Ellen Trolle

Prevalence and trends in overweight and obesity among children and adolescents in Denmark

Aim: To study the current prevalence and trends in overweight and obesity among children and adolescents in Denmark from 1995 to 2000—2002. Methods: Cross-sectional national dietary surveys were conducted in 1995 and 2000—2002. The analysis was based on two random population samples from the Danish civil registration system. Body mass index (BMI) was calculated from self-reported height and weight for 1,026 and 1,152 children and adolescents (4—18 years), who participated in 1995 and 2000—2002, respectively. The prevalence of overweight and obesity was defined according to the international age and gender-specific child BMI cut-off points. In the statistical analysis, overweight and obesity were included in the prevalence of overweight. Results: Mean BMI increased significantly between 1995 and 2000—2002 for all combinations of age groups (4—6, 7—10, 11—14 and 15—18 years) and genders. Prevalence of overweight increased between survey years for boys and girls for all age groups (4—6, 7—10, 11—14 and 15—18 years), although formal statistical significance was not reached (p>0.05). When all children and adolescents (4—18 years) were analysed, the prevalence of overweight rose significantly from 10.9% (95% confidence interval (CI) 9.0—12.8) to 14.4% (95% CI 12.5—16.3) between 1995 and 2000— 2002 (p=0.01), whereas the increase in the prevalence of obesity did not reach significance (1995, 2.3% (95% CI 1.3—3.3) vs. 2000—2002, 2.4% (95% CI 1.6—3.3); p=0.74). Conclusions: The present study revealed a significant increase from 1995 to 2000—2002 in mean BMI for boys and girls for all age groups and a significant increase in the prevalence of overweight when all Danish children and adolescents (4—18 years) were analysed.

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.

The standardized computerized 24-h dietary recall method EPIC-Soft adapted for pan-European dietary monitoring

Background/Objectives:The EPIC-Soft program (the software initially developed to conduct 24-h dietary recalls (24-HDRs) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) was recommended as the best way to standardize 24-HDRs for future pan-European dietary monitoring. Within European Food Consumption Validation (EFCOVAL), EPIC-Soft was adapted and further developed on various aspects that were required to optimize its use. In this paper, we present the structure and main interview steps of the EPIC-Soft program, after implementation of a series of new specifications deemed to satisfy specific requirements of pan-European monitoring surveys and other international studies.Subjects/Methods:Updates to optimize the EPIC-Soft program were ascertained according to the following stepwise approach: (1) identification of requested specifications to be potentially implemented through an ad hoc ‘EPIC-Soft specifications questionnaire’ sent to past, current and possible future users of the software; (2) evaluation of the specifications in collaboration with two ad hoc task force groups and through a workshop; (3) development of a technical solution for each retained specification; (4) implementation of the specifications by software developers; (5) testing and amendment of bugs.Results:A number of new specifications and facilities were implemented to EPIC-Soft program. In addition, the software underwent a full reprogramming and migration to a modern Windows environment, including changes in its internal architecture and user interface. Although the overall concept and structure of the initial software were not changed substantially, these improvements ease the current and future use of EPIC-Soft and increase further its adaptation to other countries and study contexts.Conclusions:EPIC-Soft is enriched with further functions and facilities expected to fulfil specific needs of pan-European dietary monitoring and risk assessment purposes. The validity, feasibility and relevance of this software for different national and international study designs, and the logistical aspects related to its implementation are reported elsewhere.

Seasonal changes in vitamin D status among Danish adolescent girls and elderly women: the influence of sun exposure and vitamin D intake.

