Anette E. Buyken

Pattern of beverage consumption and long-term association with body-weight status in German adolescents--results from the DONALD study.

In the present study the relationship between the consumption of different beverage groups and body-weight status in 5 years of study participation in German adolescents was investigated. We used anthropometric and dietary data from 3 d weighed records of 244 subjects between 9 and 18 years of age participating in the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study. Only subjects with at least four out of six possible weighed dietary records were considered. A repeated-measures regression model (PROC MIXED) was used to analyse the effect of beverage consumption on body-weight status. BMI standard deviation scores (BMI-SDS) and body fat percentage (%BF) were chosen as the dependent variables. In boys, energetic beverage consumption was not associated with BMI-SDS or %BF, neither cross-sectionally nor prospectively. In girls, baseline consumption of energetic beverages did not predict baseline BMI-SDS, baseline %BF, or change in either variable over the study period. However, an increase in energetic beverage consumption over the study period was associated with an increase in BMI-SDS (+0.070 SDS/MJ increase in energetic beverage consumption; P = 0.01). Separate consideration of regular soft drinks and fruit juices revealed that, in girls, BMI-SDS increased with increased fruit juice consumption (+0.096 SDS/MJ increase in fruit juice consumption; P = 0.01), and to a lesser extent with regular soft drink consumption (+0.055 SDS/MJ increase in regular soft drink consumption; P = 0.08). In conclusion, these results suggest that an increase in energetic beverage consumption may result in weight gain, at least in adolescent girls.

Evidence-Based Guideline of the German Nutrition Society: Carbohydrate Intake and Prevention of Nutrition-Related Diseases

The relative contribution of nutrition-related chronic diseases to the total disease burden of the society and the health care costs has risen continuously over the last decades. Thus, there is an urgent necessity to better exploit the potential of dietary prevention of diseases. Carbohydrates play a major role in human nutrition – next to fat, carbohydrates are the second biggest group of energy-yielding nutrients. Obesity, type 2 diabetes mellitus, dyslipoproteinaemia, hypertension, metabolic syndrome, coronary heart disease and cancer are wide-spread diseases, in which carbohydrates could have a pathophysiologic relevance. Correspondingly, modification of carbohydrate intake could have a preventive potential. In the present evidence-based guideline of the German Nutrition Society, the potential role of carbohydrates in the primary prevention of the named diseases was judged systematically. The major findings were: a high carbohydrate intake at the expense of total fat and saturated fatty acids reduces the concentrations of total, LDL and HDL cholesterol. A high carbohydrate consumption at the expense of polyunsaturated fatty acids increases total and LDL cholesterol, but reduces HDL cholesterol. Regardless of the type of fat being replaced, a high carbohydrate intake promotes an increase in the triglyceride concentration. Furthermore, a high consumption of sugar-sweetened beverages increases the risk of obesity and type 2 diabetes mellitus, whereas a high dietary fibre intake, mainly from whole-grain products, reduces the risk of obesity, type 2 diabetes mellitus, dyslipoproteinaemia, cardiovascular disease and colorectal cancer at varying evidence levels. The practical consequences for current dietary recommendations are presented.

Association of prepubertal body composition in healthy girls and boys with the timing of early and late pubertal markers.

BACKGROUND It is controversial whether prepubertal body composition is implicated in the timing of puberty onset. OBJECTIVE The objective was to investigate whether body composition in the 2 y preceding the start of the pubertal growth spurt -- a marker of puberty onset -- is associated with the attainment of early and late pubertal markers in healthy German boys and girls. DESIGN Multivariate-adjusted regression analyses were performed in 215 participants of the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study for whom body mass index (BMI) and its components fat mass/height(2) (FM/m(2)) and fat-free mass/height(2) (FFM/m(2)) 1 and 2 y before the onset of the pubertal growth spurt (age at takeoff; ATO) and information on early life exposures were available. In addition, age at peak height velocity (APHV) and menarche were examined. RESULTS Higher BMIs and FM/m(2) z scores 1 and 2 y before ATO showed modest associations with chronological age at ATO among girls only (girls: P for = trend 0.05-0.1, adjusted for early life factors; boys: P = 0.2-0.6). FFM/m(2) z scores were not related to age at ATO (P for trend = 0.5-0.8). Conversely, prepubertal BMI and FM/m(2) more clearly predicted APHV and puberty duration (APHV minus ATO) in both sexes and age at menarche in girls (girls: adjusted P for trend <0.0001-0.03; boys: P = 0.01-0.046). CONCLUSION This longitudinal study suggests that prepubertal body composition in healthy boys and girls may not be critical for the initiation of the pubertal growth spurt but instead affects the progression of pubertal development, which results in earlier attainment of later pubertal stages.

