101
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Fadnes LT, Nankabirwa V, Engebretsen IM, Sommerfelt H, Birungi N, Lombard C, Swanevelder S, Van den Broeck J, Tylleskär T, Tumwine JK. Effects of an exclusive breastfeeding intervention for six months on growth patterns of 4-5 year old children in Uganda: the cluster-randomised PROMISE EBF trial. BMC Public Health 2016; 16:555. [PMID: 27405396 PMCID: PMC4942943 DOI: 10.1186/s12889-016-3234-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 06/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background Breastfeeding promotion is regarded as one of the most effective interventions to improve child health, and could reduce under-5-mortality by 8 % globally. Few studies have assessed the health outcomes beyond infancy of interventions promoting exclusive breastfeeding. Methods This study assessed growth in under-five children who participated in a cluster-randomised trial in Eastern Uganda (ClinicalTrials.gov.no.NCT00397150). In the intervention arm, peer counsellors promoted exclusive breastfeeding during the first 6 months of infancy. There were no interventions after 6 months of age. Mother-infant pairs were interviewed at visits scheduled at 3, 6, 12 and 24 weeks after birth and follow-up visits at 2 and 5 years, with 765 included in the analyses. Results The mean length/height-for-age and weight-for-age-z-score (HAZ, WAZ) decreased with increasing age in both the intervention and control arms. At the three weeks visit, HAZ in the intervention was −0.45 (−0.68;−0.21) and −0.32 (−0.56;−0.07) in the control arm. At the 2 year follow-up, the mean HAZ in the intervention was −1.85 (95 % CI −1.97;−1.73) compared to −1.61 (−1.87;−1.34) in the control. Similarly, at the 5 year follow-up, the mean HAZ in the intervention was −1.78 (−2.08;−1.47) compared to −1.53 (−1.79;−1.28) in the control arm. At the 2 year follow-up visit, 139 (45 %) were stunted (HAZ<−2) in the intervention compared to 109 (37 %) in the control arm, odds ratio (OR) 1.7 (1.1;2.4). Underweight (WAZ<−2) was also more common in the intervention arm than in the control at the five years follow-up (OR 1.7 (1.0;2.8)), with a mean WAZ of −1.28 (−1.47;−1.08) and −1.06 (−1.19;−0.92) in the intervention and control arm, respectively. Conclusion While stunting was widespread at 2 and 5 years of age in both arms, it was more common in the intervention arm. It is questionable whether community-based support from lay people with short training and focussing only on exclusive breastfeeding, is an appropriate strategy to improve child health and development. Trial registration ClinicalTrials.gov.no.NCT00397150. Registered 7th of November 2006. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3234-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lars T Fadnes
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Post box 7804, 5020, Bergen, Norway. .,Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
| | - Victoria Nankabirwa
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda.,Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - Ingunn M Engebretsen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Post box 7804, 5020, Bergen, Norway
| | - Halvor Sommerfelt
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Post box 7804, 5020, Bergen, Norway.,Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.,Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Nancy Birungi
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Carl Lombard
- Medical Research Council, Cape Town, Francie Van Zyl Drive, 7535, South Africa
| | - Sonja Swanevelder
- Medical Research Council, Cape Town, Francie Van Zyl Drive, 7535, South Africa
| | - Jan Van den Broeck
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Post box 7804, 5020, Bergen, Norway
| | - Thorkild Tylleskär
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Post box 7804, 5020, Bergen, Norway
| | - James K Tumwine
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
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102
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Savitri AI, Idris NS, Indawati W, Saldi SRF, Amelia D, Baharuddin M, Sastroasmoro S, Grobbee DE, Uiterwaal CSPM. BReastfeeding Attitude and Volume Optimization (BRAVO) trial: study protocol for a randomized controlled trial. Trials 2016; 17:271. [PMID: 27250730 PMCID: PMC4890480 DOI: 10.1186/s13063-016-1397-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A growing body of evidence shows the short-term benefits of breastfeeding, which include protection against infections, allergies, and lung diseases. However, evidence on the long-term benefits of breastfeeding is scarce and often conflicting. The BReastfeeding Attitude and Volume Optimization (BRAVO) trial is designed to study the effect of breastfeeding on early signs of later chronic diseases, particularly cardiovascular, respiratory, and metabolic risks later in life. In addition, the effectiveness of breastfeeding empowerment in promoting breastfeeding will also be evaluated. METHODS/DESIGN This study is an ongoing randomized trial in Jakarta, Indonesia, that began in July 2012. Pregnant women are being screened for their breastfeeding plan in the third trimester, and those with low intention to breastfeed are randomly allocated to either receiving an add-on breastfeeding-optimization program or usual care. Primary outcomes include breastfeeding rate, lung function, and blood pressure during the first year of life and vascular/cardiac characteristics, which will be measured at the age of 4 to 5 years. Child growth and infection/illness episodes are measured, whereas cognitive testing is planned for the children at 5 years of age. DISCUSSION To date, 784 women (80 %) have been randomized of the 1,000 planned, with satisfactory completeness of the 1-year follow up (90.1 %). Included mothers are of lower socioeconomic status and more often have blue-collar jobs, similar to what was observed in the pilot study. TRIAL REGISTRATION ClinicalTrials.gov, NCT01566812 . Registered on 27 March 2012.
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Affiliation(s)
- Ary I Savitri
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nikmah S Idris
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Child Health/Center for Clinical Epidemiology and Evidence Based Medicine (CEEBM) Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo National General Hospital, Jl. Salemba 6, Jakarta, Pusat, 10430, Indonesia.
| | - Wahyuni Indawati
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Child Health/Center for Clinical Epidemiology and Evidence Based Medicine (CEEBM) Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo National General Hospital, Jl. Salemba 6, Jakarta, Pusat, 10430, Indonesia
| | - Siti Rizny F Saldi
- Department of Child Health/Center for Clinical Epidemiology and Evidence Based Medicine (CEEBM) Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo National General Hospital, Jl. Salemba 6, Jakarta, Pusat, 10430, Indonesia
| | | | | | - Sudigdo Sastroasmoro
- Department of Child Health/Center for Clinical Epidemiology and Evidence Based Medicine (CEEBM) Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo National General Hospital, Jl. Salemba 6, Jakarta, Pusat, 10430, Indonesia
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center Utrecht, Utrecht, The Netherlands
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103
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Fields DA, Schneider CR, Pavela G. A narrative review of the associations between six bioactive components in breast milk and infant adiposity. Obesity (Silver Spring) 2016; 24:1213-21. [PMID: 27151491 PMCID: PMC5325144 DOI: 10.1002/oby.21519] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 03/01/2016] [Accepted: 03/06/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This narrative review examines six important non-nutritive substances in breast milk, many of which were thought to have little to no biological significance. The overall objective is to provide background on key bioactive factors in breast milk believed to have an effect on infant outcomes (growth and body composition). METHODS The evidence for the effects of the following six bioactive compounds in breast milk on infant growth outcomes are reviewed: insulin, leptin, adiponectin, ghrelin, interleukin-6, and tumor necrosis factor-α. RESULTS The existing literature on the effects of breast milk insulin, ghrelin, interleukin-6, and tumor necrosis factor-α and their associations with infant growth and adiposity is sparse. Of the bioactive compounds reviewed, leptin and adiponectin are the most researched. Data reveal that breast milk adiponectin has negative associations with growth in infancy. CONCLUSIONS There is a need for innovative, well-designed studies to improve causal inference and advance our understanding in the effects of breast milk and its components on offspring growth and body composition. The recommendations provided, along with careful consideration of both known and unknown factors that affect breast milk composition, will help improve, standardize, and ultimately advance this emergent field.
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Affiliation(s)
- David A Fields
- Department of Pediatrics, Section of Endocrinology and Diabetes, University
of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Camille R Schneider
- Department of Nutrition Sciences, University of Alabama at Birmingham,
Birmingham, AL
| | - Gregory Pavela
- Department of Health Behavior, University of Alabama at Birmingham,
Birmingham, AL
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104
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Blake-Lamb TL, Locks LM, Perkins ME, Woo Baidal JA, Cheng ER, Taveras EM. Interventions for Childhood Obesity in the First 1,000 Days A Systematic Review. Am J Prev Med 2016; 50:780-789. [PMID: 26916260 PMCID: PMC5207495 DOI: 10.1016/j.amepre.2015.11.010] [Citation(s) in RCA: 227] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 11/03/2015] [Accepted: 11/17/2015] [Indexed: 12/19/2022]
Abstract
CONTEXT The "first 1,000 days"-conception through age 24 months-are critical for the development and prevention of childhood obesity. This study systematically reviews existing and ongoing interventions during this period, identifies gaps in current research, and discusses conceptual frameworks and opportunities for future interventions. EVIDENCE ACQUISITION PubMed, Embase, Web of Science, and ClinicalTrials.gov were searched to identify completed and ongoing interventions implemented during pregnancy through age 24 months that aimed to prevent overweight/obesity between ages 6 months and 18 years. English-language, controlled interventions published between January 1, 1980 and December 12, 2014, were analyzed between December 13, 2014 and March 15, 2015. EVIDENCE SYNTHESIS Of 34 completed studies from 26 unique identified interventions, nine were effective. Effective interventions focused on individual- or family-level behavior changes through home visits, individual counseling or group sessions in clinical settings, a combination of home and group visits in a community setting, and using hydrolyzed protein formula. Protein-enriched formula increased childhood obesity risk. Forty-seven ongoing interventions were identified. Across completed and ongoing interventions, the majority target individual- or family-level changes, many are conducted in clinical settings, and few target early-life systems and policies that may impact childhood obesity. CONCLUSIONS Obesity interventions may have the greatest preventive effect if begun early in life. Yet, few effective interventions in the first 1,000 days exist, and many target individual-level behaviors of parents and infants. Interventions that operate at systems levels and are grounded in salient conceptual frameworks hold promise for improving future models of early-life obesity prevention.
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Affiliation(s)
- Tiffany L Blake-Lamb
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; Kraft Center for Community Health Leadership, Partners Healthcare, Boston, Massachusetts
| | - Lindsey M Locks
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Meghan E Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Jennifer A Woo Baidal
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts;; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York City, New York
| | - Erika R Cheng
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Elsie M Taveras
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts;.
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105
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Bion V, Lockett GA, Soto-Ramírez N, Zhang H, Venter C, Karmaus W, Holloway JW, Arshad SH. Evaluating the efficacy of breastfeeding guidelines on long-term outcomes for allergic disease. Allergy 2016; 71:661-70. [PMID: 26714430 DOI: 10.1111/all.12833] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2015] [Indexed: 01/30/2023]
Abstract
BACKGROUND WHO guidelines advocate breastfeeding for 6 months, and EAACI guideline recommends exclusive breastfeeding for 4-6 months. However, evidence for breastfeeding to prevent asthma and allergic disease is conflicting. We examined whether following recommended breastfeeding guidelines alters the long-term risks of asthma, eczema, rhinitis or atopy. METHODS The effect of nonexclusive (0, >0-6, >6 months) and exclusive breastfeeding (0, >0-4, >4 months) on repeated measures of asthma (10, 18 years), eczema, rhinitis, and atopy (1-or-2, 4, 10, 18 years) risks was estimated in the IoW cohort (n = 1456) using log-linear models with generalized estimating equations. The Food Allergy and Intolerance Research (FAIR) cohort (n = 988), also from the IoW, was examined to replicate results. RESULTS Breastfeeding (any or exclusive) had no effect on asthma and allergic disease in the IoW cohort. In the FAIR cohort, any breastfeeding for >0-6 months protected against asthma at 10 years (RR = 0.50, 95% CI = 0.32-0.79, P = 0.003), but not other outcomes, whilst exclusive breastfeeding for >4 months protected against repeated rhinitis (RR = 0.36, 95% CI = 0.18-0.71, P = 0.003). Longer breastfeeding was protective against late-onset wheeze in the IoW cohort. CONCLUSION The protective effects of nonexclusive and exclusive breastfeeding against long-term allergic outcomes were inconsistent between these colocated cohorts, agreeing with previous observations of heterogeneous effects. Although breastfeeding should be recommended for other health benefits, following breastfeeding guidelines did not appear to afford a consistent protection against long-term asthma, eczema, rhinitis or atopy. Further research is needed into the long-term effects of breastfeeding on allergic disease.
