Kiefte-de Jong, J.C.

Levels of antibodies against tissue transglutaminase during pregnancy are associated with reduced fetal weight and birth weight (Article)

2013-04-01T00:00:00Z

Background & Aims: Celiac disease in pregnant women has been associated with poor growth of the fetus, but little is known about how the level of celiac disease affects fetal growth or birth outcomes. We assessed the associations between levels of antibodies against tissue transglutaminase (anti-tTG, a marker of celiac disease) and fetal growth and birth outcomes for pregnant women. Methods: We performed a population-based prospective birth cohort study of 7046 pregnant women. Serum samples were collected during the second trimester of pregnancy and analyzed for levels of anti-tTG. Based on these levels, the women were categorized into 3 groups: negative anti-tTG (≤0.79 U/mL; n = 6702), intermediate anti-tTG (0.8 to ≤6 U/mL; n = 308), or positive anti-tTG (>6 U/mL; n = 36). Data on fetal growth and birth outcomes were collected from ultrasound measurements and medical records. Results: Fetuses of women in the positive anti-tTG group weighed 16 g less than those of women in the negative anti-tTG group (95% confidence interval [CI], -32 to -1 g) during the second trimester and weighed 74 g less (95% CI, -140 to -8 g) during the third trimester. Newborns of women in the intermediate and positive anti-tTG groups weighed 53 g (95% CI, -106 to -1 g) and 159 g (95% CI, -316 to -1 g) less at birth, respectively, than those of women in the negative anti-tTG group. The reduction in birth weight in offspring of mothers in the intermediate anti-tTG group was 2-fold greater among mothers who carried HLA-DQ2 or -DQ8 than among those without HLA-DQ2 or -DQ8. Conclusions: Levels of anti-tTG in pregnant women are inversely associated with fetal growth. Growth was reduced to the greatest extent in fetuses of women with the highest levels of anti-tTG (>6 U/mL). Birth weight was also reduced in women with intermediate levels of anti-tTG (0.8 to ≤6 U/mL) and further reduced in those carrying HLA-DQ2 and -DQ8. © 2013 AGA Institute.

Correlates of Physical Activity in 2-Year-Old Toddlers: The Generation R Study (Article)

2013-03-22T00:00:00Z

Objective: To describe and identify correlates of objectively measured physical activity and sedentary behavior in 2-year-old toddlers. Study design: A total of 347 children participating in a birth cohort study wore a unaxial ActiGraph accelerometer during 1 weekday and 1 weekend day. Information on potential correlates was assessed by parent-reported questionnaires, delivery reports, and regular visits to child health centers. Univariate and multivariable linear regression analyses were conducted to examine the associations between potential correlates and the following physical activity outcomes: percentage of time spent in sedentary behavior, percentage of time spent in moderate-to-vigorous physical activity, and mean counts per minute. Results: A high percentage of monitored time was spent in sedentary behavior; 85.6% on weekdays and 84.5% on weekend days. Four correlates were significantly associated with at least 1 physical activity outcome in the multivariable regression models: child's sex, child's age, number of siblings, and season of measurement. The associations of gross motor development with moderate-to-vigorous physical activity and mean counts per minute approached significance. Associations of socioeconomic variables and child's body mass index z-score with physical activity outcomes were not significant. Conclusion: Two-year-old toddlers spend most of their time in sedentary behavior. No modifiable correlates were identified. Further research on physical activity and associated health benefits among very young children is warranted.

Early life nutrition and gastrointestinal and allergic outcomes: the Generation R Study (Doctoral Thesis)

2012-09-12T00:00:00Z

This thesis particularly focused on the outcomes of constipation, celiac disease auto antibodies, asthma-like symptoms, and atopic dermatitis, which are all prevalent in the general population. In line with this, the main goals of this thesis were to assess: · Infant nutrition: o Consequences of timing of complementary feeding o Determinants of dietary patterns in toddlers · Gastrointestinal outcomes: o Consequences of celiac disease autoantibodies during pregnancy o Nutritional and endocrinological determinants of functional constipation in childhood · Asthma-like symptoms and atopic dermatitis: o Nutritional determinants of asthma-like symptoms and atopic dermatitis during the pre- and postnatal phase. These aims were explored within the framework of the Generation R Study, a population-based prospective multi-ethnic cohort study from fetal life onwards. The studies in this thesis particularly referred to the pre-school period of the child (i.e. from birth to 4 years of age).

