Eye-blinking rates are slower in infants with iron-deficiency anemia than in nonanemic iron-deficient or iron-sufficient infants

Iron deficiency has been shown to impair dopamine functioning in rodent models, but it is challenging to obtain evidence of such effects in human infants. Because spontaneous eye-blink rate may provide a noninvasive assessment of dopamine functioning, we hypothesized that eye-blink rate would be lower in infants with iron-deficiency anemia and would increase with iron therapy. A 4-min eye-blink assessment was conducted for quiet, alert infants sitting on their mother's lap. Data were available for 61 9- to 10-mo-old infants from inner-city Detroit (19 iron-deficient anemic, 23 nonanemic iron-deficient, and 19 nonanemic iron-sufficient). Iron-deficient and iron-sufficient nonanemic groups had similar eye-blink rates (P = 0.90) and were therefore combined. We used Poisson regression based on generalized estimation equation methodology to test for differences between iron-deficient anemic and nonanemic infants in blinks/min and change after 3 mo of iron therapy. Iron-deficient anemic infants had a lower initial eye-blink rate than nonanemic infants (mean +/- SD) (4.0 +/- 1.9 vs. 5.3 +/- 2.8 blinks/min; P = 0.02; effect size = 0.6 SD). At 12 mo, eye-blink rate increased by 2.1 blinks/min in the iron-deficient anemic group (P = 0.008); there was no change in the nonanemic group (P = 0.96). These results are consistent with reduced dopamine function in iron-deficient anemic infants. The clinical importance of a lower eye-blink rate is unclear, but impaired dopamine functioning is likely to have broader impact, given the role dopamine plays in regulating movement, motivation, cognition, and hormone release.

Body mass index and timing of pubertal initiation in boys

OBJECTIVE

To examine the association between body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) and timing of pubertal onset in a population-based sample of US boys.

DESIGN

Longitudinal prospective study.

SETTING

Ten US sites that participated in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development.

PARTICIPANTS

Of 705 boys initially enrolled in the study, information about height and weight measures and pubertal stage by age 11.5 years was available for 401 boys.

MAIN EXPOSURE

The BMI trajectory created from measured heights and weights at ages 2, 3, 4.5, 7, 9, 9.5, 10.5, and 11.5 years.

MAIN OUTCOME MEASURE

Onset of puberty at age 11.5 years as measured by Tanner genitalia staging.

RESULTS

Boys in the highest BMI trajectory (mean BMI z score at age 11.5 years, 1.84) had a greater relative risk of being prepubertal compared with boys in the lowest BMI trajectory (mean BMI z score at age 11.5 years, -0.76) (adjusted relative risk = 2.63; 95% confidence interval, 1.05-6.61; P = .04).

CONCLUSIONS

The relationship between body fat and timing of pubertal onset is not the same in boys as it is in girls. Further studies are needed to better understand the physiological link between body fat and timing of pubertal onset in both sexes.

Depressed mood and speech in Chilean mothers of 5½-year-old children

Previous research on maternal speech and depression has focused almost exclusively on how depressed mothers talk to their infants and toddlers in the U.S. and U.K., two English-speaking countries. This study considered how depressed Spanish-speaking mothers from a Latin American country talk about their preschool-age children. Five-minute speech samples were provided by 178 Chilean mothers who were asked to talk about their 5½-year-old children to a project psychologist. Maternal depressive symptomatology was measured by the Spanish-language version of the Center for Epidemiologic Studies Depression Scale (CES-D). In multivariate analysis of covariance (MANCOVA), higher maternal depressed mood showed statistically significant associations with the following maternal speech characteristics: more criticisms, less laughter, fewer medium pauses, less positive satisfaction with the child's behavior or characteristics, a rating of a negative overall relationship with the child, and more crying (suggestive trend). A structural equation model confirmed these findings and found an indirect effect between laughter and criticisms: mothers with higher depressed mood who laughed less criticized their children less. The findings illustrate that depressed mood adversely affects how a group of Chilean mothers speak about their children.

