Purpose To describe age and time trends in dietary intake of Total Dairy (TD) (g/1000 kcal Total Energy Intake) and types of dairy (weight percent of total dairy intake, w%TD) represented as Low Fat Dairy (LFD), High Sugar Dairy (HSD), Fermented Dairy (FD) and Liquid Dairy (LD) among children and adolescents in Germany. Methods Overall, 10,333 3-day dietary records kept between 1985 and 2019 by 1275 DONALD participants (3.5–18.5 years; boys: 50.8%) were analyzed using polynomial mixed-effects regression models. Results TD intake decreased with age (♂: linear trend p < 0.0001; ♀: linear and quadratic trend p < 0.0001), whereas FD (♀: linear, quadratic, cubic trend p ≤ 0.02) increased slightly in girls. HSD (♂: linear, quadratic, cubic trend p ≤ 0.004; ♀: linear, quadratic, cubic trend p ≤ 0.005) and LD (linear, quadratic trend p ≤ 0.0002) decreased with age. In terms of time trends, TD intake decreased in the last three decades, especially since 1995 (quadratic trend for ♂ 0.0007 and ♀ p = 0.004). LFD intake increased until 2010 and decreased thereafter (linear, quadratic, cubic trend p < 0.0001). HSD decreased until 1995, then increased until 2010 and decreased again afterwards (♂: linear, quadratic, cubic trend p ≤ 0.001; ♀: linear, quadratic, cubic trend p ≤ 0.003). While FD intake increased linear (in both ♂ and ♀: p < 0.0001), LD intake decreased (linear, quadratic trend p ≤ 0.03). Conclusion Our results showed changes in dairy consumption patterns among children and adolescents over the past three decades, demonstrating a decrease in TD intake with age and time, and a shift from liquid to solid dairy products with a simultaneous increase in fermented dairy products, while LFD and HSD fluctuated over time. Further evaluations will examine the health significance of these consumption patterns.

Background High gluten intake is associated with increased risk of celiac disease (CD) in children at genetic risk. Objectives To investigate if different dietary gluten sources up to age two years confer different risks of celiac disease autoimmunity (CDA) and CD in children at genetic risk. Design Three-day food records were collected at age six, nine, 12, 18 and 24 months from 2088 Swedish genetically at-risk children participating in a 15-year follow-up cohort study on type 1 diabetes and celiac disease. Screening for celiac disease was performed with tissue transglutaminase autoantibodies (tTGA). The primary outcome was CDA, defined as persistent tTGA positivity. The secondary outcome was CD, defined as having a biopsy showing Marsh score ≥ 2 or an averaged tTGA level ≥ 100 Units. Cox regression adjusted for total gluten intake estimated hazard ratios (HR) with 95% confidence intervals (CI) for daily intake of gluten sources. Results During follow-up, 487 (23.3%) children developed CDA, and 242 (11.6%) developed CD. Daily intake of ≤158 g porridge at age nine months was associated with increased risk of CDA (HR 1.53, 95% CI 1.05, 2.23, P = 0.026). A high daily bread intake (&gt;18.3 g) at age 12 months was associated with increased risk of both CDA (HR 1.47, 95% CI 1.05, 2.05, P = 0.023) and CD (HR 1.79, 95% CI 1.10, 2.91, P = 0.019). At age 18 months, milk cereal drink was associated with an increased risk of CD (HR 1.16, 95% CI 1.00, 1.33, P = 0.047) per 200 g/day increased intake. No association was found for other gluten sources up to age 24 months and risk of CDA or CD. Conclusions A high daily intake of bread at age 12 months and milk cereal drink during the second year in life is associated with increased risk of both celiac disease autoimmunity and celiac disease in genetically at-risk children.

OBJECTIVE To distinguish among predictors of seroconversion, progression to multiple autoantibodies and from multiple autoantibodies to type 1 diabetes in young children. RESEARCH DESIGN AND METHODS Genetically high-risk newborns (n = 8,502) were followed for a median of 11.2 years (interquartile range 9.3–12.6); 835 (9.8%) developed islet autoantibodies and 283 (3.3%) were diagnosed with type 1 diabetes. Predictors were examined using Cox proportional hazards models. RESULTS Predictors of seroconversion and progression differed, depending on the type of first appearing autoantibody. Male sex, Finnish residence, having a sibling with type 1 diabetes, the HLA DR4 allele, probiotic use before age 28 days, and single nucleotide polymorphism (SNP) rs689_A (INS) predicted seroconversion to IAA-first (having islet autoantibody to insulin as the first appearing autoantibody). Increased weight at 12 months and SNPs rs12708716_G (CLEC16A) and rs2292239_T (ERBB3) predicted GADA-first (autoantibody to GAD as the first appearing). For those having a father with type 1 diabetes, the SNPs rs2476601_A (PTPN22) and rs3184504_T (SH2B3) predicted both. Younger age at seroconversion predicted progression from single to multiple autoantibodies as well as progression to diabetes, except for those presenting with GADA-first. Family history of type 1 diabetes and the HLA DR4 allele predicted progression to multiple autoantibodies but not diabetes. Sex did not predict progression to multiple autoantibodies, but males progressed more slowly than females from multiple autoantibodies to diabetes. SKAP2 and MIR3681HG SNPs are newly reported to be significantly associated with progression from multiple autoantibodies to type 1 diabetes. CONCLUSIONS Predictors of IAA-first versus GADA-first autoimmunity differ from each other and from the predictors of progression to diabetes.

