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BackgroundEarly adiposity rebound (AR) has been associated with increased risk of overweight or obesity in adulthood. However, little is known about early predictors of age at AR. We aimed to study the role of perinatal factors and genetic susceptibility to obesity in the kinetics of AR.MethodsBody mass index (BMI) curves were modelled by using mixed-effects cubic models, and age at AR was estimated for 1415 children of the EDEN mother–child cohort study. A combined obesity risk-allele score was calculated from genotypes for 27 variants identified by genome-wide association studies of adult BMI. Perinatal factors of interest were maternal age at delivery, parental education, parental BMI, gestational weight gain, maternal smoking during pregnancy, and newborn characteristics (sex, prematurity, and birth weight). We used a hierarchical level approach with multivariable linear regression model to investigate the association between these factors, obesity risk-allele score, and age at AR.ResultsA higher genetic susceptibility to obesity score was associated with an earlier age at AR. At the most distal level of the hierarchical model, maternal and paternal educational levels were positively associated with age at AR. Children born to parents with higher BMI were more likely to exhibit earlier age at AR. In addition, higher gestational weight gain was related to earlier age at AR. For children born small for gestational age, the average age at AR was 88 [±39] days lower than for children born appropriate for gestational age and 91 [±56] days lower than for children born large for gestational age.ConclusionThe timing of AR seems to be an early childhood manifestation of the genetic susceptibility to adult obesity. We further identified low birth weight and gestational weight gain as novel predictors of early AR, highlighting the role of the intrauterine environment in the kinetics of adiposity.

Childbirth is a major life-changing event, this period is an opportunity to improve eating habits. The aim of this longitudinal study was to identify and characterise dietary changes in women according to their parity status. Dietary intake data from 4194 women of childbearing age included in the NutriNet-Santé cohort were derived using a FFQ, administered in 2014 and 2018, distinguishing between organic and conventional food consumption. Women were classified into four groups: ‘previous children’, ‘multiparous’, ‘primiparous’ and ‘nulliparous’. Multi-adjusted ANCOVA models were used to estimate the changes according to the parity group. Changes in food consumption towards a more plant-based, healthier and organic diet were observed in all four groups of women, although to various degrees. In multivariable models, ‘Nulliparous’ women showed a greater improvement in terms of ‘sustainable’ food consumption than ‘previous children’ women. ‘Primiparous’ women significantly increased their energy intake (+349 (269–429) kcal/d) and their consumption of dairy products (+30 (3–56) g/d), and they significantly decreased their consumption of alcohol (–23 (–32–15) g/d), coffee and tea (–107 (–155–60) g/d). Regarding organic food, ‘nulliparous’ women increased their consumption more than ‘previous children’ and ‘primiparous’ women were those who were most frequently in the top quintile of organic food increase. Although there were dietary changes in all groups of women according to their parity, childless women have a shift moving towards a more sustainable diet. Women who had a first child reduced their alcohol and caffeine consumption.

