Children Nutrition as a Protective or Health-risk Factor

Nutrition can act either as a risk or protective factor in the development of a series of non-communicable diseases. While such effects were established for the whole life cycle, the nutrition in early life may be particularly relevant for its long-term impact on later life health. The reliable scientific data on dietary intakes and nutritional status of the representing sample population serve as a basis to elucidate the role, the specific nutritional factors exert on human health. The scientific background of the proposed applicative research project is based on the fact that the studies, following the link between the early nutrition, initial intestinal microbiota, and development of children, over a longer time period, are limited. Therefore, the key scientific challenges addressed are focused on the effects of the early life nutrition on growth and health of participating children, and to investigate the relationship among various markers of health.

While the work programme of this multidisciplinary applicative prospective study will be focused onto children, it shall be tightly linked to former "My-Milk" project (SRA J43606; finished in the year 2013), where the role of early nutrition in the development of breast fed children and their intestinal microbiota, during the first year of life, was investigated. This study will be conducted within the population of 6-7 years olds included in the first "My-Milk" study. The study will characterize the key modifying factors during participant's early life (defined through maternal variables (BMI before pregnancy, weight gain during pregnancy, nutrition during pregnancy and lactation, fatty acid composition of human milk, and vitamin D concentration in serum) and infant variables (duration of breastfeeding and antibiotic treatments, faecal microbiota at first month, anthropometrics and bone mineral density in the neonatal period)) on participant's nutritional status at the age 6-7 years. The current nutritional status will be defined by participant's dietary intakes, anthropometrics, body composition - bone density, percentage of fat and muscle tissue), health (blood pressure, blood cholesterol, frequency and severity of infections), and fecal microbiota.

The study population invited to participate will include all singleton children of mothers who completed the detailed part of the My-Milk study at child's first year of age (N=147). Considering a very low drop-out rate in the first detailed part of the study My-Milk (33 participating mothers out of 185, approximately 18 percent), investigators expect that at least 70-75 percentage of the invited participants will respond, meaning between 100 - 110 children may get enrolled in the study. This population will represent 0,5 percentage of children born in 2011 (21947 children - statistical data for Slovenia).

The following parameters will be measured and evaluated: the nutrition of children by using the standard dietary assessment methodology for children and adults/elderly population as provided in the European Food Safety Authority guidance (EFSA). Namely, the food consumption survey will be carried out on the individual level by repeated 24-h food diary and Computer Assisted Personal/Telephone Interview method (CAPI/CATI) and by supporting General Questionnaire and the Food Propensity Questionnaire (FPQ) according to PANCAKE - Pilot study for the Assessment of Nutrient intake and Food Consumption Among Kids in Europe. The 24-h structured diet recall interview is a quantitative research method used in the nutritional assessment. A trained dietitian investigator will ask a parent or caretaker to recall all foods and drinks that the participating child consumed during the previous 24 hours at two different time points during the study (non-consecutive days at least 8 - 20 days between the two records) to receive the proper information about the habitual intake of foods. From the data obtained by 24-h recall investigators intend to evaluate nutritional intakes of the population sub-groups. In addition, connections between the nutrition of children and body composition and health markers will be studied. FPQ will enable the estimation of certain relevant, infrequently consumed food groups. Data will be collected using validated questionnaires using computer -assisted data collection methods and processing. Evaluation of the dietary intake data will be performed by dietary software Open Platform for Clinical Nutrition (OPEN) by Jožef Stefan Institute (IJS). OPEN is a web-based application for dietary assessment and treatment as well as upgraded to support the 24h -recall/food diary method and FPQs in line with the EFSA pan-European food consumption survey, also known as the EU Menu, methodology. OPEN is an efficient, first Slovenian web-based tool for dietary assessment based on the local food items. OPEN allows the dietitian to enter the food and amounts for each participant. After food items, amounts and preparations are entered into the OPEN, the program creates an analysis with the breakdown of nutritional information.

The assessment of growth, development, and health status in 6-7 years old participants will base on the conducted clinical examination and data obtained from the medical records. Clinical examination will include the assessment of clinical status, anthropometric measurements, and quantitative ultrasound measurements of the bone mineral density and measurement of blood pressure.