J Matern Fetal Neonatal Med. 2010 Sep 14. [Epub ahead of print]

Cow's milk protein allergy.

Solinas C, Corpino M, Maccioni R, Pelosi U.

Children and Mother Care Department, Paediatrics Unit, S. Barbara Hospital, Iglesias.

Abstract

Cow's milk protein allergy (CMPA) affects 2-7.5% of children; persistence in adulthood is uncommon since a tolerance developing in 51% of cases within the 2 years and 80% within 3-4 years. CMPA is an immunological reaction to one o more milk protein: ?-lactalbumin, ?-lactoglobulin, casein, IgE or non-IgE associated, responsible of immediate or late onset symptoms. The suspicion of CMPA is based on detailed family and medical history, skin test, patch test, laboratory test, an elimination diet and food challenge. The general treatment for CMPA is dietary: elimination of cow's milk protein and introduction of extensively hydrolyzed whey or casein formula, aminoacid formula, and soy formula. Extensively hydrolyzed whey or casein formula is recommend as first choice for infants in mild or moderate reactions, aminoacid formula in severe CMPA and in cases with poor response to extensively hydrolysed whey or casein formula.

Int J Obes (Lond). 2010 Sep 14. [Epub ahead of print]

Nonalcoholic fatty liver disease: a challenge for pediatricians.

Widhalm K, Ghods E.

Division of Pediatric Nutrition and Prevention, Department of Pediatrics, Medical University of Vienna, Vienna, Austria.

Abstract

Background:Nonalcoholic fatty liver disease (NAFLD) is the most common cause of pediatric liver disease. Its prevalence is related to the growing epidemic in childhood obesity during the past decades. At present, NAFLD and nonalcoholic steatohepatitis (NASH) are increasingly recognized worldwide. In spite of alarming trend in the epidemiology in pediatric field and growing risk of end stage liver disease, there is no significant advance in its diagnosis and treatment.Aim:To provide a detailed review for diagnosis and management of NAFLD and NASH.Methods:By using Pubmed to find review articles and relevant research.Results:The prevalence ranges from at least 3% in children overall to about 50% in obese children. The noninvasive biomarkers can be used to identify NAFLD/NASH patients. Diagnostic criteria based on biochemical and immunological indicators in the high-risk group of children could prevent about half of cases from receiving an invasive test. The pharmacological and surgical interventions have shown a growing role in pediatric NAFLD. Novel treatment modalities, such as probiotics, have hardly been studied.Conclusion:Early diagnosis by using noninvasive screening methods in high-risk groups is the most effective strategy against the NAFLD. The biology of early growth and development, including hepatic metabolism, may hold the key to pediatric NAFLD. Prevention of overweight children and childhood obesity is undoubtedly the best strategy for treating NAFLD.International Journal of Obesity advance online publication, 14 September 2010; doi:10.1038/ijo.2010.185

The history of infant nutrition.

Castilho SD, Barros Filho AA.

Pontificia Universidade Catolica de Campinas (PUC-Campinas), Campinas, SP, Brazil.

Abstract

OBJECTIVE: To retrace the history of infant nutrition with the objective of better understanding breastfeeding. SOURCES: Bibliographic searches were run on MEDLINE, LILACS, SciELO, and the Internet. Encyclopedias, scientific textbooks and books for the general public, in addition to literature, art and history, were also used. Texts on child care from several different periods were consulted, in addition to the history of medicine and recent scientific articles on infant nutrition. SUMMARY OF THE FINDINGS: During the preindustrial period, customs varied little and the likelihood of survival was linked to breastfeeding or its substitution by a wetnurse's milk. Where this was not possible, infants were given animal milk, pre-chewed foods or paps that were poor in nutrients and contaminated, which caused high mortality rates. There was nothing that could successfully substitute breastfeeding and the survival of the species was dependent on breastfeeding. Once the industrial revolution had started, women who had been accustomed to breastfeeding went to work in factories, stimulating the search for alternative infant nutrition. Consumption of animal milk and formulae (diluted, flour-based, powdered milk) and premature introduction of complementary foods compromised children's health. The feminist movement and the contraceptive pill caused a fall in birth rates. Manufacturers in search of profits developed modified formulae and invested in advertising. Society reacted with breastfeeding support movements. CONCLUSIONS: Nowadays, the advantages of breastmilk are recognized and exclusive breastfeeding is recommended up to 6 months, to be supplemented with other foods from this age on and continued until at least 2 years of age. Infant nutrition, whether natural or artificial, has always been determined and conditioned by the social value attributed to breastfeeding.

Public Health Nutr. 2010 Jun;13(6A):947-56.

Food consumption and nutrient intake in Finnish 1-6-year-old children.

Kyttala P, Erkkola M, Kronberg-Kippila C, Tapanainen H, Veijola R, Simell O, Knip M, Virtanen SM.

