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Background: Several studies suggest that carbohydrate nutrition is related to oxidative stress and inflammatory markers. Objective: We examined whether dietary glycemic index (GI), dietary fiber, and carbohydrate-containing food groups were associated with the mortality attributable to noncardiovascular, noncancer inflammatory disease in an older Australian cohort. Design: Analysis included 1490 postmenopausal women and 1245 men aged [greater than or equal to] 49 y at baseline (1992-1994) from a population-based cohort who completed a validated food-frequency questionnaire. Cox proportional hazards ratios were calculated both for death from diseases in which inflammation or oxidative stress was a predominant contributor and for cardiovascular mortality. Results: Over a 13-y period, 84 women and 86 men died of inflammatory diseases. Women in the highest GI tertile had a 2.9-fold increased risk of inflammatory death compared with women in the lowest GI tertile [multivariate hazard ratio in energy-adjusted tertile 3 (tertile 1 as reference): 2.89; 95% CI: 1.52, 5.51; P for trend: 0.0006, adjusted for age, smoking, diabetes, and alcohol and fiber consumption]. Increasing intakes of foods high in refined sugars or refined starches (P = 0.04) and decreasing intakes of bread and cereals (P = 0.008) or vegetables other than potatoes (P = 0.007) also independently predicted a greater risk, with subjects' GI partly explaining these associations. In men, only an increased consumption of fruit fiber (P = 0.005) and fruit (P = 0.04) conferred an independent decrease in risk of inflammatory death. No associations were observed with cardiovascular mortality. Conclusion: These data provide new epidemiologic evidence of a potentially important link between GI and inflammatory disease mortality among older women. doi: 10.3945/ajcn.2010.29390

Background: It has been suggested that phytoestrogens and dietary fiber can affect puberty timing. Objective: We examined whether intake of isoflavone and fiber in healthy white children before their pubertal growth spurt [age at take-off (ATO)] was associated with puberty timing. Design: Multivariate regression analyses were performed in 227 DONALD (DOrtmund Nutritional and Anthropometric Longitudinally Designed) Study participants with 3-d weighed dietary records and information on potential confounders at baseline (1 and 2 y before ATO). In a subsample (n = 111), urinary isoflavones were determined in 24-h urine samples by gas chromatography-mass spectrometry analysis. Puberty timing was examined by using ATO and chronologic ages at pubertal stage 2 for breast development (B2) or gonadal development, peak height velocity (PHV), and menarche or voice break. Results: Girls whose diet was in the highest dietary isoflavone tertile experienced Tanner stage 2 for breast development [approximately equal to]0.7 y later and reached PHV [approximately equal to]0.6 y later than did girls whose diet was in the lowest isoflavone tertile [age (95% CI) at B2:10.7 y (10.4, 10.9 y) compared with 10.0 y (9.7, 10.3 y), respectively; P for trend = 0.04; age at PHV: I 1.9 y (11.6, 12.2 y) compared with 11.3 y (11.0, 11.6 y), respectively; P for trend = 0.04; adjusted for body mass index z score and fiber intake]. In boys, dietary isoflavones were not associated with pubertal markers. Urinary isoflavone and dietary fiber intakes were not associated with pubertal markers. Conclusions: Girls, but not boys, with higher prepubertal isoflavone intakes appear to enter puberty at a later age. Fiber intake in this sample of healthy white girls and boys was not relevant for puberty timing. doi: 10.3945/ajcn.2010.29394

Background: Early age at puberty onset may predispose an individual to many currently prevalent diseases, including cancer and adiposity. Objective: The objective was to investigate whether early life exposures influence the timing of puberty, as defined by both early and late markers, in healthy German girls and boys. Design: Term participants (n = 215; 49.8% female) of the DONALD (DOrtmund Nutritional and Anthropometric Longitudinally Designed) Study, with sufficient repeated anthropometric measurements between 6 and 13 y to allow estimation of age at take-off of the pubertal growth spurt (ATO) and information on a variety of early life exposures, including birth weight, breastfeeding status, velocity of weight gain, and parental characteristics, were studied. Age at peak height velocity (APHV) and menarche were also considered. Results: Children who weighed between 2500 and 0.67) experienced ATO 4 mo earlier than those who had gained weight normally (-0.34 [+ or -] 0.15 y; P = 0.02). Rapid weight gain was also associated with an earlier APHV (P = 0.0006) and, in girls, with an earlier menarche (P = 0.002). Adjustment for body mass index SD score or body fat percentage 1, 2, or 3 y before ATO did not account for these effects. Conclusion: In both boys and girls, intrauterine and early postnatal growth factors appear to influence both early and later markers of puberty onset independently of prepubertal body composition. Am J Clin Nutr 2009;90:1559-65. doi: 10.3945/ajcn.2009.28259.

