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BACKGROUND/OBJECTIVES: Maternal vitamin D deficiency during pregnancy may influence offspring kidney health. We aimed to examine the associations of 25-hydroxyvitamin D (25(OH)D) blood levels during fetal life with kidney outcomes at school age. SUBJECTS/METHODS: This study was embedded in a population-based prospective cohort study among 4212 mother-child pairs. We measured maternal second trimester (18-25 weeks) and fetal cord blood (at birth) 25(OH)D levels. At a median age of 6.0 years, we measured children's combined kidney volume, glomerular filtration rate (eGFR) from creatinine and cystatin C serum levels, and microalbuminuria from albumin and creatinine urine levels. RESULTS: Of all mothers, 21.9% had severely deficient levels (25(OH)D < 25.0 nmol/l), 25.7% had deficient levels (25.0-49.9 nmol/l), 25% had sufficient levels (50.0-74.9 nmol/l) and 27.4% had optimal levels (≥ 75.0 nmol/l). Maternal 25(OH)D levels were not consistently associated with childhood combined kidney volume. Higher maternal 25(OH)D levels were associated with lower childhood eGFR (difference -0.94 ml/min per 1.73 [m.sup.2] (95% confidence interval, -1.73;-0.15) per 1 standard deviation (s.d.) increase in 25(OH)D). Maternal 25(OH)D levels were not associated with microalbuminuria. Cord blood 25(OH)D levels were not associated with childhood kidney outcomes. The associations of maternal 25(OH)D levels with childhood eGFR were partly explained by childhood vitamin D status. CONCLUSIONS: Our findings suggest that maternal 25(OH)D levels during pregnancy may influence childhood kidney outcomes. These results should be considered hypothesis generating. Further studies are needed to replicate the observations, to examine the underlying mechanisms and to identify the long-term clinical consequences. European Journal of Clinical Nutrition (2016) 70, 629-634; doi: 10.1038/ejcn.2015.216; published online 23 December 2015, INTRODUCTION Vitamin D deficiency is related to various adverse health outcomes in early and later life. (1-4) An accumulating body of evidence suggests that vitamin D status during pregnancy may [...]

BACKGROUND/OBJECTIVES: The Dutch guidelines for a healthy diet aim to reduce major chronic diseases. However, supporting evidence on their overall association with all-cause and cause-specific mortality is limited. Recently, the Dutch Healthy Diet-index (DHD-index) has been developed to assess adherence to these guidelines. The aim was to examine the association between the DHD-index and all-cause mortality and deaths from cardiovascular disease (CVD), coronary heart disease (CHD), stroke and cancer. SUBJECTS/METHODS: We followed 3593 men and women aged 55 years and older enrolled in the Rotterdam Study, a populationbased prospective cohort study, from baseline in 1990-1993 to 2011. A validated 170-item food frequency questionnaire at baseline was used to calculate the DHD-index score (maximum 90 points). Cox proportional hazard models were used to estimate hazard ratios (HRs) adjusting for age, sex, total energy intake, smoking and educational level. RESULTS: During the 20-year follow-up, 1831 (51%) deaths were reported. Mean DHD-index score was 60.6 (s.d. 10.6). The score was inversely associated with all-cause mortality (highest vs lowest quartile HR 0.77;95% confidence interval (CI) 0.67, 0.89). Inverse but non-significant associations were observed for mortality due to CVD (HR 0.74;95% CI 0.55, 1.01), CHD (HR 0.60;95% CI 0.34, 1.06) and stroke (HR 0.67;95% CI 0.36,1.22), whereas no association was observed with cancer mortality (HR 0.99;95% CI 0.90,1.11). CONCLUSIONS: A higher level of adherence to the Dutch dietary guidelines, as assessed with the DHD-index, was associated with a lower risk of all-cause mortality, probably due to an inverse association with cardiovascular causes of death. European Journal of Clinical Nutrition (2016) 70, 262-268; doi:10.1038/ejcn.2015.163; published online 21 October 2015, INTRODUCTION Traditionally, nutritional epidemiology focused on investigating associations between energy, single nutrients, food products, or food groups, and diseases. However, several biological and statistical arguments have been put forward to [...]