Changes in body mass index z score over the course of the academic year among children attending Head Start

OBJECTIVE

We tested the hypothesis that among 3- to 5-year-old children attending Head Start, body mass index z score will decline during the academic year and increase during the summer.

METHODS

We used retrospective longitudinal growth data collected over 5 academic years from 1914 children (51% boys, 62% white) enrolled in a Michigan Head Start program. Changes in body mass index (BMI) z score, calculated as annual rate of change, during 2 academic years and the intervening summer were assessed by piecewise linear regression analysis. Potential covariates were gender, single-parent status, program year, race/ethnicity, age at initial enrollment, and family income (divided by household size).

RESULTS

Mean BMI z score at the start of Head Start enrollment was 0.52 (95% confidence interval [95% CI] 0.39 to 0.65). Mean annual rates of BMI z score change were: -0.07 (95% CI -0.28 to 0.14) during the first year of enrollment, 0.62 (95% CI -0.0005 to 1.23) over the summer, and -0.82 (95% CI -1.50 to -0.13) during the second year of enrollment. The effect was most robust among girls of minority race/ethnicity.

CONCLUSIONS

Head Start is associated with a shifting of BMI z scores toward the norm among low-income preschool-aged children, particularly among girls of minority race/ethnicity.

Early vocabulary development in Mandarin (Putonghua) and Cantonese

Parent report instruments adapted from the MacArthur-Bates Communicative Development Inventories (CDI) examined vocabulary development in children aged 0 ; 8 to 2 ; 6 for two Chinese languages, Mandarin (n=1694) and Cantonese (n=1625). Parental reports suggested higher overall scores for Mandarin- than for Cantonese-speaking children from approximately 1 ; 4 onward. Factors relevant to the difference were only-child status, monolingual households and caregiver education. In addition to the comparison of vocabulary scores overall, the development of noun classifiers, grammatical function words common to the two languages, was assessed both in terms of the age and the vocabulary size at which these terms are acquired. Whereas age-based developmental trajectories again showed an advantage for Beijing children, Hong Kong children used classifiers when they had smaller vocabularies, reflecting the higher frequencies and greater precision of classifier use in adult Cantonese. The data speak to the importance of using not just age, but also vocabulary size, as a metric by which the acquisition of particular linguistic elements can be examined across languages.

Linear and ponderal growth trajectories in well-nourished, iron-sufficient infants are unimpaired by iron supplementation

Iron deficiency remains the most common nutritional deficiency worldwide and supplementation is recommended during periods of high risk, including infancy. However, questions have been raised about possible adverse effects of iron on growth in iron-sufficient (IS) infants and the advisability of across-the-board iron supplementation. This study examined whether short- or long-term growth was impaired in IS infants who received iron supplementation. From a longitudinal study of healthy, breast-fed, low- to middle-income Chilean infants randomly assigned to iron supplementation or usual nutrition at 6 or 12 mo, we retrospectively identified infants meeting criteria for iron sufficiency at the time of random assignment (n = 273). Using multilevel analysis, ponderal and linear growth were modeled before, during, and after iron supplementation up to 10 y in 3 comparisons: 1) iron supplementation compared with usual nutrition from 6 to 12 mo; 2) iron supplementation compared with usual nutrition from 12 to 18 mo; and 3) 15 mg/d of iron as drops compared with iron-fortified formula (12 mg/L). Growth trajectories did not differ during or after supplementation indicating no adverse effect of iron in any comparison. These results suggest that, at least in some environments, iron does not impair growth in IS infants.

Higher infant blood lead levels with longer duration of breastfeeding

OBJECTIVE

To determine whether longer breastfeeding is associated with higher infant lead concentrations.