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Affiliation(s)
- V. Bion
- Human Development and Health; Faculty of Medicine; University of Southampton; Southampton UK
| | - G. A. Lockett
- Human Development and Health; Faculty of Medicine; University of Southampton; Southampton UK
| | - N. Soto-Ramírez
- Division of Epidemiology, Biostatistics and Environmental Health; School of Public Health; University of Memphis; Memphis TN USA
| | - H. Zhang
- Division of Epidemiology, Biostatistics and Environmental Health; School of Public Health; University of Memphis; Memphis TN USA
| | - C. Venter
- School of Health Sciences and Social Work; University of Portsmouth; Portsmouth UK
- The David Hide Asthma and Allergy Research Centre; St. Mary's Hospital; Isle of Wight UK
| | - W. Karmaus
- Division of Epidemiology, Biostatistics and Environmental Health; School of Public Health; University of Memphis; Memphis TN USA
| | - J. W. Holloway
- Human Development and Health; Faculty of Medicine; University of Southampton; Southampton UK
- Clinical and Experimental Sciences; Faculty of Medicine; University of Southampton; Southampton UK
| | - S. H. Arshad
- The David Hide Asthma and Allergy Research Centre; St. Mary's Hospital; Isle of Wight UK
- Clinical and Experimental Sciences; Faculty of Medicine; University of Southampton; Southampton UK
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106
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Pérez-Escamilla R, Martinez JL, Segura-Pérez S. Impact of the Baby-friendly Hospital Initiative on breastfeeding and child health outcomes: a systematic review. MATERNAL AND CHILD NUTRITION 2016; 12:402-17. [PMID: 26924775 DOI: 10.1111/mcn.12294] [Citation(s) in RCA: 318] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 12/21/2015] [Accepted: 12/31/2015] [Indexed: 12/12/2022]
Abstract
The Baby-friendly Hospital Initiative (BFHI) is a key component of the World Health Organization/United Nations Children's Fund Global Strategy for Infant and Young Child Feeding. The primary aim of this narrative systematic review was to examine the impact of BFHI implementation on breastfeeding and child health outcomes worldwide and in the United States. Experimental, quasi-experimental and observational studies were considered eligible for this review if they assessed breastfeeding outcomes and/or infant health outcomes for healthy, term infants born in a hospital or birthing center with full or partial implementation of BFHI steps. Of the 58 reports included in the systematic review, nine of them were published based on three randomized controlled trials, 19 followed quasi-experimental designs, 11 were prospective and 19 were cross-sectional or retrospective. Studies were conducted in 19 different countries located in South America, North America, Western Europe, Eastern Europe, South Asia, Eurasia and Sub-Saharan Africa. Adherence to the BFHI Ten Steps has a positive impact on short-term, medium-term and long-term breastfeeding (BF) outcomes. There is a dose-response relationship between the number of BFHI steps women are exposed to and the likelihood of improved BF outcomes (early BF initiation, exclusive breastfeeding (EBF) at hospital discharge, any BF and EBF duration). Community support (step 10) appears to be essential for sustaining breastfeeding impacts of BFHI in the longer term.
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Affiliation(s)
- Rafael Pérez-Escamilla
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Josefa L Martinez
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
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107
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Williams AM, Chantry C, Geubbels EL, Ramaiya AK, Shemdoe AI, Tancredi DJ, Young SL. Breastfeeding and Complementary Feeding Practices among HIV-Exposed Infants in Coastal Tanzania. J Hum Lact 2016; 32:112-22. [PMID: 26628498 DOI: 10.1177/0890334415618412] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 10/30/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Appropriate infant feeding is a persistent challenge for human immunodeficiency virus (HIV)-infected mothers in sub-Saharan Africa. OBJECTIVE This study aimed to describe correlates of infant feeding among HIV-infected mothers in coastal Tanzania. METHODS HIV-infected women (n = 400) with infants younger than 18 months were enrolled from June to November 2011 from 3 public health facilities in Pwani, Tanzania: Tumbi Regional Hospital (TRH), Chalinze Health Center (CHC), and Bagamoyo District Hospital (BDH). Participants were surveyed about sociodemographics and infant feeding behavior at enrollment; infant feeding data were collected prospectively and retrospectively in the month of study follow-up. RESULTS Statistically significant correlates of exclusive breastfeeding (EBF) were infant age (months) (adjusted odds ratio [AOR] = 0.6; 95% confidence interval [CI], 0.5-0.9), enrollment facility (TRH: reference; CHC: AOR = 5.0, 95% CI, 1.2-20.8; BDH: AOR = 11.6, 95% CI, 2.3-59.9), and HIV disclosure to one's mother (AOR = 0.2; 95% CI, 0.1-0.6). Exclusive breastfeeding prevalence among infants younger than 6 months was 77%, but 50% of infants older than 6 months no longer receiving breast milk did not receive animal source foods (ASF) daily. Enrollment facility (TRH: reference; CHC: AOR = 0.2, 95% CI, 0.1-1.0; BDH: AOR = 0.1, 95% CI, 0.01-0.4) and HIV disclosure (to mother-in-law: AOR = 0.2, 95% CI, 0.1-0.8; to brother: AOR = 0.3, 95% CI, 0.1-0.8) were negatively associated with ASF provision. CONCLUSION High prevalence of EBF suggests that it is an attainable behavior, whereas low prevalence of daily ASF provision suggests that adequate diets are difficult to achieve after breastfeeding cessation. These findings support current recommendations for HIV-infected mothers in resource-poor regions to continue breastfeeding for at least 1 year and suggest the need for greater support with complementary feeding. Associations between HIV disclosure and infant feeding merit further exploration, and correlations between enrollment facility and infant feeding highlight the potential influence of clinics on achieving infant feeding recommendations.
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Affiliation(s)
- Anne M Williams
- Program in International and Community Nutrition, University of California, Davis, CA, USA
| | - Caroline Chantry
- Program in International and Community Nutrition, University of California, Davis, CA, USA Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA, USA
| | | | | | | | - Daniel J Tancredi
- Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA, USA
| | - Sera L Young
- Department of Population Medicine & Diagnostic Sciences, Program in International Nutrition, Cornell University, Ithaca, NY, USA
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108
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Perng W, Rifas-Shiman SL, Kramer MS, Haugaard LK, Oken E, Gillman MW, Belfort MB. Early Weight Gain, Linear Growth, and Mid-Childhood Blood Pressure: A Prospective Study in Project Viva. Hypertension 2016; 67:301-8. [PMID: 26644238 PMCID: PMC4769100 DOI: 10.1161/hypertensionaha.115.06635] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 11/15/2015] [Indexed: 12/22/2022]
Abstract
In recent years, the prevalence of hypertension and prehypertension increased markedly among children and adolescents, highlighting the importance of identifying determinants of elevated blood pressure early in life. Low birth weight and rapid early childhood weight gain are associated with higher future blood pressure. However, few studies have examined the timing of postnatal weight gain in relation to later blood pressure, and little is known regarding the contribution of linear growth. We studied 957 participants in Project Viva, an ongoing US prebirth cohort. We examined the relations of gains in body mass index z-score and length/height z-score during 4 early life age intervals (birth to 6 months, 6 months to 1 year, 1 to 2 years, and 2 to 3 years) with blood pressure during mid-childhood (6-10 years) and evaluated whether these relations differed by birth size. After accounting for confounders, each additional z-score gain in body mass index during birth to 6 months and 2 to 3 years was associated with 0.81 (0.15, 1.46) and 1.61 (0.33, 2.89) mm Hg higher systolic blood pressure, respectively. Length/height gain was unrelated to mid-childhood blood pressure, and there was no evidence of effect modification by birth size for body mass index or length/height z-score gain. Our findings suggest that more rapid gain in body mass index during the first 6 postnatal months and in the preschool years may lead to higher systolic blood pressure in mid-childhood, regardless of size at birth. Strategies to reduce accrual of excess adiposity during early life may reduce mid-childhood blood pressure, which may also impact adult blood pressure and cardiovascular health.
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Affiliation(s)
- Wei Perng
- From the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI (W.P.); Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (S.L.R.-S., E.O., M.W.G.); Departments of Pediatrics and Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada (M.S.K.); Novo Nordisk Foundation Center for Basic Metabolic Research, Health and Medical Sciences, University of Copenhagen, Denmark (L.K.H.); Institute of Preventive Medicine; Bispebjerg and Frederiksberg Hospitals, The Capital Region, Copenhagen, Denmark (L.K.H.); Department of Nutrition, T.H. Chan Harvard School of Public Health, Boston, MA (E.O., M.W.G.); and Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA (M.B.B.).
| | - Sheryl L Rifas-Shiman
- From the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI (W.P.); Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (S.L.R.-S., E.O., M.W.G.); Departments of Pediatrics and Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada (M.S.K.); Novo Nordisk Foundation Center for Basic Metabolic Research, Health and Medical Sciences, University of Copenhagen, Denmark (L.K.H.); Institute of Preventive Medicine; Bispebjerg and Frederiksberg Hospitals, The Capital Region, Copenhagen, Denmark (L.K.H.); Department of Nutrition, T.H. Chan Harvard School of Public Health, Boston, MA (E.O., M.W.G.); and Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA (M.B.B.)
| | - Michael S Kramer
- From the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI (W.P.); Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (S.L.R.-S., E.O., M.W.G.); Departments of Pediatrics and Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada (M.S.K.); Novo Nordisk Foundation Center for Basic Metabolic Research, Health and Medical Sciences, University of Copenhagen, Denmark (L.K.H.); Institute of Preventive Medicine; Bispebjerg and Frederiksberg Hospitals, The Capital Region, Copenhagen, Denmark (L.K.H.); Department of Nutrition, T.H. Chan Harvard School of Public Health, Boston, MA (E.O., M.W.G.); and Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA (M.B.B.)
| | - Line K Haugaard
- From the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI (W.P.); Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (S.L.R.-S., E.O., M.W.G.); Departments of Pediatrics and Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada (M.S.K.); Novo Nordisk Foundation Center for Basic Metabolic Research, Health and Medical Sciences, University of Copenhagen, Denmark (L.K.H.); Institute of Preventive Medicine; Bispebjerg and Frederiksberg Hospitals, The Capital Region, Copenhagen, Denmark (L.K.H.); Department of Nutrition, T.H. Chan Harvard School of Public Health, Boston, MA (E.O., M.W.G.); and Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA (M.B.B.)
| | - Emily Oken
- From the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI (W.P.); Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (S.L.R.-S., E.O., M.W.G.); Departments of Pediatrics and Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada (M.S.K.); Novo Nordisk Foundation Center for Basic Metabolic Research, Health and Medical Sciences, University of Copenhagen, Denmark (L.K.H.); Institute of Preventive Medicine; Bispebjerg and Frederiksberg Hospitals, The Capital Region, Copenhagen, Denmark (L.K.H.); Department of Nutrition, T.H. Chan Harvard School of Public Health, Boston, MA (E.O., M.W.G.); and Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA (M.B.B.)
| | - Matthew W Gillman
- From the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI (W.P.); Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (S.L.R.-S., E.O., M.W.G.); Departments of Pediatrics and Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada (M.S.K.); Novo Nordisk Foundation Center for Basic Metabolic Research, Health and Medical Sciences, University of Copenhagen, Denmark (L.K.H.); Institute of Preventive Medicine; Bispebjerg and Frederiksberg Hospitals, The Capital Region, Copenhagen, Denmark (L.K.H.); Department of Nutrition, T.H. Chan Harvard School of Public Health, Boston, MA (E.O., M.W.G.); and Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA (M.B.B.)
| | - Mandy B Belfort
- From the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI (W.P.); Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (S.L.R.-S., E.O., M.W.G.); Departments of Pediatrics and Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada (M.S.K.); Novo Nordisk Foundation Center for Basic Metabolic Research, Health and Medical Sciences, University of Copenhagen, Denmark (L.K.H.); Institute of Preventive Medicine; Bispebjerg and Frederiksberg Hospitals, The Capital Region, Copenhagen, Denmark (L.K.H.); Department of Nutrition, T.H. Chan Harvard School of Public Health, Boston, MA (E.O., M.W.G.); and Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA (M.B.B.)
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Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387:475-90. [PMID: 26869575 DOI: 10.1016/s0140-6736(15)01024-7] [Citation(s) in RCA: 3742] [Impact Index Per Article: 467.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The importance of breastfeeding in low-income and middle-income countries is well recognised, but less consensus exists about its importance in high-income countries. In low-income and middle-income countries, only 37% of children younger than 6 months of age are exclusively breastfed. With few exceptions, breastfeeding duration is shorter in high-income countries than in those that are resource-poor. Our meta-analyses indicate protection against child infections and malocclusion, increases in intelligence, and probable reductions in overweight and diabetes. We did not find associations with allergic disorders such as asthma or with blood pressure or cholesterol, and we noted an increase in tooth decay with longer periods of breastfeeding. For nursing women, breastfeeding gave protection against breast cancer and it improved birth spacing, and it might also protect against ovarian cancer and type 2 diabetes. The scaling up of breastfeeding to a near universal level could prevent 823,000 annual deaths in children younger than 5 years and 20,000 annual deaths from breast cancer. Recent epidemiological and biological findings from during the past decade expand on the known benefits of breastfeeding for women and children, whether they are rich or poor.