BACKGROUND/OBJECTIVES: Gait is an important health indicator, relating strongly to the risk of falling, morbidity and mortality. In a community-dwelling population, we investigated associations of alcohol, coffee and tobacco consumption with gait. SUBJECTS/METHODS: Two thousand forty-six non-demented participants from the Rotterdam Study underwent gait assessment by electronic walkway. We measured gait velocity and Global Gait, which is the average of seven gait domains: Rhythm, Phases, Variability, Pace, Tandem, Turning and Base of Support. Alcohol, coffee and tobacco consumption was assessed by questionnaires. With analysis of covariance, we investigated associations of consumption of alcoholic beverages, coffee consumption and smoking with Global Gait, gait velocity and the seven individual gait domains. RESULTS: In all, 81.9% of participants drank alcohol, 92.4% drank coffee, 17.3% were current smokers and 50.9% were past smokers. Moderate alcohol consumption (1-3 glasses per day) associated with better gait, as measured by Global Gait (0.20 standard deviations (s.d.) (95% confidence interval: 0.10;0.31)), gait velocity (2.65 cm/s (0.80;4.50)), Rhythm and Variability. Consuming high amounts of coffee (> 3 cups per day) associated with better Global Gait (0.18 s.d. (0.08;0.28)), gait velocity (2.63 cm/s (0.80;4.45)), Pace, Turning and Variability. Current smoking associated with worse Global Gait (-0.11 s.d. (-0.21;0.00)), gait velocity (-3.47 cm/s (-5.33;- 1.60)), Rhythm and Pace, compared with non-smokers. CONCLUSIONS: In a community-dwelling population, consuming > 1 cup of coffee and 1-3 glasses of alcohol relate to better gait, whereas smoking is related to worse gait. Further studies are required to evaluate whether interventions targeting substance consumption may aid to prevent or reduce gait deterioration and thereby related health problems. doi:10.1038/ejcn.2015.120;published online 29 July 2015, INTRODUCTION Alcohol, coffee and tobacco are widely consumed and have addictive properties. (1-6) These substances contain many different components, which have various effects on health with chronic use. (1-5,7-9) Although [...]

BACKGROUND/OBJECTIVES: A shorter breastfeeding duration is associated with an increased risk of cardiovascular disease in adulthood. Early microvasculature structure adaptations may be part of the underlying mechanism. We examined the associations of ever breastfeeding, breastfeeding duration and exclusivity, and the timing of introduction of solid foods with retinal vessel calibers in children. SUBJECTS/METHODS: We performed a population-based prospective cohort study from fetal life onwards in the city of Rotterdam, the Netherlands. We obtained information on ever breastfeeding, breastfeeding duration and exclusivity, and age at introduction of solid foods from postal questionnaires at the ages of 2,6 and 12 months after birth. At the median age of 6.0 years (90% range: 5.7-6.8), we measured retinal arteriolar and venular calibers from digitized retinal photographs among 3220 children. Grader-specific s.d. scores (SDS) for both central retinal and arteriolar equivalents were constructed. RESULTS: We observed that in the models only adjusted for child's age, sex and ethnicity, children who were never breastfed had narrower retinal arteriolar and venular calibers in childhood as compared with children who were breastfed (differences in retinal arteriolar and venular calibers, respectively: -0.16 SDS (95% confidence interval (CI): -0.29, -0.03) and -0.18 SDS (95% CI: -0.32, -0.04)). After additional adjustment for maternal and childhood socio-demographic and lifestyle-related characteristics, never breastfeeding was only associated with narrower retinal venular caliber (difference: -0.15 SDS (95% CI: -0.29, -0.02)). We did not observe associations of breastfeeding duration or exclusivity, or age at introduction of solid foods with retinal vessel calibers. CONCLUSIONS: Children who were never breastfed tended to have narrower retinal venular calibers. We did not observe associations of breastfeeding duration with retinal vessel calibers. Family-based socio-demographic factors, maternal lifestyle-related factors and childhood factors only slightly influenced the observed associations. These results should be considered a hypothesis generating for further observational and experimental studies. doi:10.1038/ejcn.2015.113; published online 15 July 2015, INTRODUCTION A shorter breastfeeding duration and non-exclusivity in infancy have been associated with higher risks of hypertension in adulthood. (1) Studies in children have also shown that shorter duration of [...]