Background/objectives:To determine seasonal variation in vitamin D status in healthy Caucasian adolescent girls and elderly community-dwelling women living in Denmark, and to quantify the impact of sun exposure and intake on the seasonal changes in vitamin D status.Subjects/methods:A 1-year longitudinal observational study of 54 girls (11–13 years) and 52 women (70–75 years). The participants were examined three times (winter–summer–winter). Serum 25-hydroxyvitamin D (S-25OHD) concentration and vitamin D intake were measured at each visit. Sun exposure was measured during summer.Results:S-25OHD concentrations (winter, summer, winter) were median (25, 75 percentiles) 23.4 (16.5, 36.4), 60.3 (42.7, 67.7), 29.5 (22.2, 40.4) and 47.2 (27.3, 61.1), 67.3 (35.1, 79.2), 50.5 (32.7, 65.5)  nmol/l for girls and women, respectively. The usual sun habits were determinant (P=0.002) for change in vitamin D status from winter to summer. Vitamin D intake from supplements (P<0.0001) and diet (P=0.002) were determinants for change in vitamin D status from summer to winter. Winter vitamin D status of 50 nmol/l is achievable when vitamin D status the previous summer was ∼100 nmol/l. If summer vitamin D status is only ∼60 nmol/l, vitamin D status the following winter would be ∼28 nmol/l.Conclusions:Low vitamin D status among adolescent girls and elderly women during two consecutive winter seasons, improved vitamin D status during the summer and better vitamin D status in women than in girls was found. The estimations show that a summer S-25OHD concentration ∼100 nmol/l is needed to achieve a concentration of ∼50 nmol/l the following winter.

Evaluation of Web-based Dietary Assessment Software for Children: comparing reported fruit, juice and vegetable intakes with plasma carotenoid concentration and school lunch observations

Web-based Dietary Assessment Software for Children (WebDASC) was developed to estimate dietary intake in a school meal intervention study among 8- to 11-year-old Danish children. The present study validates self-reported fruit, juice and vegetable (FJV) intakes in 8- to 11-year-old children by comparing intake with plasma carotenoid concentration, and by comparing the reported FJV intake to actually eaten FJV, as observed by a photographic method. A total of eighty-one children, assisted by parents, reported their diet for seven consecutive days. For the same five schooldays as they reported their diet, the childrens school lunch was photographed and weighed before and after eating. In the week after the diet reporting, fasting blood samples were taken. Self-reported intake of FJV and estimated intake of carotenoids were compared with plasma carotenoid concentration. Accuracy of self-reported food and FJV consumption at school lunch was measured in terms of matches, intrusion, omission and faults, when compared with images and weights of lunch intake. Self-reported intake of FJV was significantly correlated with the total carotenoid concentration (0·58) (P< 0·01). Fruit and juice consumption showed higher correlations than vegetables with plasma carotenoid concentration (0·38 and 0·42 v. 0·33) (P< 0·01). A total of 82 % of the participants fell into the same or adjacent quartiles when cross-classified by FJV intake and carotenoids biomarkers. WebDASC attained 82 % reporting matches overall and a higher percentage match for reporting fruits compared with beverages. The present study indicated that WebDASC can be used to rank 8- to 11-year-old Danish children according to their intake of FJV overall and at school meals.

Vitamin D supplementation does not affect serum lipids and lipoproteins in Pakistani immigrants.

Potential long-term negative effects of increased vitamin D consumption are not thoroughly examined. The aim of this study was to investigate possible negative effects of vitamin D supplementation on serum lipids and lipoproteins. A 1-year long randomised double-blinded placebo-controlled intervention study with two doses of vitamin D3 (10 and 20 μg/day) was carried out among 89 women (18–53 years of age) and 84 men (18–64 years of age) of Pakistani origin living in Denmark with low vitamin D status. This study did not find changes in total cholesterol, LDL-cholesterol, HDL-cholesterol, LDL-cholesterol/HDL-cholesterol ratio, VLDL-cholesterol and triacylglycerol after daily supplementation with 10 or 20 μg vitamin D for 1 year. In conclusion, increasing the vitamin D intake by 10–20 μg per day for 1 year is safe for Pakistani immigrants with regards to serum lipids and lipoproteins.