Purpose To analyse the association between intake of total dairy (TD) and types of dairy [liquid dairy (LD), solid dairy (SD), low-fat dairy (LFD), high-fat dairy (HFD), high sugar dairy (HSD), low-sugar dairy (LSD), not fermented dairy (NFD), as well as fermented dairy (FD)] and long-term changes in body weight status and composition among children and adolescents in Germany. Methods In total, 9999 3-day dietary records collected between 1985 and 2019 by 1126 participants (3.5–18.5 years; boys: 50.8%) of the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study were analysed. Polynomial mixed-effects regression models were used to examine whether changes (median follow-up: 9 years) in the intake of TD and dairy types (in 100 g/1000 kcal total energy intake) were associated with changes in body-mass-index-standard-deviation-score (BMI-SDS); fat mass index (FMI); fat-free mass index (FFMI) over time. Results An individual increase in TD intake was slightly but significantly associated with an increase in BMI-SDS (β = 0.0092; p = 0.0371), FMI (β = 0.022; p = 0.0162), and FFMI (β = 0.0156; p = 0.0417) after adjustment for potential confounder. Analyses for LD (BMI-SDS: β = 0.0139; p = 0.0052; FMI: β = 0.0258; p = 0.0125; FFMI: β = 0.0239; p = 0.0052) and LSD intake (BMI-SDS: β = 0.0132; p = 0.0041, FMI: β = 0.02; p = 0.0316, FFMI: β = 0.0183; p = 0.0189) showed similar results to TD. Both processing method and fat content showed no association with body composition in our analyses. Conclusion Increases in TD, LD, and LSD intake showed small but significant increases in BMI and concomitant increases in fat mass and lean mass. However, the observed changes were too small to expect biological or physiological meaningful effects. Overall, our results showed that policies to promote dairy intake in childhood are to be welcomed, as no negative effects on body composition are expected, while the intake of important nutrients for growth is ensured. The type of dairy does not seem to matter.

OBJECTIVE Biomarkers predicting risk of type 1 diabetes (stage 3) among children with islet autoantibodies are greatly needed to prevent diabetic ketoacidosis and facilitate prevention therapies. RESEARCH DESIGN AND METHODS Children in the prospective The Environmental Determinants of Diabetes in the Young (TEDDY) study (n = 707) with confirmed diabetes-associated autoantibodies (GAD antibody, IA-2A, and/or insulin autoantibody) and two or more HbA1c measurements were followed to diabetes or median age 11.1 years. Once confirmed autoantibody positive, HbA1c was measured quarterly. Cox models and receiver operative characteristic curve analyses revealed the prognostic utility for risk of stage 3 on a relative HbA1c increase from the baseline visit or an oral glucose tolerance test (OGTT) 2-h plasma glucose (2-hPG). This HbA1c approach was then validated in the Type 1 Diabetes TrialNet Pathway to Prevention Study (TrialNet) (n = 1,190). RESULTS A 10% relative HbA1c increase from baseline best marked the increased risk of stage 3 in TEDDY (74% sensitive; 88% specific). Significant predictors of risk for HbA1c change were age and HbA1c at the baseline test, genetic sex, maximum number of autoantibodies, and maximum rate of HbA1c increase by time of change. The multivariable model featuring a HbA1c ≥10% increase and these additional factors revealed increased risk of stage 3 in TEDDY (hazard ratio [HR] 12.74, 95% CI 8.7–18.6, P &lt; 0.0001) and TrialNet (HR 5.09, 95% CI 3.3–7.9, P &lt; 0.0001). Furthermore, the composite model using HbA1c ≥10% increase performed similarly to an OGTT 2-hPG composite model (TEDDY area under the curve [AUC] 0.88 and 0.85, respectively) and to the HbA1c model in TrialNet (AUC 0.82). CONCLUSIONS An increase of ≥10% in HbA1c from baseline is as informative as OGTT 2-hPG in predicting risk of stage 3 in youth with genetic risk and diabetes-associated autoantibodies.