Publications by authors named "Suvi Ahonen"

29 Publications

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Consumption of differently processed milk products and the risk of asthma in children.

Pediatr Allergy Immunol 2021 Sep 2. Epub 2021 Sep 2.

Public Health and Welfare Department, Finnish Institute for Health and Welfare, Helsinki, Finland.

Background: Consumption of unprocessed cow's milk has been associated with a lower risk of childhood asthma and/or atopy. Not much is known about differently processed milk products. We aimed to study the association between the consumption of differently processed milk products and asthma risk in a Finnish birth cohort.

Methods: We included 3053 children from the Finnish Type 1 Diabetes Prediction and Prevention (DIPP) Nutrition Study. Asthma and its subtypes were assessed at the age of 5 years, and food consumption by food records, at the age of 3 and 6 months and 1, 2, 3, 4, and 5 years. We used conventional and processing (heat treatment and homogenization)-based classifications for milk products. The data were analyzed using a joint model for longitudinal and time-to-event data.

Results: At the age of 5 years, 184 (6.0%) children had asthma, of whom 101 (54.9%) were atopic, 75 (40.8%) were nonatopic, and eight (4.3%) could not be categorized. Consumption of infant formulas [adjusted hazard ratio (95% confidence intervals) 1.15 (1.07, 1.23), p < .001] and strongly heat-treated milk products [1.06 (1.01, 1.10), p = .01] was associated with the risk of all asthma. Consumption of all cow's milk products [1.09 (1.03, 1.15), p = .003], nonfermented milk products [1.08 (1.02, 1.14), p = .008], infant formulas [1.23 (1.13, 1.34), p < .001], and strongly heat-treated milk products [1.08 (1.02, 1.15), p = .006] was associated with nonatopic asthma risk. All these associations remained statistically significant after multiple testing correction.

Conclusions: High consumption of infant formula and other strongly heat-treated milk products may be associated with the development of asthma.
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http://dx.doi.org/10.1111/pai.13659DOI Listing
September 2021

Effect of Early Feeding on Intestinal Permeability and Inflammation Markers in Infants with Genetic Susceptibility to Type 1 Diabetes: A Randomized Clinical Trial.

J Pediatr 2021 Jul 20. Epub 2021 Jul 20.

Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland. Electronic address:

Objectives: To assess whether weaning to an extensively hydrolyzed formula (EHF) decreases gut permeability and/or markers of intestinal inflammation in infants with HLA-conferred diabetes susceptibility, when compared with conventional formula.

Study Design: By analyzing 1468 expecting biological parent pairs for HLA-conferred susceptibility for type 1 diabetes, 465 couples (32 %) potentially eligible for the study were identified. After further parental consent, 332 babies to be born were randomized at 35th gestational week. HLA genotyping was performed at birth in 309 infants. Out of 87 eligible children, 73 infants participated in the intervention study: 33 in the EHF group and 40 in the control group. Clinical visits took place at 3, 6, 9, and 12 months of age. The infants were provided either EHF or conventional formula whenever breastfeeding was not available or additional feeding was required over the first 9 months of life. The main outcome was the lactulose to mannitol ratio (L/M ratio) at 9 months. The secondary outcomes were L/M ratio at 3, 6, and 12 months of age, and fecal calprotectin and human beta-defensin 2 (HBD-2) levels at each visit.

Results: Compared with controls, the median L/M ratio was lower in the EHF group at 9 months (.006 vs .028; P = .005). Otherwise, the levels of intestinal permeability, fecal calprotectin, and HBD-2 were comparable between the two groups, although slight differences in the age-related dynamics of these markers were observed.

Conclusions: It is possible to decrease intestinal permeability in infancy through weaning to an extensively hydrolyzed formula. This may reduce the early exposure to dietary antigens.

Trial Registration: Clinicaltrials.gov: NCT01735123.
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http://dx.doi.org/10.1016/j.jpeds.2021.07.042DOI Listing
July 2021

Maternal Vitamin C and Iron Intake during Pregnancy and the Risk of Islet Autoimmunity and Type 1 Diabetes in Children: A Birth Cohort Study.

Nutrients 2021 Mar 13;13(3). Epub 2021 Mar 13.

Unit of Health Sciences, Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland.

Our aim was to study the associations between maternal vitamin C and iron intake during pregnancy and the offspring's risk of developing islet autoimmunity and type 1 diabetes. The study was a part of the Finnish Type 1 Diabetes Prediction and Prevention (DIPP) prospective birth cohort including children genetically at risk of type 1 diabetes born between 1997-2004. The diets of 4879 mothers in late pregnancy were assessed with a validated food frequency questionnaire. The outcomes were islet autoimmunity and type 1 diabetes. Cox proportional hazards regression analysis adjusted for energy, family history of diabetes, human leukocyte antigen (HLA) genotype and sex was used for statistical analyses. Total intake of vitamin C or iron from food and supplements was not associated with the risk of islet autoimmunity (vitamin C: HR 0.91: 95% CI (0.80, 1.03), iron: 0.98 (0.87, 1.10)) or type 1 diabetes (vitamin C: 1.01 (0.87, 1.17), iron: 0.92 (0.78, 1.08)), neither was the use of vitamin C or iron supplements associated with the outcomes. In conclusion, no association was found between maternal vitamin C or iron intake during pregnancy and the risk of islet autoimmunity or type 1 diabetes in the offspring.
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http://dx.doi.org/10.3390/nu13030928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001228PMC
March 2021

Maternal Nitrate and Nitrite Intakes during Pregnancy and Risk of Islet Autoimmunity and Type 1 Diabetes: The DIPP Cohort Study.

J Nutr 2020 11;150(11):2969-2976

Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland.

Background: High dietary intake of nitrate and nitrite might increase the risk of type 1 diabetes. To our knowledge, no earlier prospective study has explored whether maternal dietary intake of nitrate and nitrite during pregnancy is associated with the risk of type 1 diabetes in the offspring.

Objective: Our aim was to study association between maternal intake of nitrate and nitrite during pregnancy and the risk of islet autoimmunity and type 1 diabetes in the offspring.

Design: Children born between 1997 and 2004 at Oulu and Tampere University Hospitals in Finland and carrying increased human leukocyte antigen (HLA)-conferred risk for type 1 diabetes were followed in the Type 1 Diabetes Prediction and Prevention (DIPP) study from 3 mo of age. Islet autoantibodies were screened at 3- to 12-mo intervals from serum samples. Of 4879 children, 312 developed islet autoimmunity and 178 developed type 1 diabetes during a 15-y follow-up. Maternal intake of nitrate and nitrite during the eighth month of pregnancy was assessed after birth using a validated self-administered FFQ. Cox proportional hazards regression was used for the statistical analyses.