STUDY DESIGN

Data were analyzed from 3 studies of developmental effects of iron deficiency in infancy: Costa Rica (1981-1984), Chile (1991-1996), and Detroit (2002-2003). The relation between duration of breastfeeding and lead levels was assessed with Pearson product-moment or partial correlation coefficients.

RESULTS

More than 93% of the Costa Rica and Chile samples was breastfed (179 and 323 breastfed infants, respectively; mean weaning age, 8-10 months), as was 35.6% of the Detroit sample (53 breastfed infants; mean weaning age, 4.5 months). Lead concentrations averaged 10.8 microg/dL (Costa Rica, 12-23 months), 7.8 microg/dL (Chile, 12 months), and 2.5 microg/dL (Detroit, 9-10 months). Duration of breastfeeding as sole milk source and total breastfeeding correlated with lead concentration in all samples (r values = 0.14-0.57; P values = .06-<.0001).

CONCLUSIONS

Longer breastfeeding was associated with higher infant lead concentration in 3 countries, in 3 different decades, in settings differing in breastfeeding patterns, environmental lead sources, and infant lead levels. The results suggest that monitoring lead concentrations in breastfed infants be considered.

Longitudinal evaluation of externalizing and internalizing behavior problems following iron deficiency in infancy

OBJECTIVE

This study examined externalizing and internalizing behavior problem trajectories as a function of both iron status in infancy and infant characteristics.

METHODS

A sample of 185 healthy Costa Rican children who either had chronic, severe iron deficiency or good iron status in infancy were followed for 19 years.

RESULTS

Mother ratings of externalizing and internalizing problems from age 5 to 11-14 years were higher for the chronic iron deficiency group compared with those with the good iron status. Iron deficiency in infancy predicted persisting externalizing problems over this time period, especially for those with low physical activity in infancy. Beyond adolescence, youth in the chronic iron deficiency group did not report more problems than those in the good iron group.

CONCLUSIONS

These findings underscore the importance of considering infant iron status along with early behavioral characteristics to better identify those children at greatest risk for persisting long-term behavior problems.

Short stature in a population-based cohort: social, emotional, and behavioral functioning

OBJECTIVE

The goal was to determine whether there were significant differences between children of normative versus short stature in behavioral functioning and peer relationships, according to teacher and child reports.

METHODS

The study included 712 boys and girls in the sixth grade, from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Main outcome measures included Achenbach Teacher's Report Form internalizing, externalizing, and total scores; Children's Depression Inventory scores (child report); Life Orientation Test-Revised scores (child report); Child Behavior with Peers questionnaire asocial with peers, excluded by peers, and peer victimization subscale scores (teacher report); peer social support and victimization scores (child report); and relationships with peers score (teacher report). In bivariate comparisons, these outcomes were compared for children of relatively short (height of <10th percentile) versus nonshort (height of > or =10th percentile) stature, and effect sizes were calculated. Multivariate linear regression models adjusted for maternal education, income/needs ratio, race, and gender.

RESULTS

Effect sizes ranged from 0.00 to 0.35. Short children reported marginally higher levels of self-perceived peer victimization, compared with their nonshort peers. There were no significant differences in the rest of the outcomes for children of short versus nonshort stature, in either unadjusted or adjusted models.

CONCLUSION

Although short children from a population-based sample reported marginally higher levels of self-perceived peer victimization, they did not differ from their nonshort peers in a range of social, emotional, and behavioral outcomes.

Insights into the mechanisms and mediators of the effects of air pollution exposure on blood pressure and vascular function in healthy humans