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Affiliation(s)
- Cesar G Victora
- International Center for Equity in Health, Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health (MCA), WHO, Geneva, Switzerland
| | - Aluísio J D Barros
- International Center for Equity in Health, Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Giovanny V A França
- International Center for Equity in Health, Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Susan Horton
- Department of Economics, University of Waterloo, ON, Canada
| | - Julia Krasevec
- Data and Analytics Section, Division of Data, Research, and Policy, UNICEF, New York, NY, USA
| | - Simon Murch
- University Hospital Coventry and Warwickshire, Coventry, UK
| | - Mari Jeeva Sankar
- WHO Collaborating Centre for Training and Research in Newborn Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Neff Walker
- Institute for International Programs, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nigel C Rollins
- Department of Maternal, Newborn, Child and Adolescent Health (MCA), WHO, Geneva, Switzerland
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Redsell SA, Edmonds B, Swift JA, Siriwardena AN, Weng S, Nathan D, Glazebrook C. Systematic review of randomised controlled trials of interventions that aim to reduce the risk, either directly or indirectly, of overweight and obesity in infancy and early childhood. MATERNAL & CHILD NUTRITION 2016; 12:24-38. [PMID: 25894857 PMCID: PMC5029770 DOI: 10.1111/mcn.12184] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The risk factors for childhood overweight and obesity are known and can be identified antenatally or during infancy, however, the majority of effective interventions are designed for older children. This review identified interventions designed to reduce the risk of overweight/obesity that were delivered antenatally or during the first 2 years of life, with outcomes reported from birth to 7 years of age. Six electronic databases were searched for papers reporting randomised controlled trials of interventions published from January 1990 to September 2013. A total of 35 eligible studies were identified, describing 27 unique trials of which 24 were behavioural and three were non-behavioural. The 24 behavioural trials were categorised by type of intervention: (1) nutritional and/or responsive feeding interventions targeted at parents of infants, which improved feeding practices and had some impact on child weight (n = 12); (2) breastfeeding promotion and lactation support for mothers, which had a positive effect on breastfeeding but not child weight (n = 5); (3) parenting and family lifestyle (n = 4); and (4) maternal health (n = 3) interventions that had some impact on feeding practices but not child weight. The non-behavioural trials comprised interventions manipulating formula milk composition (n = 3). Of these, lower/hydrolysed protein formula milk had a positive effect on weight outcomes. Interventions that aim to improve diet and parental responsiveness to infant cues showed most promise in terms of self-reported behavioural change. Despite the known risk factors, there were very few intervention studies for pregnant women that continue during infancy which should be a priority for future research.
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Affiliation(s)
- Sarah A. Redsell
- Faculty of Health, Social Care and EducationAnglia Ruskin UniversityCambridgeUK
| | - Barrie Edmonds
- School of Health SciencesQueen's Medical CentreUniversity of NottinghamNottinghamUK
| | - Judy Anne Swift
- Division of Nutritional SciencesSchool of BiosciencesUniversity of NottinghamNottinghamUK
| | | | - Stephen Weng
- Division of Primary CareUniversity of NottinghamNottinghamUK
| | - Dilip Nathan
- Department of Child HealthQueen's Medical CentreNottingham University Hospitals TrustNottinghamUK
| | - Cris Glazebrook
- Institute of Mental HealthUniversity of Nottingham Innovation ParkNottinghamUK
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111
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Bohr AD, Boardman JD, Domingue BW, McQueen MB. Breastfeeding is associated with waist-to-height ratio in young adults. BMC Public Health 2015; 15:1281. [PMID: 26700003 PMCID: PMC4688938 DOI: 10.1186/s12889-015-2611-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 12/14/2015] [Indexed: 11/28/2022] Open
Abstract
Background The current study investigated the association between breastfeeding and adult weight distribution using an emerging indicator of weight distribution, the waist-to-height ratio (WHtR). Methods The study sample consisted of two subsamples of individuals that were part of the National Longitudinal Study of Adolescent Health. One sample (n = 1 179) consisted of individuals from the sibling pair data. A second sample (n = 4 648) consisted of individuals that were not part of the paired data. Regression models were constructed to establish if there was a relationship between breastfeeding and two measures of weight distribution: WHtR and body mass index (BMI). Controls for parental socioeconomic status, maternal smoking, race, sex, age, birth weight, maternal BMI, genetic ancestry, and a genetic risk score (GRS) for obesity were included. In addition, a behavioral risk score (BRS) was constructed to control for other residual confounding factors. Results A significant, inverse relationship between breastfeeding and adult WHtR persisted in models constructed from the sibling pair sample (P = 0.002) and unrelated sample (P <0.0001). This association remained significant with the inclusion of ancestry principal components, GRS, and a measure of maternal obesity. Conclusions The moderate association between breastfeeding and weight distribution persists into adulthood while controlling for potential confounders. This paper also provides evidence that the WHtR may be a superior outcome measure to BMI in studies investigating breastfeeding and obesity. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2611-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adam D Bohr
- University of Colorado Boulder, 4185 47th St., Unit C, Boulder, CO, 80301, USA.
| | - Jason D Boardman
- Institute of Behavioral Science, University of Colorado Boulder, 483 UCB, Boulder, CO, 80309-0483, USA.
| | - Benjamin W Domingue
- Graduate School of Education, Stanford University, 502 Galvez Mall, Stanford, CA, 94305, USA.
| | - Matthew B McQueen
- Department of Integrative Physiology, University of Colorado Boulder, 354 UCB, Clare Small 102, Boulder, CO, 80309-0354, USA.
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112
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Ozdogan S, Tabakci B, Demirel AS, Atli B, Besli GE, Kose G. The evaluation of risk factors for recurrent hospitalizations resulting from wheezing attacks in preschool children. Ital J Pediatr 2015; 41:91. [PMID: 26577276 PMCID: PMC4650256 DOI: 10.1186/s13052-015-0201-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 11/11/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND We aimed to evaluate the risk factors in preschool children admitted to inpatient services with a diagnosis of recurrent attacks of wheezing. METHOD The medical files of 44 preschool children with 2 or more recurrent hospitalizations resulting from wheezing between November 2011 and January 2012 were retrospectively investigated. RESULTS There were 28 males (64 %) and 16 females. The median age was 14 months (2.0-50). The median numbers of previous wheezing attacks and hospitalizations were 4 (2-10) and 2 (2-8), respectively. Fourteen patients (32 %) had been treated for gastroesophageal reflux (GER). The previous and recent hospital evaluations were investigated. Bronchopulmonary dysplasia and anemia were significantly more common in patients with 3 or more hospitalizations for wheezing than in those with 2 hospitalizations (p = 0.010 and p < 0.001, respectively). A review of the cases with 3 or more hospitalizations revealed that a history of GER and anemia were significant risk factors. CONCLUSION Anemia and GER are risk factors for recurrent hospitalizations resulting from wheezing and should be treated. If the history and physical examination suggest asthma, inhaler therapy treatment should be administered, with other investigations planned for patients who do not respond to treatment as expected.
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Affiliation(s)
- Sebnem Ozdogan
- Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey.
- Sinan Ercan Sok, Isiklar 1 Apt. No 34, Da: 23, 34742, Kozyataği, Istanbul, Turkey.
| | - Burcu Tabakci
- Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey.
| | | | - Bilge Atli
- Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey.
| | - Gulser Esen Besli
- Istanbul Medeniyet University, Faculty of Medicine, Goztepe, Turkey.
| | - Gulsen Kose
- Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey.
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113
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Epidemiology of elevated blood pressure and associated risk factors in Chinese children: the SNEC study. J Hum Hypertens 2015; 30:231-6. [PMID: 26446390 DOI: 10.1038/jhh.2015.104] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/27/2015] [Accepted: 09/07/2015] [Indexed: 12/19/2022]
Abstract
Despite the association of childhood blood pressure (BP) with hypertension later in the life course, there remains dearth of information regarding the prevalence and emergence of hypertension in children, especially in China. To investigate the current status of BP, prevalence of elevated BP and related factors in Chinese children, a cross-sectional survey in a representative sample of 9354 Chinese children 5-17 years old was conducted in seven cities in Northeastern China during 2011 and 2012. BP measurements were taken by mercury sphygmomanometer. Elevated BP in children was defined as an average diastolic BP or systolic BP that is in the 95th percentile or higher for their gender, age and height. Overall, total prevalence of elevated BP was 13.8%, and no significant difference between males and females was identified. Multivariate analyses revealed that children having a higher area of residence had a lower of elevated BP. Increased odds for elevated BP were found for individuals who were lean (odds ratio (OR)=2.12; 95% confidence interval (CI): 1.67-2.69), overweight (OR=2.05; 95% CI: 1.74-2.42), obese (OR=3.15; 95% CI: 2.70-3.68), were born with low birth weight (OR=1.26; 95%CI: 1.01-1.63), premature birth (OR=1.46; 95%CI: 1.13-1.88), and were with home coal use (OR=1.24; 95%CI: 1.02-1.52). In conclusion, elevated BP was found to be prevalent in children in urban areas of Northeast China. These results underscore the importance of implementing a package of measures aimed at reducing malleable risk for this cardiovascular condition in school-aged children in Northeast China.
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114
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Gage SH, Munafò MR, Davey Smith G. Causal Inference in Developmental Origins of Health and Disease (DOHaD) Research. Annu Rev Psychol 2015; 67:567-85. [PMID: 26442667 DOI: 10.1146/annurev-psych-122414-033352] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Studies of the developmental origins of health and disease (DOHaD) often rely on prospective observational data, from which associations between developmental exposures and outcomes in later life can be identified. Typically, conventional statistical methods are used in an attempt to mitigate problems inherent in observational data, such as confounding and reverse causality, but these have serious limitations. In this review, we discuss a variety of methods that are increasingly being used in observational epidemiological studies to help strengthen causal inference. These methods include negative controls, cross-contextual designs, instrumental variables (including Mendelian randomization), family-based studies, and natural experiments. Applications within the DOHaD framework, and in relation to behavioral, psychiatric, and psychological domains, are considered, and the considerable potential for expanding the use of these methods is outlined.
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Affiliation(s)
- Suzanne H Gage
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol BS8 2BN, United Kingdom; .,UK Center for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol BS8 1TU, United Kingdom
| | - Marcus R Munafò
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol BS8 2BN, United Kingdom; .,UK Center for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol BS8 1TU, United Kingdom
| | - George Davey Smith
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol BS8 2BN, United Kingdom;
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115
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Schwartz R, Vigo Á, Dias de Oliveira L, Justo Giugliani ER. The Effect of a Pro-Breastfeeding and Healthy Complementary Feeding Intervention Targeting Adolescent Mothers and Grandmothers on Growth and Prevalence of Overweight of Preschool Children. PLoS One 2015; 10:e0131884. [PMID: 26161657 PMCID: PMC4498782 DOI: 10.1371/journal.pone.0131884] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 06/08/2015] [Indexed: 12/29/2022] Open
Abstract
Introduction The pattern and duration of breastfeeding (BF) and the age at onset of complementary feeding, as well as its quality, have been associated with the prevalence of overweight in childhood. Objective To assess the effect of a pro-BF and healthy complementary feeding intervention, targeted to adolescent mothers and maternal grandmothers, on growth and prevalence of overweight and obesity in children at preschool age. This intervention had a positive impact on duration of BF and timing of onset of complementary feeding. Methods This randomized clinical trial involved 323 adolescent mothers, their infants, and the infants’ maternal grandmothers, when they cohabited. Mothers and grandmothers in the intervention group received counseling sessions on BF and healthy complementary feeding at the maternity ward and at home (7, 15, 30, 60, and 120 days after delivery). When children were aged 4 to 7 years, they underwent anthropometric assessment and collection of data on dietary habits. Multivariable Poisson regression with robust estimation was used for analysis. Results BMI-for-age and height-for-age were similar in the intervention and control groups, as was the prevalence of overweight (39% vs. 31% respectively; p=0.318). There were no significant between-group differences in dietary habits. Conclusion Although the intervention prolonged the duration of exclusive BF and delayed the onset of complementary feeding, it had no impact on growth or prevalence of overweight at age 4 to 7 years. Trial Registration ClinicalTrials.gov NCT00910377
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Affiliation(s)
- Renata Schwartz
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- * E-mail:
| | - Álvaro Vigo
- Department of Statistics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luciana Dias de Oliveira
- Department of Nutrition, Universidade Federal do Rio Grande do Sul, Center for Food and Nutrition Studies (CESAN), Hospital de Clínicas de Porto Alegre, HCPA, Porto Alegre, Rio Grande do Sul, Brazil
| | - Elsa Regina Justo Giugliani
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Abstract
The adoption of healthful lifestyles by individuals and families can result in a reduction in many chronic diseases and conditions of which obesity is the most prevalent. Obesity prevention, in addition to treatment, is an important public health priority. This clinical report describes the rationale for pediatricians to be an integral part of the obesity-prevention effort. In addition, the 2012 Institute of Medicine report "Accelerating Progress in Obesity Prevention" includes health care providers as a crucial component of successful weight control. Research on obesity prevention in the pediatric care setting as well as evidence-informed practical approaches and targets for prevention are reviewed. Pediatricians should use a longitudinal, developmentally appropriate life-course approach to help identify children early on the path to obesity and base prevention efforts on family dynamics and reduction in high-risk dietary and activity behaviors. They should promote a diet free of sugar-sweetened beverages, of fewer foods with high caloric density, and of increased intake of fruits and vegetables. It is also important to promote a lifestyle with reduced sedentary behavior and with 60 minutes of daily moderate to vigorous physical activity. This report also identifies important gaps in evidence that need to be filled by future research.