Protein intake and urinary albumin excretion rates in the EURODIAB IDDM Complications Study

Summary For people with insulin-dependent diabetes mellitus (IDDM) renal disease represents a life-threatening and costly complication. The EURODIAB IDDM Complications Study, a cross-sectional, clinic-based study, was designed to determine the prevalence of renal complications and putative risk factors in stratified samples of European individuals with IDDM. The present study examined the relationship between dietary protein intake and urinary albumin excretion rate (AER). Food intake was assessed centrally by a standardized 3-day dietary record. Urinary AER was determined in a central laboratory from a timed 24-h urine collection. Complete data were available from 2696 persons with IDDM from 30 centres in 16 European countries. In individuals who reported protein consumption less than 20 % of total food energy intake, mean AER was below 20 μg/min. In those in whom protein intake constituted more than 20 %, mean AER increased, a trend particularly pronounced in individuals with hypertension and/or poor metabolic control. Trends reached statistical significance for intakes of total protein (% of energy, p = 0.01) and animal protein (% of energy, p = 0.02), while no association was seen for vegetable protein (p = 0.83). These findings support the current recommendation for people with diabetes not to exceed a protein intake of 20 % of total energy. Monitoring and adjustment of dietary protein appears particularly desirable for individuals with AER exceeding 20 μg/min (approximately 30 mg/24 h), especially when arterial pressure is raised and/or diabetic control is poor. [Diabetologia (1997) 40: 1219–1226]

Nutrient intakes as predictors of body weight in European people with type 1 diabetes

BACKGROUND: Overweight and obesity are also found among persons with type 1 diabetes.OBJECTIVE: The present study examined which nutrients predict the body mass index (BMI), the waist-to-hip ratio (WHR) and the waist circumference (WC) of European persons with type 1 diabetes.DESIGN: Cross-sectional, clinic-based study (EURODIAB Complications Study).SUBJECTS AND METHODS: Nutrient intakes (assessed by a 3-day dietary record) predicting measures of body weight (BMI, WHR and WC) were determined by stepwise forward regression analysis in 1458 males and 1410 females with type 1 diabetes (P≤0.05 for inclusion).RESULTS: In men, a higher carbohydrate intake was a significant independent predictor for lower levels of BMI, WHR and WC, an increased saturated fat intake and a lower intake of cereal fibre predicted a higher WHR, a higher monounsaturated fat intake and a lower glycaemic index of the diet determined lower levels of WHR and WC, and a moderate consumption of alcohol determined an increased WC. In women, a higher carbohydrate intake predicted a lower BMI and a thinner WC, no alcohol consumption determined a lower BMI, and an increased intake of saturated fat and a lower consumption of cereal fibre were significant independent predictors for a higher WHR.CONCLUSIONS: A modified fat intake, an increase of carbohydrate and cereal fibre intake and a preferred consumption of low glycaemic index foods are independently related to lower measures of body weight in European persons with type 1 diabetes.

Nutritional intake of 2868 IDDM patients from 30 centres in Europe

SummaryThe EURODIAB IDDM Complications Study, a cross-sectional, clinic-based study, was designed to measure the prevalence of diabetic complications in stratified samples of European insulin-dependent diabetic (IDDM) patients. As diet may be related to diabetic complications, nutritional intake was analysed in the study population. The aims of this first nutritional paper are to describe the nutrient intake in 2868 IDDM patients from 30 centres in 16 countries throughout Europe, to investigate the degree of regional differences in nutrient intake and to compare current intakes with recommended levels. Nutritional intake from 1458 male and 1410 female IDDM patients was assessed by a validated 3-day record (two weekdays, Sunday) and centrally analysed. Mean energy intake for all patients was 2390±707 kcal/day. Mean protein intake was 1.5±0.5 g/kg body weight. Carbohydrate intake was 43% and fibre intake 18 g/day. Alcohol intake for the total cohort was 2% of energy. Total fat contributed 38% of energy, with 14% from saturated fat. The Italian centres reported lower total and saturated fat intakes compared with other centres. Recommendations from the Diabetes and Nutrition Study Group of the EASD for total fat, saturated fatty acids and carbohydrate were only achieved by 14%, 14% and 15% of patients, respectively. The data of the present study clearly indicate current problems in the nutritional intake of European IDDM patients. These findings contribute to the definition of future targets in the nutritional management of IDDM patients, to be achieved as part of the initiatives taken by the St. Vincent Declaration action programme.

Dietary Protein Intake throughout Childhood Is Associated with the Timing of Puberty

Early puberty onset is associated with hormone-related cancers, but whether diet in childhood influences pubertal timing is controversial. We examined the association of protein intake in early and mid-childhood with the ages at take-off of the pubertal growth spurt (ATO), peak height velocity (APHV), and menarche in girls and voice break in boys using data from the longitudinal Dortmund Nutritional and Anthropometric Longitudinally Designed Study. Among participants who provided 3-d weighed dietary records at 12 mo, 18-24 mo, 3-4 y, and 5-6 y, 112 had sufficient anthropometric measurements between 6 and 13 y to allow estimation of ATO. Life-course plots were used to identify critical periods of total, animal, and vegetable protein intake (percentage of total energy intake) for pubertal timing. At these ages, the association between tertiles of protein intake (T1-T3) and the outcomes was investigated using multiple linear regression analysis. A higher total and animal protein intake at 5-6 y was related to an earlier ATO. In the highest tertile of animal protein intake at 5-6 y, ATO occurred 0.6 y earlier than in the lowest [(mean, 95% CI) T1: 9.6, 9.4-9.9 vs. T2: 9.4, 9.1-9.7 vs. T3: 9.0, 8.7-9.3 y; P-trend = 0.003, adjusted for sex, total energy, breast-feeding, birth year, and paternal university degree]. Similar findings were seen for APHV (P-trend = 0.001) and the timing of menarche/voice break (P-trend = 0.02). Conversely, a higher vegetable protein intake at 3-4 and 5-6 y was related to later ATO, APHV, and menarche/voice break (P-trend = 0.02-0.04). These results suggest that animal and vegetable protein intake in mid-childhood might be differentially related to pubertal timing.