Fine particulate matter air pollution plus ozone impairs vascular function and raises diastolic blood pressure. We aimed to determine the mechanism and air pollutant responsible. The effects of pollution on heart rate variability, blood pressure, biomarkers, and brachial flow-mediated dilatation were determined in 2 randomized, double-blind, crossover studies. In Ann Arbor, 50 subjects were exposed to fine particles (150 microg/m(3)) plus ozone (120 parts per billion) for 2 hours on 3 occasions with pretreatments of an endothelin antagonist (Bosentan, 250 mg), antioxidant (Vitamin C, 2 g), or placebo. In Toronto, 31 subjects were exposed to 4 different conditions (particles plus ozone, particles, ozone, and filtered air). In Toronto, diastolic blood pressure significantly increased (2.9 and 3.6 mm Hg) only during particle-containing exposures in association with particulate matter concentration and reductions in heart rate variability. Flow-mediated dilatation significantly decreased (2.0% and 2.9%) only 24 hours after particle-containing exposures in association with particulate matter concentration and increases in blood tumor necrosis factor alpha. In Ann Arbor, diastolic blood pressure significantly similarly increased during all of the exposures (2.5 to 4.0 mm Hg), a response not mitigated by pretreatments. Flow-mediated dilatation remained unaltered. Particulate matter, not ozone, was responsible for increasing diastolic blood pressure during air pollution inhalation, most plausibly by instigating acute autonomic imbalance. Only particles from urban Toronto additionally impaired endothelial function, likely via slower proinflammatory pathways. Our findings demonstrate credible mechanisms whereby fine particulate matter could trigger acute cardiovascular events and that aspects of exposure location may be an important determinant of the health consequences.

Ability to delay gratification at age 4 years and risk of overweight at age 11 years

OBJECTIVES

To determine if limited ability to delay gratification (ATDG) at age 4 years is independently associated with an increased risk of being overweight at age 11 years and to assess confounding or moderation by child body mass index z score at 4 years, self-reported maternal expectation of child ATDG for food, and maternal weight status.

DESIGN

Longitudinal prospective study.

SETTING

Ten US sites.

PARTICIPANTS

Participants in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Main Exposure Ability to delay gratification at 4 years, measured as pass or fail on a validated task.

OUTCOME MEASURES

Overweight at 11 years, defined as a body mass index greater than or equal to the 85th percentile based on measured weight and height.

RESULTS

Of 805 children, 47% failed the ATDG task. Using multiple logistic regression, children who failed the ATDG task were more likely to be overweight at 11 years (relative risk, 1.29; 95% confidence interval, 1.06-1.58), independent of income to needs ratio. Body mass index z score at 4 years and maternal expectation of child ATDG for food did not alter the association, but maternal weight status reduced the association significantly.

CONCLUSIONS

Children with limited ATDG at age 4 years were more likely to be overweight at age 11 years, but the association was at least partially explained by maternal weight status. Further understanding of the association between the child's ATDG and maternal and child weight status may lead to more effective obesity intervention and prevention programs.

Baby's first 10 words

Although there has been much debate over the content of children's first words, few large sample studies address this question for children at the very earliest stages of word learning. The authors report data from comparable samples of 265 English-, 336 Putonghua- (Mandarin), and 369 Cantonese-speaking 8- to 16-month-old infants whose caregivers completed MacArthur-Bates Communicative Development Inventories and reported them to produce between 1 and 10 words. Analyses of individual words indicated striking commonalities in the first words that children learn. However, substantive cross-linguistic differences appeared in the relative prevalence of common nouns, people terms, and verbs as well as in the probability that children produced even one of these word types when they had a total of 1-3, 4-6, or 7-10 words in their vocabularies. These data document cross-linguistic differences in the types of words produced even at the earliest stages of vocabulary learning and underscore the importance of parental input and cross-linguistic/cross-cultural variations in children's early word-learning.

Long-term outcomes of physician peer teaching

Research conducted in 10 cities assessed long-term pediatric asthma outcomes from a peer teaching intervention for physicians to improve their asthma-related clinical and counseling skills. Hypotheses were better outcomes for patients, symptom reduction, less health care use, and enhanced view of the physician. Peers trained 53 intervention group pediatricians (seeing 418 patients); 48 pediatricians (seeing 452 patients) were controls. Patients provided baseline and 2-year follow-up data, collected by telephone interview and from medical records. Intent-to-treat analyses used Poisson regression and general estimation equations. Treatment physicians' patients gave them higher performance ratings ( P = .02). Patients had fewer sleep disruptions from asthma symptoms ( P = .03). Those with baseline health care use had fewer ED visits ( P = .005), hospitalizations (P = .03), and urgent office visits (P = .001), and they made fewer phone calls to the doctor's office (P = .02). Treatment physicians spent no more patient visit time than control physicians. Peer training increased patient's positive views of clinician's performance and reduced children's symptoms and health care use up to two years post program.

