Torbjörn Lind

Thirty Years of Prospective Nationwide Incidence of Childhood Type 1 Diabetes: The Accelerating Increase by Time Tends to Level Off in Sweden

OBJECTIVE During the past few decades, a rapidly increasing incidence of childhood type 1 diabetes (T1D) has been reported from many parts of the world. The change over time has been partly explained by changes in lifestyle causing rapid early growth and weight development. The current study models and analyzes the time trend by age, sex, and birth cohort in an exceptionally large study group. RESEARCH DESIGN AND METHODS The present analysis involved 14,721 incident cases of T1D with an onset of 0–14.9 years that were recorded in the nationwide Swedish Childhood Diabetes Registry from 1978 to 2007. Data were analyzed using generalized additive models. RESULTS Age- and sex-specific incidence rates varied from 21.6 (95% CI 19.4–23.9) during 1978–1980 to 43.9 (95% CI 40.7–47.3) during 2005–2007. Cumulative incidence by birth cohort shifted to a younger age at onset during the first 22 years, but from the birth year 2000 a statistically significant reversed trend (P < 0.01) was seen. CONCLUSIONS Childhood T1D increased dramatically and shifted to a younger age at onset the first 22 years of the study period. We report a reversed trend, starting in 2000, indicating a change in nongenetic risk factors affecting specifically young children.

Iron supplementation of iron-replete Indonesian infants is associated with reduced weight-for-age.

Background: General iron supplementation to prevent iron deficiency in infants who are iron sufficient when starting supplementation may adversely affect their health.

BMI at 4 years of age is associated with previous and current protein intake and with paternal BMI.

Objectives:To evaluate possible associations between body mass index (BMI) at 4 years of age, current and previous dietary intakes and parental BMI.Methods:A follow-up of dietary intake and anthropometry in 127 4-year-old children corresponding to 54% of children who completed an initial intervention study at 18 months of age.Results:Fourteen percent of the girls and 13% of the boys were overweight (age-adjusted BMI⩾25) and 2% of the girls and 3% of the boys were obese (age-adjusted BMI⩾30). Thirty-four percent and 9% of the fathers and 19 and 7% of the mothers were overweight and obese, respectively. BMI at 6–18 months was a strong predictor of BMI at 4 years. Univariate regression analyses revealed that intake of protein in particular, and also of total energy and carbohydrates at 17/18 months and at 4 years, was positively associated with BMI at 4 years. Although BMI at 6–18 months was the strongest predictor of BMI at 4 years, in the final multivariate models of the childs BMI, protein intake at 17–18 months and at 4 years, energy intake at 4 years and the fathers—but not the mothers—BMI were also independent contributing factors.Conclusions:Among these healthy children, BMI at 4 years of age tracked from 6 to 18 months of age and were associated with previous and current protein intake as well as parental BMI, particularly that of the father.

Diet Intake and Caries Prevalence in Four-Year-Old Children Living in a Low-Prevalence Country

Preventive measures have dramatically decreased the prevalence of dental caries in children. However, risk factors for the disease in children living in low-prevalence areas remain elusive. In the present study we evaluated associations between dental caries, saliva levels of mutans streptococci and lactobacilli, and diet with special emphasis on the intake of fermentable carbohydrates and dairy products in 4-year-old children living in an area where the overall caries prevalence was low. Dietary intake was recorded in 234 infants as part of the Study of Infant Nutrition in Umeå, Sweden (SINUS). Of these the parents of 124 children gave consent to participate in a follow-up at 4 years of age. Dietary intake, height and weight, dental caries, oral hygiene, including tooth brushing habits, presence of plaque and gingival inflammation, fluoride habits and numbers of mutans streptococci and lactobacilli in saliva were recorded. Using multivariate stepwise logistic regression, caries experience was negatively associated with intake frequency of cheese (OR = 0.67; 95% CI = 0.44–0.98) and positively associated with the salivary level of mutans streptococci (OR = 1.57; 95% CI = 1.21–2.03). Caries experience was not correlated with intake frequency or amounts of carbohydrate-containing foods, with any other particular food, or with daily intake of energy, carbohydrate or any other macro- or micronutrient. We conclude that cheese intake may have a caries-protective effect in childhood populations where the overall caries prevalence and caries experience are low and the children are regularly exposed to fluoride from toothpaste.

Moderately elevated body mass index is associated with metabolic variables and cardiovascular risk factors in Swedish children

Aim:  To evaluate associations between anthropometrics and metabolic variables as well as cardiovascular risk factors among children.

A One-Year Intervention Has Modest Effects on Energy and Macronutrient Intakes of Overweight and Obese Swedish Children

To decrease BMI in overweight and obese children, improved dietary intake and increased physical activity are key elements. Our objective was to evaluate the impact of a 1-y food and physical activity intervention on energy and macronutrient intake in overweight and obese children. A randomized open trial was conducted with 92 overweight or obese 10.4 ± 1.08-y-old children. The intervention included 14 group sessions with different themes regarding food and physical activity. Dietary intake was assessed with diet history interviews covering 14 d at baseline and 4-d food records after 1 y and was evaluated according to national dietary recommendations. The control group participated in the same measurements as the intervention group but did not take part in group sessions. After 1 y, both groups had decreased their energy intake (EI) relative to total energy expenditure, but the effect was more pronounced for the intervention group than for the control group. At 1 y follow-up, a larger proportion of children in the intervention group compared with the control group met the recommended intake of refined sugar (P = 0.019). However, the groups did not differ in the proportion children who met the recommended intake of dietary fiber. Further, SFA intake relative to total EI did not differ between the groups at 1 y follow-up. In conclusion, despite a rather comprehensive intervention, only modest effects were achieved with respect to reduced EI and improved macronutrient intake.