Background: Adrenarche is the increase in adrenal androgen (AA) production starting in childhood. Until now, it has been unknown whether or not nutritional factors modulate adrenarche. Objective: The objective was to examine whether body composition and certain dietary intakes are associated with AA production in children after accounting for urinary indicators of major adrenarche-related steroidogenic enzymes. Design: Androgen and glucocorticoid metabolites were profiled by gas chromatography-mass spectrometry in 24-h urine samples of 137 healthy prepubertal children aged 3-12 y, for whom birth characteristics, growth velocity data, and 3-d weighed-diet record information were available. Associations of the sum of C19 metabolites (reflecting daily AA secretion) with nutritional factors [fat mass (FM), fat-free mass (FFM), nutrient intakes, glycemic index, and glycemic load] and AA-relevant estimates of steroidogenic enzyme were examined in stepwise multiple regression models adjusted for age, sex, urine volume, and total energy intake. Enzyme activity estimates were calculated by using specific urinary steroid metabolite ratios. Results: Of the nutrition-relevant predictors, FM (P < 0.0001) explained most of the variation of AA secretion ([R.sup.2] = 5%). Animal protein intake was also positively associated with AA secretion (P < 0.05), which explained 1% of its variation. FFM (P = 0.1) and total protein intake (P = 0.05) showed positive trends. The difference in daily AA secretion between the lowest and highest quartile of FM was comparable to that between the lowest and highest estimated activity of one of the major steroidogenic enzymes. Conclusions: Body fat mass may relevantly influence prepubertal adrenarchal androgen status. In addition, animal protein intake may also make a small contribution to AA secretion in children. doi: 10.3945/ajcn.2009.27964.

Background: It is controversial whether prepubertal body composition is implicated in the timing of puberty onset. Objective: The objective was to investigate whether body composition in the 2 y preceding the start of the pubertal growth spurt--a marker of puberty onset--is associated with the attainment of early and late pubertal markers in healthy German boys and girls. Design: Multivariate-adjusted regression analyses were performed in 215 participants of the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study for whom body mass index (BMI) and its components fat mass/[height.sup.2] (FM/[m.sup.2]) and fat-free mass/[height.sup.2] (FFM/[m.sup.2]) 1 and 2 y before the onset of the pubertal growth spurt (age at takeoff; ATO) and information on early life exposures were available. In addition, age at peak height velocity (APHV) and menarche were examined. Results: Higher BMIs and FM/[m.sup.2] z scores l and 2 y before ATO showed modest associations with chronological age at ATO among girls only (girls: P for = trend 0.05-0.1, adjusted for early life factors; boys: P = 0.2-0.6). FFM/[m.sup.2] z scores were not related to age at ATO (P for trend = 0.5-0.8). Conversely, prepubertal BMI and FM/[m.sup.2] more clearly predicted APHV and puberty duration (APHV minus ATO) in both sexes and age at menarche in girls (girls: adjusted P for trend Conclusion: This longitudinal study suggests that prepubertal body composition in healthy boys and girls may not be critical for the initiation of the pubertal growth spurt but instead affects the progression of pubertal development, which results in earlier attainment of later pubertal stages.