The clinician-patient partnership paradigm: outcomes associated with physician communication behavior

OBJECTIVE

To identify physician communication behaviors associated with perceptions of quality of care and predictive of positive patient outcomes.

PATIENTS AND METHODS

A total of 452 families seeing 48 pediatricians for a child's asthma participated. Perceptions and health care use were assessed at baseline and after 12 months through interviews and medical records. The measures used were 10 physician communication behaviors and 6 items describing physician's performance, asthma office visits, emergency department visits, and hospitalization.

RESULTS

Positive perceptions of physicians' performance were related to (P < or = .05) careful listening, inquiring about at-home management, nonverbal attention, interactive conversation, tailoring short-term goals, and long-term therapeutic plan. Loss in health care use was predicted (P < or = .05) by interactive conversation, short-term goals, criteria for decision making, long-term treatment plan, and tailoring according to needs. The use of these techniques did not lengthen the patient visit. A clinician-patient partnership paradigm is provided based on these findings.

CONCLUSIONS

The specific clinician communication behaviors predicted reduced health care use and positive perceptions of quality of care.

Heart disease management by women: does intervention format matter?

A randomized controlled trial of two formats of a program (Women Take PRIDE) to enhance management of heart disease by patients was conducted. Older women (N = 575) were randomly assigned to a group or self-directed format or to a control group. Data regarding symptoms, functional health status, and weight were collected at baseline and at 4, 12, and 18 months. The formats produced different outcomes. At 18 months, the self-directed format was better than the control in reducing the number (p < or = .02), frequency (p < or = .03), and bothersomeness (p < or = .02) of cardiac symptoms. The self-directed format was also better than the group format in reducing symptom frequency of all types (p < or = .04). The group format improved ambulation at 12 months (p < or = .04) and weight loss at 18 months (p < or = .03), and group participants were more likely to complete the program ( p < or = .05). The availability of different learning formats could enhance management of cardiovascular disease by patients.

Anaerobic dental flora and the acute coronary syndrome

OBJECTIVE

Evidence exists that coronary heart disease is influenced by anaerobic bacterial flora and gingival inflammation. We assessed the association of periodontal bacteria, coronary artery disease, and acute coronary events.

METHODS

The benzoyl-DL-arginine naphthylamide test, which detects several periodontal pathogens, and the papillary bleeding score were used to quantify gingival health. Participants with coronary heart disease (n=245) presenting with (n=92) and without an acute coronary syndrome were compared with persons seeking dental treatment (University dental, n=195) and a healthy cohort (Healthy dental, n=156).

RESULTS

An 'infection', defined by a positive benzoyl-DL-arginine naphthylamide test score in>or=50% of sampled sites, was present in 408 participants. Compared with Healthy dental, the odds ratio for coronary heart disease having an infection was 8.6 (95% confidence interval, 4.0-18.4) and for University dental odds ratio=16 (95% confidence interval, 6.5-39.5). Patients with an acute coronary syndrome at the time of benzoyl-DL-arginine naphthylamide sampling were 3.95 times more likely to have an infection compared with coronary heart disease patients with no history of acute coronary syndrome (P=0.003), a finding independent of other covariates.

CONCLUSIONS

Persons with coronary heart disease, particularly associated with an acute coronary syndrome, have anaerobic bacterial dental flora similar to individuals seeking periodontal dental care, and unlike periodontally healthy individuals.