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117
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Cloutier MM, Wiley J, Wang Z, Grant A, Gorin AA. The Early Childhood Obesity Prevention Program (ECHO): an ecologically-based intervention delivered by home visitors for newborns and their mothers. BMC Public Health 2015; 15:584. [PMID: 26104068 PMCID: PMC4477472 DOI: 10.1186/s12889-015-1897-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 06/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity is a major problem in the United States, particularly among socio-economically disadvantaged Latino and Black children. Effective interventions that can be disseminated to large numbers of at-risk children and their families are needed. The goals of the Early Childhood Obesity Prevention Program (ECHO) are to examine the 12-month efficacy of a primary obesity prevention program targeting the first year of life that is delivered by home visitors and that engages mothers as agents of change to modify their own behavior and their infant's behavior through education and skill-building around nutrition, physical activity, and wellness, and then "echoes" her training with linkages to neighborhood programs and resources. METHODS/DESIGN Six family centers located in low-income neighborhoods in Hartford, CT were randomized into control and intervention neighborhoods. Fifty-seven mothers were recruited either prenatally or shortly after delivery into the Nurturing Families Network home visitation program; 27 lived in a control neighborhood and received the standard home visitation program and 30 lived in an intervention neighborhood and received both the standard home visitation program and the ECHO intervention. The intervention increases maternal skills in goal-setting, stimulus control and problem-solving, engages family members to support changes, links mothers to neighborhood resources and is embedded in the standard home visitation program. ECHO targets include breastfeeding, solids, juice and sugar-sweetened beverages, routines for sleep and responding to infant cues, television/screen time, and maternal diet and physical activity. We hypothesize that infants in ECHO will have been breastfed longer and exclusively, will have delayed introduction of solids and juice, have longer sleep duration, decreased television/screen time and a lower weight for length z-score at 12 months, and their mothers will have greater fruit and vegetable consumption and higher levels of physical activity. DISCUSSION ECHO will provide important information about whether an enhanced behavior change curriculum integrated into an existing home visitation program, focused on the mother as the agent of change and linked to neighborhood resources is effective in changing energy balance behaviors in the infant and in the mother. If effective, the intervention could be widely disseminated to prevent obesity in young children. TRIAL REGISTRATION ClinicalTrials.gov NCT02052518 January 30, 2014.
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Affiliation(s)
- Michelle M Cloutier
- Department of Pediatrics, University of Connecticut Health Center, Farmington, CT, USA.
- Children's Center for Community Research, Connecticut Children's Medical Center, 282 Washington St, Hartford, CT, 06106, USA.
| | - James Wiley
- Children's Center for Community Research, Connecticut Children's Medical Center, 282 Washington St, Hartford, CT, 06106, USA.
| | - Zhu Wang
- Department of Research, Connecticut Children's Medical Center, 282 Washington St, Hartford, CT, 06106, USA.
| | - Autherene Grant
- Children's Center for Community Research, Connecticut Children's Medical Center, 282 Washington St, Hartford, CT, 06106, USA.
| | - Amy A Gorin
- Department of Psychology, Center for Health, Intervention and Prevention, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT, 06269-1248, USA.
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118
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Ramirez-Silva I, Rivera JA, Trejo-Valdivia B, Martorell R, Stein AD, Romieu I, Barraza-Villarreal A, Ramakrishnan U. Breastfeeding status at age 3 months is associated with adiposity and cardiometabolic markers at age 4 years in Mexican children. J Nutr 2015; 145:1295-302. [PMID: 25926414 PMCID: PMC4442109 DOI: 10.3945/jn.114.198366] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 07/24/2014] [Accepted: 04/06/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The effect of breastfeeding (BF) on cardiometabolic risk factors is not well characterized. OBJECTIVE The objective was to assess the association of BF status at 3 mo and duration with adiposity and cardiometabolic markers at 4 y. METHODS We studied 727 children with prospectively collected BF information and anthropometric measurements at 4 y, of whom 524 provided a nonfasting blood sample. BF status at 3 mo was classified as exclusive or predominant (EBF-PreBF), partial (PaBF), or nonbreastfeeding (NBF). Total duration of any BF was classified as <3 mo, 3- 6 mo, >6 to 12 mo, and >12 mo. We modeled associations of BF with body mass index (BMI; in kg/m(2)), serum total cholesterol and low-density lipoprotein (LDL) cholesterol, triglycerides (TGs), and insulin at 4 y. RESULTS Children who were NBF or PaBF at 3 mo had higher BMI [0.46 (95% CI: 0.16, 0.76) and 0.31 (95% CI: 0.07, 0.54), respectively] than the EBF-PreBF group (P < 0.01). NBF children had higher total cholesterol (8.02 mg/dL; 95% CI: 1.39, 14.64; P = 0.02) than children who were EBF-PreBF. LDL cholesterol (5.04 mg/dL; 95% CI: -0.72, 10.81) and TGs (12% change; 95% CI: -0.01, 0.24) showed similar patterns. An inverse association between EBF-PreBF and insulin, mediated through abdominal circumference, was documented (P < 0.05). Children breastfed <3 mo had higher BMI (0.44; 95% CI: 0.11, 0.77) at 4 y than children breastfed for >12 mo. CONCLUSION EBF and PreBF at 3 mo were associated with lower adiposity and serum total cholesterol in children at 4 y. In addition, BF >12 mo was associated with lower adiposity. These data confirm the importance of exclusive BF and prolonged BF for later cardiometabolic health.
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Affiliation(s)
| | | | - Belem Trejo-Valdivia
- Center for Evaluation Research and Surveys, National Institute of Public Health, Cuernavaca, Mexico
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA; and
| | - Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA; and
| | - Isabelle Romieu
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | | | - Usha Ramakrishnan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA; and
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Growth trajectories in early childhood, their relationship with antenatal and postnatal factors, and development of obesity by age 9 years: results from an Australian birth cohort study. Int J Obes (Lond) 2015; 39:1049-56. [PMID: 26008137 DOI: 10.1038/ijo.2015.42] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 12/08/2014] [Accepted: 12/18/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND In an era where around one in four children in the United Kingdom, the United States, and Australia are overweight or obese, the development of obesity in early life needs to be better understood. We aimed to identify groups of children with distinct trajectories of growth in infancy and early childhood, to examine any association between these trajectories and body size at age 9, and to assess the relative influence of antenatal and postnatal exposures on growth trajectories. DESIGN Prospective Australian birth cohort study. SUBJECTS AND METHODS In total, 557 children with serial height and weight measurements from birth to 9 years were included in the study. Latent class growth models were used to derive distinct groups of growth trajectories from birth to age 3½ years. Multivariable logistic regression models were used to explore antenatal and postnatal predictors of growth trajectory groups, and multivariable linear and logistic regression models were used to examine the relationships between growth trajectory groups and body size at age 9 years. RESULTS We identified four discrete growth trajectories from birth to age 3½ years, characterised as low, intermediate, high, or accelerating growth. Relative to the intermediate growth group, the low group had reduced z-body mass index (BMI) (-0.75 s.d.; 95% confidence interval (CI) -1.02, -0.47), and the high and accelerating groups were associated with increased body size at age 9 years (high: z-BMI 0.70 s.d.; 95% CI 0.49, 0.62; accelerating: z-BMI 1.64 s.d.; 95% CI 1.16, 2.11). Of the antenatal and postnatal exposures considered, the most important differentiating factor was maternal obesity in early pregnancy, associated with a near quadrupling of risk of membership of the accelerating growth trajectory group compared with the intermediate growth group (odds ratio (OR) 3.72; 95% CI 1.15, 12.05). CONCLUSIONS Efforts to prevent childhood obesity may need to be embedded within population-wide strategies that also pay attention to healthy weight for women in their reproductive years.
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Gabida M, Chemhuru M, Tshimanga M, Gombe NT, Takundwa L, Bangure D. Effect of distribution of educational material to mothers on duration and severity of diarrhoea and pneumonia, Midlands Province, Zimbabwe: a cluster randomized controlled trial. Int Breastfeed J 2015; 10:13. [PMID: 26246847 PMCID: PMC4525732 DOI: 10.1186/s13006-015-0037-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 03/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exclusive breastfeeding rates remain low in most countries in sub-Saharan Africa. We assessed the effects of a mother-based intervention on duration of diarrhoea and pneumonia in communities that were trained and those not trained in community infant and young child feeding (cIYCF) in Midlands Province, Zimbabwe. METHODS We evaluated communities with village health workers who received training in cIYCF and the distribution of educational materials (newsletter) to mothers in promotion of exclusive breastfeeding using a two-by-two factorial cluster randomized controlled trial. The trial arms included clusters trained in cIYCF only, clusters with mothers that received a newsletter only, clusters that received both interventions and clusters receiving no intervention. Consenting mother-infant pairs identified within 72 hours of delivery were followed up at 14 and 20 weeks where duration of diarrhoea and pneumonia as well as severity of diarrhoea was assessed. Clusters were facility catchment areas assigned by an independent statistician using randomization generated by a computer using Stata 10. All admitting facilities and facilities at borders were excluded as buffer zones and eight clusters were analysed. Nutritionists who collected data were not aware of the hypothesis being tested and analysis was by intention-to-treat. RESULTS A total of 357 mother-infant pairs were available for analysis in all the clusters. The interaction between cIYCF training and the newsletter was statistically significant at 14 weeks (p = 0.022). The mean duration of diarrhoea was 2.9 (SD = 0.9) days among infants of mothers who resided in communities trained and received a newsletter compared to 5.2 (SD = 1.1) days in communities that received neither. The protective efficacy of the cIYCF plus newsletter was 76% during the first 20 weeks of life. In the two way ANOVA, the newsletter was more effective on duration of pneumonia (p = 0.010) at 14 weeks and remained significantly effective at 20 weeks (p < 0.0001). CONCLUSIONS A combined community and distribution of a newsletter to mothers on promotion of exclusive breastfeeding reduces duration of diarrhoea at 14 weeks. At 20 weeks, the newsletter worked better for both duration of diarrhoea and pneumonia compared to cIYCF training alone.
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Affiliation(s)
- Meggie Gabida
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Milton Chemhuru
- Provincial Medical Directorate, Midlands Province, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Mufuta Tshimanga
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Notion T Gombe
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Lucia Takundwa
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Donewell Bangure
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
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Grube MM, von der Lippe E, Schlaud M, Brettschneider AK. Does breastfeeding help to reduce the risk of childhood overweight and obesity? A propensity score analysis of data from the KiGGS study. PLoS One 2015; 10:e0122534. [PMID: 25811831 PMCID: PMC4374721 DOI: 10.1371/journal.pone.0122534] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 02/17/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Current studies suggest that the beneficial effect of breastfeeding on overweight and obesity may have been largely overestimated. We examined the relationship between >4 months of full breastfeeding and overweight/obesity in children living in Germany. METHODS We analyzed retrospectively collected data on breastfeeding from children aged 3-17 years who participated in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS baseline study) between 2003 and 2006 (n = 13163). To minimize confounding, we applied propensity score matching and multivariate logistic regression analyses to estimate the effect of breastfeeding on childhood overweight and obesity. RESULTS Adjusted analyses of the matched dataset (n = 8034) indicated that children who were breastfed for >4 months had a significant reduction in the odds of overweight (OR 0.81 [95% CI 0.71–0.92]) and obesity (OR 0.75 [95% CI 0.61–0.92]) compared to children who were not breastfed or who were breastfed for a shorter duration [corrected].Further analyses stratified by age group showed that the association was strongest in children aged 7-10 years (OR 0.67 [95% CI 0.53-0.84] for overweight and OR 0.56 [95% CI 0.39-0.81] for obesity), while no significant effect could be seen in other age groups. DISCUSSION Our findings support the hypothesis that breastfeeding does have a beneficial effect on childhood overweight and obesity, although the effect seems to be strongest in children of primary school age.
