Faecal lactoferrin--a novel test to differentiate between the irritable and inflamed bowel?

BACKGROUND

Distinguishing between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) can be challenging.

AIMS

To investigate the utility of faecal lactoferrin as a marker of inflammation in patients with IBD, IBS and controls.

METHODS

Disease activity in IBD patients was assessed using the modified Harvey-Bradshaw Activity Index. Stool samples were analysed using an ELISA assay.

RESULTS

We recruited 137 patients with IBS, 126 with ulcerative colitis (UC) and 104 with Crohn's disease (CD), and 98 healthy volunteers. The median +/- IQ lactoferrin concentration (microg/g faecal weight) was 0 +/- 1.4 for IBS patients, 6.6 +/- 42 for UC patients, 4 +/- 12.7 for CD patients and 0.5 +/- 2 for healthy controls. Lactoferrin levels were significantly higher in IBD patients compared with IBS/healthy controls (P < 0.001). The median lactoferrin concentrations were significantly higher in active UC & CD patients compared with inactive patients (P < 0.001 and P = 0.002 respectively). The sensitivity, specificity, positive and negative predictive values of lactoferrin in distinguishing active IBD from IBS/healthy controls were 67% and 96%, 87% and 86.8% respectively.

CONCLUSIONS

Lactoferrin is useful to differentiate between IBD and IBS, and can be used as an adjunct to blood parameters to determine IBD patients who have ongoing inflammation.

Dysautonomia in a six-year-old mule in the United States

Equine dysautonomia, also known as equine grass sickness (EGS), is a well documented disease in several countries. To the authors' knowledge, EGS has not been reported previously in North America. This report describes EGS in a 6-year-old female mule in the USA. Failure initially to consider EGS resulted in a delayed diagnosis. EGS should be considered as a differential diagnosis and appropriate diagnostic tests performed in similar cases in North America.

Republished review. [corrected] Late-onset retinal macular degeneration: clinical insights into an inherited retinal degeneration

AIM

This study describes, in detail, the phenotype of late-onset retinal macular degeneration (L-ORMD) an inherited condition affecting both the retina and anterior segment. A staging based on clinical characteristics is proposed, and the relevance of this condition to current understanding of age-related macular degeneration is discussed.

METHODS

A systematic review of the literature regarding this condition supports a detailed description of the natural history. Clinical experiences in identifying, monitoring and managing patients are also presented.

RESULTS

L-ORMD is a rare fully penetrant autosomal dominant condition resulting from a mutation in the C1QTNF5 gene on chromosome 11. Affected individuals develop bilateral loss of vision, dark-adaptation abnormalities, fundus drusen-like yellow spots, midperipheral pigmentation, choroidal neovascularisation, chorioretinal atrophy and long anteriorly inserted lens zonules. Patients may benefit from treatment with high-dose vitamin A.

CONCLUSIONS

Raised awareness of L-ORMD should lead to earlier diagnosis and improved care for patients. New antivascular endothelial growth factor treatment may provide a new possibility for management. A deeper insight into molecular and genetic mechanisms of L-ORMD may suggest avenues to explore new treatments of this disorder.

The Healthy African American Families' risk communications initiative: using community partnered participatory research to address preterm birth at the local level

Preterm birth is the leading cause of infant death for African Americans and is significantly associated with lifelong morbidity. Primary prevention efforts using medical strategies to reduce the rates of preterm birth have been unsuccessful. Using community partnered participatory processes, the Healthy African American Families project in Los Angeles developed a multilevel, risk communications strategy to promote awareness about preterm birth in the local community. Participants included community members, community-based organizations, local government, healthcare providers, and national-level advocates. The initiative focused on increasing social support for pregnant women, providing current information on preterm birth risks, and improving quality of health services. The initiative includes components addressing community education, mass media, provider education, and community advocacy. Products include 100 Intentional Acts of Kindness toward a Pregnant Woman, a doorknob brochure on signs and symptoms of preterm labor, and an education manual on preterm birth and other African American health issues. Cooperation, affiliation, and community self-help were key aspects of the planning process and the health promotion products. Additional community benefits included increased leadership and skills development. The process and products described here may be useful in other communities and for addressing other health outcomes in communities of color.