Shorter sleep duration is associated with increased risk for being overweight at ages 9 to 12 years

OBJECTIVE

The potential association between short sleep duration or sleep problems and childhood overweight has not been well described. The objective of this study was to test the independent associations of sleep duration and problems with overweight risk in children.

METHODS

Data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were analyzed. In 3rd and 6th grades, sleep duration and problems were obtained by maternal report, and height and weight were measured, with overweight defined as a BMI of > or = 95th percentile for age and gender. Logistic regression evaluated the association of sleep duration and problems with overweight at 6th grade cross-sectionally adjusting for gender, race, and maternal education. Additional covariates tested individually included the level of chaos at home, the quality of the home environment, the lax-parenting subscale score of the Raising Children Checklist, and the Child Behavior Checklist internalizing and externalizing subscale scores. Logistic regression also evaluated the relationship of sleep duration at 3rd grade and overweight at 6th grade, adjusting for gender, race, maternal education, and the child's BMI z score in 3rd grade.

RESULTS

Of 785 children, 50% were male, 81% were white, and 18% were overweight in 6th grade. Shorter sleep duration in 6th grade was independently associated with a greater likelihood of overweight in 6th grade. Shorter sleep duration in 3rd grade was also independently associated with overweight in 6th grade, independent of the child's weight status in 3rd grade. Sleep problems were not associated with overweight.

CONCLUSION

One preventive approach to overweight may be to ensure adequate sleep in childhood.

Shorter sleep duration is associated with increased risk for being overweight at ages 9 to 12 years

OBJECTIVE

The potential association between short sleep duration or sleep problems and childhood overweight has not been well described. The objective of this study was to test the independent associations of sleep duration and problems with overweight risk in children.

METHODS

Data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were analyzed. In 3rd and 6th grades, sleep duration and problems were obtained by maternal report, and height and weight were measured, with overweight defined as a BMI of > or = 95th percentile for age and gender. Logistic regression evaluated the association of sleep duration and problems with overweight at 6th grade cross-sectionally adjusting for gender, race, and maternal education. Additional covariates tested individually included the level of chaos at home, the quality of the home environment, the lax-parenting subscale score of the Raising Children Checklist, and the Child Behavior Checklist internalizing and externalizing subscale scores. Logistic regression also evaluated the relationship of sleep duration at 3rd grade and overweight at 6th grade, adjusting for gender, race, maternal education, and the child's BMI z score in 3rd grade.

RESULTS

Of 785 children, 50% were male, 81% were white, and 18% were overweight in 6th grade. Shorter sleep duration in 6th grade was independently associated with a greater likelihood of overweight in 6th grade. Shorter sleep duration in 3rd grade was also independently associated with overweight in 6th grade, independent of the child's weight status in 3rd grade. Sleep problems were not associated with overweight.

CONCLUSION

One preventive approach to overweight may be to ensure adequate sleep in childhood.

Weight status in young girls and the onset of puberty

OBJECTIVE

We sought to examine the association between weight status in early childhood and onset of puberty.

PATIENTS AND METHODS

The study included 354 girls from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Girls were followed longitudinally with height and weight measurements at 36 and 54 months and grades 1, 4, 5, and 6 and with assessment of pubertal stage by physical examination and maternal report in grades 4 through 6. The main outcome was the presence of early puberty, indexed as follows: (a) breast development at or more than Tanner stage 2 by physical examination at grade 4; (b) breast development at or more than Tanner stage 3 by physical examination at grade 5; (c) maternal report of breast development at or more than Tanner stage 3 at grade 5; and (d) maternal report of menarche having already occurred (yes versus no) at grade 6. Multiple logistic regression models predicting early versus late puberty were constructed by using the covariate BMI z score at 36 months, rate of change of BMI and accelerated BMI between 36 months and grade 1, race, maternal education, and maternal age of menarche.

