidence. We conclude that higher protein intakes during the second year of life are likely to increase fatness in childhood, but there is limited evidence regarding the association with other outcomes such as body mass index or change in adiposity rebound onset. Further well-designed and adequately powered clinical trials are needed since this issue has considerable public health relevance

Micronutrient intake adequacy in children from birth to 8 years. Data from the Childhood Obesity Project

Background: In European countries, suboptimal intake has been reported for several micronutrients (as calcium, iron, zinc, vitamin B12, D and folate) in both adulthood and childhood. No studies to date have prospectively compiled nutrient intake from healthy children in different European countries using the same methodology. Aim: To describe the adequacy of micronutrient intake during the first eight years of life in children from 5 European countries. Methods: Prospective observational trial analyzing data from the EU Childhood Obesity Project. Infants were enrolled within the first two months of life and were followed regularly to age 8 years. Dietary intake was collected periodically with 3-day food records. Nutrient intake adequacy was estimated for calcium, phosphorus, iron, zinc, magnesium, iodine, folate and vitamins B12, A and D, following the American Institute of Medicine (IOM) guidelines at group (prevalence of adequacy >80%) and individual (high probability of adequate intake >80% of the children) level; the assessment was based on the Estimated Average Requirements of nutrients of the FAO, WHO and United Nations University (FAO/WHO/UNU) or the IOM if FAO/WHO/UNU data were not available. Results: Intake data were available for a decreasing number of children, from 904 at 3 months to 396 at 8 years. Iron, iodine, folate and vitamin D were inadequately consumed when assessing adequacy at group level; at individual-level less than 80% of the children showed high probability of adequate intake for iron, iodine, folate and zinc at all ages, and calcium from 12 months onwards. Conclusions: Accurate dietary intake and adequacy assessment methodology in this prospective cohort of European children found iron, calcium, vitamin D, folate, iodine and zinc to be inadequately consumed in childhood, as described previously by epidemiologic studies. Further studies are needed to elucidate health consequences of these deficiencies. CHOP trial was registered at clinicaltrials.gov as NCT00338689.0SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Commercial complementary food use amongst European infants and children: results from the EU Childhood Obesity Project

Purpose: The objective of this secondary analysis is to describe the types of commercial complementary foods (CCF) consumed by infants and young children enrolled in the European Childhood Obesity Project (CHOP), to describe the contribution of CCF to dietary energy intakes and to determine factors associated with CCF use over the first 2 years of life. Methods: The CHOP trial is a multicenter intervention trial in Germany, Belgium, Italy, Poland and Spain that tested the effect of varying levels of protein in infant formula on the risk for childhood obesity. Infants were recruited from October 2002 to June 2004. Dietary data on CCF use for this secondary analysis were taken from weighted, 3-day dietary records from 1088 infants at 9 time points over the first 2 years of life. Results: Reported energy intakes from CCF during infancy (4–9 months) was significantly higher (p ≤ 0.002) amongst formula-fed children compared to breastfed children. Sweetened CCF intakes were significantly higher (p ≤ 0.009) amongst formula-fed infants. Female infants were fed significantly less CCF and infant age was strongly associated with daily CCF intakes, peaking at 9 months of age. Infants from families with middle- and high-level of education were fed significantly less quantities of CCF compared to infants with parents with lower education. Sweetened CCF were very common in Spain, Italy and Poland, with over 95% of infants and children fed CCF at 9 and 12 months of age consuming at least one sweetened CCF. At 24 months of age, 68% of the CHOP cohort were still fed CCF. Conclusions: CCF comprised a substantial part of the diets of this cohort of European infants and young children. The proportion of infants being fed sweetened CCF is concerning. More studies on the quality of commercial complementary foods in Europe are warranted, including market surveys on the saturation of the Western European market with sweetened CCF products.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

Increased protein intake augments kidney volume and function in healthy infants

Protein intake has been directly associated with kidney growth and function in animal and human observational studies. Protein supply can vary widely during the first months of life, thus promoting different kidney growth patterns and possibly affecting kidney and cardiovascular health in the long term. To explore this further, we examined 601 healthy 6-month-old formula-fed infants who had been randomly assigned within the first 8 weeks of life to a 1-year program of formula with low-protein (LP) or high-protein (HP) contents and compared them with 204 breastfed (BF) infants. At 6 months, infants receiving the HP formula had significantly higher kidney volume (determined by ultrasonography) and ratios of kidney volume to body length and kidney volume to body surface area than did infants receiving the LP formula. BF infants did not differ from those receiving the LP formula in any of these parameters. Infants receiving the HP formula had significantly higher serum urea and urea to creatinine ratios than did LP formula and BF infants. Hence, in this European multicenter clinical trial, we found that a higher protein content of the infant formula increases kidney size at 6 months of life, whereas a lower protein supply achieves kidney size indistinguishable from that of healthy BF infants. The potential long-term effects of a higher early protein intake on long-term kidney function needs to be determined