Is there an association between wheezing and constipation in preschool children? Explanations from a longitudinal birth cohort (Article)

2011-10-11T00:00:00Z

Objective: To assess whether wheezing and atopic dermatitis were associated with constipation in preschool children and to what extent shared risk factors contribute to this relationship. Methods: A population-based sample of 4651 preschool children was used. At the age of 24, 36 and 48 months, a parental report of functional constipation was available according to the Rome II criteria, and data on atopic dermatitis and wheezing were available using age-adapted questionnaires from the International Study of Asthma and Allergies in Childhood. Stepwise multivariate analyses were performed to assess whether body mass index, infection exposure, food allergy and infant nutrition, and parental stress explained the association between wheezing, atopic dermatitis and constipation. Results: Out of 4651 children, 12-17% had functional constipation between 24 and 48 months. Symptoms of wheezing decreased from 20% to 12% and atopic dermatitis decreased from 30% to 18% at the age of 24 and 48 months respectively. Between the age of 24 and 48 months, wheezing symptoms were significantly associated with functional constipation (OR 1.17; 1.02 to 1.34) but these results were mainly explained by the child's exposure to infections and use of antibiotics (adjusted odds ratio 1.08; 95% CI 0.95 to 1.24). No significant association was found between symptoms of atopic dermatitis and functional constipation (OR 1.08; 95% CI 0.94 to 1.23). Conclusions: These findings suggest that functional constipation coexists with wheezing in childhood but is mainly explained by the child's infection exposure and use of antibiotics. Therefore, an independent association between respiratory symptoms and functional bowel disorders as suggested in previous studies is questionable.

The introduction of allergenic foods and the development of reported wheezing and eczema in childhood: The generation R study (Article)

2011-10-01T00:00:00Z

Objective: To examine whether the timing of introduction of the allergenic foods cow's milk, hen's egg, peanuts, tree nuts, soy, and gluten is associated with eczema and wheezing in children 4 years of age or younger. Design: Population-based prospective cohort study from fetal life until young adulthood. Setting: Rotterdam, the Netherlands, from April 2002 through January 2006. Participants: A total of 6905 preschool children participating in the Generation R study. Main Exposure: Timing of introduction of cow's milk, hen's egg, peanuts, tree nuts, soy, and gluten collected by questionnaires at 6 and 12 months of age. Main Outcome Measures: Information on the outcomes eczema and wheezing were obtained by questions from the age-adapted version of the "International Study of Asthma and Allergies in Childhood" core questionnaire and questionnaire data on parentally reported physician diagnosis for eczema. Results: Of 6905 children, wheezing was reported in 31% at age 2 years and in 14% at ages 3 and 4 years. Eczema was reported in 38%, 20%, and 18% of children at the ages of 2, 3, and 4 years, respectively. The introduction of cow's milk, hen's egg, peanuts, tree nuts, soy, and gluten before the age of 6 months was not significantly associated with eczema or wheezing at any age after adjustment for potential confounders (P>.10 for all comparisons). The results did not alter after stratification according to the child's history of cow's milk allergy and parental history of atopy. Conclusion: This study does not support the recommendation for delayed introduction of allergenic foods after age 6 months for the prevention of eczema and wheezing.