Results: Maternal intake of nitrate and nitrite during pregnancy was not associated with the child's risk of islet autoimmunity [nitrate: HR 0.99 (95% CI: 0.88, 1.11); nitrite: HR 1.03 (95% CI: 0.92, 1.15)] or type 1 diabetes [nitrate: HR 1.02 (95% CI: 0.88, 1.17); nitrite: HR 0.97 (95% CI: 0.83, 1.12)] when adjusted for energy (residual method), sex, HLA risk group, and family history of diabetes. Further adjustment for dietary antioxidants (vitamin C, vitamin E, and selenium) did not change the results.

Conclusion: Maternal dietary intake of nitrate or nitrite during pregnancy is not associated with the risk of islet autoimmunity or type 1 diabetes in the offspring genetically at risk for type 1 diabetes.
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http://dx.doi.org/10.1093/jn/nxaa250DOI Listing
November 2020

Consumption of differently processed milk products in infancy and early childhood and the risk of islet autoimmunity.

Br J Nutr 2020 Feb 27:1-8. Epub 2020 Feb 27.

Department of Public Health Solutions, Finnish Institute for Health and Welfare, FI-00271Helsinki, Finland.

Several prospective studies have shown an association between cows' milk consumption and the risk of islet autoimmunity and/or type 1 diabetes. We wanted to study whether processing of milk plays a role. A population-based birth cohort of 6081 children with HLA-DQB1-conferred risk to type 1 diabetes was followed until the age of 15 years. We included 5545 children in the analyses. Food records were completed at the ages of 3 and 6 months and 1, 2, 3, 4 and 6 years, and diabetes-associated autoantibodies were measured at 3-12-month intervals. For milk products in the food composition database, we used conventional and processing-based classifications. We analysed the data using a joint model for longitudinal and time-to-event data. By the age of 6 years, islet autoimmunity developed in 246 children. Consumption of all cows' milk products together (energy-adjusted hazard ratio 1·06; 95 % CI 1·02, 1·11; P = 0·003), non-fermented milk products (1·06; 95 % CI 1·01, 1·10; P = 0·011) and fermented milk products (1·35; 95 % CI 1·10, 1·67; P = 0·005) was associated with an increased risk of islet autoimmunity. The early milk consumption was not associated with the risk beyond 6 years. We observed no clear differences based on milk homogenisation and heat treatment. Our results are consistent with the previous studies, which indicate that high milk consumption may cause islet autoimmunity in children at increased genetic risk. The study did not identify any specific type of milk processing that would clearly stand out as a sole risk factor apart from other milk products.
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http://dx.doi.org/10.1017/S0007114520000744DOI Listing
February 2020

Association of Cereal, Gluten, and Dietary Fiber Intake With Islet Autoimmunity and Type 1 Diabetes.

JAMA Pediatr 2019 Oct;173(10):953-960

Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland.

Importance: Dietary proteins, such as gluten, have been suggested as triggers of the disease process in type 1 diabetes (T1D).

Objective: To study the associations of cereal, gluten, and dietary fiber intake with the development of islet autoimmunity (IA) and T1D.

Design, Setting, And Participants: The prospective birth cohort Finnish Type 1 Diabetes Prediction and Prevention Study recruited children with genetic susceptibility to type 1 diabetes from September 1996 to September 2004 from 2 university hospitals in Finland and followed up every 3 to 12 months up to 6 years for diet, islet autoantibodies, and T1D. Altogether 6081 infants (78% of those invited) participated in the study. Dietary data were available for 5714 children (94.0%) and dietary and IA data were available for 5545 children (91.2%), of whom 3762 (68%) had data on islet autoantibodies up to age 6 years. Information on T1D was available for all children. Data were analyzed in 2018 and end point data were updated in 2015.

Exposures: Each child's intake of cereals, gluten, and dietary fiber was calculated from repeated 3-day food records up to 6 years.

Main Outcomes And Measures: Islet autoimmunity was defined as repeated positivity for islet cell antibodies and at least 1 biochemical autoantibody of 3 analyzed, or T1D. Data on the diagnosis of T1D were obtained from Finnish Pediatric Diabetes Register.

Results: Of 5545 children (2950 boys [53.2%]), 246 (4.4%) developed IA and of 5714 children (3033 boys [53.1%]), 90 (1.6%) developed T1D during the 6-year follow-up. Based on joint models, the intake of oats (hazard ratio [HR], 1.08; 95% CI, 1.03-1.13), wheat (HR, 1.09; 95% CI, 1.03-1.15), rye (HR, 1.13; 95% CI, 1.03-1.23), gluten-containing cereals (HR, 1.07; 95% CI, 1.03-1.11), gluten without avenin from oats (HR, 2.23; 95% CI, 1.40-3.57), gluten with avenin (HR, 2.06; 95% CI, 1.45-2.92), and dietary fiber (HR, 1.41; 95% CI, 1.10-1.81) was associated with the risk of developing IA (HRs for 1 g/MJ increase in intake). The intake of oats (HR, 1.10; 95% CI, 1.00-1.21) and rye (HR, 1.20; 95% CI, 1.03-1.41) was associated with the risk of developing T1D. After multiple testing correction, the associations with IA remained statistically significant.

Conclusions And Relevance: A high intake of oats, gluten-containing cereals, gluten, and dietary fiber was associated with an increased risk of IA. Further studies are needed to confirm or rule out the findings and study potential mechanisms.
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http://dx.doi.org/10.1001/jamapediatrics.2019.2564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6692682PMC
October 2019

Carotenoid Intake and Serum Concentration in Young Finnish Children and Their Relation with Fruit and Vegetable Consumption.

Nutrients 2018 Oct 17;10(10). Epub 2018 Oct 17.

Nutrition Unit, Department of Public Health Solutions, The National Institute for Health and Welfare, PO Box 30, 00271 Helsinki, Finland.

Fruit and vegetable intake has been associated with a reduced risk of many chronic diseases. These foods are the main dietary source of carotenoids. The aim of the present study was to evaluate the associations between dietary intake and serum concentrations of α- and β-carotene in a sample of young Finnish children from the population-based birth cohort of the Type 1 Diabetes Prediction and Prevention (DIPP) Study. The current analysis comprised 3-day food records and serum samples from 207 children aged 1, 2 and 3 years. Spearman and partial correlations, as well as a cross-classification analyses, were used to assess the relationship between dietary intake and the corresponding biomarkers. Serum concentrations of α- and β-carotene were significantly higher among the 1-year-old compared to the 3-year-old children. Dietary intakes of α- and β-carotene correlated significantly with their respective serum concentrations in all age groups, the association being highest at the age of 1 year (α-carotene = 0.48; < 0.001 and β-carotene = 0.47; < 0.001), and lowest at the age of 3 years (α-carotene = 0.44; < 0.001 and β-carotene = 0.30; < 0.001). A cross-classification showed that 72⁻81% of the participants were correctly classified to the same or adjacent quartile, when comparing the reported dietary intakes and the concentrations of the corresponding carotenoid in serum. The 3-day food record seems to be reasonably valid in the assessment of root vegetable consumption among young Finnish children. Root vegetables were the main dietary source of both carotenoids in all age groups. The high consumption of commercial baby foods among the 1-year-old children was reflected in the relatively high dietary intake and serum concentration of both carotenoids.
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http://dx.doi.org/10.3390/nu10101533DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213073PMC
October 2018

Infant Feeding in Relation to the Risk of Advanced Islet Autoimmunity and Type 1 Diabetes in Children With Increased Genetic Susceptibility: A Cohort Study.