Results of the external quality assessment of Mycobacterium tuberculosis drug susceptibility testing in Russia, 2005-2007

SETTING

External quality assessment (EQA) of Mycobacterium tuberculosis drug susceptibility testing (DST) in bacteriological tuberculosis (TB) laboratories in the Russian Federation.

OBJECTIVE

To improve the EQA of DST of first-line anti-tuberculosis drugs using proficiency testing in the Russian Federation.

METHOD

Three rounds of DST proficiency testing using Mycobacterium tuberculosis isolates provided by the Swedish Institute for Infectious Disease Control, a World Health Organization Supranational Reference Laboratory (SRL). In total, 42 TB laboratories in the Russian civilian and prison sectors participated in at least one round of proficiency testing, and 17 laboratories participated in all three rounds.

RESULTS

Ninety-seven per cent (87/89) of reports were received for the three rounds: 67% of laboratories in the first round and 86% of laboratories in the second round demonstrated >or=95% accuracy for isoniazid, and respectively 72% and 80% of laboratories in the first and second rounds reported >or=95% accuracy for rifampicin.

CONCLUSION

Coordination with the SRL network resulted in the introduction of 90 well-characterised strains for EQA in the Russian Federation. Successive rounds of DST proficiency testing have helped to identify highly proficient laboratories that will be used as expert laboratories for proficiency testing in the future.

An examination of the relation of gender, mass media influence, and loneliness to disordered eating among college students

Previous research has found that mass media influence and loneliness relate to disordered eating behaviors in women, but little is known about this relation in men. The present study examined the relations among disordered eating patterns, gender, mass media influence, and loneliness in male and female college students. Results of a stepwise regression revealed that disordered eating attitudes and behaviors (as measured by the Eating Attitudes Test-26) were predicted by mass media influence, gender, and loneliness, respectively. In the present study both male and female college students appear susceptible to developing disordered eating patterns. Clinicians may wish to address unrealistic comparisons to media and client interpersonal skills when designing treatment plans.

Validity of foot-to-foot bio-electrical impedance analysis body composition estimates in overweight and obese children

OBJECTIVES: To examine the validity of body composition estimates obtained using foot-to-foot bio-electrical impedance analysis (BIA) in overweight and obese children by comparison to a reference four-compartment model (4-CM). SUBJECTS/METHODS: 38 males: age (mean +/- sd) 13.6 +/- 1.3 years, body mass index 30.3 +/- 6.0 kg.m(-2) and 14 females: age 14.7 +/- 2.2 years, body mass index 32.4 +/- 5.7 kg.m(-2) participated in the study. Estimates of fat-free mass (FFM), fat mass (FM) and percentage body fat (PBF) obtained using a Tanita model TBF-310 and a 4-CM (derived from body mass, body volume, total body water and total body bone mineral measurements) were compared using bias and 95% limits of agreement (Tanita minus 4-CM estimates). RESULTS: Body composition estimates obtained with the Tanita TBF-310 were not significantly different from 4-CM assessments: for all subjects combined the bias was -0.7kg for FM, 0.7kg for FFM and -1.3% for PBF. However, the 95% limits of agreement were substantial for individual children: males, up to +/-9.3kg for FFM and FM and +/-11.0% for PBF; females, up to +/-5.5kg for FFM and FM and +/-6.5% for PBF. CONCLUSIONS: The Tanita TBF-310 foot-to-foot BIA body composition analyser with the manufacturer's prediction equations is not recommended for application to individual children who are overweight and obese although it may be of use for obtaining group mean values.