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Affiliation(s)
- Maike Miriam Grube
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- * E-mail:
| | - Elena von der Lippe
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Martin Schlaud
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Fairley L, Santorelli G, Lawlor DA, Bryant M, Bhopal R, Petherick ES, Sahota P, Greenwood DC, Hill AJ, Cameron N, Ball H, Barber S, Wright J. The relationship between early life modifiable risk factors for childhood obesity, ethnicity and body mass index at age 3 years: findings from the Born in Bradford birth cohort study. BMC OBESITY 2015. [PMID: 26217524 PMCID: PMC4510905 DOI: 10.1186/s40608-015-0037-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Many modifiable risk factors in early infancy have been shown to be associated with childhood overweight and obesity. These risk factors have not been studied within children of South Asian origin in the UK. The aims of this paper are to describe differences in the prevalence of modifiable risk factors for childhood obesity between children of White British and Pakistani origin and investigate the association between these risk factors and childhood BMI measured at age 3 years. We used data from a sub-study of the Born in Bradford birth cohort with detailed follow-up visits throughout early childhood. 987 participants with a BMI measurement at age 3 were included; 39% were White British, 48% were of Pakistani origin and 13% were of other ethnicities. Linear and Poisson regression models were used to assess the association between risk factors and two outcomes at age 3; BMI z-scores and child overweight. Results Compared to Pakistani mothers, White British mothers were more likely to smoke during pregnancy, have higher BMI, breastfeed for a shorter duration and wean earlier, while Pakistani mothers had higher rates of gestational diabetes and were less active. There was no strong evidence that the relationship between risk factors and BMI z-score differed by ethnicity. There were associations between BMI z-score and maternal smoking (mean difference in BMI z-score 0.33 (95% CI 0.13, 0.53)), maternal obesity (0.37 (0.19, 0.55)), indulgent feeding style (0.15 (−0.06, 0.36)), lower parental warmth scores (0.21 (0.05, 0.36)) and higher parental hostility scores (0.17 (0.01, 0.33)). Consistent associations between these risk factors and child overweight were found. Mean BMI and the relative risk of being overweight were lower in children of mothers with lower parental self-efficacy scores and who watched more hours of TV. Other risk factors (gestational diabetes, child diet, child sleep, child TV viewing and maternal physical activity) were not associated with BMI. Conclusions Whilst the prevalence of risk factors that have been associated with childhood greater BMI differ between White British and Pakistani the magnitude of their associations with BMI are similar in the two groups. Electronic supplementary material The online version of this article (doi:10.1186/s40608-015-0037-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lesley Fairley
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, BD9 6RJ Bradford, UK ; Faculty of Health Studies, University of Bradford, Bradford, UK
| | | | - Debbie A Lawlor
- MRC Integrated Epidemiology Unit at the University of Bristol, Bristol, UK ; School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Maria Bryant
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, BD9 6RJ Bradford, UK ; Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Raj Bhopal
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Emily S Petherick
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, BD9 6RJ Bradford, UK ; Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Pinki Sahota
- Institute of Health and Well-being, Leeds Metropolitan University, Leeds, UK
| | | | - Andrew J Hill
- Institute of Health Sciences, Leeds University School of Medicine, Leeds, UK
| | - Noel Cameron
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK
| | - Helen Ball
- Parent-Infant Sleep Lab, Department of Anthropology, Durham University, Durham, UK
| | - Sally Barber
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, BD9 6RJ Bradford, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, BD9 6RJ Bradford, UK
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Casazza K, Brown A, Astrup A, Bertz F, Baum C, Brown MB, Dawson J, Durant N, Dutton G, Fields DA, Fontaine KR, Heymsfield S, Levitsky D, Mehta T, Menachemi N, Newby PK, Pate R, Raynor H, Rolls BJ, Sen B, Smith DL, Thomas D, Wansink B, Allison DB. Weighing the Evidence of Common Beliefs in Obesity Research. Crit Rev Food Sci Nutr 2015; 55:2014-53. [PMID: 24950157 PMCID: PMC4272668 DOI: 10.1080/10408398.2014.922044] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Obesity is a topic on which many views are strongly held in the absence of scientific evidence to support those views, and some views are strongly held despite evidence to contradict those views. We refer to the former as "presumptions" and the latter as "myths." Here, we present nine myths and 10 presumptions surrounding the effects of rapid weight loss; setting realistic goals in weight loss therapy; stage of change or readiness to lose weight; physical education classes; breastfeeding; daily self-weighing; genetic contribution to obesity; the "Freshman 15"; food deserts; regularly eating (versus skipping) breakfast; eating close to bedtime; eating more fruits and vegetables; weight cycling (i.e., yo-yo dieting); snacking; built environment; reducing screen time in childhood obesity; portion size; participation in family mealtime; and drinking water as a means of weight loss. For each of these, we describe the belief and present evidence that the belief is widely held or stated, reasons to support the conjecture that the belief might be true, evidence to directly support or refute the belief, and findings from randomized controlled trials, if available. We conclude with a discussion of the implications of these determinations, conjecture on why so many myths and presumptions exist, and suggestions for limiting the spread of these and other unsubstantiated beliefs about the obesity domain.
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Affiliation(s)
- Krista Casazza
- a Department of Nutrition Sciences , University of Alabama at Birmingham , Birmingham , Alabama USA
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Hathcock A, Krause K, Viera AJ, Fuemmeler BF, Lovelady C, Østbye T. Satiety responsiveness and the relationship between breastfeeding and weight status of toddlers of overweight and obese women. Matern Child Health J 2014; 18:1023-30. [PMID: 23925718 DOI: 10.1007/s10995-013-1331-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Numerous studies indicate an association between breastfeeding and decreased toddler adiposity. The mechanism behind this association is still unknown. One possibility is that children who are breastfed may have increased responsiveness to internal satiety cues. This study assessed the effect of satiety responsiveness on the association between breastfeeding and weight status among toddlers. We conducted a secondary analysis of data from 428 toddlers aged 2 years. Mothers' body mass index (BMI) and children's BMI z score were calculated from measured height and weight. Mothers completed a detailed breastfeeding survey and the satiety responsiveness subscale of the Child Eating Behaviour Questionnaire. Multiple linear regression and logistic regression were used to determine if satiety responsiveness mediated the effect of breastfeeding on BMI z score or overweight/obesity (BMI ≥ 85th percentile). Establishment of breastfeeding was associated with decreased BMI z score (0.40 vs. 0.60; p = 0.04), and increased breastfeeding intensity was associated with lower odds of overweight/obesity (OR 0.97, p = 0.04). Satiety responsiveness was not associated with either breastfeeding measures, suggesting it does not play a meditational role in the relationship between breastfeeding and toddler weight status. Furthermore, a relationship between satiety responsiveness and obesity does not exist after controlling for well-known confounders. This study did not find a mediation effect of satiety responsiveness on the association between breastfeeding and weight status in toddlers. More research is needed to characterize satiety responsiveness and its influence on the relationship between breastfeeding and childhood obesity.
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Affiliation(s)
- Amber Hathcock
- Department of Pediatrics, Duke University Medical Center, PO Box 3099, Durham, NC, 27710, USA,
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125
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Yan J, Liu L, Zhu Y, Huang G, Wang PP. The association between breastfeeding and childhood obesity: a meta-analysis. BMC Public Health 2014; 14:1267. [PMID: 25495402 PMCID: PMC4301835 DOI: 10.1186/1471-2458-14-1267] [Citation(s) in RCA: 422] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 12/08/2014] [Indexed: 12/30/2022] Open
Abstract
Background The increase in childhood obesity is a serious public health concern. Several studies have indicated that breastfed children have a lower risk of childhood obesity than those who were not breastfed, while other studies have provided conflicting evidence. The objective of this meta-analysis was to investigate the association between breastfeeding and the risk of childhood obesity. Methods The PubMed, EMBASE and CINAHL Plus with Full Text databases were systematically searched from start date to 1st August 2014. Based on the meta-analysis, pooled adjusted odds ratio (AOR) and 95% confidence interval (CI) were calculated. I2 statistic was used to evaluate the between-study heterogeneity. Funnel plots and Fail-safe N were used to assess publication bias and reliability of results, and results from both Egger test and Begg test were reported. Results Twenty-five studies with a total of 226,508 participants were included in this meta-analysis. The studies’ publication dates ranged from 1997 to 2014, and they examined the population of 12 countries. Results showed that breastfeeding was associated with a significantly reduced risk of obesity in children (AOR = 0.78; 95% CI: 0.74, 0.81). Categorical analysis of 17 studies revealed a dose-response effect between breastfeeding duration and reduced risk of childhood obesity. Conclusion Results of our meta-analysis suggest that breastfeeding is a significant protective factor against obesity in children.
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Affiliation(s)
| | | | | | - Guowei Huang
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St, John's, Newfoundland and Labrador A1B 3 V6, Canada.
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126
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Vieira SA, Magalhães TCA, Ribeiro AQ, Priore SE, Franceschini SDCC, Sant'Ana LFDR. Influence of weight gain rate on early life nutritional status and body composition of children. ScientificWorldJournal 2014; 2014:616108. [PMID: 25538953 PMCID: PMC4236901 DOI: 10.1155/2014/616108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 10/06/2014] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the influence of the weight gain rate at 4-6 months on nutritional status and body composition in children between 4 and 7 years of age. METHODS Retrospective cohort study, sample of 257 children. Data collection was performed in two stages, with the first relating to retrospective data of weight gain from birth to the first 4-6 months of life in the patient records. Measurements of weight, height, waist circumference, and body composition in children between ages 4 and 7 years were obtained. Nutritional status was assessed by the BMI/age. Control variables, such as pregnancy, breastfeeding, lifestyle, and sociodemographics, were studied. Descriptive analysis and multiple linear regression were performed. RESULTS In the nutritional status assessment, the prevalence of overweight observed was 24.9%. After adjusting for control variables, it was found that the increase of the WGR at 4-6 months of age explained the occurrence of higher BMI/age, percentage of total body fat, body fat percentage in the android region, and waist circumference in children between 4 and 7 years of age. CONCLUSION The increase of the WGR in the first months of life can lead to the occurrence of higher values of parameters of nutritional status and body composition in later life.
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Affiliation(s)
- Sarah Aparecida Vieira
- Department of Nutrition and Health, Federal University of Viçosa, 36570-000 Viçosa, MG, Brazil
| | | | - Andréia Queiroz Ribeiro
- Department of Nutrition and Health, Federal University of Viçosa, 36570-000 Viçosa, MG, Brazil
| | - Silvia Eloiza Priore
- Department of Nutrition and Health, Federal University of Viçosa, 36570-000 Viçosa, MG, Brazil
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Richmond RC, Al-Amin A, Smith GD, Relton CL. Approaches for drawing causal inferences from epidemiological birth cohorts: a review. Early Hum Dev 2014; 90:769-80. [PMID: 25260961 PMCID: PMC5154380 DOI: 10.1016/j.earlhumdev.2014.08.023] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Large-scale population-based birth cohorts, which recruit women during pregnancy or at birth and follow up their offspring through infancy and into childhood and adolescence, provide the opportunity to monitor and model early life exposures in relation to developmental characteristics and later life outcomes. However, due to confounding and other limitations, identification of causal risk factors has proved challenging and published findings are often not reproducible. A suite of methods has been developed in recent years to minimise problems afflicting observational epidemiology, to strengthen causal inference and to provide greater insights into modifiable intra-uterine and early life risk factors. The aim of this review is to describe these causal inference methods and to suggest how they may be applied in the context of birth cohorts and extended along with the development of birth cohort consortia and expansion of "omic" technologies.
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Affiliation(s)
- Rebecca C Richmond
- Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK.
| | - Aleef Al-Amin
- University of Bristol Medical School, University of Bristol, Bristol, UK.
| | - George Davey Smith
- Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK.
| | - Caroline L Relton
- Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK; Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.