BACKGROUND/OBJECTIVES: High vitamin A intake may be associated with a decreased bone mineral density (BMD) and increased risk of fractures. Our objectives were to study whether dietary intake of vitamin A (total, retinol or beta-carotene) is associated with BMD and fracture risk and if associations are modified by body mass index (BMI) and vitamin D. SUBJECTS/METHODS: Participants were aged 55 years and older (n = 5288) from the Rotterdam Study, a population-based prospective cohort. Baseline vitamin A and D intake was measured by a food frequency questionnaire. BMD was measured by dual-energy X-ray absorptiometry at four visits between baseline (1989-1993) and 2004. Serum vitamin D was assessed in a subgroup (n = 3161). Fracture incidence data were derived from medical records with a mean follow-up time of 13.9 years. RESULTS: Median intake of vitamin A ranged from 684 retinol equivalents (REs)/day (quintile 1) to 2000 REs/day (quintile 5). After adjustment for confounders related to lifestyle and socioeconomic status, BMD was significantly higher in subjects in the highest quintile of total vitamin A (mean difference in BMD (95% confidence interval (CI)) = 11.53 (0.37-22.7) mg/[cm.sup.2]) and retinol intake (mean difference in BMD (95% CI) = 12.57 (1.10-24.05) mg/[cm.sup.2]) than in the middle quintile. Additional adjustment for BMI diluted these associations. Fracture risk was reduced in these subjects. Significant interaction was present between intake of retinol and overweight (BMI >25 kg/[m.sup.2]) in relation to fractures (P for interaction =0.05), but not BMD. Stratified analysis showed that these favourable associations with fracture risk were only present in overweight subjects (BMI >25 kg/[m.sup.2]). No effect modification by vitamin D intake or serum levels was observed. CONCLUSIONS: Our results suggest a plausible favourable relation between high vitamin A intake from the diet and fracture risk in overweight subjects, whereas the association between vitamin A and BMD is mainly explained by BMI. European Journal of Clinical Nutrition (2015) 69, 1360-1368;doi: 10.1038/ejcn.2015.154; published online 16 September 2015, INTRODUCTION Adequate nutrition is an important modifiable factor for maintaining bone mineral density (BMD). Although the emphasis in previous studies has been on the intake of calcium and vitamin D, [...]

BACKGROUND/OBJECTIVE: Intake of sugar-containing beverages (SCBs) has been associated with higher body mass index (BMI) in childhood. The potential effect of SCB intake during infancy is unclear. We examined the association of SCB intake at 13 months with BMI development until 6 years and body composition at age 6 years. SUBJECTS/METHODS: This study included 2371 Dutch children from a population-based prospective cohort study. SCB intake at 13 months was assessed using a Food Frequency Questionnaire with validation against 24-h recalls and was standardized for total energy. BMI was calculated from repeated weight and height measurements, and age- and sex- specific s.d. scores were calculated. Adiposity was measured using Dual-energy X-ray absorptiometry. RESULTS: In girls, higher SCB intake at 13 months was significantly associated with higher BMI at ages 2, 3, 4 and 6 years (at age 6 years BMI (s.d. score) increase 0.11 (95% confidence interval (CI) +0.00;0.23), high versus low intake). We observed a tendency towards higher android/gynoid fat ratio in girls with high intake (s.d. increase 0.14 (95% CI - 0.02;0.29), versus low intake) but not with body fat percentage. In boys, there was no association with BMI or body composition, but boys with high SCB intake at 13 months were taller at age 6 years (s.d. increase 0.14 (95% CI +0.00; 0.27), versus low intake). CONCLUSIONS: Higher SCB intake at 13 months was associated with higher BMI up to age 6 years in girls but not in boys. Our results imply that the unfavorable effects of SCB intake start early in life and that dietary advice regarding limiting SCB intake should already be given early in life. European Journal of Clinical Nutrition (2015) 69, 314-321; doi: 10.1038/ejcn.2015.2; published online 4 February 2015, INTRODUCTION The prevalence of childhood obesity has increased dramatically over the past decades. In 2010, it was estimated to be 11.7% in the developed countries. (1) Similarly, intake of sugar-containing [...]

