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Identifier

000397361

Title

Early life diet and child psychomotor and behavioral development : the "Rhea" mother-child cohort in Crete, Greece

Alternative Title

Προοπτική μελέτη του ρόλου της διατροφής κατά τη βρεφική και παιδική ηλικία στην ψυχολογική,κινητική και συμπεριφορική ανάπτυξη των παιδιών

Author

Λεβεντάκου, Βασιλική

Thesis advisor

Χατζή. Λήδα

Reviewer

Γαλανάκης, Εμμανουήλ
Μπίτσιος, Παναγιώτης
Λιονής, Χρήστος
Φιλαλήθης, Αναστάσιος
Σίμος, Παναγιώτης
Κογεβίνας, Μανόλης

Abstract

Introduction: During fetal and early postnatal life genetic and environmental factors play an equally critical role in the shaping of brain growth and development. Environmental determinants such as nutrition can have direct effect on gene expression in brain through epigenetic mechanisms. The preschool years is a time of rapid and dramatic changes in the brain, and it is time for acquisition of fundamental cognitive and behavioral changes. The research hypothesis of the present thesis is that early life nutrition starting in pregnancy up to preschool age may be associated with children’s neurodevelopment. Specific Objectives: • To evaluate the association of diet during pregnancy with fetal growth, length of gestation, birth weight as strong predictors of children’s future neurodevelopment. • To investigate the role of breastfeeding initiation and duration in infant mental and psychomotor development, in Crete, Greece. • To identify the dietary patterns followed by Greek preschool children with the use of validated Food Frequency Questionnaire (FFQ) and to examine the influence of multiple socio-demographic characteristics and lifestyle factors on children’s diet. • To examine the impact of children's dietary patterns on cognitive and psychomotor development at preschool age. • To investigate in depth the association of eating behaviours with Attention Deficit Hyperactivity Disorder symptoms in a population-based sample of Greek preschool children. Methods: In order to investigate diet during pregnancy, a case study was performed in collaboration with 19 European birth cohort studies including 151.880 pregnant women. A 2 stage approach was used to assess the association of fish intake during pregnancy with birth outcomes. First associations were analyzed at a cohort level and second, cohort specific effect estimates were combined by using meta-analysis. Data originated from the Rhea mother-child cohort were used to examine the role of nutrition on children’s neurodevelopment up to preschool age, including 1000 women and their children. Information on breastfeeding practices was collected at the 9th month postpartum, and this information was updated at the age of 18 months with the use of questionnaires. Dietary assessment at 4 years of age was performed with the use of a validated semi-quantitative FFQs. For the assessment of children’s eating behaviour in preschool age we used the Children’s Eating Behaviour Questionnaire (CEBQ). This instrument was designed to be completed by parents referring to children’s eating behavior. Children’s neurodevelopment was assessed by trained psychologists, with the use of Baykey III at 18 months and with the McCarthy Scales of Children’s Abilities at age 4 years. The ADHD symptoms in preschool children were assessed with the 36-item ADHD interview test (ADHDT) as developed by Gilliam in 1995. Parents completed the interview, which is based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for ADHD. Results: 1) Diet during pregnancy was investigated in a case study performed in collaboration of 19 European birth cohort studies and it was observed that women who ate fish more than once a week during pregnancy had a lower risk of preterm birth compared with women who rarely ate fish (once a week or less). In addition, women with a higher intake of fish during pregnancy gave birth to neonates with higher birth weight by 15.2g for more than 3 times a week compared to those that consumed fish less than once a week. 2) Longer duration of breastfeeding duration (in months) was associated with increased scores in the scales of cognitive, language, and fine motor development at 18 months of age. For every additional month of breastfeeding children had increased scores in the neurodevelopmental scales. Children who were breastfed longer than 6 months had 4.44 points increase in the scale of fine motor development compared with those never breastfed. 3) Three dietary patterns were identified in preschool age: the ‘mediterranean’, the ‘snacky and the ‘western’ pattern. Preschool attendance and increased time spent with the mother (≥ 2 hours/day) was positively associated with the ‘mediterranean’ pattern. Lower parental education, maternal age and earlier introduction to solid foods (< 6 months) were positively associated with the ‘snacky’ pattern. Higher scores on the ‘western’ type diet were associated with exposure to passive smoking and TV watching. 4) The following study includes the investigation of the association of dietary patterns with child cognitive and psychomotor development in preschool children. In this analysis, children who followed the ‘snacky’ pattern had lower scores in the scale of verbal ability, general cognitive and cognitive functions of posterior cortex. In the minimally adjusted model, the ‘western’ type diet was also associated with lower scores in almost all neurodevelopmental scales but these associations were attenuated with further adjustment for maternal and child characteristics. 5) In preschool age a positive association was observed between children’s eating behavior with ADHD symptoms. In particular, food approach behaviors such as food responsiveness and emotional overeating were positively associated with impulsivity, inattention and hyperactivity. Conclusions: In summary, findings in the present thesis support that nutrition in early life may affect neurodevelopment in infancy and childhood. The investigation of dietary patterns and the early recognition of neurodevelopmental problems or ADHD symptoms can provide an avenue for prevention and intervention policies and thus lead to more effective management of these problems in early childhood. The long term follow up is needed to better understanding the relation between nutrition and neurodevelopment.

Language

English, Greek

Subject

Preschool age

Νευροανάπτυξη

Προσχολική ηλικία

Issue date

2015-12-18

Collection

School/Department--School of Medicine--Department of Medicine--Doctoral theses

Type of Work--Doctoral theses

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