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128
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Patel R, Tilling K, Lawlor DA, Howe LD, Bogdanovich N, Matush L, Nicoli E, Kramer MS, Martin RM. Socioeconomic differences in childhood length/height trajectories in a middle-income country: a cohort study. BMC Public Health 2014; 14:932. [PMID: 25200513 PMCID: PMC4181044 DOI: 10.1186/1471-2458-14-932] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 08/29/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Socioeconomic disadvantage is associated with shorter adult stature. Few studies have examined socioeconomic differences in stature from birth to childhood and the mechanisms involved, particularly in middle-income former Soviet settings. METHODS The sample included 12,463 Belarusian children (73% of the original cohort) born in 1996-1997, with up to 14 stature measurements from birth to 7 years. Linear spline multi-level models with 3 knots at 3, 12 and 34 months were used to analyse birth length and growth velocity during four age-periods by parental educational achievement (up to secondary school, advanced secondary/partial university, completed university) and occupation (manual, non-manual). RESULTS Girls born to the most (versus least) educated mothers were 0.43 cm (95% confidence interval (CI): 0.28, 0.58) longer at birth; for boys, the corresponding difference was 0.30 cm (95% CI: 0.15, 0.46). Similarly, children of the most educated mothers grew faster from birth-3 months and 12-34 months (p-values for trend ≤ 0.08), such that, by age 7 years, girls with the most (versus least) educated mothers were 1.92 cm (95% CI: 1.47, 2.36) taller; after controlling for urban/rural and East/West area of residence, this difference remained at 1.86 cm (95% CI: 1.42, 2.31), but after additionally controlling for mid-parental height, attenuated to 1.10 cm (95% CI: 0.69, 1.52). Among boys, these differences were 1.95 cm (95% CI: 1.53, 2.37), 1.89 cm (95% CI: 1.47, 2.31) and 1.16 cm (95% CI: 0.77, 1.55), respectively. Additionally controlling for breastfeeding, maternal smoking and older siblings did not substantively alter these findings. There was no evidence that the association of maternal educational attainment with growth differed in girls compared to boys (p for interaction = 0.45). Results were similar for those born to the most (versus least) educated fathers, or who had a parent with a non-manual (versus manual) occupation. CONCLUSIONS In Belarus, a middle-income former Soviet country, socioeconomic differences in offspring growth commence in the pre-natal period and generate up to approximately 2 cm difference in height at age 7 years. These associations are partly explained by genetic or other factors influencing parental stature. TRIAL REGISTRATION Current Controlled Trials: NCT01352247 assigned 9 Sept 2005; ClinicalTrials.gov. Identifier: NCT01561612 received 20 Mar 2012.
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Affiliation(s)
- Rita Patel
- />School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Kate Tilling
- />School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Debbie A Lawlor
- />School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
- />MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Laura D Howe
- />School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
- />MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Natalia Bogdanovich
- />The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Lidia Matush
- />The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Emily Nicoli
- />School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Michael S Kramer
- />Department of Pediatrics, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada
- />Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada
| | - Richard M Martin
- />School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
- />MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- />National Institute for Health Research, Bristol Biomedical Research Unit in Nutrition, Bristol, UK
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Abstract
Obesity among children, adolescents and adults has emerged as one of the most serious public health concerns in the 21st century. The worldwide prevalence of childhood obesity has increased remarkably over the past 3 decades. The growing prevalence of childhood obesity has also led to appearance of obesity-related comorbid disease entities at an early age. Childhood obesity can adversely affect nearly every organ system and often causes serious consequences, including hypertension, dyslipidemia, insulin resistance, dysglycemia, fatty liver disease and psychosocial complications. It is also a major contributor to increasing healthcare expenditures. For all these reasons, it is important to prevent childhood obesity as well as to identify overweight and obese children at an early stage so they can begin treatment and attain and maintain a healthy weight. At present, pharmacotherapy options for treatment of pediatric obesity are very limited. Therefore, establishing a comprehensive management program that emphasizes appropriate nutrition, exercise and behavioral modification is crucial. The physician's role should expand beyond the clinical setting to the community to serve as a role model and to advocate for prevention and early treatment of obesity.
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Affiliation(s)
- Neslihan Koyuncuoğlu Güngör
- Louisiana State University Health Sciences Center-Shreveport, Department of Pediatric Endocrinology, Shreveport, LA, USA
,* Address for Correspondence: Louisiana State University Health Sciences Center-Shreveport, Department of Pediatric Endocrinology, Shreveport, LA, USA GSM: +1 312 6756070 E-mail:
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Jing H, Xu H, Wan J, Yang Y, Ding H, Chen M, Li L, Lv P, Hu J, Yang J. Effect of breastfeeding on childhood BMI and obesity: the China Family Panel Studies. Medicine (Baltimore) 2014; 93:e55. [PMID: 25170931 PMCID: PMC4616333 DOI: 10.1097/md.0000000000000055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The objective of this study is to investigate the effect of breastfeeding on childhood obesity in China.We used data collected from the China Family Panel Studies, an ongoing, prospective, and nationwide longitudinal study to explore the extensive and dynamic social changes in China. A total of 7967 children were included in the analysis. Duration of breastfeeding was first treated as a continuous variable and subsequently dichotomized into ever versus never, ≥6 months versus <6 months, ≥8 months versus < 8 months, and ≥12 months versus <12 months. Multiple imputation was conducted and regressions with propensity score matching were performed. We also performed quantile regression to examine whether breastfeeding has an effect on childhood obesity among children with a specific quantile of body mass index (BMI).Consistent with findings from recent studies, in both adjusted and adjusted regressions, we did not find any statistically significant effect of breastfeeding on reducing the risk of obesity (unadjusted odds ratio, OR = 1.02, 95% confidence interval, CI 0.99, 1.05, P = 0.12; adjusted OR 1.01, 95% CI 0.98, 1.05, P = 0.36) or excessive weight (unadjusted OR = 1.01, 95% CI 0.99, 1.03, P = 0.26; adjusted OR = 1.00, 95% CI 0.98, 1.02, P = 0.90). Results were similar using various dichotomization of duration of breastfeeding. Quantile regression revealed that longer duration of breastfeeding is associated with higher BMI among children with small to medium quantile of BMI.Our findings echo recent research and caution against any population-wide strategy in attempting to reduce overweight and obesity through promotion of breastfeeding.
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Affiliation(s)
- Huiquan Jing
- Institute of Social Science Survey, Peking University, Beijing (HJ, HD, MC, PL, JH); Department of Social Science (HJ); Section of Discipline Construction and Development Planning (YY), Shenyang Medical College; Emergency Department (LL), Shengjing Hospital, China Medical University, Shenyang, Liaoning, China; Institute for Social Research (HX), University of Michigan, Ann Arbor, Michigan; Graduate School of Economics (JW), Fukuoka University, Fukuoka City, Fukuoka, Japan; and Rush Alzheimer's Disease Center and Department of Neurological Sciences (JY), Rush University Medical Center, Chicago, Illinois
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131
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Kramer MS, Martin RM, Bogdanovich N, Vilchuk K, Dahhou M, Oken E. Is restricted fetal growth associated with later adiposity? Observational analysis of a randomized trial. Am J Clin Nutr 2014; 100:176-81. [PMID: 24787489 PMCID: PMC4144097 DOI: 10.3945/ajcn.113.079590] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Several recent "developmental origins" studies have reported increased long-term risks of adiposity, especially truncal adiposity, among children born small for gestational age (SGA). OBJECTIVE We assessed the effects of SGA birth and weight gain in early infancy on adiposity at age 11.5 y. DESIGN From a cluster-randomized breastfeeding promotion trial in 17,046 Belarusian children, we measured height, weight, waist and hip circumferences, triceps and subscapular skinfold thicknesses, and bioimpedance measures of percentage body fat at age 11.5 y. Children born SGA (birth weight <10th percentile) and those born large for gestational age (LGA; >90th percentile for gestational age) were compared with those born appropriate for gestational age (AGA). Weight gain from birth to 6 mo was categorized as high (>0.67-SD increase in weight-for-age), low (>0.67-SD decrease in weight-for-age), or normal. Multilevel statistical models accounted for clustered measurement and controlled for maternal and paternal height and body mass index (BMI), maternal education, geographic region, urban compared with rural residence, and the child's exact age at follow-up. RESULTS Children born SGA had a significantly lower BMI, percentage body fat, and fat mass index than did those born AGA, with a dose-response effect across 2 subcategories of SGA (P < 0.001 for all comparisons). No difference was observed in waist-to-hip ratio, although the subscapular-to-triceps skinfold ratio was slightly but significantly (P < 0.001) higher in children born SGA. Differences among the study groups continued to increase since the previous follow-up at 6.5 y. SGA infants with catch-up growth in the first 3-6 mo had growth and adiposity measures intermediate between those born SGA without catch-up and those born AGA. Opposite effects of similar magnitude were observed in children born LGA. CONCLUSION The 11.5-y-old Belarusian children born SGA were shorter, were thinner, and had less body fat than their non-SGA peers, irrespective of postnatal weight gain. The Promotion of Breastfeeding Intervention Trial was registered at www.isrctn.org as ISRCTN-37687716.
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Affiliation(s)
- Michael S Kramer
- From the Departments of Pediatrics (MSK and MD) and Epidemiology, Biostatistics and Occupational Health (MSK), McGill University Faculty of Medicine, Montreal, Canada; the School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (RMM); the National Institute for Health Research, Bristol Biomedical Research Unit in Nutrition, Bristol, United Kingdom (RMM); State Institution "the Republican Scientific and Practical Centre Mother and Child," Ministry of Health, Republic of Belarus (NB and KV); and the Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (EO)
| | - Richard M Martin
- From the Departments of Pediatrics (MSK and MD) and Epidemiology, Biostatistics and Occupational Health (MSK), McGill University Faculty of Medicine, Montreal, Canada; the School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (RMM); the National Institute for Health Research, Bristol Biomedical Research Unit in Nutrition, Bristol, United Kingdom (RMM); State Institution "the Republican Scientific and Practical Centre Mother and Child," Ministry of Health, Republic of Belarus (NB and KV); and the Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (EO)
| | - Natalia Bogdanovich
- From the Departments of Pediatrics (MSK and MD) and Epidemiology, Biostatistics and Occupational Health (MSK), McGill University Faculty of Medicine, Montreal, Canada; the School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (RMM); the National Institute for Health Research, Bristol Biomedical Research Unit in Nutrition, Bristol, United Kingdom (RMM); State Institution "the Republican Scientific and Practical Centre Mother and Child," Ministry of Health, Republic of Belarus (NB and KV); and the Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (EO)
| | - Konstantin Vilchuk
- From the Departments of Pediatrics (MSK and MD) and Epidemiology, Biostatistics and Occupational Health (MSK), McGill University Faculty of Medicine, Montreal, Canada; the School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (RMM); the National Institute for Health Research, Bristol Biomedical Research Unit in Nutrition, Bristol, United Kingdom (RMM); State Institution "the Republican Scientific and Practical Centre Mother and Child," Ministry of Health, Republic of Belarus (NB and KV); and the Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (EO)
| | - Mourad Dahhou
- From the Departments of Pediatrics (MSK and MD) and Epidemiology, Biostatistics and Occupational Health (MSK), McGill University Faculty of Medicine, Montreal, Canada; the School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (RMM); the National Institute for Health Research, Bristol Biomedical Research Unit in Nutrition, Bristol, United Kingdom (RMM); State Institution "the Republican Scientific and Practical Centre Mother and Child," Ministry of Health, Republic of Belarus (NB and KV); and the Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (EO)
| | - Emily Oken
- From the Departments of Pediatrics (MSK and MD) and Epidemiology, Biostatistics and Occupational Health (MSK), McGill University Faculty of Medicine, Montreal, Canada; the School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (RMM); the National Institute for Health Research, Bristol Biomedical Research Unit in Nutrition, Bristol, United Kingdom (RMM); State Institution "the Republican Scientific and Practical Centre Mother and Child," Ministry of Health, Republic of Belarus (NB and KV); and the Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (EO)
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Jonsdottir OH, Fewtrell MS, Gunnlaugsson G, Kleinman RE, Hibberd PL, Jonsdottir JM, Eiriksdottir I, Rognvaldsdottir AM, Thorsdottir I. Initiation of complementary feeding and duration of total breastfeeding: unlimited access to lactation consultants versus routine care at the well-baby clinics. Breastfeed Med 2014; 9:196-202. [PMID: 24621390 PMCID: PMC4066226 DOI: 10.1089/bfm.2013.0094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Breastfeeding has several advantages for both mother and child. Lactation consultants may promote prolonged breastfeeding, but little is known about their impact on the initiation of complementary feeding. SUBJECTS AND METHODS Dietary intake during the initial complementary feeding period from 5 to 6 months was collected on mother-infant pairs who had unlimited access to lactation consultants along with those mother-infant pairs who received routine care at the well-baby clinics. The total duration of breastfeeding in each study population was also recorded, and total breastfeeding durations of infants receiving complementary foods from 4 months and those exclusively breastfed for 6 months in each of the two study populations were compared. RESULTS Higher proportion of infants of mothers with unlimited access to lactation consultants were fed vegetable and vegetable purées (p=0.05) and more than one food type (p=0.05) at 5 months. Furthermore, a lower percentage of them had three meals per day at 6 months (p=0.001) compared with those receiving routine care at the well-baby clinics. Infants exclusively breastfed for 6 months all had similar duration of total breastfeeding. CONCLUSIONS Mother-infant pairs with unlimited access to lactation consultant had slower introduction of complementary foods at the initial complementary feeding period, according to number of infant's meals at 6 months of age. Furthermore, those exclusively breastfed for 6 months had more prolonged breastfeeding compared with mothers who began complementary feeding at 4 months regardless of exposure to lactation consultants.