RESULTS

BMI z score at 36 months, rate of change of BMI between 36 months and grade 1, an earlier age of maternal menarche, and nonwhite race were each consistently and positively associated with an earlier onset of puberty across the various measures of puberty.

CONCLUSIONS

Higher BMI z score in girls as young as 36 months of age and higher rate of change of BMI between 36 months old and grade 1, a period well before the onset of puberty, are associated with earlier puberty, which suggests that increasing rates of obesity in the United States may result in an earlier average age of onset of puberty for US girls.

Preschool-aged children with iron deficiency anemia show altered affect and behavior

This study compared social looking and response to novelty in preschool-aged children (47-68 mo) with or without iron deficiency anemia (IDA). Iron status of the participants from a low-income community in New Delhi, India, was based on venous hemoglobin, mean corpuscular volume, and red cell distribution width. Children's social looking toward adults, affect, and wary or hesitant behavior in response to novelty were assessed in a semistructured paradigm during an in-home play observation. Affect and behavior were compared as a function of iron status: IDA (n = 74) vs. nonanemic (n = 164). Compared with nonanemic preschoolers, preschoolers with IDA displayed less social looking toward their mothers, moved close to their mothers more quickly, and were slower to display positive affect and touch novel toys for the first time. These results indicate that IDA in the preschool period has affective and behavioral effects similar to those reported for IDA in infancy.

Language and false belief: Evidence for general, not specific, effects in cantonese-speaking preschoolers

Two studies were conducted with Cantonese-speaking preschoolers examining J. de Villiers's (1995) hypothesis that syntactic complements play a unique role in the acquisition of false belief (FB). In Study 1, the authors found a positive correlation between FB and syntactic complements in 72 four- to six-year-old Cantonese-speaking preschoolers. Study 2 followed 72 three- to five-year-old Cantonese-speaking children who initially failed an FB screening task and were then tested on general language abilities, short-term memory, inhibition, nonverbal IQ, and on FB and complement tasks. Once age and initial FB understanding were controlled for in both multiple regression and hierarchical linear modeling analyses, complements no longer uniquely predicted FB. Instead, individual differences in general language abilities and short-term memory contributed to the variation in both complements and FB.

The figure rating scale as an index of weight status of women on videotape

OBJECTIVE

To determine whether Stunkard's Figure Rating Scale (FRS) is a valid and reliable index of weight status when an unbiased observer assigns the figure ratings of adult women viewed on videotape.

RESEARCH METHODS AND PROCEDURES

Seventy-two women drawn from a community sample participated in a videotaped study in which height and weight were measured. The FRS is a rating scale displaying 9 silhouettes ranging from very thin to very obese. Women were assigned a figure rating "in-person" by a research assistant (FRS used as a 17-point scale) and by additional research assistants viewing women only on videotape (FRS used as both a 17- and 9-point scale). Pearson's correlation coefficients were calculated for in-person figure ratings, mean videotape figure ratings, and BMI.

RESULTS

BMI and in-person figure ratings were highly correlated (r = 0.91), as were BMI and both mean 17-point videotape figure ratings and mean 9-point videotape figure ratings (r = 0.89 and 0.87, respectively). Inter-rater agreement for in-person figure ratings and mean 17-point videotape figure ratings was 0.86, and agreement between in-person figure ratings and mean 9-point videotape figure ratings was 0.82.

DISCUSSION

The FRS can be used as an index of women's weight status by an unbiased observer, with subjects viewed in-person or on videotape.

Iron deficiency in infancy: applying a physiologic framework for prediction

BACKGROUND

Infants aged 6-24 mo are at high risk of iron deficiency. Numerous studies worldwide have sought to identify predictors of iron deficiency in this age group.

OBJECTIVE

The objectives of the study were to apply a physiologic model to identify risk factors for iron deficiency and to consider those risk factors under different conditions of iron supplementation. We predicted that factors related to iron status at birth (lower gestational age and lower birth weight), postnatal needs for iron (more rapid growth), and bioavailable iron (more cow milk) would be major risk factors.

