Dietary patterns in toddlers The Generation R Study Jessica Kiefte-de Jong, RD, MSc Department of Paediatrics / The Generation R Study group Erasmus Medical Centre, Rotterdam, The Netherlands

Content Objectives Methods Dietary pattern analysis Results Conclusion Future perspectives

Objectives Aim: To identify dietary patterns in toddlers and to assess socio-demographic and lifestyle determinants of these dietary patterns Identifying children at potential risk for unhealthy eating behaviour in future. Forming a basis for future studies on dietary patterns and health outcomes within our cohort Percentage of mothers who breastfed during their child's first 6 months of life, according to mother's educational level (N = 2914).

Methods: Generation R Generation R Study, Rotterdam, The Netherlands. Population based prospective cohort study from fetal life onwards. N=5088 mothers with a delivery data between April 2002 and January 2006 provided consent for follow-up and received a food frequency questionnaire for their child at 14 months. (Mean; SD: 14; 2 months).

Methods: Food groups Refined grains Whole grains Pasta and rice Dairy Fruit Soy substitutes Vegetables Potatoes Soups and sauces Savoury and snacks Confectionary Vegetable oils Other fats (margarines, butter) Fish Shellfish Meat Eggs Legumes Sugar-containing beverages Non-sugar containing beverages Composite dishes

Methods: statistical analyses (1) Food groups were entered in PCA by grams/day consumed. Dietary patterns with an Eigenvalue of >1.5 were extracted. Explaining 24.5% of the variation in food consumption. Varimax rotation to reduce correlation between patterns Individual ‘adherence scores’ on the dietary patterns by using regression-based factor scores. Multivariate analyses on dietary pattern score Stepwise backward elimination procedure retaining only the strongest predictors.

Methods: statistical analyses (2) Variables in model: Mother factors: Maternal educational background Household income Marital status Maternal alcohol consumption Maternal smoking Folic acid supplementation Maternal BMI Maternal age Parity Parental stress Any history of depression or anxiety Any diabetes, hypertension or hypercholesterolemia Maternal macronutrient intake Child factors: Age of food assessment Gender Birth weight Breast-feeding Timing of solid introduction Daycare attendance Weight and Height Watching TV

Methods: Dietary patterns analysis (PCA) ‘Western-like dietary pattern’ ‘Health conscious dietary pattern’

Health conscious dietary pattern Western-like dietary pattern Mean intake grams/day Health conscious dietary pattern Western-like dietary pattern Refined bread and breakfast cereals 15 - 0.57 Whole bread and breakfast cereals 62 Pasta and rice 23 0.62 Dairy 626 Fruit 162 0.32 Soy substitutes 4 Vegetables 52 0.74 Potatoes 34 0.61 Soups and sauces 9 0.23 Savoury and snacks 0.59 Confectionary 28 0.72 Vegetable oils 1 0.50 Animal fats 11 0.58 Fish 8 0.22 Shellfish 0.3 Meat 26 0.21 0.27 Eggs 2 Legumes Sugar-containing beverages 198 Non-sugar containing beverages 56 Composite dishes 102

Results: Western-like dietary pattern Maternal indicators of a Western-like dietary pattern Difference in western-like dietary pattern score

Results: Western-like dietary pattern Child indicators of a Western-like dietary pattern Introduction of solids after the age of 6 months Difference in western-like dietary pattern score

Results: Health conscious dietary pattern Mother and child indicators of a Health conscious dietary pattern Difference in Health conscious dietary pattern score

Conclusion A Western-like and Health conscious dietary pattern can already be identified in children aged 14 months. Adherence to a Western-like dietary pattern clusters with early-life risk factors for overweight in later life. Determinants of a Health conscious diet may be less straightforward and need further elucidation

Future perspectives (1) Dietary variety in toddlers Tracking dietary patterns? Consequences for later health?

Thank you for your attention!