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Affiliation(s)
- Olof H Jonsdottir
- 1 Unit for Nutrition Research, Landspitali, The National University Hospital of Iceland and Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland , Reykjavik, Iceland
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Associations between infant feeding and the size, tempo and velocity of infant weight gain: SITAR analysis of the Gemini twin birth cohort. Int J Obes (Lond) 2014; 38:980-7. [PMID: 24722545 PMCID: PMC4088337 DOI: 10.1038/ijo.2014.61] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 03/27/2014] [Accepted: 04/06/2014] [Indexed: 12/30/2022]
Abstract
Objective: Infant growth trajectories, in terms of size, tempo and velocity, may programme lifelong obesity risk. Timing of breastfeeding cessation and weaning are both implicated in rapid infant growth; we examined the association of both simultaneously with a range of growth parameters. Design: Longitudinal population-based twin birth cohort. Subjects: The Gemini cohort provided data on 4680 UK infants with a median of 10 (interquartile range=8–15) weight measurements between birth and a median of 6.5 months. Age at breastfeeding cessation and weaning were reported by parents at mean age 8.2 months (s.d.=2.2, range=4–20). Growth trajectories were modelled using SuperImposition by Translation And Rotation (SITAR) to generate three descriptors of individual growth relative to the average trajectory: size (grams), tempo (weeks, indicating the timing of the peak growth rate) and velocity (% difference from average, reflecting mean growth rate). Complex-samples general linear models adjusting for family clustering and confounders examined associations between infant feeding and SITAR parameters. Results: Longer breastfeeding (>4 months vs never) was independently associated with lower growth velocity by 6.8% (s.e.=1.3%) and delayed growth tempo by 1.0 (s.e.=0.2 weeks), but not with smaller size. Later weaning (⩾6 months vs <4 months) was independently associated with lower growth velocity by 4.9% (s.e.=1.1%) and smaller size by 102 g (s.e.=25 g). Conclusions: Infants breastfed for longer grew slower for longer after birth (later peak growth rate) but were no different in size, while infants weaned later grew slower overall and were smaller but the timing of peak growth did not differ. Slower trajectories with a delayed peak in growth may have beneficial implications for programming later obesity risk. Replication in cohorts with longer follow-up, alternative confounding structures or randomised controlled trials are required to confirm the long-term effects and directionality, and to rule out residual confounding.
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Skugarevsky O, Wade KH, Richmond RC, Martin RM, Tilling K, Patel R, Vilchuck K, Bogdanovich N, Sergeichick N, Davey Smith G, Gillman MW, Oken E, Kramer MS. Effects of promoting longer-term and exclusive breastfeeding on childhood eating attitudes: a cluster-randomized trial. Int J Epidemiol 2014; 43:1263-71. [PMID: 24706729 DOI: 10.1093/ije/dyu072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Observational studies suggest that breastfeeding benefits later maternal child-feeding practices, which in turn may contribute to positive eating attitudes. We investigated the effect of a randomized intervention to increase duration and exclusivity of breastfeeding on pre-adolescent eating attitudes. METHODS Long-term follow-up of the Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial in 31 maternity hospitals and affiliated polyclinics in Belarus. Sites were randomly assigned an experimental intervention to promote longer duration and exclusivity of breastfeeding in mothers who initiated breastfeeding (n = 16 sites), or a control intervention of continuing usual care (n = 15 sites); 17 046 healthy infants were enrolled in 1996-7, of whom 13 751 (80.7%) completed the Children's Eating Attitude Test (ChEAT) at 11.5 years of age. A ChEAT score ≥ 22.5 (85th percentile) was used as an indicator of problematic eating attitudes. Analysis was based on intention-to-treat, accounting for clustering within hospitals/clinics. RESULTS Compared with the control arm, the experimental intervention substantially increased breastfeeding exclusivity (43.3% vs 6.4% exclusively breastfed at 3 months of age) and duration of any breastfeeding throughout infancy. The proportion of children with ChEAT scores ≥ 22.5 was lower in the experimental than control arm (boys 11.4% vs 17.2%; girls 18.5% vs 23.4%) [cluster-adjusted odds ratio (OR), boys: 0.44; 95% confidence interval (CI): 0.21,0.93; girls: 0.51; 95% CI: 0.27,0.99). Results were robust to adjustment for potential confounders and using a ChEAT score ≥ 25.5 (91st percentile) as the outcome (OR: 0.53; 95% CI: 0.28,1.03). CONCLUSIONS An intervention to improve the duration and exclusivity of breastfeeding among term infants in Belarus was associated with a reduction in problematic eating attitudes at 11.5 years of age.
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Affiliation(s)
- Oleg Skugarevsky
- Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Kaitlin H Wade
- Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, CanadaPsychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Rebecca C Richmond
- Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, CanadaPsychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Richard M Martin
- Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, CanadaPsychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, CanadaPsychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospital
| | - Kate Tilling
- Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Rita Patel
- Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Konstantin Vilchuck
- Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Natalia Bogdanovich
- Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Natalia Sergeichick
- Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - George Davey Smith
- Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, CanadaPsychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Matthew W Gillman
- Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Emily Oken
- Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Michael S Kramer
- Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus, School of Social and Community Medicine, University of Bristol, Bristol, UK, Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK, University of Bristol / University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA and Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
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Martin RM, Patel R, Kramer MS, Vilchuck K, Bogdanovich N, Sergeichick N, Gusina N, Foo Y, Palmer T, Thompson J, Gillman MW, Smith GD, Oken E. Effects of promoting longer-term and exclusive breastfeeding on cardiometabolic risk factors at age 11.5 years: a cluster-randomized, controlled trial. Circulation 2014; 129:321-9. [PMID: 24300437 PMCID: PMC3946966 DOI: 10.1161/circulationaha.113.005160] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/15/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND The duration and exclusivity of breastfeeding in infancy have been inversely associated with future cardiometabolic risk. We investigated the effects of an experimental intervention to promote increased duration of exclusive breastfeeding on cardiometabolic risk factors in childhood. METHODS AND RESULTS We followed-up children in the Promotion of Breastfeeding Intervention Trial, a cluster-randomized trial of a breastfeeding promotion intervention based on the World Health Organization/United Nations Children's Fund Baby-Friendly Hospital Initiative. In 1996 to 1997, 17 046 breastfeeding mother-infant pairs were enrolled from 31 Belarusian maternity hospitals and affiliated polyclinics (16 intervention versus 15 control sites); 13 879 (81.4%) children were followed up at 11.5 years, with 13 616 (79.9%) who had fasted and did not have diabetes mellitus. The outcomes were blood pressure; fasting insulin, adiponectin, glucose, and apolipoprotein A1; and the presence of metabolic syndrome. Analysis was by intention to treat, accounting for clustering within hospitals/clinics. The intervention substantially increased breastfeeding duration and exclusivity in comparison with the control arm (43% versus 6% and 7.9% versus 0.6% exclusively breastfed at 3 and 6 months, respectively). Cluster-adjusted mean differences at 11.5 years between experimental versus control groups were as follows: 1.0 mm Hg (95% confidence interval, -1.1 to 3.1) for systolic and 0.8 mm Hg (-0.6 to 2.3) for diastolic blood pressure; -0.1 mmol/L (-0.2 to 0.1) for glucose; 8% (-3% to 34%) for insulin; -0.3 μg/mL (-1.5 to 0.9) for adiponectin; and 0.0 g/L (-0.1 to 0.1) for apolipoprotein A1. The cluster-adjusted odds ratio for metabolic syndrome, comparing experimental versus control groups, was 1.21 (0.85 to 1.72). CONCLUSIONS An intervention to improve breastfeeding duration and exclusivity among healthy term infants did not influence cardiometabolic risk factors in childhood. CLINICAL TRIAL REGISTRATION Current Controlled Trials: ISRCTN37687716 (http://www.controlled-trials.com/ISRCTN37687716). URL: http://clinicaltrials.gov. Unique identifier: NCT01561612.
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Affiliation(s)
- Richard M Martin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK
- National Institute for Health Research, Bristol Biomedical Research Unit in Nutrition, Bristol, UK
| | - Rita Patel
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Michael S. Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada
| | - Konstantin Vilchuck
- National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Natalia Bogdanovich
- National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Natalia Sergeichick
- National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Nina Gusina
- National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Ying Foo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Tom Palmer
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jennifer Thompson
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Matthew W Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - George Davey Smith
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Medical Research Council / University of Bristol Integrated Epidemiology Unit, University of Bristol, Bristol, UK
| | - Emily Oken
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
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Wade KH, Skugarevsky O, Kramer MS, Patel R, Bogdanovich N, Vilchuck K, Sergeichick N, Richmond R, Palmer T, Davey Smith G, Gillman M, Oken E, Martin RM. Prospective associations of parental smoking, alcohol use, marital status, maternal satisfaction, and parental and childhood body mass index at 6.5 years with later problematic eating attitudes. Nutr Diabetes 2014; 4:e100. [PMID: 24394456 PMCID: PMC3904081 DOI: 10.1038/nutd.2013.40] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 11/26/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Few studies have prospectively investigated whether early-life exposures are associated with pre-adolescent eating attitudes. OBJECTIVE The objective of this study is to prospectively investigate associations of parental smoking, alcohol use, marital status, measures of maternal satisfaction, self-reported parental body mass index (BMI) and clinically measured childhood BMI, assessed between birth and 6.5 years, with problematic eating attitudes at 11.5 years. METHODS Observational cohort analysis nested within the Promotion of Breastfeeding Intervention Trial, a cluster-randomised trial conducted in 31 maternity hospitals and affiliated polyclinics in Belarus. Our primary outcome was a Children's Eating Attitudes Test (ChEAT) score 22.5 (85th percentile), an indicator of problematic eating attitudes. We employed multivariable mixed logistic regression models, which allow inference at the individual level. We also performed instrumental variable (IV) analysis using parents' BMIs as instruments for the child's BMI, to assess whether associations could be explained by residual confounding or reverse causation. SUBJECTS Of the 17 046 infants enrolled between 1996 and 1997 across Belarus, 13 751 (80.7%) completed the ChEAT test at 11.5 years. RESULTS In fully adjusted models, overweight children at age 6.5 years had a 2.14-fold (95% confidence interval (CI): 1.82, 2.52) increased odds of having ChEAT scores 85th percentile at age 11.5 years, and those who were obese had a 3.89-fold (95% CI: 2.95, 5.14) increased odds compared with normal-weight children. Children of mothers or fathers who were themselves overweight or obese were more likely to score 85th percentile (P for trend 0.001). IV analysis was consistent with a child's BMI causally affecting future eating attitudes. There was little evidence that parental smoking, alcohol use, or marital status or maternal satisfaction were associated with eating attitudes. CONCLUSION In our large, prospective cohort in Belarus, both parental and childhood overweight and obesity at 6.5 years were associated with pre-adolescent problematic eating attitudes 5 years later.
