Jetta Tuokkola

Diet composition of pregnant Finnish women: changes over time and across seasons

OBJECTIVE To describe the diet of a population of pregnant Finnish women over a period of 7 years, with special attention paid to seasonal fluctuations in food consumption and nutrient intake. DESIGN A validated 181-item FFQ was applied retrospectively, after delivery, to assess the maternal diet during the 8th month of pregnancy. SETTING Type 1 Diabetes Prediction and Prevention Nutrition Study Cohort. SUBJECTS The cohort comprised a total of 4880 women who had newly delivered during the years 1997-2004, with the offspring carrying increased genetic risk for type 1 diabetes mellitus. RESULTS Over the study period, the proportion of energy derived from fat decreased while the intake from protein and carbohydrate increased. The intake of vitamin D increased from food sources. Seasonal variation was observed in the mean daily consumption of vegetables, fruits and berries and cereals. Intake of dietary fibre, total fat, MUFA, vitamins A, D, E and C, folate and iron also showed seasonal fluctuation. CONCLUSIONS These results show an overall positive trend in the diet of pregnant Finnish women through the study years. However, there is still room for improvement, particularly in the types of dietary fats. Although food fortification with vitamin D since 2003 was reflected in the increased intake of vitamin D from foods, the mean intake levels still fell below the recommendations. Seasonal changes in food consumption were observed and related to corresponding fluctuations in nutrient intakes. The mean folate intake fell below the recommendation throughout the year.

Agreement between parental reports and patient records in food allergies among infants and young children in Finland

RATIONALE, AIMS AND OBJECTIVES A third of parents suspect food allergy in their children. Questionnaire-based studies usually overestimate the occurrence of food allergies. The aim of the present study was to validate a study questionnaire by comparing childrens use of special diets as reported by parents with patient records at the hospital. METHODS A population-based cohort with genetic susceptibility to type 1 diabetes (15% of those screened) was recruited in the Tampere area between 1997 and 2001, and followed for development of food allergy for 3 years. Food allergies and other special diets were queried at the age of 3 years with a structured questionnaire. The hospital records of the children, whose parents had reported an elimination diet of the child, were studied to validate the parental reports of food allergies. The hospital database was also checked for the respective diagnosis codes to estimate underreporting. RESULTS Altogether, 1122 parents returned the questionnaire at the study center visit when the child was 3 years old. Food allergy was reported by 15.0% of the parents. In 10.6% of the children food allergy had been diagnosed or confirmed at the hospital. Hospital-confirmed food allergy was unreported in 0.9% of the cases. The measure of agreement between reported and hospital-confirmed food allergies, using crosstabulation with Cohens Kappa, was within 0.71-0.88 for cows milk allergy, 0.74-0.82 for cereal allergy and 0.66-0.86 for any reported food allergy. CONCLUSION We found that the validity of the questionnaire obtaining information on food allergies of infants and young children was good to excellent based on a comparison between parental reports and information obtained from patient records.

Maternal diet during pregnancy and lactation and cow's milk allergy in offspring.

Background/Objectives:Diet during pregnancy and lactation may have a role in the development of allergic diseases. There are few human studies on the topic, especially focusing on food allergies. We sought to study the associations between maternal diet during pregnancy and lactation and cow’s milk allergy (CMA) in offspring.Subjects/Methods:A population-based birth cohort with human leukocyte antigen-conferred susceptibility to type 1 diabetes was recruited in Finland between 1997 and 2004 (n=6288). Maternal diet during pregnancy and lactation was assessed by a validated, 181-item semi-quantitative food frequency questionnaire. Register-based information on diagnosed CMA was obtained from the Social Insurance Institution and completed with parental reports. The associations between maternal food consumption and CMA were assessed using logistic regression, comparing the highest and the lowest quarters to the middle half of consumption.Results:Consumption of milk products in the highest quarter during pregnancy was associated with a lower risk of CMA in offspring (odds ratio (OR) 0.56, 95% confidence interval (CI) 0.37–0.86; P<0.01). When stratified by maternal allergic rhinitis and asthma, there was evidence of an inverse association between high use of milk products and CMA in offspring of non-allergic mothers (OR 0.30, 95% CI 0.13–0.69, P<0.001). Cord blood IgA correlated positively with the consumption of milk products during pregnancy, indicating exposure to CMA and activation of antigen-specific immunity in the infant during pregnancy.Conclusions:High maternal consumption of milk products during pregnancy may protect children from developing CMA, especially in offspring of non-allergic mothers.

Cow's milk allergy in children: adherence to a therapeutic elimination diet and reintroduction of milk into the diet

Background/Objectives:The basic treatment for cows milk allergy (CMA) is the elimination of all cows milk proteins (CMP) from the diet. This study aimed at characterizing the diet of children with a diagnosis of CMA, to assess the degree of adherence to the elimination diet and to evaluate the factors associated with the adherence and age of recovery.Subjects/Methods:From a birth cohort study, food records of 267 children diagnosed with CMA were studied to define how strictly the elimination diet was adhered to. Subsequent food records were studied to assess the age at reintroduction of milk products in the childs diet.Results:The families adhered to the elimination diet of the child with extreme accuracy in 85% of the cases. Older and monosensitized children had more often small amounts of CMP in their diet, possibly because of the absence of nutritional information by a dietitian/nutritionist. Adherence to the diet was neither related to any other sociodemographic factor studied nor to the age at reintroduction of milk products into the diet.Conclusions:The therapeutic elimination diet of children diagnosed with CMA was well adhered to. Low intakes of vitamin D, calcium, and riboflavin are of concern in children who follow or have followed a cows milk-free diet.

Food consumption and risk of childhood asthma

The consumption of foods rich in n‐3 polyunsaturated fatty acids has been proposed to protect against childhood asthma. This study explores the association of food consumption (including cows milk (CM)‐free diet) in early life and the risk of atopic and non‐atopic asthma.

Validation of a questionnaire on cow’s milk allergy: parental reports and physician’s diagnosis

1.Department of Public Health, University of Helsinki, Helsinki, Finland 2.Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland 3.Hospital for Children and Adolescents, Helsinki, Finland 4.Department of Pediatrics, Tampere University Hospital, Tampere, Finland 5.Social Insurance Institution, Helsinki, Finland (deceased) 6.Department of Paediatrics, University of Oulu, Oulu, Finland 7.Department of Pediatrics, University of Turku, Turku, Finland 8.Research Unit, Tampere University Hospital, Tampere, Finland 9.Folkhälsan Research Institute, Helsinki, Finland 10.Tampere School of Public Health, University of Tampere, Tampere, Finland

Eliminating cows’ milk, but not wheat, barley or rye, increases the risk of growth deceleration and nutritional inadequacies

Our study examined the growth and nutritional intake of children on milk and/or wheat, barley or rye elimination diets.

Validation of a questionnaire on cow's milk allergy: parental reports and physician's diagnosis

1.Department of Public Health, University of Helsinki, Helsinki, Finland 2.Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland 3.Hospital for Children and Adolescents, Helsinki, Finland 4.Department of Pediatrics, Tampere University Hospital, Tampere, Finland 5.Social Insurance Institution, Helsinki, Finland (deceased) 6.Department of Paediatrics, University of Oulu, Oulu, Finland 7.Department of Pediatrics, University of Turku, Turku, Finland 8.Research Unit, Tampere University Hospital, Tampere, Finland 9.Folkhälsan Research Institute, Helsinki, Finland 10.Tampere School of Public Health, University of Tampere, Tampere, Finland