Prevalence and risk factors for multidrug-resistant tuberculosis in the Republic of Georgia: a population-based study

SETTING

Multidrug-resistant tuberculosis (MDR-TB, defined as resistance to at least isoniazid and rifampicin) has emerged as a serious global public health problem, especially in the former Soviet republics. The extent of the problem in Georgia has been incompletely defined.

OBJECTIVE

To determine the prevalence and risk factors for MDR-TB in Georgia.

DESIGN

A population-based study was carried out between July 2005 and May 2006.

RESULTS

Of 1314 patients with acid-fast bacilli smear- and culture-positive pulmonary tuberculosis (TB), 799 (60.8%) were newly diagnosed patients and 515 (39.2%) had been treated previously. Overall, 733 (56%) patients had resistance to at least one anti-tuberculosis drug and 195 (15%) had MDR-TB. Patients who had been treated previously for TB were significantly more likely to have MDR-TB than newly diagnosed patients (141/515 [27.4%] vs. 54/794 [6.8%], OR 5.27, 95%CI 3.75-7.41). In multivariate analysis, previous TB treatment (aOR 5.47, 95%CI 3.87-7.74) and female sex (aOR1.58, 95%CI 1.02-2.32) were independent risk factors for the presence of MDR-TB.

CONCLUSIONS

Drug-resistant TB, including MDR-TB, has emerged as a major public health problem in Georgia. Further TB control efforts need to be implemented to prevent the development of new cases of MDR-TB and to treat existing patients with MDR-TB.

Where is the Theoretical Basis for Understanding and Measuring the Environment for Physical Activity?

Researchers are beginning to explore environmental correlates to further the field of physical activity research. Before interventions and experimental investigations can be undertaken, it is necessary to identify specific environmental features that are consistent correlates of physical activity. There has been a plethora of research measuring such cross-sectional associations since this field came to the fore in 2003. This paper posits that it is time for researchers to evaluate the state of knowledge, and suggests that future developments in this field focus on the theoretical bases for (i) measurement of the environment and (ii) understanding the links between perceptions of the environment and behaviour through psychological theories of cognition. Key theories considered include social ecology and the theory of planned behaviour. It is suggested that with a continued absence of a common conceptual framework, vocabulary and measurement tools the majority of studies may remain at a correlates stage. In highlighting issues with current methodologies, this commentary encourages more grounded theoretical approaches to the study of the environment and physical activity.

Second-line drug resistance in multidrug-resistant tuberculosis cases of various origins in the Netherlands

SETTING

The Netherlands.

OBJECTIVE

To investigate the frequency of resistance to second-line drugs among multidrug-resistant tuberculosis (MDR-TB) cases and its correlation with patients' geographic origin.

DESIGN

Retrospective laboratory database study of multidrug-resistant Mycobacterium tuberculosis complex strains isolated in the Netherlands between January 1993 and October 2007.

RESULTS

We found 153 patients with MDR-TB, of whom 18 (12%) were native Dutch. Complete second-line drug susceptibility testing was performed for 131 MDR-TB patients. Resistance to second-line drugs was noted in primary samples of 28 (21%) MDR-TB patients. Resistance to a single second-line drug was most frequent (24/28 [86%]; 9 to prothionamide [PTH], 6 to para-aminosalicylic acid, 4 to amikacin [AMK], 4 to ciprofloxacin and 1 to cycloserine). Four MDR-TB patients had strains resistant to multiple second-line drugs; two were extensively drug-resistant M. bovis. In MDR-TB patients of European and Central Asian origin, resistance to second-line drugs was most frequent and involved the widest range of drugs. PTH resistance was frequent among African and American MDR-TB patients, while AMK resistance was frequent among South-East Asians.

CONCLUSION

Resistance to second-line drugs is infrequent among MDR-TB patients in the Netherlands. Most second-line drug resistance is recorded among immigrants, with substantial differences in second-line drug resistance in MDR-TB patients originating from different geographical areas.