Am J Epidemiol 2018 01;187(1):34-44

Faculty of Social Sciences, University of Tampere, Tampere, Finland.

Breastfeeding, age at introduction of foods, and food diversity in infancy were studied for associations with advanced islet autoimmunity and type 1 diabetes. During 1996--2004, a total of 5,915 newborns with human leukocyte antigen-conferred susceptibility to type 1 diabetes were enrolled in the prospective Finnish Type 1 Diabetes Prediction and Prevention Nutrition Study. Children were assessed at intervals of 3-12 months for the appearance of 4 types of islet autoantibodies and type 1 diabetes up to the age of 15 years. Survival models indicated the 3 variables of interest were not associated with advanced islet autoimmunity or type 1 diabetes in the cohort. Early introduction of solid foods was associated with increased risk of advanced islet autoimmunity in children up to age 3 years (for <3 months vs. >4 months, hazard ratio = 2.33, 95% confidence interval: 1.39, 3.91; for 3-4 months vs. >4 months, hazard ratio = 2.18; 95% confidence interval: 1.38, 3.47) but not in longer follow-up (P for interaction = 0.046). Similar results were observed for age at introduction of roots, cereals, egg, and meat relative to risk of advanced islet autoimmunity. No consistent, long-term associations between infant feeding and advanced islet autoimmunity or type 1 diabetes were observed.
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http://dx.doi.org/10.1093/aje/kwx191DOI Listing
January 2018

Development of a harmonized food grouping system for between-country comparisons in the TEDDY Study.

J Food Compost Anal 2017 10 25;63:79-88. Epub 2017 Jul 25.

Health Informatics Institute, Department of Pediatrics, Morsani College of Medicine, University of South Florida, 3650 Spectrum Blvd, Tampa, FL, 33612, USA.

The Environmental Determinants of Diabetes in the Young (TEDDY) is an international study aiming to investigate associations between dietary and other environmental factors and the risk of developing islet autoimmunity and type 1 diabetes. Dietary intake was assessed using a 24-hour recall and repeated 3-day food records and analyzed using country-specific food composition databases (FCDBs) in Finland, Germany, Sweden, and the U.S. with respective in-house calculation programs. A food grouping harmonization process between four country-specific FCDBs was conducted to evaluate and achieve comparability on food group definitions and quantification of food consumption across the countries. Systematic review revealed that the majority of existing food groups of the TEDDY FCDBs were not comparable. Therefore, a completely new classification system of 15 mutually exclusive main food groups (e.g. vegetables) and 89 subgroups (e.g. root vegetables, leafy vegetables) was developed. Foods and beverages were categorized into basic foods (single ingredient) and composite dishes (multiple ingredients). Composite dishes were broken down to ingredients using food composition data available in the FCDBs or generic recipes created for the harmonization effort. The daily consumption of every food group across FCDBs was quantified consistently as either raw or prepared weight depending on the food group to achieve maximal comparability.
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http://dx.doi.org/10.1016/j.jfca.2017.07.037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5690566PMC
October 2017

Vitamin D intake during the first 4 years and onset of asthma by age 5: A nested case-control study.

Pediatr Allergy Immunol 2017 Nov 8;28(7):641-648. Epub 2017 Sep 8.

Faculty of Social Sciences/Health, University of Tampere, Tampere, Finland.

Background: Early-life vitamin D intake has been linked to asthma risk in childhood, but the role of longitudinal vitamin D exposure has not been previously evaluated. We investigated the association between vitamin D intake during the first 4 years of life and asthma risk by age 5.

Methods: Within a Finnish population-based birth cohort, 182 incident asthma cases were matched to 728 controls on sex, genetic risk for type 1 diabetes, delivery hospital, and time of birth. Vitamin D intake was assessed by age-specific 3 day food records. Parents completed a validated version of the International Study of Asthma and Allergies in Childhood questionnaire at 5 years.

Results: At 3 months, supplements were the main source of vitamin D intake; intake from foods increased from 3 months on, mainly from fortified milk products. Vitamin D intake at each specific age was associated with an increased risk of any asthma, atopic, and non-atopic asthma, but only intake at 1 and 2 years was statistically significantly associated with asthma. Longitudinal vitamin D intake was associated with an increased risk of asthma (OR 1.24; 95%CI 1.00-1.53).

Conclusions: Increased vitamin D intake in childhood, particularly intake at 1 and 2 years of age, may increase risk of childhood asthma. This might reflect a true effect or residual confounding by lifestyle or environmental factors. Repeated assessment of vitamin D intake allowed evaluation of the longitudinal and age-dependent impact of vitamin D on the risk of asthma. Further longitudinal studies are required to confirm or question these findings.
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http://dx.doi.org/10.1111/pai.12773DOI Listing
November 2017

Fatty acid status in infancy is associated with the risk of type 1 diabetes-associated autoimmunity.

Diabetologia 2017 07 4;60(7):1223-1233. Epub 2017 May 4.

Department of Public Health Solutions, National Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland.

Aims/hypothesis: We investigated the association of early serum fatty acid composition with the risk of type 1 diabetes-associated autoimmunity. Our hypothesis was that fatty acid status during infancy is related to type 1 diabetes-associated autoimmunity and that long-chain n-3 fatty acids, in particular, are associated with decreased risk.

Methods: We performed a nested case-control analysis within the Finnish Type 1 Diabetes Prediction and Prevention Study birth cohort, carrying HLA-conferred susceptibility to type 1 diabetes (n = 7782). Serum total fatty acid composition was analysed by gas chromatography in 240 infants with islet autoimmunity and 480 control infants at the age of 3 and 6 months. Islet autoimmunity was defined as repeated positivity for islet cell autoantibodies in combination with at least one of three selected autoantibodies. In addition, a subset of 43 infants with primary insulin autoimmunity (i.e. those with insulin autoantibodies as the first autoantibody with no concomitant other autoantibodies) and a control group (n = 86) were analysed. A third endpoint was primary GAD autoimmunity defined as GAD autoantibody appearing as the first antibody without other concomitant autoantibodies (22 infants with GAD autoimmunity; 42 infants in control group). Conditional logistic regression was applied, considering multiple comparisons by false discovery rate <0.05.