DESIGN

The physiologic framework was assessed in 1657 Chilean infants (aged 12 mo) with birth weights >or=3 kg who were randomly assigned at age 6 mo to high or low iron supplementation or no added iron. Based on venous blood, the analysis used mean corpuscular volume and concentrations of hemoglobin, free erythrocyte protoporphyrin, and ferritin. Logistic regression models were used to identify predictors of iron deficiency anemia and iron deficiency without anemia.

RESULTS

The prevalence of iron deficiency (>or=2 abnormal iron measures) was 34.9% at age 12 mo. Of 186 infants with hemoglobin concentrations <110 g/L, 158 (84.9%) were iron deficient. The only consistent (and the strongest) predictor of iron deficiency or iron deficiency anemia was lower 6-mo hemoglobin. Factors related to poorer iron status at birth (lower birth weight, shorter gestation though full-term, or both) were predictors in the no-added-iron and high-iron groups. Otherwise, predictors varied by iron supplementation.

CONCLUSION

Variations in predictors of iron deficiency or iron deficiency anemia according to iron supplementation suggest that direct comparisons across studies are tenuous at best without data on early iron status and certainty that specific conditions are comparable.

Iron deficiency in infancy predicts altered serum prolactin response 10 years later

Serum prolactin may reflect CNS dopaminergic function. Because iron deficiency (ID) alters brain dopamine in rats, serum prolactin levels were previously investigated in infants with varied iron status. High serum prolactin levels correlated with behaviors typical of chronic ID. The objective of this study was to determine the effect of infant iron status on serum prolactin levels after a stressor in early adolescence. One hundred fifty-nine of 191 children enrolled in infancy (chronic ID, n = 46; good iron comparison group, n = 113) had serum prolactin measurements after catheter placement at 11-14 y of age. Serum prolactin levels were compared by sex, pubertal status and infant iron status and the pattern of change over time was compared by infant iron status controlling for pubertal stage and background factors. Males and less mature adolescents had lower serum prolactin concentrations than females and more mature adolescents. Controlling for these factors, the serum prolactin response pattern differed significantly by infant iron status. Serum prolactin declined earlier for the chronic ID group. In conclusion, an altered serum prolactin response pattern was observed 10 y after chronic ID in infancy and may suggest a long-lasting effect of ID on the regulation of prolactin.

The Diagnosis of Periodontal Disease in Private Practice

BACKGROUND

Periodontal disease is an inflammatory reaction to the bacteria in dental plaque. The present study compared the prevalence of periodontal disease in patients using as a diagnostic either probing depth measurements, an inflammatory marker such as numbers of white blood cells in plaque samples, or microbiological markers such as the microscopic count and the benzoyl-DL-arginine naphthylamide (BANA) test.

METHODS

Teeth with the most inflammation and/or deepest pockets in each quadrant were probed and subgingival plaque was sampled from 1,043 consecutive new patients enrolled in a private practice. Multivariate "diagnostic" models were developed based upon the probing depth (general linear models), percentage of white blood cell-positive and percentage of BANA-positive plaques (logistic regression models) to determine the prevalence of patients with periodontal disease.

RESULTS

Plaque samples were removed from 3,694 sites. Fifty-two percent of sampled pockets were >4 mm; 49% of sites were inflamed, using the presence of white blood cells, and 28% were infected using the BANA test. Diagnostic models were highly significant at P<0.0001. The white blood cell model was the most parsimonious as demonstrated by the lowest Akaike information criteria statistic and had the highest receiver operator characteristic (ROC) curve relative to the probing depth and BANA models.

CONCLUSIONS

Periodontal disease can be diagnosed chairside by the presence of white blood cells in plaque samples, a finding that reflects the inflammatory nature of the disease process. This approach would reduce the misclassification of subjects as having periodontal disease (130 patients in the present study who had pockets) but minimal evidence of an inflammatory response.