Independent measurement of the total active 8B solar neutrino flux using an array of 3He proportional counters at the Sudbury Neutrino Observatory

The Sudbury Neutrino Observatory (SNO) used an array of 3He proportional counters to measure the rate of neutral-current interactions in heavy water and precisely determined the total active (nu_x) 8B solar neutrino flux. This technique is independent of previous methods employed by SNO. The total flux is found to be 5.54_-0.31;+0.33(stat)-0.34+0.36(syst)x10(6) cm(-2) s(-1), in agreement with previous measurements and standard solar models. A global analysis of solar and reactor neutrino results yields Deltam2=7.59_-0.21;+0.19x10(-5) eV2 and theta=34.4_-1.2;+1.3 degrees. The uncertainty on the mixing angle has been reduced from SNO's previous results.

Family-centred service coordination in childhood health and disability services: the search for meaningful service outcome measures

BACKGROUND

Potential service outcome measures were tested for their utility in the assessment of the quality of 'family centred' service coordination in the provincial network of children's disability services in Manitoba, Canada.

METHODS

This study is based on in-home survey data provided by 103 mothers at 6 and 18 months following assignment of a 'dedicated' service coordinator. Service outcome indicators included measures of parent self-esteem, parenting stress, family functioning and the need for family support resources.

RESULTS

Hierarchical regression analyses showed no relationship between level of quality of family-centred service coordination and standardized psychosocial measures of parent and family functioning. However, family centredness of service coordination was found to predict significant reduction in level of family need for psychosocial support resources after 18 months of contact with a service coordinator.

CONCLUSIONS

Outcome measures that are focused on specific and tangible results of service coordination appear to be of higher utility in service quality assessment than are more global, standardized measures of parent and family functioning.

External quality control of Mycobacterium tuberculosis drug susceptibility testing: results of two rounds in endemic countries

SETTING

Quality assurance for the World Health Organization (WHO)/International Union Against Tuberculosis and Lung Disease (The Union) global tuberculosis (TB) drug resistance surveillance programme.

OBJECTIVE

To monitor the quality of drug susceptibility testing (DST) in different countries.

METHODS

In 2002-2003 and 2005-2006, 20 Mycobacterium tuberculosis strains were sent by the WHO/Union Supranational Reference Laboratory of Rome to TB reference laboratories in Albania, Bahrain, Kosovo, Mozambique, Oman, Qatar and Turkey for external quality control (EQC).

RESULTS

In 2002-2003, the specificity, sensitivity, efficiency, reproducibility and predictive values for resistance/susceptibility were >or=90% for streptomycin (SM), isoniazid (INH) and ethambutol (EMB). In 2005-2006, all statistical values were >or=96% for SM, INH, rifampicin and EMB.

CONCLUSION

EQC improved the quality of M. tuberculosis DST in the participating countries.

Uptake and acceptability of influenza vaccination in day nursery children

Preschoolers play an important role in the transmission of influenza, and suffer significant morbidity. Paediatric vaccination could prevent serious outcomes and offer broader societal benefits. This study explored parental views on influenza and paediatric vaccination and determined the uptake of a nursery-based vaccination programme for infants aged 6-23 months. Children were offered two doses of inactivated vaccine in 2004/05, and a single dose at the start of the 2005/06 season. An uptake rate of 11% (60/535) was achieved with 83% (50/60) of participants completing the programme. Semi-structured interviews were conducted with 10 parents. Thematic analysis of the data informed the development of a questionnaire. This was distributed to 650 parents, with children aged 6-30 months attending one of the 18 supporting nurseries. A response rate of 13% (83/650) was achieved. The low uptake rate achieved in the programme and findings from the interviews/questionnaire suggest parents were not convinced about the seriousness of paediatric influenza. Indeed, over two-thirds (55/81) questioned the necessity for an annual vaccination. Parents found it difficult to differentiate influenza from other respiratory illnesses, and expressed concerns about the need for annual injections and vaccine safety. Paediatric vaccination to increase herd immunity was held in balance with the notion that children should only be vaccinated if they are the main beneficiaries. Parental education on the burden of childhood influenza, on the direct benefits of influenza vaccination, and on indirect benefits to society is a necessity for a successful paediatric vaccination programme.