The European Food Consumption Validation Project: conclusions and recommendations

Background/Objectives:To outline and discuss the main results and conclusions of the European Food Consumption Validation (EFCOVAL) Project.Subjects/Methods:The EFCOVAL Project was carried out within the EU Sixth Framework Program by researchers in 11 EU countries. The activities focused on (1) the further development of the EPIC-Soft software (the software developed to conduct 24-h dietary recalls (24-HDRs) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) and the validation of the 2-day non-consecutive 24-HDR method using EPIC-Soft, (2) defining and investigating the applicability of the most appropriate dietary assessment method to younger age groups and expanding the applicability of the software for use in exposure assessment of some potentially hazardous chemicals and (3) to improve the methodology and statistical methods that estimate usual intake distributions from short-term dietary intake information and develop a methodology to quantify uncertainty in usual intake distributions.Results:The preexisting EPIC-Soft application was reprogrammed into a Windows environment and more than 60 new specifications were implemented in the software. A validation study showed that two non-consecutive EPIC-Soft 24-HDRs are suitable to estimate the usual intake distributions of protein and potassium of European adult populations. The 2-day non-consecutive 24-HDRs in combination with a food propensity questionnaire also appeared to be appropriate to rank individuals according to their fish and fruit and vegetable intake in a comparable way in five European centers. Dietary intake of (young) children can be assessed by the combination of EPIC-Soft 24-HDRs and food recording booklets. The EPIC-Soft-standardized method of describing foods is useful to estimate dietary exposure to potentially hazardous chemicals such as specific flavoring substances. With the developed Multiple Source Method, repeated non-consecutive 24-HDR data in combination with food propensity data can be used to estimate the population distribution of the usual intake by estimating the individual usual intakes.Conclusions:The findings provide sufficient evidence to conclude that the repeated 24-HDR using EPIC-Soft for standardization in combination with a food propensity questionnaire and modeling of usual intake is a suitable method for pan-European surveillance of nutritional adequacy and food safety among healthy adults and maybe in children aged 7 years and older. To facilitate this methodology in other European countries, the next step is to provide and standardize an implementation plan that accounts for maintenance and updates, sampling designs, national surveillance programs, tailored capacity building and training, and linkage to food composition and occurrence databases.

Skim Milk, Whey, and Casein Increase Body Weight and Whey and Casein Increase the Plasma C-Peptide Concentration in Overweight Adolescents

In adults, dietary protein seems to induce weight loss and dairy proteins may be insulinotropic. However, the effect of milk proteins in adolescents is unclear. The objective was to test whether milk and milk proteins reduce body weight, waist circumference, homeostatic model assessment, plasma insulin, and insulin secretion estimated as the plasma C-peptide concentration in overweight adolescents. Overweight adolescents (n = 203) aged 12-15 y with a BMI of 25.4 ± 2.3 kg/m(2) (mean ± SD) were randomized to 1 L/d of skim milk, whey, casein, or water for 12 wk. All milk drinks contained 35 g protein/L. Before randomization, a subgroup of adolescents (n = 32) was studied for 12 wk before the intervention began as a pretest control group. The effects of the milk-based test drinks were compared with baseline (wk 0), the water group, and the pretest control group. Diet and physical activity were registered. Outcomes were BMI-for-age Z-scores (BAZs), waist circumference, plasma insulin, homeostatic model assessment, and plasma C-peptide. We found no change in BAZ in the pretest control and water groups, whereas it was greater at 12 wk in the skim milk, whey, and casein groups compared with baseline and with the water and pretest control groups. The plasma C-peptide concentration increased from baseline to wk 12 in the whey and casein groups and increments were greater than in the pretest control (P < 0.02). There were no significant changes in plasma C-peptide in the skim milk or water group. These data suggest that high intakes of skim milk, whey, and casein increase BAZs in overweight adolescents and that whey and casein increase insulin secretion. Whether the effect on body weight is primary or secondary to the increased insulin secretion remains to be elucidated.