Background: Observational studies in adults suggest that a diet with a high glycemic index (GI) or glycemic load (GL), a high intake of sugary foods, or a low fiber intake may increase the risk of overweight. Objectives: We aimed to examine prospectively whether dietary GI, GL, added sugar intake, or fiber intake between age 2 and 7 y are associated with the development of body composition. If so, we aimed to ascertain whether these associations are modified by meal frequency. Design: Linear mixed-effect regression analyses were performed in 380 participants of the DOrtmund Nutrition and Anthropometric Longitudinally Designed (DONALD) Study for whom 4-6 weighed 3-d dietary records and anthropometric data were obtained between ages 2 and 7 y. Results: Changes in dietary GI, GL, or added sugar intake between ages 2 and 7 y were not associated with concurrent changes in percentage body fat (%BF, as estimated from skinfold thicknesses) or body mass index SD scores. An increase in fiber intake was related to a concurrent decrease in %BF between ages 2 and 7 y only in children who consumed Conclusions: Dietary GI, GL, or added sugar intake between ages 2 and 7 y does not appear to influence the development of body composition. Potential benefits associated with increasing fiber intake throughout childhood may be limited to toddlers with a lower meal frequency. Am J Clin Nutr 2008;88:755-62.

Background: It is unclear which exposures may cause or modify the adverse effect of rapid weight gain on fat mass development in term children whose birth weight is appropriate-for-gestational age (AGA). Objective: To determine which intrauterine or postnatal exposures increase the risk of or modify the effect of rapid weight gain on body fat percentage (BF%) and body mass index (BMI) trajectories between 2 and 6 y of age. Design: Term AGA singletons (n = 370) from the German Multi-center Allergy Study (MAS-90), a longitudinal birth cohort study, with repeated anthropometric measurements until 6 y, and data on breastfeeding status, exposure to smoking during pregnancy, and maternal anthropometric and socioeconomic characteristics were included in this analysis. Results: A shorter gestation [multivariate-adjusted odds ratio (OR): 5.12; 95% CI: 2.22, 11.82; P = 0.0001], being firstborn (OR: 2.01; 95% CI: 1.10, 3.69; P = 0.02), and having been bottle-fed (OR: 3.02; 95% CI: 1.68, 5.43; P = 0.0002) all significantly increased a child's risk of gaining weight rapidly, whereas a larger BMI at birth was protective (OR: 0.54; 95% CI: 0.38, 0.77; P = 0.0006). Multilevel model analyses showed that rapid growers exposed to tobacco in utero subsequently gained more BF% between 2 and 6 y than did rapid growers who had not been exposed ([beta] [+ or -] SE: 0.78 [+ or -] 0.28%/y; P = 0.005). Similarly, change in BF% was greater in rapid growers with an overweight mother than in those with a normal-weight mother (1.01 [+ or -] 0.30%/y; P = 0.0007). Conclusions: The occurrence of rapid weight gain between birth and 2 y and the magnitude of its effect on BF% development in AGA children is influenced by both intrauterine and postnatal exposures.

Background: A high early protein intake has been proposed to increase obesity risk. Objective: We examined whether a critical period of protein intake for later obesity may exist early in childhood and investigated the relation between protein intake from different sources and body mass index SD score and body fat percentage (BF%) at 7 y of age. Design: The study population included 203 participants of the Dortmund Nutritional and Longitudinally Designed Study with information on diet at 6 mo, 12 mo, 18-24 mo, 3-4 y, and 5-6 y. Life-course plots were constructed to assess when protein intake (% of energy) was associated with body mass index SD score and BF% at 7 y. Mean values were then compared among tertiles (T1-T3) of protein from different sources at the important time points. Results: The ages of 12 mo and 5-6 y were identified as critical ages at which higher total and animal, but not vegetable, protein intakes were positively related to later body fatness. In fully adjusted models, animal protein intake at 12 mo was associated with BF% at 7 y as follows [[bar.x] (95% CI) BF%]: T1, 16.20 (15.23, 17.25); T2, 17.21 (16.24, 18.23); T3, 18.21 (17.12, 19.15); P for trend = 0.008. With respect to food groups, dairy, but not meat or cereal protein intake, at 12 mo was related to BF% at 7 y (P for trend = 0.07). Animal protein at 5-6 y yielded similar results (P for trend = 0.01), but food group associations were less consistent. Conclusion: A higher animal, especially dairy, protein intake at 12 mo may be associated with an unfavorable body composition at 7 y. The age of 5-6 y might represent another critical period of protein intake for later obesity risk. KEY WORDS BMI, obesity, dairy protein, critical periods, adiposity rebound