Optimal dietary approaches for prevention of type 2 diabetes: a life-course perspective

In recent years, several alternative dietary approaches, including high-protein and low-glycaemic-load diets, have produced faster rates of weight loss than traditional low-fat, high-carbohydrate diets. These diets share an under-recognised unifying mechanism: the reduction of postprandial glycaemia and insulinaemia. Similarly, some food patterns and specific foods (potatoes, white bread, soft drinks) characterised by hyperglycaemia are associated with higher risk of adiposity and type 2 diabetes. Profound compensatory hyperinsulinaemia, exacerbated by overweight, occurs during critical periods of physiological insulin resistance such as pregnancy and puberty. The dramatic rise in gestational diabetes and type 2 diabetes in the young may therefore be traced to food patterns that exaggerate postprandial glycaemia and insulinaemia. The dietary strategy with the strongest evidence of being able to prevent type 2 diabetes is not the accepted low-fat, high-carbohydrate diet, but alternative dietary approaches that reduce postprandial glycaemia and insulinaemia without adversely affecting other risk factors.

Relation of Dietary Glycemic Index, Glycemic Load, and Fiber and Whole-Grain Intakes During Puberty to the Concurrent Development of Percent Body Fat and Body Mass Index

The authors prospectively examined whether change in dietary glycemic index (GI), glycemic load (GL), fiber intake, or whole-grain intake during puberty is associated with concurrent change in percentage of body fat (%BF) or body mass index (BMI; weight (kg)/height)(2). Linear mixed-effects regression analyses were performed in 215 participants from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study (Dortmund, Germany) who possessed weighed 3-day dietary records and anthropometric data at puberty onset (defined by age at takeoff) and over the subsequent 4 years (1988-2007). Neither changes in dietary GI, GL, fiber intake, nor whole-grain intake were associated with concurrent changes in %BF throughout puberty (change in %BF: -0.03 (standard error (SE), 0.11) per standard deviation (SD) increase in GI (P = 0.8); -0.01 (SE, 0.11) per SD increase in GL (P = 0.9); 0.02 (SE, 0.14) per SD increase in fiber intake (P = 0.9); and 0.09 (SE, 0.13) per SD increase in whole-grain intake (P = 0.5)). Similarly, no concurrent associations were observed between these dietary factors and BMI SD scores. Associations of dietary GI with %BF and BMI SD score differed between overweight and normal-weight adolescents (for concurrent association, P for interaction was 0.03 for %BF and 0.08 for BMI SD score). Dietary GI, GL, and fiber and whole-grain intakes in healthy, free-living adolescents do not appear to be relevant to the development of %BF or BMI during puberty.

Association between carbohydrate quality and inflammatory markers: systematic review of observational and interventional studies

BACKGROUND Chronic low-grade inflammation is a likely intermediary between quality of carbohydrate and chronic disease risk. OBJECTIVE We conducted a systematic literature search to evaluate the relevance of carbohydrate quality on inflammatory markers in observational and intervention studies. DESIGN MEDLINE, EMBASE, and the Cochrane Library were searched for studies on associations between glycemic index (GI), glycemic load (GL), dietary fiber or fiber supplements or whole grain intake, and high-sensitivity C-reactive protein (hsCRP) or interleukin 6 (IL-6). Included studies had to be conducted on adults (healthy, overweight, with type 2 diabetes or metabolic syndrome features, but without inflammatory disease) with ≥20 participants and a 3-wk duration. RESULTS In total, 22 of the 60 studies that met our inclusion criteria examined GI/GL: 5 of 9 observational studies reported lower concentrations of hsCRP or IL-6 among persons with a lower dietary GI/GL; 3 of 13 intervention studies showed significant antiinflammatory effects of a low-GI/GL diet, and 4 further studies suggested beneficial effects (trends or effects in a subgroup). For fiber intake, 13 of 16 observational studies reported an inverse relation with hsCRP or IL-6, but only 1 of 11 intervention studies showed a significant antiinflammatory effect of fiber intake, and a further trial reported a beneficial trend. For whole-grain intake, 6 of 7 observational studies observed an inverse association with inflammatory markers, but only 1 of 7 intervention studies reported significant antiinflammatory effects, 1 further study was suggestive (in a subgroup) of such, and another study found an adverse effect (trend only). CONCLUSIONS Evidence from intervention studies for antiinflammatory benefits is less consistent for higher-fiber or whole-grain diets than for low-GI/GL diets. Benefits of higher fiber and whole-grain intakes suggested by observational studies may reflect confounding.