Voeding op jonge leeftijd: de rol van voedingspatronen in de kindertijd op gezondheid. Dr.ir. Trudy Voortman 11 oktober 2016

Transcriptie

1 Voeding op jonge leeftijd: de rol van voedingspatronen in de kindertijd op gezondheid Dr.ir. Trudy Voortman 11 oktober 2016

2 Disclosures Het Generation R onderzoek is mede mogelijk gemaakt door financiële steun van: Erasmus MC; Erasmus Universiteit Rotterdam; Ministerie van Volksgezondheid, Welzijn en Sport; Ministerie van Jeugd en Gezin; Europe Container Terminals; NWO (Nederlandse organisatie voor Wetenschappelijk Onderzoek); en ZonMW. De ErasmusAGE groep heeft onderzoeksgeld ontvangen van Metagenics Inc., Nestle Nutrition (Nestec Ltd.) en AXA.

3

4

5 Voeding in het vroege leven

6 Voeding in het vroege leven» Borstvoeding World Health Organization (WHO)

7 Voeding in het vroege leven» Introductie van bijvoeding ESPGHAN committee on Nutrition, 2008

8 Voeding in het vroege leven» Voeding na het eerste levensjaar?

9 Voeding in het vroege leven Belang van goede voeding in de kindertijd:» Aanleren van smaken en voedings gewoonten» Snelle groei en ontwikkeling» Effecten op latere gezondheid Schwartz et al., Appetite, 2011; Northstone & Emmett, Br J Nutr, 2008; Smithers et al., Nutrition Reviews, 2011

10 The Generation R Study

11 Generation R onderzoekspopulatie» Pregnant women» Living in the study area (~Rotterdam)» Expected delivery date: between April 2002 and January 2006» 9,778 mothers and their unborn children 11

12 Generation R metingen Detailed measurements in pregnancy, infancy and childhood:» Ultrasounds» Blood and urine collection» Questionnaires» Growth data from child health centers» Physical examinations at our research center 12

13 Generation R metingen

14 Generation R metingen

15 Voedingsdata in de Generation R Study

16 Voedingsdata in de Generation R Study Early pregnancy FFQ-mother Breastfeeding Q FFQ-child FFQ-child Folate, Hcy, B12 FAs, vit D Folate, Hcy, B12, vit D Vit D?

17 Voedingsinname

18 Wat eten de Rotterdamse kinderen in onze studie?

19 Voedingsdata in de Generation R Study Early pregnancy FFQ-mother Breastfeeding Q FFQ-child FFQ-child Folate, Hcy, B12 FAs, vit D Folate, Hcy, B12, vit D Vit D?

20 Macronutriënten inname op 1-jarige leeftijd

21 Macronutriënten inname op 1-jarige leeftijd Total energy intake (kcal/d) 1265 ( ) Total protein intake (E%) 12.9 (± 2.4) Total fat intake (E%) 28.6 (± 5.6) Total carbohydrate intake (E%) 58.4 (± 5.9) Values are median (95% range) or mean (± SD)

22 Macronutriënten inname op 1-jarige leeftijd Total energy intake (kcal/d) 1265 ( ) Total protein intake (E%) 12.9 (± 2.4) Total fat intake (E%) 28.6 (± 5.6) Total carbohydrate intake (E%) 58.4 (± 5.9) Values are median (95% range) or mean (± SD) Voortman et al., J Nutr 2015

23 Macronutriënten inname op 1 en 8 jaar 1 jaar Total energy intake (kcal/d) 1265 (± 290) Total protein intake (E%) 12.9 (± 2.4) Total fat intake (E%) 28.6 (± 5.6) Total carbohydrate intake (E%) 58.4 (± 5.9) 8 jaar 1496 ± % 32.4% 51.1% Values are mean (± SD) Voortman et al., J Nutr 2015; van der Velde et al., in process

24 Eiwitinname

25 Eiwitinname op 1 jaar & groei t/m 6 jaar Height SDS Regression coefficients with 95%CI for energy-adjusted protein intake per 10 g/d with repeated growth outcomes from linear mixed models Adjusted for child sex, total energy intake at 1 y and age at body composition measurement; maternal age, prepregnancy BMI, educational level, and smoking during pregnancy; household income; and child s ethnicity, birth weight Z-score, breastfeeding in the first 4 months of life, age at dietary assessment, total fat intake at 1 y, diet quality score at 1 y, screen time at 6 y, and participation in sports at 6 y.

