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. [email protected]
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.
[email protected]
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.
[email protected]
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
EurJClinNutr.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. [email protected]
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]
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.
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. [email protected]
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
Pediatr Allergy
Immunol.
2009 Feb;20(1):5-11.
Mechanisms of food
allergy.
Eigenmann PA.
Department of Pediatrics, Geneva University Hospitals and University of
Geneva, Geneva, Switzerland. [email protected]
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.
Pediatrics.2009 Jan;123(1):102-8.
Growth-curve
standards and the assessment of early excess weight gain in infancy.
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.
J Allergy Clin
Immunol.
2009 Feb 20. [Epub ahead of print]
Association of
obesity with IgE levels and allergy symptoms in children and
adolescents: Results from the National Health and Nutrition
Examination Survey 2005-2006.
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]
Sleep and Obesity
in Preschool Children.
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
Wei Sheng Yan Jiu.
2008 Nov;37(6):728-32.
[Changes in the
distribution of body mass index among aged children 6-17
in
China from 1991 to 2006]
[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.
Saudi J Kidney Dis Transpl.
2009 Mar-Apr;20(2):260-5.
Epidemiology of
nutritional rickets in children.
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.
[email protected].
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.
Pediatr Allergy Immunol.
2009 Feb 4. [Epub ahead of print]
Factors
associated with maternal dietary intake, feeding and weaning
practices, and the development of food hypersensitivity in the
infant.
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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