Tampere School of Public Health, University of Tampere, FI-33014, Tampere, Finland. pipsa.kyttala@uta.fi

Abstract

OBJECTIVE: To study food consumption and nutrient intake in Finnish children aged 1-6 years and to assess the effect of age and sex on food consumption and nutrient intake. DESIGN: Cross-sectional samples of children participating in the Type 1 Diabetes Prediction and Prevention (DIPP) birth cohort study in Finland. SUBJECTS: The study population comprised healthy children recruited in the nutrition study within the DIPP study in 1998-2003. Three-day food records (2535 in total) from 1-, 2-, 3-, 4- and 6-year-old children were kept between the years 2003 and 2005. RESULTS: The energy-adjusted consumption of fruits and berries, cereal products, infant formulas and meat dishes was higher and the consumption of vegetables, salads, breads, dairy products, fat spreads, drinks, sweets and sugar was lower among 1-year-old children than older age groups (P for all

BMC Pregnancy Childbirth. 2010 May 29;10(1):27. [Epub ahead of print]

Breastfeeding and weaning practices among Hong Kong mothers: a prospective study.

Tarrant M, Fong DY, Wu KM, Lee IL, Wong EM, Sham A, Lam C, Dodgson JE.

Abstract

ABSTRACT: BACKGROUND: Breastfeeding provides optimal and complete nutrition for newborn babies. Although new mothers in Hong Kong are increasingly choosing to breastfeed their babies, rates of exclusive breastfeeding are low and duration remains short. The purpose of this study was to describe the breastfeeding and weaning practices of Hong Kong mothers over the infant's first year of life to determine the factors associated with early cessation. METHODS: A cohort of 1417 mother-infant pairs was recruited from the obstetric units of four public hospitals in Hong Kong in the immediate post-partum period and followed prospectively for 12 months or until weaned. We used descriptive statistics to describe breastfeeding and weaning practices and multiple logistic regression to investigate the relationship between maternal characteristics and breastfeeding cessation. RESULTS: At 1 month, 3 months, 6 months and 12 months only 63%, 37.3%, 26.9%, and 12.5% of the infants respectively, were still receiving any breast milk; approximately one-half of breastfeeding mothers were exclusively breastfeeding. Younger mothers, those with a longer duration of residence in Hong Kong, and those returning to work postpartum were more likely to wean before 1 month. Mothers with higher education, previous breastfeeding experience, who were breastfed themselves and those who were planning to exclusively breastfeed and whose husbands preferred breastfeeding were more likely to continue breastfeeding beyond 1 month. The introduction of infant formula before 1 month and returning to work postpartum were predictive of weaning before 3 months. CONCLUSIONS: Breastfeeding promotion programs have been successful in achieving high rates of breastfeeding initiation but the focus must now shift to helping new mothers exclusively breastfeed and sustain breastfeeding for longer.

J Am Diet Assoc. 2009 Dec;109(12):2057-62.

Nutrient profile of household food supplies of families with young children.

Byrd-Bredbenner C, Abbot JM, Cussler E.

Department of Nutritional Sciences, Rutgers, The State University of New Jersey, 26 Nichol Ave, 220 Davison, New Brunswick, NJ 08901, USA. bredbenner@aesop.rutgers.edu

Currently, little is known about the home food environment. This cross-sectional study was designed to describe the food sources of calories and key nutrients in the households of 100 families with at least one child aged 12 years or younger and compare nutrient availability to recommended levels. Participating households were food secure, ate dinner at home at least three times weekly, had parents who were married or living as domestic partners and not employed in a health-related profession, and resided in New Jersey. Researchers visited each household once during 2006/2007 to inventory all foods except alcoholic beverages, commercial baby food, infant formula, pet foods, refrigerated leftovers, foods of minimal nutrient and calorie content, condiments typically consumed in small quantities per eating occasion, and bulk supplies of staples. Inventories were taken using commercial diet analysis software customized to use barcode scanners for foods with standard barcodes and keyword searches for foods lacking barcodes. Protein, carbohydrate, and fat in the households supplied an average of approximately 15%, 57%, and 29% of calories, respectively. Saturated fat and total sugar accounted for an average of approximately 10% and 20%, respectively, of calories. Mean nutrient adequacy ratio for nutrients recommended to be maximized (ie, vitamins A and C, protein, dietary fiber, iron, calcium) was less than optimal, and mean ratio for those recommended to be minimized (ie, total fat, cholesterol, sodium, and sugar) exceeded recommendations. Categorization by food group revealed that the greatest availability of calories, carbohydrates, dietary fiber, total sugar, sodium, and iron was from grains. The greatest availability of total fat, cholesterol, and protein was from meat/protein foods. Dairy products contained the greatest quantities of saturated fat and calcium. This study expands the limited research on the home food supply and provides insights that may have important implications for health-promotion interventions.

J Am Diet Assoc. 2009 Dec;109(12):2017-28.

Determinants of early weaning and use of unmodified cow's milk in infants: a systematic review.

Wijndaele K, Lakshman R, Landsbaugh JR, Ong KK, Ogilvie D.

MRC Epidemiology Unit, Institute of Metabolic Science, Box 285, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0QQ, United Kingdom. katrien.wijndaele@mrc-epid.cam.ac.uk

Comment in:

·         J Am Diet Assoc. 2009 Dec;109(12):1979.

