Annett Hilbig

Dietary exposure assessments for children in europe (the EXPOCHI project): rationale, methods and design.

Background/purposeThe number of dietary exposure assessment studies focussing on children is very limited. Children are however a vulnerable group due to their higher food consumption level per kg body weight. Therefore, the EXPOCHI project aims [1] to create a relational network of individual food consumption databases in children, covering different geographical areas within Europe, and [2] to use these data to assess the usual intake of lead, chromium, selenium and food colours.MethodsEXPOCHI includes 14 food consumption databases focussed on children (1-14 y old). The data are considered representative at national/regional level: 14 regions covering 13 countries. Since the aim of the study is to perform long-term exposure assessments, only data derived from 24 hr dietary recalls and dietary records recorded on at least two non-consecutive days per individual were included in the dietary exposure assessments. To link consumption data and concentration data of lead, chromium and selenium in a standardised way, categorisation of the food consumption data was based on the food categorisation system described within the SCOOP Task report 3.2.11. For food colours, the food categorisation system specified in the Council Directive 94/36/EC was used.ConclusionThe EXPOCHI project includes a pan-European long-term exposure assessment of lead, chromium, selenium and food colours among children living in 13 different EU countries. However, the different study methods and designs used to collect the data in the different countries necessitate an in-depth description of these different methods and a discussion about the resulting limitations.

Estimation of the dietary intake of acrylamide by German infants, children and adolescents as calculated from dietary records and available data on acrylamide levels in food groups

Dietary intakes of acrylamide for the general population were estimated by FAO/WHO to be in the range of 0.3 to 0.8 microg/(kg(bw) *d). It was supposed that children and adolescents would generally have intakes twice to three times higher than adults. However, relevant data is rare. Therefore, 3- or 7-day dietary records (n = 2956) from infants, children and adolescents aged 0.5 to 18 years from the DONALD study (2001) and other studies (RUB studies) were evaluated to estimate the potential dietary intake of acrylamide. Statistical data of the intake of 6 food groups relevant for acrylamide exposure were combined with available data for ranges of acrylamide concentrations in more than 1500 foods in Germany. Scenarios were calculated assuming minimum, median and maximum acrylamide concentration in food groups. Assuming median (minimum; maximum) acrylamide concentrations in foods and mean consumed food amounts, the calculated intake of acrylamide ranged from 0.21-0.43 (0.12-0.19; 0.98-1.79) microg/(kg(bw) *d) between the age groups from <1 to <19 years in the DONALD study and was 0.61 (0.21; 2.58) microg/(kg(bw) *d) from 1 to <7 years in the RUB studies. The highest intake was calculated for children aged 1-<7 years. The highest proportions of total intake of acrylamide came from the intake of commercial baby food (86-91%) in infants, and bread (18-46%), pastries (16-35%), and potato products (7-35%) in children and adolescents, depending on scenario and age. Our estimated data are in the range of reports from the literature for adolescents and adults in Germany and other European countries and lower than reports for infants. Our results do not confirm that children and adolescents will have higher exposures to acrylamide than adults. Practical suggestions to lower the risk of acrylamide exposure by food without decreasing the quality of the nutrition in the diet are given.

Dietary intake of nickel and zinc by young children - results from food duplicate portion measurements in comparison to data calculated from dietary records and available data on levels in food groups.

