Toddler food and activity patterns and body composition: a study of the offspring of mothers treated for gestational diabetes mellitus
Accumulation of excess body fat tracks from an early age and interventions aimed at preventing childhood obesity may need to begin early in life, particularly for children exposed to gestational diabetes mellitus (GDM). There is evidence from animal studies food and activity patterns in offspring may be programmed by an adverse intrauterine environment, however evidence of an effect in humans is lacking. The ethnic diversity of young people in New Zealand is increasing but little is known with respect to the early life ethnic differences in food and activity patterns and body composition. Understanding differences may help explain the genesis of ethnic disparity in the prevalence of obesity and associated health conditions The primary aim of this study was to examine and compare food and activity patterns and body composition in a sample of 147 children at the mid-toddler stage of development. The average age was 27.7 months and 48 European (F 26; M 28), 41 Polynesian (F 22; M 19), 36 Indian (F 17; M 19), 18 Asian (F 12; M 6) and 4 Other (F 3; M 1) children were studied. Because the children in this study were born to mothers treated for GDM, the effects of maternal glucose control and GDM treatment (metformin versus insulin) on food and activity patterns were also examined. Food and activity data were collected by a food frequency questionnaire, 24-hour food recall and a 24-hour activity recall. Body composition was measured using anthropometry, bioimpedance analysis (BIA) and dual-energy x-ray absorptiometry (DEXA) when possible. DEXA scans were used to validate a BIA equation to predict fat free mass. When compared with the Ministry of Health (MoH) nutritional guidelines, two-thirds of toddlers did not consume breads and cereals four or more time per day, and one-third and one-quarter did not consume fruit and vegetables twice a day respectively. Three-quarters of toddlers consumed treat foods at least once a day, and takeaways at least twice a week and more than two-thirds consumed sweet drinks at least once a day. Toddlers slept on average 12.5 hours per 24 hour period, watched 1.0 hour of television, and played actively for almost 5.0 hours. Overall girls had a higher fatness (3%) than boys. No associations between food and activity patterns and body composition at 2 years of age were found, and no associations between maternal glucose control, GDM treatment (metformin versus insulin) or food and activity patterns at 2 years of age were found. Marked ethnic differences in food and activity patterns and body composition were found. Specifically: - Less Indian children consumed fruit twice a day and meat once a day than European children, and more Polynesian children consumed takeaways at least five times a week than European children. - Polynesian, Asian and Indian toddlers slept for 1.0 hour less than European toddlers and watched around 0.5 hours more television per day. - Polynesian toddlers were taller and heavier than other ethnic groups and had on average 2% more body fat than European toddlers. - After adjusting for height, weight and age, Indian children had on average 0.3kg more fat mass than European and Polynesian toddlers. Overall, a notable proportion of toddlers did not consume the recommended servings of breads and cereals, fruit and vegetables per day, regularly consumed treat foods, sweet drinks and takeaways, and watched TV. Ethnic differences in food and activity patterns and body composition were identified in this study in that could contribute to the ethnic disparity in the prevalence of obesity and related diseases. With food and activity patterns and body composition shown to track from an early age, interventions aimed at preventing obesity may need to begin early in life and be sustained throughout the life course.