Predicting Diabetes: Clinical, Biological, and Genetic Approaches Data from the Epidemiological Study on the Insulin Resistance Syndrome (DESIR) Beverley Balkau , PHD 1 , Céline Lange , BSC 1 , Leopold Fezeu , MD, MSC 1 , Jean Tichet , MD 2 , Blandine de Lauzon-Guillain , PHD 1 3 , Sebastien Czernichow , MD, PHD 4 5 , Frederic Fumeron , PHD 6 7 , Philippe Froguel , MD, PHD 8 9 10 , Martine Vaxillaire , PHD 8 9 10 , Stephane Cauchi , PHD 8 9 10 , Pierre Ducimetière , PHD 1 and Eveline Eschwège , MD 1 1 INSERM U780-IFR69, Villejuif, France/University Paris-Sud, Orsay, France 2 Institut inter Régional pour la Santé, La Riche, France 3 INSERM, Regional INSERM Research Group 20, New INSERM Research Group 4045, Institut Gustave-Roussy, Villejuif, France 4 Nutritional Epidemiology Research Unit, UMR U557 INSERM, U1125 French National Institute for Agricultural Research, National School of Arts and Trades, University Paris 13, Center for Research on Human Nutrition–Ile de France, Bobigny, France 5 Public Health Department, Avicenne Hospital, Bobigny, France 6 INSERM U695, Paris, France 7 René Diderot-Paris University, Paris, France 8 UMR 8090 and Institute of Biology, Lille, France 9 Pasteur Institute, Lille, France 10 Lille 2 University, Lille, France Corresponding author: Beverley Balkau, beverley.balkau{at}inserm.fr Abstract OBJECTIVE —To provide a simple clinical diabetes risk score and to identify characteristics that predict later diabetes using variables available in the clinic setting as well as biological variables and polymorphisms. RESEARCH DESIGN AND METHODS —Incident diabetes was studied in 1,863 men and 1,954 women, 30–65 years of age at baseline, with diabetes defined by treatment or by fasting plasma glucose ≥7.0 mmol/l at 3-yearly examinations over 9 years. Sex-specific logistic regression equations were used to select variables for prediction. RESULTS —A total of 140 men and 63 women developed diabetes. The predictive clinical variables were waist circumference and hypertension in both sexes, smoking in men, and diabetes in the family in women. Discrimination, as measured by the area under the receiver operating curves (AROCs), were 0.713 for men and 0.827 for women, a little higher than for the Finish Diabetes Risk (FINDRISC) score, with fewer variables in the score. Combining clinical and biological variables, the predictive equation included fasting glucose, waist circumference, smoking, and γ-glutamyltransferase for men and fasting glucose, BMI, triglycerides, and diabetes in family for women. The number of TCF7L2 and IL6 deleterious alleles was predictive in both sexes, but after including the above clinical and biological variables, this variable was only predictive in women ( P < 0.03) and the AROC statistics increased only marginally. CONCLUSIONS —The best clinical predictor of diabetes is adiposity, and baseline glucose is the best biological predictor. Clinical and biological predictors differed marginally between men and women. The genetic polymorphisms added little to the prediction of diabetes. Footnotes Published ahead of print at http://care.diabetesjournals.org on 8 August 2008. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact. Accepted July 16, 2008. Received February 20, 2008. DIABETES CARE

This paper aimed to examine the effect of breastfeeding on longitudinal patterns of common infections up to 2 years and respiratory symptoms up to 8 years. To assess the incidence and reoccurrence of infections and allergic symptoms in the first years of life among 1,603 children from the EDEN mother–child cohort, distinct longitudinal patterns of infectious diseases as well as skin rash and respiratory symptoms were identified by group‐based trajectory modelling. To characterize infections, we considered the parent‐reported number of cold/nasopharyngitis and diarrhoea from birth to 12 months and otitis and bronchitis/bronchiolitis from birth to 2 years. To characterize allergy‐related symptoms, we considered the parent‐reported occurrence of wheezing and skin rash from 8 months to 8 years and asthma from 2 to 8 years. Then associations between breastfeeding and these longitudinal patterns were assessed through adjusted multinomial logistic regression. Compared with never‐breastfed infants, ever‐breastfed infants were at a lower risk of diarrhoea events in early infancy as well as infrequent events of bronchitis/bronchiolitis throughout infancy. Only predominant breastfeeding duration was related to frequent events of bronchitis/bronchiolitis and infrequent events of otitis. We found no significant protective effect of breastfeeding on longitudinal patterns of cold/nasopharyngitis, skin rash, or respiratory symptoms. For an infant population with a short breastfeeding duration, on average, our study confirmed a protective effect of breastfeeding on diarrhoea events in early infancy, infrequent bronchitis/bronchiolitis and, to a lesser extent, infrequent otitis events up to 2 years but not on other infections, skin rash, or respiratory symptoms4. In an infant population with a short breastfeeding duration and using longitudinal patterns of infection, skin rash and respiratory symptoms, on average, our study confirmed a protective effect of breastfeeding on diarrhea events in early infancy, infrequent bronchitis/bronchiolitis and, to a lesser extent,infrequent otitis events up to 2 years but not on cold/ nasopharyngitis, skin rash or respiratory symptoms.

In low- and middle-income countries, the protective effect of breastfeeding against infections is well established, but in high-income countries, the effect could be weakened by higher hygienic conditions. We aimed to examine the association between breastfeeding and infections in the first 2 years of life, in a high-income country with relatively short breastfeeding duration. Among 10,349 young children from the nationwide Etude Longitudinale Française depuis l’Enfance (ELFE) birth cohort, breastfeeding and parent-reported hospitalizations, bronchiolitis and otitis events, and antibiotic use were prospectively collected up to 2 years. Never-breastfed infants were used as reference group. Any breastfeeding for <3 months was associated with higher risks of hospitalizations from gastrointestinal infections or fever. Predominant breastfeeding for <1 month was associated with higher risk of a single hospital admission while predominant breastfeeding for ≥3 months was associated with a lower risk of long duration (≥4 nights) of hospitalization. Ever breastfeeding was associated with lower risk of antibiotic use. This study confirmed the well-known associations between breastfeeding and hospitalizations but also highlighted a strong inverse association between breastfeeding and antibiotic use. Although we cannot infer causality from this observational study, this finding is worth highlighting in a context of rising concern regarding antibiotic resistance.