Use of bioelectrical impedance analysis to assess body composition in rural Gambian children

OBJECTIVE

To validate the Tanita BC-418MA Segmental Body Composition Analyser and four-site skinfold measurements for the prediction of total body water (TBW), percentage fat-free mass (%FFM) and percentage body fat (%BF) in a population of rural Gambian children.

SUBJECTS/METHODS

One hundred and thirty-three healthy Gambian children (65 males and 68 females). FFM estimated by the inbuilt equations supplied with the Tanita system was assessed by comparison with deuterium oxide dilution and novel prediction equations were produced. Deuterium oxide dilution was also used to develop equations for %BF based on four-site skinfolds (biceps, triceps, subscapular and suprailiac).

RESULTS

The inbuilt equations underestimated FFM compared to deuterium oxide dilution in all the sex and age categories (P<0.003), with greater accuracy in younger children and in males. The best prediction of %FFM was obtained from the variables height, weight, sex, impedance, age and four skinfold thickness measurements (adjusted R(2)=0.84, root mean square error (MSE)=2.07%).

CONCLUSIONS

These data suggest that the Tanita instrument may be a reliable field assessment technique in African children, when using population and gender-specific equations to convert impedance measurements into estimates of FFM.

Severe retinopathy of prematurity in infants <30 weeks' gestation in New South Wales and the Australian Capital Territory from 1992 to 2002

BACKGROUND

Retinopathy of prematurity (ROP) significantly increased in New South Wales (NSW) from 1986 to 1994, but more recent data suggest that there has now been a decrease.

OBJECTIVE

To study the incidence and treatment of severe ROP (stage >or=3) in NSW and the Australian Capital Territory (ACT) from 1992 to 2002.

METHODS

Data collected prospectively from the Neonatal Intensive Care Units' (NICUS) Data Collection over an 11-year period in infants <30 weeks' gestation were divided into four epochs and analysed retrospectively. The incidence and treatment of severe ROP were compared for gestational ages <or=24 weeks', 25-26 weeks' and 27-29 weeks' gestation over the four epochs.

RESULTS

In infants <or=24 weeks' gestation the incidence of severe ROP and those treated increased significantly (stage >or=3: from 17 (41.5%) to 41 (53.9%), p=0.052; treated: from 8 (19.5%) to 25 (32.9%), p<0.05 (first and fourth epoch)). In infants 25-26 weeks' gestation the incidence of severe ROP decreased significantly whereas there was a non-significant increase in those treated (stage >or=3: from 55 (26.2%) to 46 (19.3%), p<0.05; treated: from 19 (9.0%) to 32 (13.4%)). In infants 27-29 weeks' gestation, there was no significant change in the incidence of severe ROP or those treated (stage >or=3: from 30 (4.1%) to 17 (2.4%); treated: from 14 (1.9%) to 8 (1.1%)).

CONCLUSION

In infants <or=24 weeks' gestation there has been a significant increase in severe ROP, and in infants <27 weeks' gestation the numbers treated for severe ROP increased.

Temporal bone study of development of the organ of Corti: correlation between auditory function and anatomical structure

OBJECTIVE

To study the development of the organ of Corti in the human cochlea, and to correlate our findings with the onset of auditory function.

MATERIAL AND METHODS

Step sections of 81 human fetal temporal bones were studied, from eight weeks of gestation to full term.