Introduction of complementary foods (weaning) before 4 to 6 months of age and unmodified cow's milk before age 12 months are associated with several health risks. To develop effective interventions to discourage these practices, evidence of their determinants is needed. This systematic review identified documents from seven electronic databases (database inception 2008) and reference lists, and by contacting authors. Seventy-eight studies in developed countries, published between 1976 and 2008, quantifying the association between either feeding practice and its potential determinants were included. Study quality was systematically assessed in terms of representativeness, sample size, method of outcome ascertainment, and approach to statistical analysis. The distribution of evidence for each determinant was visualized in a harvest plot showing the strength and direction of associations found and the quality of relevant studies. The strength of evidence for each determinant was summarized as strong, moderate, limited, or inconclusive, using an algorithm based on the consistency of the results of studies of the highest available quality. Strong evidence denoted that the determinant was examined in three or more high-quality studies and >/=75% of results were consistent. Strong evidence was found for six determinants of early weaning (ie, young maternal age, low maternal education, low socioeconomic status, absence or short duration of breastfeeding, maternal smoking, and lack of information or advice from health care providers) and for two determinants of early introduction of unmodified cow's milk (ie, low maternal education and low socioeconomic status). Of these determinants, improving advice given by health care providers appears the most tractable area for intervention in the short term.

Breastfeed Med. 2009 Nov 24. [Epub ahead of print]

Design and Characterization of a Human Milk Product for the Preterm Infant.

Czank C, Simmer K, Hartmann PE.

1 Discipline of Biochemistry and Molecular Biology, School of Biomedical, Biomolecular, and Chemical Science, The University of Western Australia , Crawley, Western Australia, Australia .

Abstract Background: It is necessary to fortify human milk to promote optimal growth of the very preterm infant. However, the addition of non-human milk components to human milk is not ideal because of the risk of feeding intolerance and necrotizing enterocolitis. Human milk products (HMP) are an alternative to commercially available fortifiers, but their preparation is likely to result in modifications to the qualities of human milk. Methods: Ten batches of HMP were prepared with the aim of meeting a desired protein:energy ratio of 3.0 g of protein/100 kcal. Ultrafiltration was used to produce a skim milk concentrate, to which cream was then added to produce the final HMP. Characterization of HMP and human milk fortified with commercial human milk fortifiers (Nutriprem((R)) [Cow & Gate, Limerick, Ireland] and S-26 SMA human milk fortifier [Wyeth Nutrition, Baulkham Hills, NSW, Australia]) included quantifying macronutrient content, osmolality, microbial content, and particle distribution. Results: Average protein:energy ratio of the final batch was 2.93 +/- 0.10 g of protein/100 kcal, equating to an inaccuracy of 2.5% relative to the desired ratio of 3.0 g of protein/100 kcal. Significantly greater fat (P

Eur J Clin Nutr. 2009 Nov 18. [Epub ahead of print]

The association of maternal diet and dietary supplement intake in pregnant New Zealand women with infant birthweight.

Watson PE, McDonald BW.

Institute of Food Nutrition and Human Health, Massey University, Albany Campus, Auckland, New Zealand.

Objective:To investigate the association of infant birthweight with maternal diet and supplement intake.Subjects/Methods:Prospective cohort study of 504 European and Polynesian urban and rural pregnant volunteers recruited from northern New Zealand clinics. Subjects were visited in months 4 (mth4) and 7 (mth7) of pregnancy when height, weight and skinfolds were measured, questionnaires to determine personal details administered, and diet assessed by a 24-hour recall and 3-day food record.Results:After adjusting for confounders nutrients accounted for up to 5.0% of the total variance in birthweight. Ethnicity was not a significant confounder. A quadratic relationship existed between birthweight and % total energy (%TE) from carbohydrate, fat and protein, most significantly with carbohydrate energy (P=0.002). Birthweight was greatest ( approximately 3600 g) when carbohydrate %TE was 48%, fat 35% and protein 17%. Birthweight was reduced with high beta-carotene intakes (mth4, P=0.009) and with both high retinol and beta-carotene intakes in mth4 and 7 (average). Birthweight was positively associated with increasing pantothenic acid/biotin ratios (P=0.011), magnesium (P=0.000) and vitamin D (P=0.015) intakes in mth4; with biotin (P=0.040) and B(12) intakes above the RDI (P=0.006) in mth7; and with pantothenic acid intake in mth4&7 (P=0.002). Dietary supplement usage was associated with increased birthweight, most significantly iron supplementation (P=0.006).Conclusion:Birthweight was associated with the %TE from carbohydrate, fat and protein, and with beta-carotene, retinol, vitamins D and B(12), pantothenic acid, biotin and magnesium intakes and iron supplementation. More research may be required on some dietary recommendations for pregnancy.European Journal of Clinical Nutrition advance online publication, 18 November 2009;

Pediatrics. 2009 Dec;124(6):1549-55. Epub 2009 Nov 16.

