Nutrition and health in 4-year-olds in a Swedish well-educated urban community

Background: Recent data about nutrition in Swedish preschool children is rare. During the latest decades the increased prevalence of welfare diseases have become an important issue in the general health work and it is desirable to be able to identify risk factors early in life.Aim: The general purpose of this work was to analyze nutrition in healthy 4-year-olds´ in a Western urban community in Sweden in relation to socio-economy, life style and different aspects of health in order to improve the understanding of possible associations.Methods: The children were recruited from three pediatric child health centers in Göteborg, Sweden. 228 families (230 children) were asked to participate. Questionnaires regarding socio-economy, lifestyle and health were completed. The dietary assessment methods were a food frequency questionnaire and a 7-day food recording. Anthropometry was measured. Body composition was assessed with dual X-ray absorptiometry and serum samples were analyzed regarding metabolic markers. The study was performed according to the Helsinki Declaration and approved by the Ethics Committee of Göteborg University. Results: 182 children (79%) participated in the whole or part of the study. The drop out was significantly larger among children with parents born abroad. About 85 % of the parents were born in Sweden and about half were university educated. Almost all children were breastfed until 5 months and a fourth was reported to have allergic symptoms or food intolerance. About 85 % of the children attended preschool, half of them >30 hrs/week. A fourth of the children, overrepresented by overweight children watched television >1 hr/day. There was a significant increase in both z-score for weight and height between birth and the age of 4, and 17 % of the children were classified as overweight/obese according cut-offs from the International Obesity Task Force. Body mass index (BMI) was strongly associated with the fat mass, and fat mass index (kg/m2) seemed to be the best discriminator for overweight. The energy intake/kg was according to Nordic nutrition recommendations (NNR 2004), but a fourth of the energy came from junk food . Most children had higher intake of saturated fat and sucrose than NNR 2004, while the intake of polyunsaturated fat - especially n-3 fatty acids, vitamin D and iron were lower than recommended in most children. A higher BMI was associated with lower fat and higher sucrose intake. The girls had significantly higher metabolic markers than the boys. In girls, the HOMA ß-cell function was negatively associated with the intake of fat and positively with the intake of carbohydrates. In girls, both fS-insulin and HOMA insulin resistance were associated with changes in z-score for both weight and height from birth to the age of 4. Children with high fS-insulin were smaller at birth, without being small for gestational age, and had larger increase of z-score for both weight and height than other children. Summary: In 4-year olds with well educated parents 17 % of the children were overweight or obese but the energy intake was according to the recommendations. Most children had a higher intake of saturated fat and sucrose than recommended but the intake of n-3 fatty acids, vitamin D and iron was lower than recommended. BMI was strongly related to the fat mass. A lower fat intake was associated with higher BMI and higher HOMA ß-cell function. fS-insulin and insulin resistance were associated to increased growth rate from birth to the age of 4 (upward centile crossing). Risk factors for the metabolic syndrome can be identified already in healthy 4-year olds, especially in girls