Results: Serum fatty acid composition differed between breastfed and non-breastfed infants, reflecting differences in the fatty acid composition of the milk. Fatty acids were associated with islet autoimmunity (higher serum pentadecanoic, palmitic, palmitoleic and docosahexaenoic acids decreased risk; higher arachidonic:docosahexaenoic and n-6:n-3 acid ratios increased risk). Furthermore, fatty acids were associated with primary insulin autoimmunity, these associations being stronger (higher palmitoleic acid, cis-vaccenic, arachidonic, docosapentaenoic and docosahexaenoic acids decreased risk; higher α-linoleic acid and arachidonic:docosahexaenoic and n-6:n-3 acid ratios increased risk). Moreover, the quantity of breast milk consumed per day was inversely associated with primary insulin autoimmunity, while the quantity of cow's milk consumed per day was directly associated.

Conclusions/interpretation: Fatty acid status may play a role in the development of type 1 diabetes-associated autoimmunity. Fish-derived fatty acids may be protective, particularly during infancy. Furthermore, fatty acids consumed during breastfeeding may provide protection against type 1 diabetes-associated autoimmunity. Further studies are warranted to clarify the independent role of fatty acids in the development of type 1 diabetes.
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http://dx.doi.org/10.1007/s00125-017-4280-9DOI Listing
July 2017

Eliminating cows' milk, but not wheat, barley or rye, increases the risk of growth deceleration and nutritional inadequacies.

Acta Paediatr 2017 Jul 25;106(7):1142-1149. Epub 2017 Apr 25.

Department of Pediatrics, Tampere University Hospital, Tampere, Finland.

Aim: Our study examined the growth and nutritional intake of children on milk and/or wheat, barley or rye elimination diets.

Methods: This was a nested case-control study within the Finnish Type 1 Diabetes Prediction and Prevention Study. It investigated 295 children born in the Tampere University Hospital area between 1997 and 2004 on a diet without cows' milk and/or wheat, barley or rye due to food allergies and 265 matched controls. Nutritional intake was recorded with three-day food records at the ages of one, two and three years. Serial growth measurements were recorded annually up to the age of five years.

Results: Despite consuming a balanced diet with sufficient energy and protein, the children on milk elimination diets grew slower than the control children (p = 0.009). Wheat, barley or rye elimination was not associated with growth. The intakes of protein and calcium were lower in children in the milk elimination group than the controls, at p < 0.05 for all. However, children on elimination diets consumed less saturated fats and sugar and more vitamin C and iron than the control children.

Conclusion: Children on elimination diets faced an increased risk of growth deceleration and suboptimal intake of several micronutrients.
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http://dx.doi.org/10.1111/apa.13846DOI Listing
July 2017

ACT Internet-based vs face-to-face? A randomized controlled trial of two ways to deliver Acceptance and Commitment Therapy for depressive symptoms: an 18-month follow-up.

Behav Res Ther 2014 Oct 28;61:43-54. Epub 2014 Jul 28.

Department of Psychology, University of Jyväskylä, P. O. Box 35, FIN-40014, Finland.

The aim of the present study was to investigate two interventions based on Acceptance and Commitment Therapy (ACT) for depressive symptoms: A face-to-face treatment (ACT group) was compared to a guided self-help treatment delivered via the Internet consisting of two assessment sessions (pre and post) and an ACT-based Internet program (iACT). Outpatients experiencing at least mild depressive symptoms were randomized to either approach. The iACT treatment group received access to an ACT-based Internet program and supportive web-based contact over a period of 6 weeks. The face-to-face group received ACT-based treatment once a week over the same period of time. In both groups, the results showed a significant effect on depression symptomatology, and general wellbeing after treatment and at the 18-month follow-up. However, the data indicated that the iACT group changed differently regarding depressive symptoms and wellbeing as compared to the face-to face ACT group. Results showed large pre-treatment to 18-month follow-up within-group effect sizes for all symptom measures in the iACT treatment group (1.59-2.08), and for most outcome measures in the face-to-face ACT group (1.12-1.37). This non-inferiority study provides evidence that guided Internet-delivered ACT intervention can be as effective as ACT-based face-to-face treatment for outpatients reporting depressive symptoms, and it may offer some advantages over a face-to-face intervention.
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http://dx.doi.org/10.1016/j.brat.2014.07.006DOI Listing
October 2014

Microbial exposure in infancy and subsequent appearance of type 1 diabetes mellitus-associated autoantibodies: a cohort study.

JAMA Pediatr 2014 Aug;168(8):755-63

Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland7Children's Hospital, University of Helsinki, and University Central Hospital, Helsinki, Finland8University of Helsinki, Diabetes and Obesity Research.

Importance: The role of microbial exposure during early life in the development of type 1 diabetes mellitus is unclear.

Objective: To investigate whether animal contact and other microbial exposures during infancy are associated with the development of preclinical and clinical type 1 diabetes.

Design, Setting, And Participants: A birth cohort of children with HLA antigen-DQB1-conferred susceptibility to type 1 diabetes was examined. Participants included 3143 consecutively born children at 2 hospitals in Finland between 1996 and 2004.

Exposures: The following exposures during the first year of life were assessed: indoor and outdoor dogs and cats, farm animals, farming, visit to a stable, day care, and exposure to antibiotics during the first week of life.

Main Outcomes And Measures: Clinical and preclinical type 1 diabetes were used as outcomes. The latter was defined as repeated positivity for islet-cell antibodies plus for at least 1 of 3 other diabetes-associated autoantibodies analyzed and/or clinical type 1 diabetes. The autoantibodies were analyzed at 3- to 12-month intervals since the birth of the child.

Results: Children exposed to an indoor dog, compared with otherwise similar children without an indoor dog exposure, had a reduced odds of developing preclinical type 1 diabetes (adjusted odds ratio [OR], 0.47; 95% CI, 0.28-0.80; P = .005) and clinical type 1 diabetes (adjusted OR, 0.40; 95% CI, 0.14-1.14; P = .08). All of the other microbial exposures studied were not associated with preclinical or clinical diabetes: the odds ratios ranged from 0.74 to 1.58.

Conclusions And Relevance: Among the 9 early microbial exposures studied, only the indoor dog exposure during the first year of life was inversely associated with the development of preclinical type 1 diabetes. This finding needs to be confirmed in other populations.
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http://dx.doi.org/10.1001/jamapediatrics.2014.296DOI Listing
August 2014

Food diversity in infancy and the risk of childhood asthma and allergies.

J Allergy Clin Immunol 2014 Apr 25;133(4):1084-91. Epub 2014 Jan 25.