Food allergy among children in the United States.

Branum AM, Lukacs SL.

Infant, Child, and Women's Health Statistics Branch, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782-2003, USA. ambranum@cdc.gov

OBJECTIVES: The goals were to estimate the prevalence of food allergy and to describe trends in food allergy prevalence and health care use among US children. METHODS: A cross-sectional survey of data on food allergy among children 2007. In 2005-2006, serum immunoglobulin E antibodies to peanut were detectable for an estimated 9% of US children. Ambulatory care visits tripled between 1993 and 2006 (P

J Pediatr Gastroenterol Nutr. 2009 Oct 29. [Epub ahead of print]

Enteral Nutrient Supply for Preterm Infants: Commentary From the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Committee on Nutrition.

Agostoni C, Buonocore G, Carnielli V, De Curtis M, Darmaun D, Decsi T, Domellof M, Embleton N, Fusch C, Genzel-Boroviczeny O, Goulet O, Kalhan S, Kolacek S, Koletzko B, Lapillonne A, Mihatsch W, Moreno L, Neu J, Poindexter B, Puntis J, Putet G, Rigo J, Riskin A, Salle B, Sauer P, Shamir R, Szajewska H, Thureen P, Turck D, van Goudoever J, Ziegler E; for the ESPGHAN Committee on Nutrition.

*Department of Pediatrics, San Paolo Hospital, University of Milan, Italy daggerPediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy double daggerDivision of Neonatology, Department of Clinical Sciences, Salesi Hospital, Polytechnic University of Marche, Ancona, Italy section signUniversity of Rome, Italy ||Centre Hospitalier, Universitaire de Nantes, France paragraph signDepartment of Paediatrics, University of Pecs, Hungary #Department of Clinical Sciences, Pediatrics, Umea University, Umea, Sweden **Newcastle Neonatal Service, Department of Child Health, University of Newcastle Upon Tyne, Royal Victoria Infirmary, Newcastle Upon Tyne, UK daggerdaggerErnst-Moritz-Arndt-University, Greifswald, Germany double daggerdouble daggerNeonatologie Klinikum der Universitat Munich, Germany section sign section signPediatric Gastroenterology-Hepatology and Nutrition, Reference Center for Rare Digestive Disease, Hopital Necker-Enfants Malades/AP-HP, University of Paris 5-Rene Descartes, Paris, France ||||Department of Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA paragraph sign paragraph signUniversity Children's Hospital, Zagreb Medical University, Croatia ##Dr von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany ***Hopital Saint-Vincent de Paul, Paris, France daggerdaggerdaggerDepartment of Paediatrics, Deaconry Hospital, Schwaebisch Hall, Germany double daggerdouble daggerdouble daggerEscuela Universitaria de Ciencias de la Salud, Zaragoza, Spain section sign section sign section signDepartment of Paediatrics, University of Florida, Gainesville, USA ||||||Section of Neonatal, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA paragraph sign paragraph sign paragraph signLeeds General Infirmary, Leeds, UK ###Service de Neonatologie et de Reanimation Neonatale, Hospital de la Croix Rousse, Lyon, France ****CHR Citadelle Neonatologie, University of Liege, Belgium daggerdaggerdaggerdaggerBnai Zion Medical Center, Haifa, Israel double daggerdouble daggerdouble daggerdouble daggerService de Medicine de la Reproduction, Hospital Edouard Herriot, Lyon, France section sign section sign section sign section signDepartment of Paediatrics, University Medical Centre Groningen, The Netherlands |Division of Gastroenterology and Nutrition, Schneider Children's Medical Center, Tel-Aviv University, Tel Aviv, Israel paragraph sign paragraph sign paragraph sign paragraph sign2nd Department of Pediatrics, Medical University of Warsaw, Poland University of Colorado, Health Sciences Center, Denver, Colorado, USA Jeanne de Flandre Children's Hospital/University of Lille, France daggerdaggerdaggerdaggerdaggerErasmus MC-Sophia Children's Hospital, Department of Paediatrics, Rotterdam, The Netherlands double daggerdouble daggerdouble daggerdouble daggerdouble daggerDepartment of Pediatrics, Fomon Infant Nutrition Unit, Children's Hospital, University of Iowa, Iowa City, USA 1 Project steering committee member.

J Am Diet Assoc. 2009 Nov;109(11):1926-42.

Position of the American Dietetic Association: promoting and supporting breastfeeding.

James DC, Lessen R.

University of Florida, Gainesville, FL, USA.