BACKGROUND: Breastfeeding duration is associated with the risks of cardio- metabolic diseases in adulthood. We examined the associations of infant feeding patterns with metabolic outcomes in children and whether any association was explained by family-based socio-demographic, maternal lifestyle-related or childhood factors. SUBJECTS/METHODS: We performed a population-based prospective cohort study in 3417 children to examine the associations of breastfeeding duration and exclusivity and age at introduction of solid foods with blood levels of lipids, insulin and C-peptide and risk of clustering of cardio-metabolic risk factors at the median age of 6.0 years (90% range 5.7-6.8). RESULTS: We observed that, in the models only adjusted for child's age and sex, ever breastfeeding was not associated with childhood blood levels of lipids but was associated with higher insulin and C- peptide concentrations (P-value < 0.05). Breastfeeding duration and exclusivity were not consistently associated with metabolic outcomes. Early introduction of solid foods was associated with higher levels of total cholesterol (P-value < 0.05) but not with high- density lipoprotein and low-density lipoprotein cholesterol, triglycerides and insulin levels. Shorter breastfeeding duration and exclusive breastfeeding were associated with increased risks of clustering of cardio-metabolic risk factors. After additional adjustment for family, maternal and childhood factors, none of these associations remained significant. CONCLUSIONS: In conclusion, we found no consistent associations of infant feeding patterns with metabolic outcomes at school age, after taking into account family-based socio-demographic, maternal lifestyle-related or childhood factors. Whether infant diet composition influences metabolic outcomes in later life should be further studied. European Journal of Clinical Nutrition (2014) 68, 1008-1015; doi: 10.1038/ejcn.2014.81; published online 30 April 2014, INTRODUCTION Breastfeeding during infancy has been suggested to have a protective effect on the development of cardio-metabolic diseases and type 2 diabetes and their risk factors in later life. (1-6) [...]

BACKGROUND/OBJECTIVES: The nutrient-rich food (NRF) index assesses nutrient quality of individual food items by ranking them according to their nutrient composition. The index reflects the nutrient density of the overall diet. We examined the associations between the NRF9.3 index--a score on the basis of nine beneficial nutrients (protein, fiber, vitamins and minerals) and three nutrients to limit (saturated fat, sugar and sodium)--incidence of cardiovascular disease (CVD) events and all-cause mortality. SUBJECTS/METHODS: A total of 4969 persons aged 55 and older from the Rotterdam Study, a prospective cohort study in the Netherlands, were studied. First, all foods were scored on the basis of their nutrient composition, resulting in an NRF9.3 score on food item level. Subsequently, they were converted into individual weighted scores on the basis of the amount of calories of each food item consumed by the subjects and the total energy intake. The hazard ratios (HRs) of the NRF9.3 index score were adjusted for age, gender, body mass index, smoking history, doctor-prescribed diet, alcohol consumption and education. RESULTS: Food groups that contributed most to the NRF9.3 index score were vegetables, milk and milk products, fruit, bread and potatoes. A high NRF9.3 index score was inversely associated with all-cause mortality (HR Q4 versus Q1: 0.84 (95% confidence interval: 0.74, 0.96)). Associations were stronger in women than in men. The NRF9.3 index score was not associated with incidence of CVD. CONCLUSION: Elderly with a higher NRF9.3 index score, indicating more beneficial components and/or less limiting components, had a lower risk of all-cause mortality. Consuming a nutrient-dense diet may improve survival. European Journal of Clinical Nutrition (2014) 68, 741-747; doi:10.1038/ejcn.2014.35;published online 19 March 2014, INTRODUCTION The Dietary Guidelines for Americans, 2010 recommend eating foods that are low in calories and to focus on consuming more nutrient-dense foods and beverages. (1) Diet quality scores, for [...]