School of Health Sciences, University of Tampere, Tampere, Finland; Nutrition Unit, Department of Lifestyle and Participation, National Institute for Health and Welfare, Helsinki, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland; Science Center of Pirkanmaa Hospital District, Tampere, Finland.

Background: Recently, the bacterial diversity of the intestinal flora and the diversity of various environmental factors during infancy have been linked to the development of allergies in childhood. Food is an important environmental exposure, but the role of food diversity in the development of asthma and allergies in childhood is poorly defined.

Objective: We studied the associations between food diversity during the first year of life and the development of asthma and allergies by age 5 years.

Methods: In a Finnish birth cohort we analyzed data on 3142 consecutively born children. We studied food diversity at 3, 4, 6, and 12 months of age. Asthma, wheeze, atopic eczema, and allergic rhinitis were measured by using the International Study of Asthma and Allergies in Childhood questionnaire at age 5 years.

Results: By 3 and 4 months of age, food diversity was not associated with any of the allergic end points. By 6 months of age, less food diversity was associated with increased risk of allergic rhinitis but not with the other end points. By 12 months of age, less food diversity was associated with increased risk of any asthma, atopic asthma, wheeze, and allergic rhinitis.

Conclusion: Less food diversity during the first year of life might increase the risk of asthma and allergies in childhood. The mechanisms for this association are unclear, but increased dietary antigen exposure might contribute to this link.
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http://dx.doi.org/10.1016/j.jaci.2013.12.1069DOI Listing
April 2014

Timing of infant feeding in relation to childhood asthma and allergic diseases.

J Allergy Clin Immunol 2013 Jan 22;131(1):78-86. Epub 2012 Nov 22.

School of Health Sciences, University of Tampere, Tampere, Finland.

Background: Emerging evidence questions current recommendations on the timing of infant feeding for the prevention of childhood allergies. The evidence for asthma is inconclusive.

Objective: We sought to investigate the associations between the duration of breast-feeding and timing of introduction of complementary foods and the development of asthma and allergies by the age of 5 years.

Methods: Data were analyzed for 3781 consecutively born children. The dietary exposures were categorized into thirds and analyzed as time-dependent variables. Asthma, allergic rhinitis, and atopic eczema end points were assessed by using the International Study of Asthma and Allergies in Childhood questionnaire, whereas IgE antibodies were analyzed from serum samples at the age of 5 years. Cox proportional hazard and logistic regressions were used for the analyses.

Results: The median duration of exclusive and total breast-feeding was 1.4 months (interquartile range, 0.2-3.5 months) and 7.0 months (interquartile range, 4.0-11.0 months), respectively. Total breast-feeding of 9.5 months or less was associated with an increased risk of nonatopic asthma. Introduction of wheat, rye, oats, or barley at 5 to 5.5 months was inversely associated with asthma and allergic rhinitis, whereas introduction of other cereals at less than 4.5 months increased the risk of atopic eczema. Introduction of egg at 11 months or less was inversely associated with asthma, allergic rhinitis, and atopic sensitization, whereas introduction of fish at 9 months or less was inversely associated with allergic rhinitis and atopic sensitization.

Conclusion: Early introduction of wheat, rye, oats, and barley cereals; fish; and egg (respective to the timing of introduction of each food) seems to decrease the risk of asthma, allergic rhinitis, and atopic sensitization in childhood. Longer duration of total breast-feeding, rather than its exclusivity, was protective against the development of nonatopic but not atopic asthma, suggesting a potential differing effect of breast-feeding on different asthma phenotypes.
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http://dx.doi.org/10.1016/j.jaci.2012.10.028DOI Listing
January 2013

Iron intake, haemoglobin and risk of gestational diabetes: a prospective cohort study.

BMJ Open 2012 25;2(5). Epub 2012 Sep 25.

School of Health Sciences, University of Tampere, Tampere, Finland.

Objective: To investigate the possible association between total daily iron intake during pregnancy, haemoglobin in early pregnancy and the risk of gestational diabetes mellitus (GDM) in women at increased risk of GDM.

Design: A prospective cohort study (based on a cluster-randomised controlled trial, where the intervention and the usual care groups were combined).

Setting: Primary healthcare maternity clinics in 14 municipalities in south-western Finland.

Participants: 399 Pregnant women who were at increased risk of GDM participated in a GDM prevention trial and were followed throughout pregnancy.

Main Outcome Measurements: The main outcome was GDM diagnosed with oral glucose tolerance test at 26-28 weeks' gestation or based on a diagnosis recorded in the Finnish Medical Birth registry. Data on iron intake was collected using a 181-item food frequency questionnaire and separate questions for supplement use at 26-28 weeks' gestation.

Results: GDM was diagnosed in 72 women (18.1%) in the study population. The OR for total iron intake as a continuous variable was 1.006 (95% CI 1.000 to 1.011; p=0.038) after adjustment for body mass index, age, diabetes in first-degree or second-degree relatives, GDM or macrosomia in earlier pregnancy, total energy intake, dietary fibre, saturated fatty acids and total gestational weight gain. Women in the highest fifth of total daily iron intake had an adjusted OR of 1.66 (95% CI 0.84 to 3.30; p=0.15) for GDM. After excluding participants with low haemoglobin levels (≤120 g/l) already in early pregnancy the adjusted OR was 2.35 (95% CI 1.13 to 4.92; p=0.023).

Conclusions: Our results suggest that high iron intake during pregnancy increases the risk of GDM especially in women who are not anaemic in early pregnancy and who are at increased risk of GDM. These findings suggest that routine iron supplementation should be reconsidered in this risk group of women.
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http://dx.doi.org/10.1136/bmjopen-2012-001730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3467630PMC
October 2012

Effects of dietary counselling on food habits and dietary intake of Finnish pregnant women at increased risk for gestational diabetes - a secondary analysis of a cluster-randomized controlled trial.

Matern Child Nutr 2014 Apr 27;10(2):184-97. Epub 2012 Jun 27.

School of Health Sciences, University of Tampere, Tampere, Finland The UKK Institute for Health Promotion Research, Tampere, Finland The National Institute for Health and Welfare, The Unit of Nutrition, Helsinki, Finland Science Center of Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland The National Institute for Health and Welfare, The Unit of Sexual and Reproductive Health, Helsinki, Finland.