It is the position of the American Dietetic Association that exclusive breastfeeding provides optimal nutrition and health protection for the first 6 months of life and breastfeeding with complementary foods from 6 months until at least 12 months of age is the ideal feeding pattern for infants. Breastfeeding is an important public health strategy for improving infant and child morbidity and mortality, improving maternal morbidity, and helping to control health care costs. Breastfeeding is associated with a reduced risk of otitis media, gastroenteritis, respiratory illness,sudden infant death syndrome,necrotizing enterocolitis, obesity, and hypertension. Breastfeeding is also associated with improved maternal outcomes, including a reduced risk of breast and ovarian cancer, type 2 diabetes, and postpartum depression.These reductions in acute and chronic illness help to decrease health care-related expenses and productive time lost from work. Overall breastfeeding rates are increasing, yet disparities persist based on socioeconomic status, maternal age, country of origin,and geographic location. Factors such as hospital practices, knowledge, beliefs, and attitudes of mothers and their families, and access to breastfeeding support can influence initiation, duration, and exclusivity of breastfeeding. As experts in food and nutrition throughout the life cycle, it is the responsibility of registered dietitians and dietetic technicians, registered, to promote and support breastfeeding for its short-term and long-term health benefits for both mothers and infants.

Public Health Nutr. 2009 Oct 28:1-10. [Epub ahead of print]

Poor dietary quality of complementary foods is associated with multiple micronutrient deficiencies during early childhood in Mongolia.

Lander R, Enkhjargal T, Batjargal J, Bolormaa N, Enkhmyagmar D, Tserendolgor U, Tungalag S, Bailey K, Gibson R.

1Department of Human Nutrition, University of Otago, Union Street, PO Box 56, Dunedin 9015, New Zealand.

OBJECTIVE: To assess whether persistent micronutrient deficiencies in Mongolian children identified in our earlier biochemical study are associated with inadequacies in quantity and/or quality in their complementary diets. DESIGN: A cross-sectional study of breast-fed children aged 6-23 months, randomly selected from four districts in Ulaanbaatar and four provincial capitals. SUBJECTS: Weight and length were measured, and sociodemographic status, feeding practices and nutrient adequacy of complementary foods for children aged 6-8 months (n 26), 9-11 months (n 29) and 12-23 months (n 73) were assessed via questionnaire and in-home interactive 24 h recalls. RESULTS: No geographic differences existed so data were combined. Adherence to WHO infant and young child feeding practices was poor: few children were exclusively breast-fed up to 6 months of age or received the recommended number of feedings containing the recommended number of food groups. Nevertheless, energy intakes from complementary diets, primarily from cereals and non-nutritious snacks, were above WHO-estimated needs; vitamin C > vitamin A > Zn > Ca. CONCLUSIONS: Complementary feeding in Mongolia is compromised by deficits in several micronutrients but not energy, in part because of frequent consumption of non-nutritious snacks. The latter may interfere with breast-feeding and should be avoided. Instead, wheat-based complementary foods should be enriched with affordable cellular animal foods and fruits rich in vitamin C to combat existing micronutrient deficits.

Ugeskr Laeger. 2009 Oct 19;171(43):3099-101.

[Severe vitamin B12 deficiency in infants breastfed by vegans]

[Article in Danish]

Roed C, Skovby F, Lund AM.

Rigshospitalet, Borneafdelingen, Klinisk Genetisk Afdeling, og Hvidovre Hospital, Borneafdelingen, Denmark. casper.roed@rh.regionh.dk

Weight loss and reduction of motor skills resulted in paediatric evaluation of a 10-month-old girl and a 12-month-old boy. Both children suffered form anaemia and delayed development due to vitamin B12 deficiency caused by strict maternal vegan diet during pregnancy and nursing. Therapy with cyanocobalamin was instituted with remission of symptoms. Since infants risk irreversible neurologic damage following severe vitamin B12 deficiency, early diagnosis and treatment are mandatory. Vegan and vegetarian women should take vitamin B12 supplementation during the pregnancy and nursing period.

Ann Nutr Metab. 2009 Oct 16;55(4):334-340. [Epub ahead of print]

The Effect of Bifidobacterium lactis on the Growth of Infants: A Pooled Analysis of Randomized Controlled Studies.

Steenhout PG, Rochat F, Hager C.

Nestle Nutrition, Nestec Ltd., Vevey, Switzerland.

Background/Aims: Breast milk is the best source of nutrition for the growth of the newborn infant. It is therefore essential that mothers who cannot breastfeed or choose not to are provided with alternatives that closely match the composition and functionality of breast milk. This study aimed to investigate the growth effects of probiotic-supplemented formulas on both healthy and vulnerable populations of infants. Methods: A meta-analysis of data from 5 randomized controlled clinical trials that included infants fed formulas containing a probiotic Bifidobacterium lactis CNCM I-3446 was performed (n = 525). A sub-analysis was performed among infants of HIV-positive mothers (n = 120). Growth measurements (gain in weight and body mass index, BMI, from enrollment to 120 days) were compared between infants fed a formula containing B. lactis and those fed a control formula. Changes in length and Z-scores were also compared. Results: Formula with B.lactis was demonstrated to be at least as good as formula without B. lactis in the meta-analysis of 5 studies. The lower boundary of the 95% confidence interval (CI) of the differences in mean weight gain (95% CI 0.09-2.93 g/day) was above the predefined non-inferiority margin of -3.0 g/day. Moreover, among infants with HIV-positive mothers, weight gain of those taking B. lactis was significantly higher than of those not taking B. lactis, by 3.1 g/day (95% CI 0.4-5.8 g/day, p = 0.0226) and the BMI gains were significantly higher, by 6.4 g/m(2)/day (95% CI 0.0.3-12.5 g/m(2)/day, p = 0.0400). The corresponding weight for age and BMI Z-scores were also significantly higher, by 0.37 (95% CI 0.03-0.71, p = 0.0308) and by 0.42 (95% CI 0.02-0.83, p = 0.0377), respectively, whereas differences in length gain or length-for-age Z-score were not significant. Among infants in the non-HIV mothers group, there were no significant differences between infants fed formulas with or without B. lactis, for any of the growth parameters. Conclusions: The analysis suggests that B. lactis may have a positive effect on growth in vulnerable populations, specifically in infants born to mothers with HIV. Copyright © 2009 S. Karger AG, Basel.