26 Lichaamssamenstelling

27 Lichaamssamenstelling

28 Lichaamssamenstelling Gewicht Vetmassa Vetvrije massa» BMI (kg/m 2 )» FMI (kg/m 2 )» FFMI (kg/m 2 ) BMI Weight

29 Eiwitinname op 1 jaar & lichaamssamenstelling op 6 jaar BMI (SDS) Eiwitinname (10 g/d) 0.05 (0.00, 0.09) Model 1 is adjusted for child sex, total energy intake at 1 y and age at body composition measurement; models with animal protein intake are additionally adjusted for vegetable protein intake and vice versa. Model 2 is additionally adjusted for maternal age, prepregnancy BMI, educational level, and smoking during pregnancy; household income; and child s ethnicity, birth weight Z-score, breastfeeding in the first 4 months of life, age at dietary assessment, total fat intake at 1 y, diet quality score at 1 y, screen time at 6 y, and participation in sports at 6 y. Voortman et al., Int J Obes 2016

30 Eiwitinname op 1 jaar & lichaamssamenstelling op 6 jaar Total protein intake (10 g/d) BMI (SDS) FMI (SDS) FFMI (SDS) Eiwitinname Model 2 (confounders) (10 g/d) 0.05 (0.00, 0.09) 0.06 (0.01, 0.11) (-0.06, 0.05) Model 1 is adjusted for child sex, total energy intake at 1 y and age at body composition measurement; models with animal protein intake are additionally adjusted for vegetable protein intake and vice versa. Model 2 is additionally adjusted for maternal age, prepregnancy BMI, educational level, and smoking during pregnancy; household income; and child s ethnicity, birth weight Z-score, breastfeeding in the first 4 months of life, age at dietary assessment, total fat intake at 1 y, diet quality score at 1 y, screen time at 6 y, and participation in sports at 6 y. Voortman et al., Int J Obes 2016

31 Macronutriënten inname op 1 en 8 jaar Jen et al., in preparation

32 Eiwitinname op 8 jaar & lichaamssamenstelling op 9 jaar BMI (SDS) n = 3,991 FMI (SDS) n = 3,950 FFMI (SDS) n = 3,950 Totaal eiwit (E%) 0.04 (0.03, 0.06) 0.04 (0.02, 0.05) 0.03 (0.02, 0.05) Values are based on multivariable linear regression models and reflect differences (95% CI) in child s body composition (sex- and age adjusted SDS) per 1 E% higher protein intake at 8 years. Bold values indicates statistically significant effect estimates. Models are adjusted for gender, age child at 9 years-visit, ethnicity, total energy intake, sports, screentime, maternal BMI, maternal education level, maternal smoking, household income, and protein intake (E%) of the child at 1 year. Jen et al., in preparation

33 Eiwitinname op 8 jaar & lichaamssamenstelling op 9 jaar BMI (SDS) n = 3,991 FMI (SDS) n = 3,950 FFMI (SDS) n = 3,950 Totaal eiwit (E%) 0.04 (0.03, 0.06) 0.04 (0.02, 0.05) 0.03 (0.02, 0.05) Values are based on multivariable linear regression models and reflect differences (95% CI) in child s body composition (sex- and age adjusted SDS) per 1 E% higher protein intake at 8 years. Bold values indicates statistically significant effect estimates. Models are adjusted for gender, age child at 9 years-visit, ethnicity, total energy intake, sports, screentime, maternal BMI, maternal education level, maternal smoking, household income, and protein intake (E%) of the child at 1 year. Jen et al., in preparation

