Danish National Birth Cohort The Danish National Birth Cohort Marin Strøm, MSc, PhD Post Doc & Scientific Secretary Danish National Birth Cohort The Danish National Birth Cohort (DNBC) • a longitudinal conception-to-death study • aims to investigate associations between early-life factors and diseases in a life-course perspective • holds data from several data sweeps during pregnancy and early childhood, including an FFQ during pregnancy and follow-up at child age 7 - as well as data from national administrative registers • Holds 2 blood samples from the mother taken during pregnancy and 1 from the umbilical cord • Currently (2010-14) collects data from the 11-year-old participants as well as from their mothers in two separate questionnaires and further follow up is underway Danish National Birth Cohort DNBC Sampling All pregnant women in Denmark 1996-2002 100% 100% Appr. 30% do not receive an invitation Appr. 60% receive an invitation Appr. 40% choose not to participate Appr. 10% do not fulfill inclusion criteria Appr. 60% are enrolled in the study Total: 101.042 participants 100% 1st interview: 92.892 92% of total 4th interview: 65.764 65% of total FFQ: 70,183 69% of total 3rd interview: 70.296 70% of total 2nd interview: 87.802 87% of total Danish National Birth Cohort Data collections in the DNBC 120000 101042 100000 92892 87802 80000 % % 92 86 % 70183 % 60000 70296 87 69 65764 60242 % 69 % 65 40000 % 62 22635 20000 % 50 Time 11 -y ea r 7ye ar 4 In t 3 In t 2 In t Q FF .1 In t ed ic at io n Pr epr eg .M en ts 0 En ro lm Number of responders 87249 Danish National Birth Cohort Biological samples 100000 1,2 93000 90000 1 80000 Number of responders 71000 70000 61000 0,8 60000 50000 0,6 40000 0,4 30000 20000 0,2 10000 0 0 1st bloodsample 2nd bloodsample Umbillical sample Danish National Birth Cohort Food Frequency Questionnaire during pregnancy • • • • • • 19 pages long ~300 food items One month back in time (from gw25) Fixed time categories Fixed food item names Food supplements Ref: Olsen SF et al. Paed Perin Epi 2007 Danish National Birth Cohort Access to data : www.dnbc.dk Danish National Birth Cohort Linkage to other sources The DNBC is a national registry, owned by the Danish National Board of Health Individual level linkage via population registries allow us to: • follow the individual from birth to grave • follow diseases through generations (gene/environment) • follow millions of individuals CPR-number Birth characteristics Diseases Prescribed medication Vaccinations School performance Family, place of living Education, employment Biological specimens Danish National Birth Cohort Ongoing data collection: 11 y child questionnaire Self-reported exposure info on: Self-reported outcome info on: • Social relationships (family/peers) • School environment • Sleeping habits • Eating habits (FFQ) • Physical (in)activity • Traffic safety • Smoking and alcohol • Dental hygiene • Global health (SOCS) • Sleeping disorders • Eating disorders • Musculoskeletal problems • Child’s strengths and difficulties (SDQ) • Depression, self-injuries (DAWBA) • Psychotic symptoms/Schizophrenia (PLIKS) • Puberty (Tanner stages) Danish National Birth Cohort Ongoing data collection: 11 y child questionnaire Parent-reported exposure info on: Parent-reported outcome info on: • Organic food • Vitamins/Dietary supplements • Sun and sunscreen • Medication/Vaccination • Chlorine exposure • Housing and indoor air pollution • Hereditary factors (family disease history) • Parental factors (alcohol, smoking, anthropometrics, mental health) • Asthma/Allergy/Eczema (ISAAC) • Disabilities/Physical impairment • Infections • Diabetes/Celiac disease • Vision and hearing impairment • Enuresis • Tics (DAWBA) • Obesity (anthropometric measures) Danish National Birth Cohort Current status in the 11-year follow-up • The 11-year follow-up was launched in July 2010 • To the end of 2014 invitations are sent to approx. 