Background: It is not clear whether the adverse effects of rapid weight gain in infancy are modified by nutrition during the first 2 y of life in term children whose birth weight was appropriate for gestational age (AGA). Objective: We examined the interaction between rapid weight gain and nutrition in infancy and early childhood and their effect on body fat percentage (BF%) trajectories between 2 and 5 y of age. Design: The study population comprised 249 (51.4% female) term AGA participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study, for whom repeated anthropometric measurements until 5 y of age and information on breastfeeding status and on diet at 12 and 18-24 mo of age were available. Results: Multilevel model analyses showed that, among rapid growers, those who had been fully breastfed for [greater than or equal to] 4 mo had a lower BF% at 2 y of age than did those who had not been fully breastfed for [greater than or equal to] 4 mo ([beta] [+ or -] SE:-1.53 [+ or -] 0.59%; P = 0.009). This difference persisted until 5 y. Furthermore, those rapid growers who had a consistently high fat intake at both 12 and 18-24 mo did not show the expected physiologic decrease in BF% between 2 and 5 y seen in those rapid growers with an inconsistent or consistently low fat intake at these time points (0.73 [+ or -] 0.26%/y; P = 0.006). Conclusions: Among rapid growers, full breastfeeding for [greater than or equal to] 4 mo is protective against a high BF% at 2 y of age, whereas a consistently high fat intake in the second year of life 'inhibits' the physiologic decrease in BF% between 2 and 5 y. KEY WORDS Rapid weight gain, appropriate for gestational age, nutrition, breastfeeding, body fat percentage, children, trajectories

Background: Experimental studies have reported that the effect of a meal's glycemic index (GI) on subsequent energy intake depends on the timing of the subsequent meal. Objective: We examined whether the timing of the next meal after breakfast modifies the effect of the breakfast GI (G[I.sub.br]) on subsequent daytime energy intake of healthy free-living children. Design: Analyses included 381 participants of the DOrtmund Nutritional and Anthropometrical Longitudinally Designed (DONALD) Study who had provided weighed dietary records at ages 2, 4-5, and 7 y. Results: At all ages, among children who consumed their next meal in the early postprandial phase (after 3-4 h), children with a lower G[I.sub.br] consumed more calories throughout the remainder of the day than did children with a higher G[I.sub.br], independent of major dietary confounders. For the age groups 2, 4-5, and 7 y, energy intakes in tertiles 1 and 3 were 785 kcal (95% CI: 743-830 kcal) and 717 kcal (678 -758 kcal), P for trend = 0.2; 993 kcal (941-1047 kcal) and 949 kcal (900-1000 kcal), P for trend = 0.05; 1255 (1171-1344) and 1166 (1090-1247 kcal), P for trend = 0.03, respectively. Conversely, among children consuming their next meal in the late postprandial phase (>3-4 h), subsequent daytime energy intake was not associated with G[I.sub.br]. Conclusion: This study confirms differential early and late post-prandial effects of the G[I.sub.br] on subsequent daytime energy intake for free-living children at different ages. Interestingly, the apparent short-term satiating effect of a higher G[I.sub.br], in particular, persisted throughout the day, if a second breakfast was consumed midmorning. KEY WORDS Glycemic index, glycemic load, children, satiety, energy intake, breakfast

Background: A high protein intake during infancy and early childhood has been proposed to increase the risk of subsequent obesity. Objective: We analyzed the association of different protein intakes during 6-24 mo with body mass index (BMI; in kg/[m.sup.2]) and percentage body fat (%BF) at 7 y of age. Design: The analyses included 203 participants of the DOrtmund Nutritional and Longitudinally Designed (DONALD) Study with complete information on early diet (6, 12, and 18-24 too) and anthropometric data at the age of 7 y. The median of energy-adjusted protein intakes (in g/d) was used to distinguish different patterns of low and high protein intakes throughout the first 2 y of life, which were then related to BMI SD scores (SDSs), %BF, and the risk of overweight and overfatness at 7 y of age. Results: Although protein intake at 6 mo of age was not associated with the outcomes, a consistently high protein intake at the ages of 12 and 18-24 mo was independently related to a higher mean BMI SDS and %BF at the age of 7 y [BMI SDS: 0.37 (95% CI: 0.12, 0.61) compared with 0.08 (95% CI: -0.09, 0.26), P = 0.04; %BF: 18.37 (95% CI: 17.29, 19.51%) compared with 16.91 (95% CI: 16.19, 17.66%), P = 0.01] and a higher risk of having a BMI or %BF above the 75th percentile at that age [odds ratio for BMI: 2.39 (95% CI: 1.14, 4.99), P = 0.02); odds ratio for %BF: 2.28 (95% CI: 1.06, 4.88), P = 0.03]. Conclusions: High protein intakes during the period of complementary feeding and the transition to the family diet are associated with an unfavorable body composition at the age of 7 y. Am J Clin Nutr 2007;85:1626-33. KEY WORDS Dietary protein, complementary feeding, children, obesity, body fatness, cohort study

