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Objective: To study whether the dietary patterns of Finnish pregnant women are associated with their weight gain rate during pregnancy. Design: A validated 181-item FFQ was applied retrospectively to assess the diet during the eighth month of pregnancy, and maternal height and maternal weight at first and last antenatal visits were recalled. Information on sociodemographic characteristics, parity and smoking of the pregnant women was obtained by a structured questionnaire and from the Finnish Birth Registry. Principal components analysis was used to identify dietary patterns that described the diet of pregnant women based on their food consumption profile. Setting: Finland. Subjects: Subjects consisted of 3360 women who had newly delivered in 1997-2002 and whose baby carried human leucocyte antigen-conferred susceptibility to type 1 diabetes in two university hospital regions, Oulu and Tampere, in Finland. Results: Out of seven dietary patterns identified, the 'fast food' pattern was positively associated (b 5 0?010, SE 5 0?003, P 5 0?004) and the 'alcohol and butter' pattern was inversely associated (b 5 -0?010, SE 5 0?003, P , 0?0001) with weight gain rate (kg/week) during pregnancy after adjusting for potential dietary, perinatal and sociodemographic confounding factors. Both of the dietary pattern associations demonstrated dose dependency. Conclusions: Pregnant women should be guided to have a well-planned, balanced, healthy diet during pregnancy in order to avoid rapid gestational weight gain. The association between diet, health and maternal weight gain of the women who consumed alcohol during pregnancy should be studied further.

These observations indicate that an early exposure to cow's milk formula-feeding and rapid growth in infancy are independent risk factors of childhood type 1 diabetes.

ObjectivesTo evaluate effectiveness of a structured one-to-one behaviour change programme on weight loss in obese and overweight individuals.DesignRandomised controlled trial.Setting23 general practices in Camden, London.Participants381 adults with body mass index ≥25 kg/m2 randomly assigned to intervention (n=191) or control (n=190) group.InterventionsA structured one-to-one programme, delivered over 14 visits during 12 months by trained advisors in three primary care centres compared with usual care in general practice.Outcome measuresChanges in weight, per cent body fat, waist circumference, blood pressure and heart rate between baseline and 12 months.Results217/381 (57.0%) participants were assessed at 12 months: missing values were imputed. The difference in mean weight change between the intervention and control groups was not statistically significant (0.70 kg (0.67 to 2.17, p=0.35)), although a higher proportion of the intervention group (32.7%) than the control group (20.4%) lost 5% or more of their baseline weight (OR: 1.80 (1.02 to 3.18, p=0.04)). The intervention group achieved a lower mean heart rate (mean difference 3.68 beats per minute (0.31 to 7.04, p=0.03)) than the control group. Participants in the intervention group reported higher satisfaction and more positive experiences of their care compared with the control group.ConclusionsAlthough there is no significant difference in mean weight loss between the intervention and control groups, trained non-specialist advisors can deliver a structured programme and achieve clinically beneficial weight loss in some patients in primary care. The intervention group also reported a higher level of satisfaction with the support received. Primary care interventions are unlikely to be sufficient to tackle the obesity epidemic and effective population-wide measures are also necessary.Clinical trial registration numberTrial registrationClincaltrials.gov NCT00891943.

Background/Objectives: N-3 (omega-3) fatty acids have been reported to decrease the risk for development of b-cell autoimmunity and clinical type I diabetes. We set out to examine whether different serum fatty acids are associated with the development of advanced b-cell autoimmunity in children carrying human leukocyte antigen DQ b-1 (HLA-DQB1)-conferred susceptibility to type I diabetes. Subjects/Methods: Within a cohort, serum total fatty acid composition of 108 children with advanced b-cell autoimmunity and of 216 matched persistently autoantibody-negative controls was analyzed using gas chromatography. Non-fasting serum samples were obtained annually at the ages of 1-6 years. Conditional logistic regression was applied to analyze the associations between advanced b-cell autoimmunity and serum fatty acids. Results: The serum fatty acid profile of myristic acid (odds ratio (OR) 1.48, 95% confidence interval (CI) 1.09-2.00, P ¼ 0.011), pentadecanoic acid (OR 1.65, 95% CI 1.19-2.28, P ¼ 0.003), palmitoleic acid isomers 16:1 n-7 (omega-7) (OR 1.41, 95% CI 1.03-1.92, P ¼ 0.030) and 16:1 n-9 (omega-9) (OR 1.45, 95% CI 1.05-2.01, P ¼ 0.026) and conjugated linoleic acid (OR 1.67, 95% CI 1.16-2.41, P ¼ 0.006) closest to the time of the appearance of multiple autoantibodies were positively associated with the risk of advanced b-cell autoimmunity after adjustment for potential confounding factors. Serum linoleic acid showed inverse, marginal association with the end point. Conclusions: Serum biomarkers of milk and ruminant meat fat consumption are directly associated and linoleic acid is inversely associated with advanced b-cell autoimmunity in children with HLA-conferred susceptibility to type I diabetes.