The incidence of gestational diabetes mellitus (GDM) is increasing and GDM might be prevented by improving diet. Few interventions have assessed the effects of dietary counselling on dietary intake of pregnant women. This study examined the effects of dietary counselling on food habits and dietary intake of Finnish pregnant women as secondary outcomes of a trial primarily aiming at preventing GDM. A cluster-randomized controlled trial was conducted in 14 municipalities in Finland, including 399 pregnant women at increased risk for developing GDM. The intervention consisted of dietary counselling focusing on dietary fat, fibre and saccharose intake at four routine maternity clinic visits. Usual counselling practices were continued in the usual care municipalities. A validated 181-item food frequency questionnaire was used to assess changes in diet from baseline to 26-28 and 36-37 weeks gestation. The data were analysed using multilevel mixed-effects linear regression models. By 36-37 weeks gestation, the intervention had beneficial effects on total intake of vegetables, fruits and berries (coefficient for between-group difference in change 61.6 g day(-1), 95% confidence interval 25.7-97.6), the proportions of high-fibre bread of all bread (7.2% units, 2.5-11.9), low-fat cheeses of all cheeses (10.7% units, 2.6-18.9) and vegetable fats of all dietary fats (6.1% -units, 2.0-10.3), and the intake of saturated fatty acids (-0.67 energy-%-units, -1.16 to -0.19), polyunsaturated fatty acids (0.38 energy-%-units, 0.18-0.58), linoleic acid (764 mg day(-1), 173-1354) and fibre (2.07 g day(-1) , 0.39-3.75). The intervention improved diet towards the recommendations in pregnant women at increased risk for GDM suggesting the counselling methods could be implemented in maternity care.
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http://dx.doi.org/10.1111/j.1740-8709.2012.00426.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6860280PMC
April 2014

Sociodemographic determinants of early weaning: a Finnish birth cohort study in infants with human leucocyte antigen-conferred susceptibility to type 1 diabetes.

Public Health Nutr 2013 Feb 21;16(2):296-304. Epub 2012 May 21.

Division of Nutrition, Department of Food and Environmental Sciences, PO Box 66, FI-00014 University of Helsinki, Helsinki, Finland.

Objective: To assess the most important sociodemographic determinants of age at introduction of complementary foods in infancy.

Design: A prospective birth cohort with increased risk of type 1 diabetes, recruited between 1996 and 2004. The families completed at home a follow-up form on the age at introduction of new foods and, for each clinic visit, a structured dietary questionnaire with 3 d food records.

Setting: Data from the Type 1 Diabetes Prediction and Prevention (DIPP) Project, Finland.

Subjects: A cohort of 5991 infants (77 % of those invited) belonging to the DIPP Nutrition Study.

Results: Sixty-three per cent of the infants were introduced to complementary foods, including infant formula, before the age of 4 months. The median age at introduction of infant formula was 1·5 months (range 0-18 months) and that of the first other complementary food 3·5 months (range 0·7-8 months). All sociodemographic and lifestyle factors studied were associated with the age at introduction of infant formula and/or first other complementary food. Female sex of the infant, being born in the southern region of Finland, living in a rural municipality, the presence of siblings, the mother or the father being a high-school graduate, high maternal professional education and maternal non-smoking during pregnancy predicted later introduction of complementary foods.

Conclusions: Compliance was relatively poor with the current recommendations for the age of introducing complementary foods. Small-sized young families with less well-educated parents were most prone to introduce complementary foods early.
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http://dx.doi.org/10.1017/S1368980012002595DOI Listing
February 2013

Food consumption and advanced β cell autoimmunity in young children with HLA-conferred susceptibility to type 1 diabetes: a nested case-control design.

Am J Clin Nutr 2012 Feb 11;95(2):471-8. Epub 2012 Jan 11.

Unit of Nutrition, Department of Lifestyle and Participation, National Institute for Health and Welfare, Helsinki, Finland.

Background: Evidence for the role of food consumption during childhood in the development of β cell autoimmunity is scarce and fragmentary.

Objective: We set out to study the associations of longitudinal food consumption in children with the development of advanced β cell autoimmunity.

Design: Children with advanced β cell autoimmunity (n = 232) (ie, with repeated positivity for antibodies against islet cells) together with positivity for at least one of the other 3 antibodies analyzed or clinical type 1 diabetes were identified from a prospective birth cohort of 6069 infants with HLA-DQB1-conferred susceptibility to type 1 diabetes who were born in 1996-2004, with the longest follow-up to the age of 11 y. Repeated 3-d food records were completed by the families and daycare personnel. Diabetes-associated autoantibodies and diets were measured at 3-12-mo intervals. Four control subjects, who were matched for birth date, sex, area, and genetic risk, were randomly selected for each case.

Results: In the main food groups, only intakes of cow-milk products (OR: 1.05; 95% CI: 1.00, 1.10) and fruit and berry juices (OR: 1.09; 95% CI: 1.02, 1.12) were significantly, although marginally, associated with advanced β cell autoimmunity. The consumption of fresh milk products and cow milk-based infant formulas was related to the endpoint, whereas no evidence was shown for consumption of sour milk products and cheese. The intake of fat from all milk products and protein from fresh milk products was associated with risk of advanced β cell autoimmunity.

Conclusion: Intakes of cow milk and fruit and berry juices could be related to the development of advanced β cell autoimmunity. This trial was registered at clinicaltrials.gov as number NCT00223613.
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http://dx.doi.org/10.3945/ajcn.111.018879DOI Listing
February 2012

Maternal intake of fatty acids during pregnancy and allergies in the offspring.

Br J Nutr 2012 Aug 9;108(4):720-32. Epub 2011 Nov 9.

School of Health Sciences, University of Tampere, Tampere, Finland.

Fatty acids (FA) are known to have a number of immunological effects and, accordingly, may play a role in the development of allergic diseases. We investigated the effect of maternal intake of FA during pregnancy on the risk of allergic rhinitis, wheeze and atopic eczema in children aged 5 years. The present study analysed data from the Finnish Type 1 Diabetes Prediction and Prevention Nutrition Study, a population-based birth cohort study with a 5-year follow-up. Complete information on maternal diet (assessed by a validated FFQ) and International Study of Asthma and Allergies in Childhood-based allergic outcomes was available for 2441 children. Cox proportional regression and logistic regression were used for the analyses. After adjusting for potential confounding variables, high maternal consumption of butter and butter spreads (hazard ratio (HR) 1.33; 95 % CI 1.03, 1.71) and higher ratio of n-6:n-3 FA (HR 1.37; 95 % CI 1.07, 1.77) during pregnancy were associated with an increased risk of allergic rhinitis in the offspring by 5 years of age. High maternal intakes of total PUFA (HR 0.71; 95 % CI 0.52, 0.96) and α-linolenic FA (HR 0.73; 95 % CI 0.54, 0.98) were associated with a decreased risk of allergic rhinitis. However, these results lost their significance after adjustment for multiple comparisons. Overall, our data suggest that maternal consumption of butter, the ratio of n-6:n-3 FA and intake of PUFA and α-linolenic FA during pregnancy may be potential determinants of allergic rhinitis in the offspring.
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http://dx.doi.org/10.1017/S0007114511005940DOI Listing
August 2012

Fatty acids in serum and diet--a canonical correlation analysis among toddlers.