Public Health Nutr. 2009 Nov 5:1-8. [Epub ahead of print]

Childhood overweight and obesity among Kenyan pre-school children: association with maternal and early child nutritional factors.

Gewa CA.

Department of Global & Community Health, College of Health & Human Services, George Mason University, 4400 University Drive, MS 5B7, Fairfax, VA 22030, USA.

OBJECTIVE: To report on the prevalence of overweight and obesity among pre-school children in Kenya and examine the associations between childhood overweight and selected maternal and child-related factors. DESIGN: Demographic Health Survey data, multistage stratified cluster sampling methodology. SETTING: Rural and urban areas of Kenya. SUBJECTS: A total of 1495 children between the ages of 3 and 5 years in Kenya. RESULTS: Over 30 % of the children were stunted, approximately 16 % were underweight, 4 % were wasted, approximately 18 % were overweight and 4 % were obese; 8 % were both overweight/obese and stunted. Maternal overweight and obesity, higher levels of maternal education, being a large or very large child at birth, and being stunted were each associated with higher odds of overweight and obesity among Kenyan children. Older children and large household size were each associated with lower odds of overweight and obesity among Kenyan children. CONCLUSIONS: The analysis demonstrates the presence of under- and overnutrition among Kenyan pre-school children and the importance of focusing on expanding efforts to prevent and treat malnutrition within this population. It also identifies some of the modifiable factors that can be targeted in these efforts.

Perez-Morales ME, Bacardi-Gascon M, Jimenez-Cruz A, Armendariz-Anguiano A.

Universidad Autonoma de Baja California, Tijuana B.C., Mexico.

The prevalence of overweight and obesity in children has increased to epidemic levels. Several authors have suggested that school is the best place for effective prevention programs. The purpose of this systematic review was to assess the evidence of randomized controlled trials concerning long-term (equal to or more than 9 months) observations at schools and published in the database of MEDLINE/Pubmed from January 1st of 2006 to February 28 of 2009. Ten studies were analyzed. Overall, regarding the design, the intervention components, target population age, intervention periods, educational techniques, cultural characteristics of the population, and outcome measures were heterogeneous. The results were modest. The outcomes showed a positive impact on lifestyle as intakes of fruits and vegetables increased, consumption of sugar-sweetened carbonated beverages decreased, and sedentary behaviors and adiposity were reduced. Generally, there were no significant reductions for BMI. These results warrant more strategies to achieve parental involvement, reduction of dropouts, and additional studies assessing different educational systems and cultural environments, including those in Latin America. Longer follow-up periods are also required.

Yonsei Med J. 2009 Oct 31;50(5):617-23. Epub 2009 Oct 20.

Celiac disease: presentation of 109 children.

Kuloglu Z, Kirsaclioglu CT, Kansu A, Ensari A, Girgin N.

Dapartment of Pediatric Gastroenterology, Ankara University, School of Medicine, Ankara, Turkey. zarifekuloglu@yahoo.com

PURPOSE: The clinical features of patients with celiac disease (CD) are variable. In the present study, clinical and laboratory features of 109 patients with CD were retrospectively evaluated. MATERIALS AND METHODS: In all cases, diagnosis of CD was made by European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) criteria and clinical and laboratory findings, including hematological and biochemical analyses, immunoglobulin levels, autoantibodies [antinucler antibody (ANA), antidouble stranded DNA (dsDNA), antimitochondrial antibody (AMA), anti-smooth muscle antibody (ASMA), liver kidney antibody (LKM-1), anti thyroid peroxidase (TPO), anti thyroglobulin (Tg)], bone mineral density (BMD), and electroencephalogram were evaluated. The type of CD was recorded. RESULTS: Of 109 patients with CD, 66 (60.6%) were classical type, 41 (37.6%) were atypical type and 2 (1.8%) were silent type. The mean age was 8.81 +/- 4.63 years and the most common symptom was diarrhea (53.2%) followed by failure to thrive, short stature, and abdominal pain. Paleness (40.4%), underweight (34.8%), and short stature (31.2%) were the most common findings. Iron deficinecy anemia (81.6%), zinc deficiency (64.1%), prolonged prothrombin time (35.8%), and elevated transaminase levels (24.7%) were the most common laboratory findings. Eight percent of patients had at least 1 autoantibody, and 28 of 52 patients had low BMD. Four of 38 patients had abnormalty in electroencephalograms. The prevalance of selective immunoglobulin (Ig) A deficiency was 9.1%. Histocompatibility antigen HLA-DQ and/or DQ8 genotypes were found in 91% of patients. Abdominal distention, iron deficiency, prolonged prothrombine time, hypoalbuminemia, and elevated transaminase levels were more significantly frequent in the classical type than atypical type (p

Mechanisms of food allergy.