The daily dietary intake of nickel (Ni) and zinc (Zn) by 42 young children, 21 boys and 21 girls, from 4 to 7 years of age, living in urban and rural areas of Germany and having different food consumption behaviour, was determined by the duplicate method with a 7-day sampling period. Dietary records were also kept by the childrens parents for the 7-day sampling period. Individual reported food items were identified, assigned to food groups and, together with known Ni and Zn concentrations of foodstuffs, daily intake rates were calculated. The same method was used for calculations of the energy, fat, protein and carbohydrate intake rates. The levels in the food duplicates, determined by atomic absorption spectrometry, were in the range of 69-2000 microg Ni/kg(dry weight) (geometric mean (GM): 348) and 7.1-43 mg Zn/kg(dry weight) (GM: 17.5). Daily intake rates based on the 294 individual food duplicate analyses were 12-560 microgNi/d (GM: 92.3) and 1.5-11 mgZn/d (GM: 4.63). The results from the dietary records were 35-1050 microg Ni/d (GM: 123) and 1.7-15 mg Zn/d (GM: 5.35). The results of the daily intake rates from both methods showed a correlation with regard to Zn (r=0.56), but no correlation was found between either the Ni intake rates determined with both methods or between the Ni intake rates measured by the duplicate method and calculated intake rates from the dietary records of energy, fat, protein, carbohydrates or drinking water. In the case of nickel, the discrepancies between the methods lead one to suppose that the main factors influencing Ni intake by food are not directly caused by easily assessable food ingredients themselves. It is possible that other factors, such as contaminated drinking water or the transition of Ni from kettles or other household utensils made from stainless steel into the food, may be more relevant. In addition there are some foodstuffs with great variations in concentrations, often influenced by the growing area and environmental factors. Further, some food groups naturally high in Nickel like nuts, cocoa or teas might not have been kept sufficient within the records. In summary, the dietary record method gave sufficient results for Zn, but is insufficient for Ni. Based on the food duplicate analysis, children living in urban areas with consumption of food products from a family-owned garden or the surrounding area and/or products from domestic animals of the surrounding area had about one-third higher Ni levels in their food than children either living in an urban area or children consuming products exclusively from the supermarket. Only slight differences were found with regard to Zn. Compared to the recommendations of the German Society of Nutrition (DGE) (25-30 microgNi/d and 5.0 mgZn/d), the participants of the study had a clearly increased Ni and, in view of the geometric mean value, a nearly adequate Zn intake. Health risks are especially given with regard to the influence of nickel intake by food on dermatitis for nickel-sensitive individuals.

Effects of age and time on energy and macronutrient intake in german infants and young children : Results of the DONALD study

Objectives: To describe effects of age and time on the intake of energy and macronutrients in infants and young children. Patients and Methods: The energy and macronutrient intake of 720 DONALD study participants between 1989 and 2003 was evaluated by analysing 3027 three-day weighed dietary records (including test weighing of breast milk consumption) at 3, 6, 9, 12, 18, 24 and 36 months. Mixed models and logistic regression analyses were used to investigate the effects of age and time on intake. Results: Age affected macronutrient patterns (percentage of energy intake, E%) more often in infants than in young children. The percentage of full and partial breast-fed infants increased between 1989 and 2003. Almost no time trends were found for energy intake. Macronutrient patterns changed with time; for example, protein intake decreased throughout infancy (between −0.05 and −0.17 E%/y). An increase in fat intake (0.23 and 0.40 E%/y) was compensated by a decrease in carbohydrates (−0.18 and −0.29 E%/y) in young infants (3 and 6 months). Opposite trends in macronutrient patterns were observed in infants and young children. Conclusions: Increasing breast milk consumption over time was the most obvious factor influencing long-term trends in macronutrient patterns. In all of the age groups examined here, macronutrient patterns have come closer to the references over time.

Associations between commercial complementary food consumption and fruit and vegetable intake in children. Results of the DONALD study.