Background: It is not clear whether and how rapid growth in infancy, a risk factor for later obesity, differentially affects growth and body-composition development throughout childhood in term children with an appropriate-for-gestational age (AGA) birth weight. Objective: The aim was to examine the effect of rapid growth in infancy on body mass index SD score (BMI SDS) and body fat percentage (%BF) trajectories until age 7 y. Design: This analysis included 206 (50.5% female) AGA term participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study. Repeated anthropometric measurements were obtained between 0.5 and 7 y of age. Results: Fifty-nine of the 206 children (28.6%) displayed rapid growth (an increase in SDS for weight of >0.67 between birth and age 2 y). From 6 mo of age, their growth trajectories diverged from normal growers, and by age 7 y they had a higher BMI, more fat mass, and a higher risk of overweight (odds ratio: 6.2; 95% CI: 2.4, 16.5; P = 0.0002). Multilevel model analyses showed that the differences in BMI were achieved within the first 2 y of life [[beta] ([+ or -] SE) SDS: 1.22 [+ or -] 0.13], after which they persisted at this level until the age of 7 y, whereas differences in %BF, which were also already discernible by age 2 y (1.52 [+ or -] 0.34%), became progressively larger over the next 5 y (adjusted difference: 0.23 [+ or -] 0.11%/y; P = 0.03). Conclusions: Rapid growth in infancy and early childhood results in an increased BMI and %BF throughout childhood and an increased risk of overweight at age 7 y among AGA children. Rapid growth in AGA children has a more pronounced effect on %BF than on BMI. KEY WORDS Rapid growth, cohort study, children, body fat percentage, trajectories, appropriate for gestational age

Background: Little is known about the variation of the glycemic index (GI) in the diet of European outpatients with type 1 diabetes and how the GI of a commonly consumed diet is associated with metabolic control. Objective: The present study examined the calculated dietary GI of European outpatients with type 1 diabetes for possible relations to glycated hemoglobin (Hb [A.sub.1c]) and serum lipid concentrations. Design: The relation of the GI (calculated from a 3-d dietary record) to Hb [A.sub.1c], serum cholesterol (total, LDL, and HDL), and fasting triacylglycerol was analyzed in 2810 people with type 1 diabetes from the EURODIAB Complications Study. Results: The GI was independently related to Hb [A.sub.1c] (P = 0.0001). Compared with the highest GI quartile (median GI: 89), adjusted Hb [A.sub.1c] in the lowest GI quartile (median GI: 75) was 11% lower in patients from southern European centers and 6% lower in patients from northern, western, and eastern European centers. Of the serum lipids, only the HDL cholesterol in patients from these European centers was independently related to the GI (P = 0.002). In southern European centers, the consumption of pasta, temperate-climate fruit, white bread, and potatoes largely determined the patients' dietary GI, whereas in the northern, western, and eastern European centers, consumption of bread, potatoes, and temperate-climate fruit was most relevant. Conclusions: This study in European patients with type 1 diabetes showed that a lower dietary GI is related to lower Hb [A.sub.1c] concentrations, independently of fiber intake. The consumption of bread and pasta had the biggest effect on the overall dietary GI of European outpatients. Am J Clin Nutr 2001;73:574-81. KEY WORDS Glycemic index, type 1 diabetes, glycated hemoglobin, Hb [A.sub.1c], LDL cholesterol, HDL cholesterol, triacylglycerol, Europe, carbohydrate sources