Eigenmann PA.

Department of Pediatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland. philippe.eigenmann@hcuge.ch

Allergy type sensitization occurring in the gut results from a break in oral tolerance, mostly occurring in early childhood. In these patients, a minute amount of the large load of potential food allergens not only will result in immunoglobulin E (IgE) type sensitization mostly, but also in food allergies resulting from other mechanisms including eosinophil-driven disease or resulting from T-cell-mediated inflammation. Symptoms elicited by subsequent exposure to foods in these patients will be mostly in relation to the mechanism of the disease. In this educational review series, we described three cases of food allergy, first, a child with typical IgE-mediated food allergy, second, a child with eosinophilic proctocolitis and in the third patient, we will address tolerance acquisition mechanisms. These cases are discussed with regards to their specific immune events.

van Dijk CE, Innis SM.

Department of Pediatrics, Nutrition Research Program, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.

OBJECTIVES: Increasing overweight and obesity are growing problems among children worldwide. Prevention requires an understanding of when excess weight gain begins and the determinants that place children at risk. The aim of our study was to illustrate how the growth curve used to assess growth influences the interpretation of weight gain and the age of onset of higher weight gains in infancy. METHODS: This was a longitudinal study of Canadian infants from birth to 18 months of age. Infant feeding pattern was recorded monthly, and weight and length of 73 infants were measured at 8 different ages. Weight, length, weight for length, and BMI z scores were compared with the Centers for Disease Control and Prevention 2000 growth curves and World Health Organization growth standard. RESULTS: Comparison with the Centers for Disease Control and Prevention growth curves showed that Canadian infants grew similarly or slightly slower than their US counterparts. Using the World Health Organization growth standard, an increase in body weight occurred between 6 and 9 months of age, associated with a change from breastfeeding to formula feeding and introduction of solid foods. When compared with the World Health Organization standards, breastfed infants followed the standards, but formula-fed infants deviated with higher weight for age. When compared with the Centers for Disease Control and Prevention charts, breastfed infants showed an apparent decline in weight for age beginning at approximately 6 months. CONCLUSIONS: The choice of growth curve is important to interpreting infant growth and identifying the onset of excess weight gain. Identification of the prevalence and age of onset of early excess weight gains among Canadian infants will be best achieved by using the World Health Organization growth standards.

Visness CM, London SJ, Daniels JL, Kaufman JS, Yeatts KB, Siega-Riz AM, Liu AH, Calatroni A, Zeldin DC.

Department of Epidemiology, University of North Carolina at Chapel Hill; Rho Federal Systems Division, Inc, Chapel Hill.

BACKGROUND: The prevalence of both obesity and allergic disease has increased among children over the last several decades. Previous literature on the relationship between obesity and allergic disease has been inconsistent. It is not known whether systemic inflammation could be a factor in this relationship. OBJECTIVE: We sought to examine the association of obesity with total and allergen-specific IgE levels and allergy symptoms in US children and adolescents and to assess the role of C-reactive protein. METHODS: National Health and Nutrition Examination Survey data from 2005-2006 included measurement of total and allergen-specific IgE levels and allergy questions. Overweight was defined as the 85th or greater to less than the 95th percentile of body mass index for age, and obesity was defined as the 95th percentile or greater. Linear and logistic regression models were used to examine the association of weight categories with total IgE levels, atopy, allergen-specific IgE levels, and allergy symptoms among youth aged 2 to 19 years. RESULTS: Geometric mean total IgE levels were higher among obese (geometric mean ratio, 1.31; 95% CI, 1.10-1.57) and overweight (ratio, 1.25; 95% CI, 1.02-1.54) children than among normal-weight children. The odds ratio (OR) for atopy (any positive specific IgE measurement) was increased in the obese children compared with that seen in those of normal weight; this association was driven largely by allergic sensitization to foods (OR for atopy, 1.26 [95% CI, 1.03-1.55]; OR for food sensitization, 1.59 [95% CI, 1.28-1.98]). C-reactive protein levels were associated with total IgE levels, atopy, and food sensitization. CONCLUSIONS: Obesity might be a contributor to the increased prevalence of allergic disease in children, particularly food allergy. Systemic inflammation might play a role in the development of allergic disease.

J Pediatr. 2009 Feb 23. [Epub ahead of print]

Jiang F, Zhu S, Yan C, Jin X, Bandla H, Shen X.

Department of Child Development and Behavior, Shanghai Children's Medical Center, affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China.