OBJECTIVES Fruit and vegetable (FV) consumption is influenced by individual taste and food preferences that are developed early in life. Thus, the sensory properties of foods given during complementary feeding may shape later food acceptance and dietary intake. However, those experiences differ with respect to the preparation method of complementary food (CF), that is, homemade and commercial CF. The aim of this study therefore was to examine the association between the infants consumption of commercial CF and FV intake and variety during infancy, preschool and school age. METHODS In total, 281 children of the DONALD Study with 3-day weighed dietary records at 0.5 and 0.75 (infancy), 3 and 4 (preschool age), 6 and 7 years of age (school age) were included in this analysis. Percentage of commercial CF (%cCF) was averaged at 0.5 and 0.75 years. Individual FV intake (g/day) and FV variety scores were calculated and averaged separately for all three age groups. Multivariate linear regression was used to analyse associations between %cCF and FV intake and variety. Models were adjusted for early life and socioeconomic factors. RESULTS For boys, higher %cCF was associated with lower vegetable intake in infancy (p < 0.0001) and preschool age (p = 0.036) as well as lower total FV intake in preschool and school age (p < 0.009). For girls, higher %cCF was associated with lower vegetable intake (p < 0.0001) in infancy. FV variety scores showed no clear associations with %cCF in girls and boys. CONCLUSION The results of the DONALD Study suggest that the preparation method of CF is associated with FV consumption in infancy and at least for boys also in preschool and school age.

Breast-feeding and weaning practices in the DONALD study: age and time trends.

Objectives: Besides influencing short- and long-term health status, infant feeding practices are known to have an effect on later food preferences. This study aimed to identify present trends in breast-feeding duration and weaning practices with special focus on preparation methods of complementary food (CF), that is, homemade and commercial CF. Methods: In total, 1419 three-day weighed diet records collected between 2004 and 2012 from 366 children of the German DOrtmund Nutritional and Anthropometric Longitudinally Designed study ages 6 to 24 months were analysed. Full (n = 339) and total breast-feeding duration (n = 344) was collected by questionnaire. To investigate age and time trends, logistic regression and polynomial mixed regression models were used. Results: Infants born between 2008 and 2012 were 3.3-fold less likely to be fully breast-fed for ≥4 months than those born before 2004 (P < 0.0001). Overall, 59.3% commercial, 21.1% homemade, and 19.6% combined CF was consumed by the study sample. Subjects with high commercial CF consumption (percentage of commercial CF > median 62%) were significantly older (P < 0.0001), showed shorter full and total breast-feeding duration (P < 0.0001), and were more likely to have mothers with a lower educational status (P = 0.01). Both commercial and homemade CF showed opposing, nonlinear age trends. No time trends could be found. Conclusions: Decreasing duration of full breast-feeding should encourage health care providers to further promote longer breast-feeding duration. With the constantly high consumption of commercial CF at all ages, nutritional adequacy of both homemade and commercial CF needs to be investigated closer, as does their long-term influence on health and dietary habits, for example, fruit and vegetable intake.

Relative validity of a 3 d estimated food record in German toddlers

OBJECTIVE To determine the relative validity of a 3 d estimated food record (EFR) used to assess energy and nutrient intakes in toddlers, using a 3 d weighed food record (WDR) as the reference method. DESIGN Parents reported the food and beverage intakes of their children using an EFR concurrently with a WDR over three consecutive days. Estimation of mean differences, Spearman correlation coefficients, cross-classifications and Bland-Altman plots were used to assess the agreement between the intakes of energy and fourteen nutrients obtained from the EFR and the WDR. SETTING Data obtained from a representative sample of infants or toddlers in Germany. SUBJECTS Sixty-seven toddlers aged 10-36 months who had completed an EFR for a 3 d recording period that corresponded to the WDR were included in the present analysis. RESULTS Energy and nutrient intakes did not differ between the EFR and the WDR, except for linoleic acid and retinol. For all dietary intakes, Spearman rank correlation coefficients between the EFR and the WDR ranged from 0·35 to 0·80 (P ≤ 0·004). The proportion of participants correctly classified into quartiles ranged from 75 % for ascorbic acid intake to 96 % for Fe intake, and the percentage of misclassification was 9 % or less. The weighed κ values ranking the participants ranged from 0·23 for ascorbic acid intake to 0·59 for Fe intake. The Bland-Altman plots indicated a good agreement for all dietary intakes estimated from the EFR. CONCLUSIONS Our study suggests that this EFR is a valid assessment instrument for estimating the energy and nutrient intakes among toddlers at the group level.