To examine the relationship between breastfeeding and maternally-rated infant temperament at age 3 months, 316 infants in the prospective Cambridge Baby Growth Study, UK had infant temperament assessed at age 3 months by mothers using the Revised Infant Behavior Questionnaire, which produces scores for three main dimensions of temperament derived from 14 subscales. Infant temperament scores were related to mode of infant milk feeding at age 3 months (breast only; formula milk only; or mixed) with adjustment for infant's age at assessment and an index of deprivation. Infant temperament dimension scores differed across the three infant feeding groups, but appeared to be comparable between exclusive breast-fed and mixed-fed infants. Compared to formula milk-fed infants, exclusive breast-fed and mixed-fed infants were rated as having lower impulsivity and positive responses to stimulation (adjusted mean [95% CI] \"Surgency/Extraversion\" in formula-fed vs. mixed-fed vs. breast-fed groups: 4.3 [4.2-4.5] vs. 4.0 [3.8-4.1] vs. 4.0 [3.9-4.1]; p-heterogeneity = 0.0006), lower ability to regulate their own emotions (\"Orienting/Regulation\": 5.1 [5.0-5.2], vs. 4.9 [4.8-5.1] vs. 4.9 [4.8-5.0]; p = 0.01), and higher emotional instability (\"Negative affectivity\": 2.8 [2.6-2.9] vs. 3.0 [2.8-3.1] vs. 3.0 [2.9-3.1]; p = 0.03). Breast and mixed-fed infants were rated by their mothers as having more challenging temperaments in all three dimensions; particular subscales included greater distress, less smiling, laughing, and vocalisation, and lower soothability. Increased awareness of the behavioural dynamics of breastfeeding, a better expectation of normal infant temperament and support to cope with difficult infant temperament could potentially help to promote successful breastfeeding.

Breastfeeding is associated with multiple domains of health for both mothers and children. Nevertheless, breastfeeding initiation is low within certain developed countries. Furthermore, comparative studies of initiation rates using harmonised data across multiple regions is scarce. The aim of the present study was to investigate and compare individual-level determinants of breastfeeding initiation using two French-speaking cohorts. Participants included ~ 3,900 mothers enrolled in two cohort studies in Canada and France. Interviews, questionnaires, and medical records were utilised to collect information on maternal, family, and medical factors associated with breastfeeding initiation. Rates of breastfeeding initiation were similar across cohorts, slightly above 70%. Women in both Canada and France who had higher levels of maternal education, were born outside of their respective countries and who did not smoke during pregnancy were more likely to initiate breastfeeding with the cohort infant. Notably, cohort effects of maternal education at the university level were found, whereby having 'some university' was not statistically significant for mothers in France. Further, younger mothers in Canada, who delivered by caesarean section and who had previous children, had reduced odds of breastfeeding initiation. These results were not found for mothers in France. While some similar determinants were observed, programming efforts to increase breastfeeding initiation should be tailored to the characteristics of specific geographical regions which may be heavily impacted by the social, cultural and political climate of the region, in addition to individual and family level factors.

Background: In France, updated data on food allergies (FAs) are lacking, despite the need for efficient FA management and prevention. This study aimed to evaluate the prevalence of FAs in children in France, describe the most common allergens and determine the prevalence of atopic diseases in children with FAs. Methods: The ELFE study comprises a French nationwide birth cohort, including 18,329 children born in 2011. FAs were assessed by parental reports of food avoidance based on medical advice related to FAs, provided at 2 months and 2, 3.5 and 5.5 years of age. Data regarding FAs were available for 16,400 children. Data were weighted to account for selection and attrition bias. Results: From birth to 5.5 years of age, FAs were reported for 5.94% (95% CI: 5.54–6.34) children. Milk was the most common allergen, followed by egg, peanut, exotic fruits, tree nuts, gluten and fish. Among children with FAs, 20.5% had an allergy to at least two different groups of allergens; 71% reported eczema at least once before 5.5 years of age; 24.4% reported incidence of asthma; and 42.3% reported incidence of allergic rhinitis or conjunctivitis. Conclusion: In France, the prevalence of FAs in children up to 5.5 years of age is approximately 6%. It was demonstrated that 1 in 5 children with allergies had multiple FAs.