OBJECTIVE: To examine the relationship between sleep and obesity in children 3 to 4 years old in Shanghai, China. STUDY DESIGN: A total of 1311 Chinese children from 10 kindergarten classes in Shanghai, aged 3 to 4 years, who were participating in the kindergarten entrance health examination in 2000, were included in the study. Body weight and height were measured, and a questionnaire was given to the children's parents about sleep and physical and social characteristics of the children and their family. The main outcome measure was obesity, defined as body mass index (kg/m(2)) >/=95th percentile for the children. RESULTS: Compared with children reporting >/=11 hours of sleep per night, the odds ratio for childhood obesity was 4.76 (95% CI, 1.28-17.69) for children with

[Article in Chinese]

Zhang J, Wang H, Wang Z, He YN.

Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing 100050, China.

OBJECTIVE: To describe changes in the distribution of body mass index among Chinese children in China from 1991 to 2006. METHODS: This paper was based on data collected in the China Health and Nutrition Survey in 1991 and 2006, and the subjects were 6- 17-years-old. Tukey mean-difference plots were used to investigate the changes in the distribution of BMI within sex-age groups. RESULTS: The distribution of BMI among Chinese children in 2006 was different from that in 1991 for all sex-age groups, there was increasing positive skewness with a greater shift in the upper part of the distribution. CONCLUSION: The children in the upper part of the BMI distribution may be more susceptible to the changes of environment than those in the lower parts. So the causes for the increase in obesity should be sought in part at the population level than focusing on individuals.

Al-Atawi MS, Al-Alwan IA, Al-Mutair AN, Tamim HM, Al-Jurayyan NA.

Department of Pediatric, National Guard Health Affairs, King Abdulaziz Medical City, Riyadh; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. alwani@ngha.med.sa.

In most developing countries, nutritional rickets is a major health problem. The aim of this study was to explore the magnitude of nutritional rickets among Saudi infants, and the various clinical presentations, as well as to address the possible operating risk factors behind the disease. We carried out a retrospective study at King Abdulaziz Medical City-King Fahad National Guard Hospital in Riyadh, Saudi Arabia. The records of Saudi infants under the age of 14 months over a 10-year period (between January 1990 and January 2000) were reviewed. Infor-mation collected included age, sex, clinical presentations, biochemical, radiological findings, infant nutrition, presence of other nutritional deficiencies and exposure to sunlight. There were 283 infants diagnosed with nutritional rickets due to Vitamin D deficiency (67% males) who were between 6 and 14 months of age. Among the total, 70% were exclusively breast-fed, and 23% were breast-fed until the age of 1 year. The most frequent clinical presentation was hypo-calcemic convulsions (34%) followed by chest infections (33%) and gastroenteritis (25%). In conclusion, nutritional rickets is still prevalent in Saudi Arabia with the primary etiology being vitamin D deficiency. Therefore we recommend that every infant, who is exclusively on breast-feeding, has routine supplement of vitamin D in the range of 200 IU/day (alone or as apart of multivitamin), started soon after birth until the time of weaning.

Venter C, Pereira B, Voigt K, Grundy J, Clayton CB, Higgins B, Arshad SH, Dean T.

The David Hide Asthma and Allergy Research Centre, St. Mary's Hospital, Newport, Isle of Wight, UK.

Venter C, Pereira B, Voigt K, Grundy J, Clayton CB, Higgins B, Arshad SH, Dean T.

Factors associated with maternal dietary intake, feeding and weaning practices, and the development of food hypersensitivity in the infant. Pediatr Allergy Immunol 2009. (c) 2009 The Authors Journal compilation (c) 2009 Blackwell MunksgaardMaternal diet during pregnancy and breastfeeding, as well as infant feeding and weaning practices, may play a role in the development of sensitization to food and food hypersensitivity (FHS) and need further investigation. Pregnant women were recruited at 12 wk pregnancy. Information regarding family history of allergy was obtained by means of a questionnaire. A food frequency questionnaire was completed at 36 wk gestation. Information regarding feeding practices and reported symptoms of atopy was obtained during the infants' first 3 yr of life. Children were also skin-prick tested at 1, 2 and 3 yr to a pre-defined panel of food allergens. Food challenges were conducted where possible. Maternal dietary intake during pregnancy, and breast-feeding duration did not influence the development of sensitization to food allergens or FHS, but weaning age (>/=16 wk) did for sensitization at 1 yr (p = 0.03), FHS by 1 yr (p = 0.02), sensitization at 3 yr (p = 0.01) and FHS by 3 yr (p = 0.02). In contrast, children who were not exposed to a certain food allergen before the age of 3-6 months were less likely to become sensitized or develop FHS. Women with a family history of allergic disease were more likely to breastfeed exclusively at 3 months (p = 0.008) and avoid peanuts from the infant's diet at 6 months (p = 0.03). Maternal dietary intake during pregnancy, and breast-feeding duration did not appear to influence the development of sensitization to food allergens or FHS. Weaning age may affect sensitization to foods and development of FHS. A history of allergic disease has very little impact on maternal dietary, feeding, and weaning practices.

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