Commercial complementary food consumption is prospectively associated with added sugar intake in childhood.

Given that commercial complementary food (CF) can contain high levels of added sugar, a high consumption may predispose to a preference for sweet taste later in life. This study examined cross-sectional associations between commercial CF consumption and added sugar intake in infancy as well as its prospective relation to added sugar intake in pre-school and primary-school age children. In all, 288 children of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study with 3-d weighed dietary records at 0·5 and 0·75 (infancy), 3 and 4 (pre-school age) and 6 and 7 years of age (primary-school age) were included in this analysis. Individual commercial CF consumption as percentage of total commercial CF (%cCF) was averaged at 0·5 and 0·75 years. Individual total added sugar intake (g/d, energy percentage/d) was averaged for all three age groups. Multivariable logistic and linear regression models were used to analyse associations between %cCF and added sugar intake. In infancy, a higher %cCF was associated with odds for high added sugar intake from CF and for high total added sugar intake (>75th percentile, P<0·033). Prospectively, a higher %cCF was related to higher added sugar intake in both pre-school (P<0·041) and primary-school age children (P<0·039), although these associations were attenuated in models adjusting for added sugar intake in infancy. A higher %cCF in infancy may predispose to higher added sugar intake in later childhood by virtue of its added sugar content. Therefore, offering home-made CF or carefully chosen commercial CF without added sugar might be one strategy to reduce sugar intake in infancy and later on.

Nutrient Adequacy and Associated Factors in a Nationwide Sample of German Toddlers.

Objectives: Nutrition in toddlerhood may have short- and long-term impacts on health and nutrition behavior. The objectives of the present article are to describe intake of energy and nutrients from the end of infancy to toddlerhood, and to examine dietary and socioeconomic factors (socioeconomic status [SES]) associated with total nutrient adequacy measured by a nutrient-based index (Nutrient Quality Index [NQI]). Methods: In the German Representative Study of Toddler Alimentation from 2008, 7-day estimated dietary records were collected cross-sectionally from toddlers ages 10 to 36 months (n = 525). The study population was recruited in the TNS access panel. The intakes of energy and 18 nutrients were evaluated and the NQI was determined. Age trends in nutrient intake were tested with analysis of variance. Analysis of the association between SES and the NQI was performed by multiple linear regression analysis. Results: In all of the age groups, energy intake was close to the reference value representing moderate physical activity. The mean intake of most vitamins and minerals reached the respective reference values, but nutrient density decreased with age. Dietary intakes of iron, iodine, and vitamin D are low in our study. The NQI reached approximately 80 points and was lower in older children than in younger children. NQI was not affected by SES but by formula use. Conclusions: Nutritional quality measured by total nutrient intake is altogether high in German toddlers, although NQI decreased with increasing age. The NQI is independent of social class. The positive association with formula intake can be explained by the general enrichment of vitamins and minerals of these products.

Harmonisation of food categorisation systems for dietary exposure assessments among European children

Within the European project called EXPOCHI (Individual Food Consumption Data and Exposure Assessment Studies for Children), 14 different European individual food consumption databases of children were used to conduct harmonised dietary exposure assessments for lead, chromium, selenium and food colours. For this, two food categorisation systems were developed to classify the food consumption data in such a way that these could be linked to occurrence data of the considered compounds. One system served for the exposure calculations of lead, chromium and selenium. The second system was developed for the exposure assessment of food colours. The food categories defined for the lead, chromium and selenium exposure calculations were used as a basis for the food colour categorisation, with adaptations to optimise the linkage with the food colour occurrence data. With this work, an initial impetus was given to make user-friendly food categorisation systems for contaminants and food colours applicable on a pan-European level. However, a set of difficulties were encountered in creating a common food categorisation system for 14 individual food consumption databases that differ in the type and number of foods coded and in level of detail provided about the consumed foods. The work done and the problems encountered in this project can be of interest for future projects in which food consumption data will be collected on a pan-European level and used for common exposure assessments.