BACKGROUND/OBJECTIVES: Many parents do not follow recommendations for the timing of introduction of complementary feeding. The aim of this study was to identify determinants associated with the timing of introduction of complementary feeding in a multiethnic birth cohort. SUBJECTS/METHODS: Subjects were 3561 mothers and infants participating in a prospective cohort study. The timing of introduction of complementary feeding and maternal and infant characteristics were obtained by parent-derived questionnaires. Regression analyses were performed to identify determinants for the timing of introduction of complementary feeding ( RESULTS: In total, 62% of infants were introduced to complementary feeding before the age of 6 months. Determinants for very early ( CONCLUSIONS: This study confirmed determinants for the timing of introduction of complementary feeding that have been identified by previous studies, which may be appropriate targets for education and guidance. Moreover, mothers whose infants attend day care and have a family history of asthma, atopy or allergy to cow's milk may need guidance to follow infant feeding recommendations. European Journal of Clinical Nutrition (2013) 67, 625-630;doi: 10.1038/ejcn.2013.50; published online 6 March 2013 Keywords: introduction of solids; infant feeding; complementary feeding; weaning, INTRODUCTION The first year of life includes many transitions in food consumption. (1) Appropriate nutrition during infancy is essential for adequate growth, development and health. (2) The World Health Organization [...]

BACKGROUND/OBJECTIVES: Maternal fish consumption during pregnancy might influence the fetal immune system through anti-inflammatory effects of omega-3 fatty acids, and might affect the risks of childhood asthma and atopy. In Generation R, a prospective cohort study in the Netherlands, we examined the associations of first trimester fish consumption with childhood wheezing and eczema in the first 4 years of life. METHODS: In total, 2976 mothers completed a 293-item semiquantitative food frequency questionnaire covering dietary intake in the first trimester. The occurrence of wheezing and eczema was yearly assessed by questionnaires. RESULTS: Median weekly fish consumption was 83 (95% range 0-316) grams per week. We observed no consistent associations of maternal total-, lean- or fatty-fish consumption during pregnancy with the risks of childhood wheezing. Maternal shellfish consumption of 1-13 g per week was associated with overall increased risks of childhood wheezing and eczema (OR 1.20 (1.04, 1.40) and OR 1.18 (1.01, 1.37), respectively). Maternal fatty fish consumption of 35-69 g per week was associated with increased overall risks of childhood eczema (OR 1.17 (1.00, 1.38)), but maternal total- or lean-fish consumption was not. CONCLUSIONS: During pregnancy, shellfish consumption was associated with increased risks of wheezing and eczema, while fatty fish consumption was associated with a higher risk of eczema only. Maternal total fish or lean fish consumption were not associated with wheezing or eczema. Further studies are needed to replicate these findings and to explore underlying mechanisms. European Journal of Clinical Nutrition (2013) 67, 353-359; doi: 10.1038/ejcn.2013.36; published online 27 February 2013 Keywords: pregnancy; fish consumption; asthma symptoms; eczema; cohort study; atopy, INTRODUCTION Specific adverse fetal and infant exposures might lead to the development of asthma and atopic disease. (1-3) Suboptimal maternal diet during pregnancy is one of these exposures, which might [...]