Recommendations for a trans-European dietary assessment method in children between 4 and 14 years

Background/Objectives:The main objective of European Food Consumption Validation (EFCOVAL)-child Project is to define and evaluate a trans-European methodology for undertaking national representative dietary surveys among children in the age group of 4–14 years. In the process of identifying the best dietary assessment methodologies, experts were brought together at a workshop. The paper presents the discussion of the best available method and the final recommendations for a trans-European dietary assessment method among 4- to 14-year-old children.Subjects/Methods:The starting point was to investigate whether the method (two non-consecutive 24-h dietary recalls (24-HDRs)) suggested for the adults in European Food Consumption Survey Method (EFCOSUM) would be usable for children in the age group between 4 and 14 years. However, all available dietary assessment methods were included in the discussion to ensure that the final recommendation would be based on the best evidence. Six criteria were defined and used as additional guidance in the process.Results:The literature does not give a clear recommendation on the dietary assessment methods that are most suitable for children in the age group of 4–14 years. Nevertheless, on the basis of the literature, the recommendations were separated for preschoolers (4–6 years) and schoolchildren (7–14 years).Conclusion:For preschoolers, two non-consecutive days of a structured food record are recommended, using a (for children adapted) picture booklet and household measures for portion-size estimation. For schoolchildren, repeated 24-HDRs are recommended, using a picture booklet and household measures for portion-size estimation. In addition, the child should bring a booklet to register what is eaten out of home. One parent should assist the schoolchild at the 24-HDR interview, and therefore face-to-face interviews are required.

Infant Gut Microbiota Development Is Driven by Transition to Family Foods Independent of Maternal Obesity

The potential influence of maternal obesity on infant gut microbiota may occur either through vertically transmitted microbes or through the dietary habits of the family. Recent studies have suggested that the heritability of obesity may partly be caused by the transmission of “obesogenic” gut microbes. However, the findings presented here suggest that maternal obesity per se does not affect the overall composition of the gut microbiota and its development after introduction of complementary foods. Rather, progression in complementary feeding is found to be the major determinant for gut microbiota establishment. Expanding our understanding of the influence of complementary diet on the development and establishment of the gut microbiota will provide us with the knowledge to tailor a beneficial progression of our intestinal microbial community. ABSTRACT The first years of life are paramount in establishing our endogenous gut microbiota, which is strongly affected by diet and has repeatedly been linked with obesity. However, very few studies have addressed the influence of maternal obesity on infant gut microbiota, which may occur either through vertically transmitted microbes or through the dietary habits of the family. Additionally, very little is known about the effect of diet during the complementary feeding period, which is potentially important for gut microbiota development. Here, the gut microbiotas of two different cohorts of infants, born either of a random sample of healthy mothers (n = 114), or of obese mothers (n = 113), were profiled by 16S rRNA amplicon sequencing. Gut microbiota data were compared to breastfeeding patterns and detailed individual dietary recordings to assess effects of the complementary diet. We found that maternal obesity did not influence microbial diversity or specific taxon abundances during the complementary feeding period. Across cohorts, breastfeeding duration and composition of the complementary diet were found to be the major determinants of gut microbiota development. In both cohorts, gut microbial composition and alpha diversity were thus strongly affected by introduction of family foods with high protein and fiber contents. Specifically, intake of meats, cheeses, and Danish rye bread, rich in protein and fiber, were associated with increased alpha diversity. Our results reveal that the transition from early infant feeding to family foods is a major determinant for gut microbiota development. IMPORTANCE The potential influence of maternal obesity on infant gut microbiota may occur either through vertically transmitted microbes or through the dietary habits of the family. Recent studies have suggested that the heritability of obesity may partly be caused by the transmission of “obesogenic” gut microbes. However, the findings presented here suggest that maternal obesity per se does not affect the overall composition of the gut microbiota and its development after introduction of complementary foods. Rather, progression in complementary feeding is found to be the major determinant for gut microbiota establishment. Expanding our understanding of the influence of complementary diet on the development and establishment of the gut microbiota will provide us with the knowledge to tailor a beneficial progression of our intestinal microbial community.