RESULTS

By the end of the 10th week, the tectorial membrane primordium could be traced even in the most apical turns. Individual hair cells became identifiable at the basal turn at 14 weeks. At the same time, a small but well formed oval space was observed between the inner and outer hair cells in the basal turn. This does not correspond to the tunnel of Corti, as is erroneously quoted in the literature, as the individual pillar cells develop at later stages. Between 14 and 15 weeks, Hensen's cells were recognised for the first time. Individual pillar cells were identifiable at 17 weeks and the tunnel of Corti opened at 20 weeks. By 25 weeks, the cochlea had reached its adult size, but continued to develop until full term.

DISCUSSION AND CONCLUSIONS

A temporal coincidence of different developmental events is responsible for early fetal audition at 20 weeks, including growth of pillar cells, opening of the tunnel of Corti and regression of Kollicker's organ, with the subsequent formation of the inner spiral sulcus and then separation of the tectorial membrane. The fine structures of the organ of Corti continue to develop well after the 25th week, and this may well alter the mechanical properties of the vibrating parts of the cochlea, which may in turn account for the frequency shift observed in preterm infants. These changes will have to be taken into account in the development of prenatal hearing screening tests.

Socio-economic and environmental factors influence energy utilization in Brazilian breast-fed infants

Energy intake recommendations for infants are based on data from industrialized countries. FAO/WHO/UNU expressed the need for studies on total energy expenditure (TEE) and basal metabolic rate from developing countries covering current and changing lifestyles. For this observational study, 65 infants of differing socioeconomic status (SES) (n = 32 middle SES, n = 33 low SES) were selected in Pelotas, southern Brazil, aiming to: 1) compare TEE, minimum observable energy expenditure (MOEE), activity energy expenditure (AEE) between breast-fed infants 8.7 mo of age from middle and low SES; and 2) investigate the effect of potential mediating factors on TEE and AEE. TEE and total body water were measured with doubly labeled water, MOEE with respiration calorimetry, breast milk intake using the dose-to-the-mother deuterium-oxide turnover method, food intake using 1-d food weighing, and prevalence of overweight using BMI Z-scores. TEE adjusted for ethnicity was 257 (95% CI 232-281) kJ/(kg . d) in middle SES infants vs. 318 (95%CI 294-342) kJ/(kg . d) in low SES infants (P = 0.001). MOEE did not differ between groups and the difference in TEE was therefore attributed to AEE (P = 0.008). The effect of SES on AEE was mediated by the number of persons per bedroom (crowding). Prevalence of overweight tended to be higher in middle SES infants (P = 0.054) than in low SES infants. The difference in TEE and AEE between SES groups emphasizes the importance of an accurate description of the SES of any population in which TEE is studied and questions the extent to which TEE data from middle-class infants in transitional countries should be considered normative.

National anti-tuberculosis drug resistance survey, 2002, in Myanmar

SETTING

Thirty townships of Myanmar.

OBJECTIVES

To determine the proportions of drug-resistant tuberculosis (TB) in new and previously treated pulmonary tuberculosis (PTB) cases in Myanmar.

DESIGN

A cross-sectional study. Drug susceptibility was tested by the proportion method at the National Tuberculosis Reference Laboratory, Yangon.

RESULTS

Of 874 TB patients included from 30 sites, 849 isolates obtained from individual patients (733 from new cases and 116 from previously treated cases) were tested for susceptibility to four primary anti-tuberculosis drugs. Of 733 isolates tested from new TB patients, 10% were resistant to any one of the anti-tuberculosis drugs, 6.5% to isoniazid (INH), 4.6% to rifampicin (RMP) and 4.0% were multidrug-resistant (MDR). Of the 116 previously treated patients, 30.2% were resistant to any one of the drugs, 26.7% to INH, 15.5% to RMP and 15.5% were MDR. Previous anti-tuberculosis treatment of more than 1 month was strongly associated with the development of MDR-TB (adjusted OR 4.8, 95% CI 2.5-9.1).