Matern Child Nutr 2013 Jul 8;9(3):381-95. Epub 2011 Nov 8.

School of Health Sciences, University of Tampere, Tampere, Finland.

Fatty acid concentrations in blood are potential biomarkers of dietary fat intake, but methodological studies among children are scarce. The large number of fatty acids and their complex interrelationships pose a special challenge in research on fatty acids. Our target was to assess the interrelationships between the total fatty acid profiles in diet and serum of young children. The study subjects were healthy control children from the birth cohort of the Type 1 Diabetes Prediction and Prevention Study. A 3-day food record and a frozen serum sample were available from 135 children at the age of 1 year, from 133 at 2 years, and from 92 at 3 years. The relationship between dietary and serum fatty acid profiles was analysed using canonical correlation analysis. The consumption of fatty milk correlated positively with serum fatty acids, pentadecanoic acid, palmitic acid and conjugated linoleic acid (CLA) at all ages. Correlations between dietary and serum eicosapentaenoic and/or docosahexaenoic acid were observed at 2 and 3 years of age. Serum linoleic acid was positively associated with the consumption of infant formula at the age of 1 year, and with the consumption of vegetable margarine at 2 and 3 years. The results indicate a high quality of the 3-day food records kept by parents and other caretakers of the children, and suitability of non-fasting, un-fractioned serum samples for total fatty acid analyses. The correlation between intake of milk fat and serum proportion of CLA is a novel finding.
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http://dx.doi.org/10.1111/j.1740-8709.2011.00374.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6860655PMC
July 2013

Validation of the Finnish ISAAC questionnaire on asthma against anti-asthmatic medication reimbursement database in 5-year-old children.

Clin Respir J 2011 Oct 1;5(4):211-8. Epub 2010 Sep 1.

Tampere School of Public Health, University of Tampere, Finland.

Background: Valid identification of childhood asthma at the population level for epidemiological purposes remains a challenge. We aimed at validating the Finnish version of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire based on parental-reported childhood asthma.

Materials And Methods: The ISAAC questionnaire has been validated against anti-asthmatic medication reimbursement data of the Finnish Social Insurance Institution, being the gold standard, among 2236 5-year-old consecutively born children (1996-2004) carrying human leukocyte antigen (HLA)-conferred susceptibility to type 1 diabetes. Two combined questionnaire questions (any wheezing symptom or use of asthma medication during the preceding 12 months plus ever asthma; any wheezing symptom or use of asthma medication during the preceding 12 months plus ever doctor-diagnosed asthma) were validated against valid reimbursement with purchase of at least one anti-asthmatic medication during a 12-month period. The validity of the questionnaire was estimated as the sensitivity, specificity, positive predictive value, negative predictive value, and Youden's index.

Results: The sensitivity 0.98 [95% confidence interval (CI) = 0.92-0.99]; specificity 0.98 (95% CI = 0.97-0.98); negative predictive value 1.00 (95% CI = 1.00-1.00); and Youden's index 0.96 (95% CI = 0.96-0.96) were the same for each of the two sets of combined questions. The positive predictive value for the first combined question was 0.63 (95% CI = 0.55-0.71), while it was 0.64 (95% CI = 0.57-0.72) for the second combined question.

Conclusion: The Finnish ISAAC questionnaire was highly valid and is an acceptable instrument for the survey of the prevalence of parental-reported childhood asthma for epidemiological purposes.
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http://dx.doi.org/10.1111/j.1752-699X.2010.00222.xDOI Listing
October 2011

Maternal diet during lactation and allergic sensitization in the offspring at age of 5.

Pediatr Allergy Immunol 2011 May 12;22(3):334-41. Epub 2011 Jan 12.

Tampere School of Public Health, University of Tampere, Tampere, Finland.

The objective of this study was to examine the effect of maternal dietary intake during lactation on allergic sensitization at the age of 5 in children carrying HLA-DQB1-conferred susceptibility to type 1 diabetes. We analyzed data for 652 consecutively born children with complete information on maternal diet and allergen-specific immunoglobulin E (IgE) measurements who are participating in the Finnish Type 1 Diabetes Prediction and Prevention (DIPP) Nutrition and allergy study. Analysis was performed using logistic regression. In models that included the significant uncorrelated dietary variables, maternal intake of butters and saturated fatty acids was associated with increased risk, while margarine was associated with a decreased risk, of sensitization to wheat allergen in the offspring. Maternal intake of potatoes, milks, and margarine and low-fat spreads were associated with decreased risk of sensitization to birch allergen. On the other hand, intake of potatoes decreased the risk, while vitamin C and eggs increased the risk, of cat allergic sensitization. Maternal intake of butters and saturated fatty acids during lactation may increase the risk, while margarines may decrease the risk, of sensitization to wheat allergen in the offspring. Maternal intake of potatoes, milks, and margarines may decrease the risk of sensitization to birch allergen. On the other hand, intake of potatoes may decrease the risk, while vitamin C and eggs may increase the risk, of cat allergic sensitization. These effects may persist regardless of maternal or parental allergic status.
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http://dx.doi.org/10.1111/j.1399-3038.2010.01114.xDOI Listing
May 2011

Maternal diet during pregnancy and allergic sensitization in the offspring by 5 yrs of age: a prospective cohort study.

Pediatr Allergy Immunol 2010 Feb 9;21(1 Pt 1):29-37. Epub 2009 Dec 9.

Tampere School of Public Health, University of Tampere, Tampere, Finland.

To examine the effect of maternal diet during pregnancy on allergic sensitization in the offspring by 5 yrs of age. The Finnish type 1 Diabetes Prediction and Prevention Nutrition Study. A population-based cohort study with 5-yr follow-up. A total of 931 children with human leukocyte antigen-conferred susceptibility to type 1 diabetes for whom maternal pregnancy food frequency questionnaire data and allergen-specific immunoglobulin E measurement at 5 yrs were available. Increasing maternal consumption of citrus fruits [odds ratio (OR) = 1.14, 95% confidence interval (CI) = 1.05-1.25] and total fruit (OR = 1.36, 95% CI = 1.09-1.70) were positively associated with sensitization to inhalant allergens, after adjustment for potential confounders. Maternal intake of vitamin D (OR = 0.56, 95% CI = 0.35-0.91) was inversely associated with sensitization to food allergens. Maternal consumption of citrus fruits during pregnancy may increase the risk to allergic sensitization in the offspring, whereas vitamin D intake may have a beneficial effect. Further studies are required to define more closely the putative effect of maternal intake of polyunsaturated fatty acids on development of allergic diseases in the offspring.
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http://dx.doi.org/10.1111/j.1399-3038.2009.00949.xDOI Listing
February 2010

Age at the introduction of solid foods during the first year and allergic sensitization at age 5 years.