350 families every week • In case of no-reply reminders are sent out 4 and 8 weeks after the invitation • effort to increase participation: win quick-reply prizes when answering within 4 weeks after invitation Danish National Birth Cohort An ongoing substudy of the DNBC AHEAD GDM study A study of long-term HEAlth after the Development of Gestational Diabetes Mellitus Collaboration between Rigshospitalet (Allan Vaag, Louise G Grunnet and others) Statens Serum Institut (Sjúrdur F Olsen and others) Harvard School of Public Health (Frank Hu and others) NIH / NICHD (Cuilin Zhang and others) Danish National Birth Cohort AHEAD GDM study: Objectives • To describe the association between mother’s GDM and child’s risk for developing T2D and metabolic disorders – influence of specific dietary components during pregnancy on the risk for developing T2D in the child – influence of physical activity during pregnancy on the propensity for developing T2D in the child – underlying epigenetic mechanisms that may mediate effects of maternal factors (GDM, diet, physical activity) on T2D propensity in the offspring Danish National Birth Cohort Study subjects • ~1500 children to GDM and control mothers (aged 9-15 years) recruited from DNBC Aarhus Copenhagen Smaller sites/mobile clinic Danish National Birth Cohort Clinical examination Children • Anthropometry: weight, height, waist, hip, head circumference • Blood pressure and heart rate • Fasting blood samples (glucose, insulin, C-peptide, incretin, leptin, adiponectine) • DEXA scanning • Urine sample • Online questionnaire (diet, physical activity) Mothers • Weight, height, waist, hip, blood pressure and heart rate • OGTT (fasting blood samples and DNA, PAX genes) • DEXA scanning • Urine (endocrine disrupting chemicals) and toenail samples (trace metals incl magnesium, chromium) • Online questionnaire and FFQ Danish National Birth Cohort Further follow up of DNBC children • Puberty study – – – – – • FFQ14 – – – – • Launched few weeks ago Aim: investigate reasons for early puberty ~20000 children invited to fill in Q on puberty stage Repeated every 6 mo Web based, focused Q Will be launched Jan 2013 Assess diet & physical activity in teenagers 14y All DNBC children asked to fill in Q Web based, built on GUTS adapted to DK Planned: FFQ in mothers Danish National Birth Cohort Thank you for your attention! www.dnbc.dk Danish National Birth Cohort Danish National Birth Cohort Danish National Birth Cohort Danish National Birth Cohort Clinical examination Standardization 3 days prior to visit - No hard physical activity No alcohol consumption The day before the examination All participants will be asked to eat a small meal at 8 PM Following the small meal: Not eat, drink and smoke On the day of visit Transport to the hospital by car or public transport – no bicycle No steps – take the elevator Danish National Birth Cohort Enrolment plan RH Esbjerg Århus Næstved (20-21) October RH Esbjerg ( 16.11) Århus Nykøbing F/Nakskov (10-11) Odense November RH Odense (114 total) Århus Holbæk (4 days) December RH Århus Herning (136 cases total) Aalborg (121 total) January Århus Herning Aalborg Thisted (32 total) February Århus Herning Aalborg Follow up March Bornholm(9 total) Follow up April Danish National Birth Cohort København Århus Næstved Esbjerg Odense The rest Total # GDM 335 211 121 201 114 311 1293 already invited 333 211 121 199 0 0 864 Not invited yet 0 0 0 0 114 310 424 Dead or alive abroad 2 0 0 2 0 1 5 Danish National Birth Cohort København Århus Næstved Esbjerg Total Completed 160 33 45 0 206 Have made appointment 18 32 9 24 83 Contact later 19 5 8 3 35 Declined to participate 65 40 23 9 137 Appointment deleted 7 2 3 0 No contact yet 64 99 33 163 PRELIMINARY PARTICIPATION RATES: CPH: 178/(160+18+19+65+7)268= 68% Århus: 58% Næstved: 61% 359 % 48% 10,6%