Introduction Sleep troubles have been associated with respiratory and allergic health problems in children, however the time line of their association is overlooked. The current study examined the associations between: (1) sleep patterns at age 1 year and respiratory and allergic multi-trajectories between 1 and 5.5 years; (2) respiratory and allergic multi-trajectories between 1 and 5.5 years and sleep patterns at age 5.5 years in a French birth cohort. Methods Clusters of sleep characteristics at age 1 year (nocturnal sleep duration (NSD), day sleep duration (DSD), sleep onset difficulties (SOD), night awakenings (NA)) and at age 5.5 years (NSD, SOD, NA) and respiratory and allergic symptoms multi-trajectory groups between 1 and 5.5 years (wheezing, asthma medication, eczema, allergic conjunctivitis) were identified using unsupervised methods. Associations between sleep clusters at each age and multi-trajectory groups were assessed using multinomial regressions adjusted for potential confounding factors among 9,577 children. Results Two sleep clusters were identified at both age 1 and 5.5 years: C1a (79.9%, age 1 year) and C1b (83.1%, age 5.5 years) characterized by adequate sleep duration and good sleep quality; C2a (20.1%, age 1 year) and C2b (16.9%, age 5.5 years) characterized by shorter sleep duration and poorer sleep quality. Four multi-trajectory groups were also identified: G1 (no/few symptoms, 44.4%), G2 (persistent non-respiratory allergic symptoms, 23.1%), G3 (transient early respiratory symptoms, 25.2%), G4 (persistent respiratory and allergic symptoms, 7.3%). Belonging to cluster C2a was associated with an increased odds of belonging to G3 (adjusted odds ratio [95% interval confidence]; 1.14 [0.99-1.31]) and G4 (1.29 [1.05-1.59]). After accounting for sleep clusters at age 1 year, belonging to G4 was associated with an increased odds of belonging to cluster C2b (1.21 [0.98-1.5]). Conclusion Sleep disturbances at 1 year were associated with poorer respiratory and allergic health between 1 and 5.5 years and respiratory and allergic problems between age 1 and 5.5 years were associated with sleep troubles at 5.5 years suggesting bidirectionality. Further research is needed to explore potential coevolution of sleep and allergic and respiratory troubles during early childhood. Support (if any) ANR-21-CE36-0001-01

ABSTRACT Background An increasing number of infant and follow-on formulas are enriched with probiotics and/or prebiotics; however, evidence for health effects of such enrichment in early childhood remains inconclusive. Objectives The present study aimed to assess whether the consumption of formula enriched with probiotics or prebiotics was associated with the risk of infection and allergic diseases in early childhood. Methods Analyses involved data for 8389 formula-fed children from the Etude Longitudinale Française depuis l'Enfance (ELFE) cohort. Enrichment of the formula with probiotics or prebiotics that was consumed from the age of 2–10 mo was identified by the formula ingredient list. Lower respiratory tract infection (LRTI), upper respiratory tract infection (URTI), gastrointestinal infection, wheezing, asthma, food allergy, and itchy rash were prospectively reported by parents up to the age of 5.5 y. Adjusted logistic regression models were used to assess associations between the consumption of enriched formula and risk of infection and allergic diseases. Results Aged 2 mo, more than half of formula-fed infants consumed the probiotic-enriched formula and only 1 in 10 consumed the prebiotic-enriched formula. Consumption of the Bifidobacterium lactis-enriched formula at 2 mo was associated with a lower risk of LRTI [OR (95% CI) = 0.84 (0.73–0.96)]. Consumption of the Bifidobacterium breve-enriched formula up to 6 mo was associated with a higher risk of LRTI [OR (95% CI) = 1.75 (1.29–2.38)] and asthma [OR (95% CI) = 1.95 (1.28–2.97)], whereas its consumption from 6 to 10 mo was associated with a lower risk of LRTI [OR (95% CI) = 0.64 (0.48–0.86)] and asthma [OR (95% CI) = 0.59 (0.40–0.88)]. Moreover, the consumption of Streptococcus thermophilus from 6 to 10 mo was associated with a higher risk of asthma [OR (95% CI) = 1.84 (1.29–2.63)]. No significant association was found for gastrointestinal infection, food allergy, and itchy rash. Overall, the consumption of prebiotic-enriched formula was not significantly associated with infection and allergy risk. Conclusions Associations between the consumption of probiotic-enriched formula and risk of respiratory symptoms differ according to the strain considered and consumption period. Further well-designed studies are needed to confirm these results.