34 Eiwitinname op 8 jaar & lichaamssamenstelling op 9 jaar BMI (SDS) n = 3,991 FMI (SDS) n = 3,950 FFMI (SDS) n = 3,950 Total protein (E%) 0.04 (0.03, 0.06) 0.04 (0.02, 0.05) 0.03 (0.02, 0.05) Values are based on multivariable linear regression models and reflect differences (95% CI) in child s body composition (sex- and age adjusted SDS) per 1 E% higher protein intake at 8 years. Bold values indicates statistically significant effect estimates. Models are adjusted for gender, age child at 9 years-visit, ethnicity, total energy intake, sports, screentime, maternal BMI, maternal education level, maternal smoking, household income, and protein intake (E%) of the child at 1 year. Jen et al., in preparation

35 Welke voedingsmiddelen?

36 Eiwitbronnen op 1-jarige leeftijd Total protein (g/d) 41.2 (12.9) - From animal sources 25.7 (10.3) - From dairy 10.0 (7.5) (excl formula and breastmilk) - From formula/breast milk 6.9 (9.1) - From meat/fish/eggs 6.7 (5.9) 14.9 (5.7) - Vegetable protein - From grain, cereal 9.1 (3.3) - From soy 0.3 (1.4) - From legumes 1.1 (0.5) Numbers are grams per day in mean (SD)

37 Protein intake from different sources and body composition

38 Eiwitinname op 1-jarige leeftijd en lichaamssamenstelling Fat mass Fat free mass -0,1-0,05 0 0,05 0,1

39 Eiwitinname op 8 jaar & lichaamssamenstelling BMI (SDS) n = 3,991 FMI (SDS) n = 3,950 FFMI (SDS) n = 3,950 Dierlijk eiwit (E%) 0.04 (0.03, 0.06) 0.04 (0.02, 0.05) 0.04 (0.02, 0.05) Plantaardig eiwit (E%) 0.06 (0.03, 0.09) 0.05 (0.02, 0.07) 0.08 (0.05, 0.11) Values are based on multivariable linear regression models and reflect differences (95% CI) in child s body composition (sex- and age adjusted SDS) per 1 E% higher protein intake at 8 years. Bold values indicates statistically significant effect estimates. Models are adjusted for gender, age child at 9 years-visit, ethnicity, total energy intake, sports, screentime, maternal BMI, maternal education level, maternal smoking, household income, and protein intake (E%) of the child at 1 year. Jen et al., in preparation

40 Zuivelinname op 1-jarige leeftijd en lichaamssamenstelling» Geen associatie met lengte, gewicht, BMI, FMI, of FFMI Garcia et al., preliminary data

41 Voedingspatronen

42 Hoe meet je voedingsinname?» Macronutriënten, bijv. vezel, eiwit» Micronutriënten, bijv. vitamine C, calcium» Voedinsmiddelen, bijv. broccoli, melk» Voedingsgroepen, bijv. groente, zuivel» Voedingspatronen, bijv. Mediterraans» Diet scores, bijv. Healthy Eating Index

43 Diet quality

44 Voedingsrichtlijnen» Vanaf 2 jaar

45 Voedingsrichtlijnen voor peuters uit andere landen» Overeenstemming» Groente en fruit» Brood, pasta, rijst, aardappelen» Goede vetten» Vlees, vis, ei» Zuivel» Niet te veel voor suikerrijke drunken» Niet te veel snacks Voortman et al., J Nutr 2015

46 Vegetables 100g/d Candy & snacks 20g/d Oils & fats 25g/d Meat, poultry, eggs & meat substitutes 35g/d Fish 15g/d Fruit 150g/d Peuter diet quality score Dairy 350g/d Bread & cereals 70g/d Sugar-sweetened beverages 100g/d Rice, pasta, potatoes & legumes 70g/d Voortman et al., J Nutr 2015