Aims/hypothesis: The aim of this study was to investigate whether the use of antimicrobials is associated with the risk of childhood type 1 diabetes. Materials and methods: The study population included all children born in Finland between 1996 and 2000 who were diagnosed with type 1 diabetes by the end of 2002. For each case (n=437), four matched controls were selected. Data on diabetes and the maternal use of antimicrobials was derived from nationwide registries. Results: Maternal use of phenoxymethyl penicillins (odds ratio [OR]=1.70, 95% CI 1.08-2.68, p=0.022) or quinolone antimicrobials (OR=2.43, 95% CI 1.16-5.10, p=0.019) before pregnancy was associated with an increased risk of type 1 diabetes in the child, whereas the use of other specific antimicrobials was not related to the risk. The risk was also higher among mother-child pairs where macrolides were used both by the mother before pregnancy and by the child, compared with pairs where neither used macrolides (OR=1.76, 95% CI 1.05-2.94, p=0.032). Maternal use of antimicrobials during pregnancy was not associated with an increased risk. The high use of antimicrobials by the child (more than seven vs seven or less purchases) was related to greater risk (OR=1.66, 95% CI 1.24-2.24, p=0.001). Conclusions/ interpretation: Overall, the use of antimicrobials before pregnancy, during pregnancy or during childhood was not related to the risk of childhood type 1 diabetes. However, the use of some specific antimicrobials by the mother before pregnancy and by the child may be associated with an increased risk. Further studies are needed to confirm these associations and to elucidate the underlying mechanisms of action.

Early introduction of root vegetables during infancy is independently associated with increased risk of ß-cell autoimmunity among Finnish children with increased genetic susceptibility to Type 1 diabetes.

Evidence for an inverse association of impaired fetal growth with stroke is less securely established than that with coronary heart disease. Even less is known about the association of fetal growth with occlusive stroke and haemorrhagic stroke. Participants, methods, and resultsThe cohort comprises all 14 611 births in the Uppsala Academic Hospital between 1915 and 1929.1 Socioeconomic circumstances and neonatal characteristics, including gestational age (number of completed weeks since last menstrual period), were available for 96% of the subjects from hospital records and follow up is 98% complete. Analyses were restricted to singletons born at 30-45 weeks' gestation for whom information was available in the 1960 and 1970 censuses. Data on occurrence of first stroke were obtained from the Swedish national hospital discharge register 2 and from the national cause of death register. Two subtypes of stroke were defined-haemorrhagic (ICD-8 (international classification of diseases, 8th revision) 430-431; ICD-9 430-432) and occlusive (ICD-8 432-436; ICD-9 433-436). Each participant was considered at risk from the time of the 1970 census to date of first stroke, emigration, death, or end of follow up (31 December 1996).The 10 853 men and women had 991 first strokes-156 haemorrhagic, 775 occlusive, and 60 ill defined. Death certificates identified 41 (26%) first haemorrhagic strokes and 17 (2%) occlusive strokes. Of haemorrhagic strokes, 21 (13%) were subarachnoid and 135 (87%) intracerebral or unspecified intracranial haemorrhages.Cox proportional hazards model showed birth weight inversely associated with risk of haemorrhagic stroke and little evidence of association with occlusive stroke. Hazard ratio per 1 kg increase in birth weight (adjusted for sex and period of birth) was 0.61 (95% confidence interval 0.45 to 0.83) for haemorrhagic stroke and 0.89 (0.77 to 1.03) for occlusive stroke. Adjustment for socioeconomic factors at birth and at the time of the 1960 and 1970 censuses had little effect on estimates (table). When head circumference and birth length were adjusted for separately and in combination, the inverse association between birth weight and haemorrhagic stroke strengthened but there was little effect on the association of birth weight with occlusive stroke. Adjustment for gestational age had no substantive effect on the estimates.