Pediatrics 2010 Jan 7;125(1):50-9. Epub 2009 Dec 7.

Tampere School of Public Health, University of Tampere, Finland.

Objective: The goal was to examine the relationship between age at the introduction of solid foods during the first year of life and allergic sensitization in 5-year-old children.

Methods: We analyzed data from the Finnish Type 1 Diabetes Prediction and Prevention nutrition study, a prospective, birth cohort study. We studied 994 children with HLA-conferred susceptibility to type 1 diabetes mellitus for whom information on breastfeeding, age at the introduction of solid foods, and allergen-specific immunoglobulin E levels at 5 years was available. The association between age at the introduction of solid foods and allergic sensitization was analyzed by using logistic regression.

Results: The median duration of exclusive breastfeeding was 1.8 months (range: 0-10 months). After adjustment for potential confounders, late introduction of potatoes (>4 months), oats (>5 months), rye (>7 months), wheat (>6 months), meat (>5.5 months), fish (>8.2 months), and eggs (>10.5 months) was significantly directly associated with sensitization to food allergens. Late introduction of potatoes, rye, meat, and fish was significantly associated with sensitization to any inhalant allergen. In models that included all solid foods that were significantly related to the end points, eggs, oats, and wheat remained the most important foods related to sensitization to food allergens, whereas potatoes and fish were the most important foods associated with inhalant allergic sensitization. We found no evidence of reverse causality, taking into account parental allergic rhinitis and asthma.

Conclusion: Late introduction of solid foods was associated with increased risk of allergic sensitization to food and inhalant allergens.
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http://dx.doi.org/10.1542/peds.2009-0813DOI Listing
January 2010

Determinants of breast-feeding in a Finnish birth cohort.

Public Health Nutr 2010 Apr 13;13(4):504-13. Epub 2009 Oct 13.

Division of Nutrition, Department of Applied Chemistry and Microbiology, University of Helsinki, Helsinki, Finland.

Objective: To assess milk feeding on the maternity ward and during infancy, and their relationship to sociodemographic determinants. The validity of our 3-month questionnaire in measuring hospital feeding was assessed.

Design: A prospective Finnish birth cohort with increased risk to type 1 diabetes recruited between 1996 and 2004. The families completed a follow-up form on the age at introduction of new foods and age-specific dietary questionnaires.

Setting: Type 1 Diabetes Prediction and Prevention (DIPP) project, Finland.

Subjects: A cohort of 5993 children (77 % of those invited) participated in the main study, and 117 randomly selected infants in the validation study.

Results: Breast milk was the predominant milk on the maternity ward given to 99 % of the infants. Altogether, 80 % of the women recalled their child being fed supplementary milk (donated breast milk or infant formula) on the maternity ward. The median duration of exclusive breast-feeding was 1.4 months (range 0-8) and that of total breast-feeding 7.0 months (0-25). Additional milk feeding on the maternity ward, short parental education, maternal smoking during pregnancy, small gestational age and having no siblings were associated with a risk of short duration of both exclusive and total breast-feeding. In the validation study, 78 % of the milk types given on the maternity ward fell into the same category, according to the questionnaire and hospital records.

Conclusions: The recommendations for infant feeding were not achieved. Infant feeding is strongly influenced by sociodemographic determinants and feeding practices on the maternity wards. Long-term breast-feeding may be supported by active promotion on the maternity ward.
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http://dx.doi.org/10.1017/S1368980009991777DOI Listing
April 2010

Sociodemographic and lifestyle characteristics are associated with antioxidant intake and the consumption of their dietary sources during pregnancy.

Public Health Nutr 2008 Dec 15;11(12):1379-88. Epub 2008 Aug 15.

Tampere School of Public Health, University of Tampere, Tampere, Finland.

Objective: To analyse the associations of selected sociodemographic and lifestyle factors with the intake of antioxidant nutrients and consumption of their main dietary sources among pregnant women.

Design: A population-based cohort study. Dietary intake during pregnancy was assessed by a self-administered FFQ one to three months after the delivery.

Setting: Type 1 Diabetes Prediction and Prevention (DIPP) Project.

Subjects: Subjects comprised 3730 women (70.1 % of those invited) who entered the DIPP Nutrition Study after delivering a child at increased genetic risk for type 1 diabetes at the university hospitals in Oulu and Tampere, Finland, 1997-2002.

Results: All sociodemographic and lifestyle factors studied showed significant associations with antioxidant intake in multiple regression models adjusting for all other factors. Older and more educated women tended to have higher intake of most antioxidants. Parity was positively associated with retinol intake and inversely with vitamin C intake. Smokers had lower intakes of most antioxidants. Only the partner's education was positively associated with high intake of fruits, whereas own education was positively associated with berry consumption. Vegetable consumption was positively associated with partner's education except for women with academic education, who tended to have high vegetable consumption irrespective of partner's education.

Conclusions: Young women, smokers and those with a low education are at risk for low antioxidant intake and non-optimal food choices during pregnancy.
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http://dx.doi.org/10.1017/S1368980008003522DOI Listing
December 2008

Use of vitamin D and other dietary supplements by Finnish children at the age of 2 and 3 years.

Int J Vitam Nutr Res 2004 Jan;74(1):27-34

Tampere School of Public Health, 33014 University of Tampere, Finland.

The aims of this study were to investigate the frequency of the use of vitamin D and other dietary supplements by Finnish children at the age of 2 and 3 years, to evaluate daily nutrient intake from supplements, and to investigate the relation between supplement use and various sociodemographic factors. The families of 534 newborn infants were invited to a birth cohort study in 1996-1997. Families of 292 children at the child's age of 2 years and families of 263 children at the age of 3 years completed a three-day food record from which the daily use of dietary supplements was calculated. The frequency of dietary supplement use was 50% among the two-year-olds, and 37% among the three-year-old children. The most commonly used supplements among the two-year-olds were vitamin D or vitamin A + D combination (38%) and fluoride (16%) and among the three-year-olds fluoride (19%) and multivitamins (16%), respectively. Intake of nutrients other than vitamin D or fluoride from supplements was rare among two-year-olds, whereas 16% of the three-year-olds received also vitamin A, C, E, and several group B vitamins. Mean daily intake of vitamin D from supplements was 6.7 micrograms at the age of 2 years and 5.3 micrograms at the age of 3 years, respectively. The level of parental education was positively associated with the child's vitamin D supplementation at the age of 2 years. As the compliance with national recommendations of vitamin D supplementation was low, intensified counseling of the parents is needed at the well-baby clinics in Finland.
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http://dx.doi.org/10.1024/0300-9831.74.1.27DOI Listing
January 2004
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