47 Vegetables 150g/d Oils & margerines 35g/d Nuts 15 g/d Processed and highfat meat 350g/w Fish 60g/w Fruit 175g/d Kind diet quality score Dairy 300g/d Legumes 40g/w Whole grains 90g/d Sugar- containing beverages 150g/d

48 Vegetables 150g/d Oils & margerines 35g/d Nuts 15 g/d Processed and highfat meat 350g/w Fruit 175g/d Groenten Child diet quality score Aanbevolen inname: 150 g/d Gerapporteerde inname: 90 g/d Score: 90/150 = 0.6 Fish 60g/w Dairy 300g/d Legumes 40g/w Whole grains 90g/d Sugar- containing beverages 150g/d

49 Diet score» 10 componenten» 0-1 per component (continu)» Totale score 0 tot 10 Voortman et al., J Nutr 2015

50 Diet quality scores in Generation R Voortman et al., J Nutr 2015

51 Diet quality scores in Generation R Voortman et al., J Nutr 2015

52 Diet quality 1 jaar 8 jaar Correlaties tussen subcomponenten van de diet score op 1 en 8 jaar (n=2608)

53 Diet quality 1 jaar 8 jaar Pearson correlatie (r) Fruit 0.20 Vegetables 0.11 Grains 0.19 Fish 0.23 Dairy 0.14 Oils and fats 0.18 Sugar-containing beverages 0.12 Meat Total 0.19 Correlaties tussen subcomponenten van de diet score op 1 en 8 jaar (n=2608)

54 Determinanten van betere diet quality» Opleidingsniveau moeder!» Gezinsinkomen» Nederlandse of Marokkaanse etnische achtergrond» Leefstijl moeder: gezond BMI en niet roken Gecontroleerd voor alle andere variabelen

55 Diet quality en lichaamssamenstelling Model 1 (basic): Adjusted for gender + age outcomes + kcal + ethnicity Model 2 (confounder): model 1 + sports + screen time + BMI mother + smoking mother + education mother + income Model 3 (diet quality 1 y): model 2 + DQ 1 y + breastfeeding

56 Diet quality en lichaamssamenstelling Diet Quality Weight Height Body mass index Score 8 years (SDS) (SDS) (SDS) n = 3,991 n = 3,991 n = 3,991 Model (0.01, 0.06) 0.04 (0.02, 0.07) 0.02 (-0.00, 0.05) Model 1 (basic): Adjusted for gender + age outcomes + kcal + ethnicity Model 2 (confounder): model 1 + sports + screen time + BMI mother + smoking mother + education mother + income Model 3 (diet quality 1 y): model 2 + DQ 1 y + breastfeeding

57 Diet quality en lichaamssamenstelling Diet Quality Weight Height Body mass index Fat mass index Fat-free mass Score 8 years (SDS) (SDS) (SDS) (SDS) index (SDS) n = 3,991 n = 3,991 n = 3,991 n = 3,950 n = 3,950 Model (0.01, 0.06) 0.04 (0.02, 0.07) 0.02 (-0.00, 0.05) 0.01 (-0.02, 0.03) 0.06 (0.03, 0.08) Model 1 (basic): Adjusted for gender + age outcomes + kcal + ethnicity Model 2 (confounder): model 1 + sports + screen time + BMI mother + smoking mother + education mother + income Model 3 (diet quality 1 y): model 2 + DQ 1 y + breastfeeding

58 Hoe meet je voedingsinname?» Macronutriënten, bijv. vezel, eiwit» Micronutriënten, bijv. vitamine C, calcium» Voedinsmiddelen, bijv. broccoli, melk» Voedingsgroepen, bijv. groente, zuivel» Voedingspatronen, bijv. Mediterraans» Diet scores, bijv. Healthy Eating Index Eiwit eiwitrijke voedingsmiddelen eiwitrijke voedingspatronen