CONCLUSION

The first national drug resistance survey in Myanmar revealed 4% and 15.5% MDR-TB among new and retreatment cases, respectively. Previous antituberculosis treatment was an important risk factor for MDR-TB. Continuous monitoring of drug resistance trends is needed

Joint Mobilization Reduces Hyperalgesia Associated With Chronic Muscle and Joint Inflammation in Rats

Joint mobilization is a common treatment used by healthcare professions for management of a variety of painful conditions, including inflammatory joint and muscle pain. We hypothesized that joint mobilization would reduce the bilateral hyperalgesia induced by muscle and joint inflammation. Mechanical hyperalgesia was measured by examining the mechanical withdrawal threshold of the rat's paw before and after induction of inflammation with 3% carrageenan (gastrocnemius muscle) or 3% kaolin/carrageenan (knee joint), and for 1 hour after knee joint mobilization. The mobilization consisted of rhythmically flexing and extending the knee joint to the end of range of extension while the tibia was simultaneously moved in an anterior to posterior direction. A bilateral decrease in mechanical withdrawal thresholds occurred 1, 2, and 4 weeks after inflammation of the knee joint or muscle. In animals with muscle inflammation, mobilization of the knee joint increased the mechanical withdrawal threshold bilaterally when given 1, 2, or 4 weeks after inflammation. However, in animals with knee joint inflammation, mobilization of the knee joint at 4 weeks increased the mechanical withdrawal threshold but had no effect when administered 1 or 2 weeks after inflammation. Therefore, joint mobilization reduces hyperalgesia induced by chronic inflammation of muscle and joint.

PERSPECTIVE

This article shows that unilateral joint mobilization reduces bilateral hyperalgesia induced by chronic muscle or joint inflammation. Understanding the pain conditions in which mobilization produces an analgesic effect should assist the clinician in selecting appropriate treatment techniques. The bilateral effect suggests that central mechanisms could mediate the analgesia.

The development of the spiral ganglion in the human foetus

The development of the spiral ganglion was studied in steps sections of 81 human temporal bones. By the 8th week, the spiral ganglion has already separated from the vestibular ganglion. At 13 weeks two distinct populations are observed that correspond to neuron and Schwann cells. At 15 weeks the spiral ganglion has increased its distance from the cochlear duct and is surrounded by mesenchyme near the scala tympani. At 14 weeks a gradual decrease in the nucleus-to-cell area ratio was observed in spiral ganglion neurons that may reflect a morphological adaptation to function. By the 23rd week the modiolus begins to ossify and the spiral ganglion is surrounded by bony trabeculae. The time course of spiral ganglion development follows that of the stria vascularis and organ of Corti, although maturation changes are still observed in the neuronal population even beyond 20 weeks.

Fetal, infant and childhood growth: relationships with body composition in Brazilian boys aged 9 years

BACKGROUND

Early growth rate has been linked to later obesity categorised by body mass index (BMI), but the development of body composition has rarely been studied.

METHODS

We tested the hypotheses that (1) birthweight and weight gain in (2) infancy or (3) childhood are associated with later body composition, in 172 Brazilian boys followed longitudinally since birth. Growth was assessed using measurements of weight and height at birth, 6 months, and 1 and 4 y. Measurements at 9 y comprised height, weight and body composition using foot-foot impedance.

RESULTS

Birthweight was associated with later height and lean mass (LM), but not fatness. Weight gain 0-6 months was associated with later height and LM, and with obesity prevalence according to BMI, but not with fatness. Weight gain 1-4 y was associated with later fatness and LM. Weight gain 4-9 y was strongly associated with fatness but not LM. Early growth rate did not correlate positively with subsequent growth rate.

CONCLUSIONS

Early rapid weight gain increased the risk of later obesity, but not through a direct effect on fatness. Childhood weight gain remained the dominant risk factor for later obesity. The reported link between early growth and later obesity may be due partly to hormonal programming, and partly to the contribution of LM to obesity indices based on weight and height. Whether our findings apply to other populations requires further research.