Serum 25-hydroxyvitamin D levels in preschool-age children in northern Sweden are inadequate after summer and diminish further during winter.

Background and Objective: Despite studies indicating that vitamin D intake among Swedish children does not meet the recommendation, little is known of their vitamin D status. The aim of the present study was to examine vitamin D status in preschool-age children in relation to vitamin D intake, season, body mass index, and skin color. Methods: Preschool-age children (n = 90; mean age 54 ± 7.1 months), all living in northern Sweden (latitude 63° north), half of them with fair skin, half with darker complexion, were recruited from well-baby clinics. The study group was examined first in August–September (late summer) and then the following January–February (winter). Skin type, vitamin D intake, anthropometrics, serum 25-hydroxyvitamin D (S-25[OH] D), and serum parathyroid hormone were assessed. Results: Mean ± SD S-25(OH) D in summer and winter were 60 ± 15 nmol/L and 55 ± 16 nmol/L, respectively (P < 0.001). Fifteen percent and 10% had S-25(OH) D ≥75 nmol/L, and 25% and 40% had S-25(OH) D <50 nmol/L, respectively. The mean vitamin D intake was higher in dark-skinned compared with fair-skinned children. In spite of this, S-25(OH) D in dark-skinned children was lower compared with fair-skinned children during both seasons. The dietary intake of vitamin D was positively associated with S-25(OH) D levels. Conclusions: Vitamin D status is inadequate in preschool-age children living in northern Sweden, especially in dark-skinned children and during the winter despite vitamin D intakes meeting the recommendations, prompting strategies to improve intake of vitamin D in this population.

Effects of mode of oral iron administration on serum ferritin and haemoglobin in infants

Aim: To investigate effects of iron‐fortified foods (FFs) and medicinal iron drops (MD) on iron status in infants.

Dietary fat in infancy should be more focused on quality than on quantity

Objective:The primary aim was to assess, the association of the quantity and quality of dietary fat intake from 6 to 12 months of age and serum lipids at 12 months.Subjects/Methods:Three hundred healthy term Swedish infants were recruited in a longitudinal prospective study at the age of 6 months; 276 remained in the study at 12 months. Food records and anthropometric data were collected monthly from 6 to 12 months; serum lipids were analysed at 6 and 12 months.Results:Swedish infants had a total fat intake within the Nordic recommendations, but intake of polyunsaturated fatty acids (PUFA) was low (5.6 percent of total energy (E%)) and intake of saturated fatty acids (SAFA) was high (15.1 E%). Higher PUFA intake was associated with lower total serum cholesterol (TC, B=−0.13, P=0.003), lower low-density-lipoprotein cholesterol (LDL-C, B=−0.12, P=0.004) and apolipoprotein B (B=−0.03) (P=0.034) in girls but not in boys. When data from the present study were compared to data from similar studies in Finland and Iceland, it appears that the quality of the dietary fat has greater impact on serum lipid levels than the quantity of fat in the diet.Conclusions:Higher PUFA and lower SAFA intakes may reduce TC and LDL-C early in life, particularly in girls. Further, with respect to lowering serum lipid concentrations in early childhood it seems appropriate to set focus on fat quality rather than the quantity.Sponsorships:Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning (Formas), Swedish Research Council, Medicine, Stiftelsen Oskar Foundation, Sven Jerring Foundation, Samariten Foundation, Stiftelsen Goljes minne and Semper AB.

Effects of weaning cereals with different phytate content on growth, development and morbidity: a randomized intervention trial in infants from 6 to 12 months of age

Background: Phytate decreases iron and zinc bioavailability and contributes to deficiencies of iron and zinc, potentially causing anaemia, poor psychomotor development, impaired growth and increased risk of diarrhoea and respiratory infections. Aim: To investigate whether a reduced dietary intake of phytate, either via extensively phytate‐reduced infant cereals [milk cereal drinks (MCDs) and porridge] or a milk‐based infant formula, would improve growth and development and reduce morbidity in infants. Design: Infants (n= 300) were, in a double‐blind design, randomized to three diet intervention groups from 6 to 12 mo of age—commercial MCD and porridge (CC group), phytate‐reduced MCD and phytate‐reduced porridge (PR group), or milk‐based infant formula and porridge with regular phytate content (IF group)—then followed until 18 mo. Dietary intake, anthropometry, development (Bayley Scales of Infant Development) and episodes of infectious diseases were registered. Results: There were no significant differences between study groups in growth, development or morbidity until 12 mo of age. The IF group had a 77% higher risk (95% CI: 1.05–2.97) of diarrhoea compared to the PR group during the 12–17‐mo period. Infants with haemoglobin concentration (Hb) <110 g/l at 12 mo had lower attained weight at 18 mo (11.14 kg vs 11.73 kg, p= 0.012). Infants with serum zinc (S‐Zn) <10.7 μmol/l at 12 mo had higher risk of respiratory infections (RR= 1.74, 95% CI: 1.19–2.56) compared to controls.