59 Samenvatting» Voeding van kinderen is suboptimaal» Dit is al op jonge leeftijd gerelateerd aan hun groei en lichaamssamenstelling» Voedingsonderzoek moet rekening houden met verschillende niveaus van voedingsinname: nutriënten, voedingsmiddelen en voedingspatronen

60 Hartelijk dank! Acknowledgements: Audry Garcia Kim Braun Vincent Jen Anh Nhi Nguyen Vincent Jaddoe Oscar Franco

61 Future Generation R 1.0 Focus at 13

62 Generation R 2.0» New cohort» 20 to 45 year-old women in Rotterdam» Aim: 7000 preconseptionally women» Start » Differences GenR 1.0» Preconceptional!» More biomarkers: blood, urine, feces, placental tissue» Genetics and epigenetics» MRIs

63 Vitamin D status in 6 year-olds in Generation R n=4,167

64 Generation R, n=4167 children age 6 years 6% 34% 24% 36%

65 Vitamin D status in different ethnic groups 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Western (n=2,767) Turkish and Moroccan (n=536) African (n=209) Asian (n=476) Optimal ( 75 nmol/l) Sufficient (50-75 nmol/l) Deficient (25-50 nmol/l) Severely deficient (<25 nmol/l)

66 Components, cut-off values and included and excluded food items of the diet quality score Component Cut-off values Included in the diet quality score Fruit 175 g/d Fresh fruit, frozen fruit, dried fruit (up to 20 g/d 1 ), canned fruit without added sugar Vegetables 150 g/d Fresh vegetables, frozen - vegetables, canned vegetables 2 Grains 90 g/d Brown/ whole grain bread or crackers, whole-grain rice, wholewheat pasta, whole grain breakfast cereals without added sugar Fish 60 g/w Fish, canned fish, shellfish Fish products (<70% fish) Legumes 40 g/w Fresh, dried or canned legumes 2 - Nuts 15 g/d Nuts, peanuts, peanut butter Coated nuts Dairy 300 g/d Skimmed and semi-skimmed milk, yoghurt or quark without added sugar, buttermilk, low-fat cheese Oils and fats 35 g/d Vegetable oils, soft margarine ( 30% saturated fat of total fat), liquid cooking and frying fats Sugar-containing beverages 150 g/d 3 Soft drinks, fruit juice, lemonade, fruit juice concentrates Meat 350 g/w Processed and/or high fat meat (>5% saturated fat) 1 A maximum of 20 g/d of dried fruit was included in the fruit component 2 Canned products with added salt or sugar not excluded, as no distinction was made in the FFQ 3 No quantitative recommendation was available for sugar-containing beverages, we chose a cut-off of 1 glass/d Not included in the diet quality score Fruit juice, dried fruit (>20 g/d) fruit products with added sugar White bread or crackers, white rice, white pasta, breakfast cereals with added sugar Full-fat milk, yoghurt or quark, dairy products with added sugar, full-fat cheese, whipped cream, ice cream Hard margarine (>30% saturated fat of total fat), hard cooking and frying fats, butter Milk based sugar-containing beverages Unprocessed low fat meat ( 5% saturated fat)

67 Cut-off values and median intake per diet quality score component and median score per diet quality score component and total diet quality score Component Score (n= 4,733) Fruit 0.64 ( ) Vegetables 0.53 ( ) Grains 1.0 ( ) Fish* 0.63 ( ) Legumes* 0.44 ( ) Nuts* 0.20 ( ) Dairy 0.55 ( ) Oils and fats 0.32 ( ) Sugar-containing beverages* 0.0 ( ) Meat * 0.08 ( ) Total 4.6 ( ) Values are median (IQR). Maximum score per component: 1. Maximum total score: 10. *A score of 0 was obtained by 27% of the participants for the fish component, 46.5% for the legumes component, 27.3% for the nuts component, 87.8% for the sugar-containing beverages component and 43.5% for the meat component.

68 Types of epidemiological research

69 Why cohort studies?» Describe health status of a population ( epidemiology )» Determinants of health and (common) diseases» Randomization not possible or not ethical