Cortisol diurnal rhythm and stress reactivity in constipation and abdominal pain: The generation R study (Article)

2011-04-16T00:00:00Z

OBJECTIVES: The aim of this study was to assess whether diurnal cortisol rhythm and cortisol stress reactivity were associated with functional constipation and abdominal pain in infancy. METHODS: This study was embedded in a subset of the Generation R Study, a prospective cohort study from fetal life onwards in Rotterdam, The Netherlands. Data of infants between 14 and 24 months of age (N = 483) were used. Salivary cortisol diurnal rhythm and salivary cortisol stress reactivity after a Strange Situation Procedure were assessed at the age of 14 months. Data on functional constipation was available according to the ROME II criteria and data on abdominal pain on the basis of the Abdominal Pain Index were available from questionnaire data at 24 months. RESULTS: In the second year of life, 13% of the infants had functional constipation and 17% had abdominal pain. Only 4% had symptoms of both functional constipation and abdominal pain. Diurnal cortisol rhythm did not differ significantly between children with and those without functional constipation and abdominal pain. Cortisol stress reactivity was slightly higher in infants with abdominal pain than those without it but this was not statistically significant (OR: 1.41; 95%CI: 0.46-4.31). No association was found between the cortisol stress reactivity and functional constipation. CONCLUSIONS: Our results suggest that cortisol as a marker for stress does not play a major role in functional constipation or abdominal pain in infancy.

Infant Nutritional Factors and Functional Constipation in Childhood: The Generation R Study (Article)

2010-04-01T00:00:00Z

OBJECTIVES:Food allergy and celiac disease may lead to childhood constipation. Early introduction of food allergens and gluten in the first year of life has been suggested to have a function in these food intolerances, but it is unclear whether this also holds true for development of childhood constipation. The aim of this study was to assess the association between the timing of introduction of food allergens and gluten early in life and functional constipation in childhood.METHODS:This study was embedded in the Generation R study, a population-based prospective cohort study from fetal life until young adulthood. Functional constipation at 24 months of age was defined in 4,651 children according to the Rome II criteria of defecation frequency <3 times a week or the presence of mainly hard feces for at least 2 weeks.RESULTS:At the age of 24 months, 12% of the children had functional constipation. Children with functional constipation got introduced to gluten more often before or at the age of 6 months than children without functional constipation (37% and 27%, respectively). After adjustment for birth weight, gestational age, gender, ethnicity, maternal education, and family history of atopy and chronic intestinal disorders, functional constipation was significantly associated with early gluten introduction (odds ratio (OR): 1.35; 95% confidence interval (CI): 1.10-1.65). No association was found between timing of introduction of cow's milk, hen's egg, soy, peanuts, and tree nuts with functional constipation. A history of cow's milk allergy in the first year of life was significantly associated with functional constipation in childhood (OR: 1.57; 95% CI: 1.04-2.36).CONCLUSIONS:These results suggest that early gluten introduction in the first year of life provide a trigger for functional constipation in a subset of children. In case of functional constipation, there also might be a role for cow's milk allergy initiated in the first year of life.Am J Gastroenterol advance online publication, 2 March 2010; doi:10.1038/ajg.2010.96.

Food questionnaire for assessment of infant gluten consumption (Article)

2007-04-01T00:00:00Z

Background: In light of the possibly preventive role of timing and amount of gluten in celiac disease, it would be helpful to have a questionnaire to assess the gluten intake in infants. Aims: Development and validation of a food questionnaire to assess gluten consumption in healthy infants aged 0-12 months (FQ-gluten). Methods: A food frequency questionnaire, previously developed for the Generation R study, was adapted for the assessment of gluten intake. The results of a 2-day food record (FR) were compared with the results of this FQ-gluten. Results: Eighty-seven parents filled in the FR and the FQ-gluten. The number of children who consume gluten and who are breast-fed is higher, reported in the FQ-gluten. The amount of gluten is comparable from the age of 3 up to 10 months, but at 11 and 12 months a higher gluten intake is reported using the FR, probably due to a larger variety of food products not detectable by the FQ-gluten. However, there is a high agreement in the food groups (Cohens' κ=0.6-0.8). Conclusions: This new, short, standardized, validated and easy to use FQ-gluten may be a useful instrument to assess gluten intake in infants, both at the individual and at the population level. The use of this method by investigators in other countries provides the opportunity for a better comparison of the results of gluten consumption in (co-operative) studies throughout different countries.