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Affiliation(s)
- K H Wade
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Medical Research Council (MRC)/University of Bristol Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
| | - O Skugarevsky
- Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus
| | - M S Kramer
- Department of Pediatrics and Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - R Patel
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - N Bogdanovich
- The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - K Vilchuck
- The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - N Sergeichick
- The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - R Richmond
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Medical Research Council (MRC)/University of Bristol Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
| | - T Palmer
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - G Davey Smith
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Medical Research Council (MRC)/University of Bristol Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
| | - M Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - E Oken
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - R M Martin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Medical Research Council (MRC)/University of Bristol Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
- Bristol Biomedical Research Unit in Nutrition, National Institute for Health Research, Bristol, UK
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137
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Islam Khan A. Effects of pre- and postnatal nutrition interventions on child growth and body composition: the MINIMat trial in rural Bangladesh. Glob Health Action 2013; 6:22476. [PMID: 24331714 PMCID: PMC3864158 DOI: 10.3402/gha.v6i0.22476] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 10/30/2013] [Accepted: 11/22/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Nutritional insults and conditions during fetal life and infancy influence subsequent growth and body composition of children. OBJECTIVES Effects of maternal food and micronutrient supplementation and exclusive breastfeeding counseling on growth of offspring aged 0-54 months and their body composition at 54 months of age were studied. METHODS In the MINIMat trial (ISRCTN16581394) in Matlab, Bangladesh, pregnant women were randomized to early (around 9 weeks) or usual invitation (around 20 weeks) to food supplementation and to one of the three daily micronutrient supplements: 30-mg Fe and 400-µg folic acid (Fe30F), 60-mg Fe and 400-µg folic acid (Fe60F), and multiple micronutrient supplements (MMS). The supplements were also randomized to exclusive breastfeeding (EBF) counseling or to usual health messages. RESULTS No differences in background characteristics were observed among the intervention groups. There was also no differential effect of prenatal interventions on birthweight or birthlength. Early food supplementation reduced the level of stunting from early infancy up to 54 months of age among boys (average difference - 6.5% units, 95% confidence interval [CI] 1.7-11.3, p=0.01) but not among girls (average difference - 2.4% units, 95% CI -2.2-7.0, p=0.31). MMS resulted in more stunting compared to standard Fe60F (average difference - 4.8% units, 95% CI 0.8-8.9, p=0.02). Breastfeeding counseling prolonged the duration of EBF (difference - 35 days, 95% CI 30.6-39.5, p<0.001). Neither pregnancy interventions nor breastfeeding counseling influenced the body composition of children at 54 months of age. CONCLUSION Early food supplementation during pregnancy reduced the occurrence of stunting among boys aged 0-54 months, while prenatal MMS increased the proportion of stunting. Food and micronutrient supplementation or EBF intervention did not affect body composition of offspring at 54 months of age. The effects of prenatal interventions on postnatal growth suggest programming effects in early fetal life.
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Affiliation(s)
- Ashraful Islam Khan
- icddr,b, Dhaka, Bangladesh; Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden;
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138
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Günther ALB, Walz H, Kroke A, Wudy SA, Riedel C, von Kries R, Joslowski G, Remer T, Cheng G, Buyken AE. Breastfeeding and its prospective association with components of the GH-IGF-Axis, insulin resistance and body adiposity measures in young adulthood--insights from linear and quantile regression analysis. PLoS One 2013; 8:e79436. [PMID: 24236134 PMCID: PMC3827372 DOI: 10.1371/journal.pone.0079436] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 09/23/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Breastfeeding may lower chronic disease risk by long-term effects on hormonal status and adiposity, but the relations remain uncertain. OBJECTIVE To prospectively investigate the association of breastfeeding with the growth hormone- (GH) insulin-like growth factor- (IGF) axis, insulin sensitivity, body composition and body fat distribution in younger adulthood (18-37 years). DESIGN Data from 233 (54% female) participants of a German cohort, the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study, with prospective data on infant feeding were analyzed. Multivariable linear as well as quantile regression were performed with full breastfeeding (not: ≤ 2, short: 3-17, long: >17 weeks) as exposure and adult IGF-I, IGF binding proteins (IGFBP) -1, -2, -3, homeostasis model assessment of insulin resistance (HOMA-IR), fat mass index, fat-free mass index, and waist circumference as outcomes. RESULTS After adjustment for early life and socio-economic factors, women who had been breastfed longer displayed higher adult IGFBP-2 (p(trend) = 0.02) and lower values of HOMA-IR (p(trend) = 0.004). Furthermore, in women breastfeeding duration was associated with a lower mean fat mass index (p(trend) = 0.01), fat-free mass index (p(trend) = 0.02) and waist circumference (p(trend) = 0.004) in young adulthood. However, there was no relation to IGF-I, IGFBP-1 and IGFBP-3 (all p(trend) > 0.05). Associations for IGFBP-2 and fat mass index were more pronounced at higher, for waist circumference at very low or high percentiles of the distribution. In men, there was no consistent relation of breastfeeding with any outcome. CONCLUSIONS Our data suggest that breastfeeding may have long-term, favorable effects on extremes of adiposity and insulin metabolism in women, but not in men. In both sexes, breastfeeding does not seem to induce programming of the GH-IGF-axis.
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Affiliation(s)
- Anke L. B. Günther
- Fulda University of Applied Sciences, Department of Nutritional, Food and Consumer Sciences, Fulda, Germany
| | - Helena Walz
- Fulda University of Applied Sciences, Department of Nutritional, Food and Consumer Sciences, Fulda, Germany
| | - Anja Kroke
- Fulda University of Applied Sciences, Department of Nutritional, Food and Consumer Sciences, Fulda, Germany
| | - Stefan A. Wudy
- Justus-Liebig-University of Giessen, Center of Child and Adolescent Medicine, Laboratory for Translational Hormone Analytics in Pediatric Endocrinology, Peptide Hormone Research Unit, Giessen, Germany
| | - Christina Riedel
- Ludwig-Maximilians-University Munich, Institute of Social Paediatrics and Adolescent Medicine, Munich, Germany
| | - Rüdiger von Kries
- Ludwig-Maximilians-University Munich, Institute of Social Paediatrics and Adolescent Medicine, Munich, Germany
| | - Gesa Joslowski
- University of Bonn, IEL-Nutritional Epidemiology, DONALD Study at the Research Institute of Child Nutrition, Bonn, Germany
| | - Thomas Remer
- University of Bonn, IEL-Nutritional Epidemiology, DONALD Study at the Research Institute of Child Nutrition, Bonn, Germany
| | - Guo Cheng
- Fulda University of Applied Sciences, Department of Nutritional, Food and Consumer Sciences, Fulda, Germany
- West China School of Public Health, Sichuan University, Chengdu, People's Republic of China
| | - Anette E. Buyken
- University of Bonn, IEL-Nutritional Epidemiology, DONALD Study at the Research Institute of Child Nutrition, Bonn, Germany
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139
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Congiu G, Campus G, Sale S, Spano G, Cagetti MG, Lugliè PF. Early childhood caries and associated determinants: a cross-sectional study on Italian preschool children. J Public Health Dent 2013; 74:147-52. [PMID: 24117607 DOI: 10.1111/jphd.12038] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 08/13/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study evaluates the influence of several determinants on the presence of early childhood caries (ECC) in preschool children living in northern Sardinia, Italy. These determinants include the educational level and occupational status of the parents as a proxy for the socioeconomical level (SES) and behavioral factors (dietary and oral hygiene). METHODS An observational cross-sectional study was designed with a dental examination and a standardized questionnaire. Five hundred forty-four subjects (260 girls and 284 boys) were enrolled and categorized into two age groups: 359 children were aged 18-47 months and 185 children were aged 48-60 months. RESULTS The total caries prevalence was 15.99%. Caries risk increased with lower parents' educational level (P = 0.01), increased number of siblings (P < 0.01), the use of bottle feeding (P = 0.02), and the use of a sweetened baby's pacifier at night (P = 0.01). In robust multivariate analysis, a high parental educational level played a protective role on the presence of caries lesion [odds ratio (OR) = 0.51, 95% confidence interval (CI) 0.34-0.78]; the mother's being employed had a positive statistically significant association with the child having decayed, missing, filled tooth surfaces = 0 (OR = 0.64, 95% CI 0.23-0.97). The presence of more than one sibling in the family was associated with caries (OR = 1.70, 95% CI 1.20-2.40). CONCLUSION ECC prevalence evaluated was similar to other western countries, and SES and behavioral habits influence the development of ECC.
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Affiliation(s)
- Giovanna Congiu
- Department of Surgery, Microsurgery and Medicine Sciences, Dental School, University of Sassari, Sassari, Italy
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140
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Lewis SJ, Relton C, Zammit S, Smith GD. Approaches for strengthening causal inference regarding prenatal risk factors for childhood behavioural and psychiatric disorders. J Child Psychol Psychiatry 2013; 54:1095-108. [PMID: 24007416 DOI: 10.1111/jcpp.12127] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND The risk of childhood behavioural and psychiatric diseases could be substantially reduced if modifiable risk factors for these disorders were identified. The critical period for many of these exposures is likely to be in utero as this is the time when brain development is most rapid. However, due to confounding and other limitations of traditional epidemiological studies, identification of causal risk factors has proved challenging and on the whole research in this area has not been fruitful. SCOPE In this review, we highlight several alternative approaches including; comparisons across settings, the use of negative controls and natural experiments, which includes migration studies, studies of individuals conceived using in vitro fertilisation and not least Mendelian randomisation. We have illustrated these approaches using examples of behavioural and psychiatric disorders. CONCLUSION By having these approaches outlined together in one review, researchers can consider which of these methods would be most suitable for their study question. We have particularly focussed on Mendelian randomisation, as this is a relatively novel concept, in doing so, we have illustrated the concept and discussed the implementation and the limitations of this approach.
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Affiliation(s)
- Sarah J Lewis
- School of Social and Community Medicine, University of Bristol, UK.
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141
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Golley RK, Smithers LG, Mittinty MN, Emmett P, Northstone K, Lynch JW. Diet quality of U.K. infants is associated with dietary, adiposity, cardiovascular, and cognitive outcomes measured at 7-8 years of age. J Nutr 2013; 143:1611-7. [PMID: 23946339 DOI: 10.3945/jn.112.170605] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Whereas the influence of pregnancy diet and milk feeding on children's health and development is well characterized, the role of early food intake and eating behaviors is largely unexplored. This study aimed to determine whether the degree of adherence to complementary feeding guidelines was associated with dietary, obesity, cardiovascular, and cognitive outcomes at 7-8 y of age. Data were analyzed from the Avon Longitudinal Study of Parents and Children using parent-completed dietary questionnaires at 6 mo of age to calculate a Complementary Feeding Utility Index score. Regression analysis was used to explore associations between the index score and dietary patterns derived via principal component analysis (n = 4326), body-mass index (BMI) (n = 4801), waist circumference (n = 4798), blood pressure (n = 4685), and lipids (n = 3232) measured at age 7 y; and intelligence quotient (IQ) measured at age 8 y (n = 4429) after adjustment for covariates. The index score was negatively associated with a "processed" dietary pattern (β = -0.16; 95% CI: -0.20, -0.13; P < 0.001) but positively associated with a "health conscious" dietary pattern [β = 0.18 (95% CI: 0.14, 0.21); P < 0.001]. A higher index score was also positively associated with total, verbal, and performance IQ scores at 8 y of age [β = 1.92 (95%CI: 1.38, 2.47); P < 0.001 for total IQ). The index score was weakly associated with waist circumference [β = -0.15 (95%CI: -0.31, -0.002); P = 0.046] and diastolic blood pressure [β = -0.24 (95%CI: -0.47, -0.01); P = 0.043] at 7 y of age but was not associated with BMI or other cardiovascular risk factors. These findings suggest that adherence to current complementary feeding guidelines may have implications for some, but not all, health and development outcomes in childhood.
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Affiliation(s)
- Rebecca K Golley
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
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142
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Exposure to parental smoking and child growth and development: a cohort study. BMC Pediatr 2013; 13:104. [PMID: 23842036 PMCID: PMC3717101 DOI: 10.1186/1471-2431-13-104] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 06/26/2013] [Indexed: 11/30/2022] Open
Abstract
Background Studies on adverse childhood health and development outcomes associated with parental smoking have shown inconsistent results. Using a cohort of Belarusian children, we examined differences in cognition, behaviors, growth, adiposity, and blood pressure at 6.5 years according to prenatal and postnatal exposure to parental smoking. Methods Using cluster-adjusted multivariable regression, effects of exposure to prenatal smoking were examined by comparing (1) children whose mothers smoked during pregnancy with those of mothers who smoked neither during nor after pregnancy and (2) children whose mothers smoked during and after pregnancy with those whose mothers smoked after pregnancy only; effects of postnatal smoking were examined by comparing (1) children whose mothers smoked after pregnancy only with those of mothers who smoked neither during nor after pregnancy and (2) children whose fathers smoked with those whose fathers did not smoke among children of non-smoking mothers after adjusting for a wide range of socioeconomic and family characteristics. Results After adjusting for confounders, children exposed vs unexposed to prenatal maternal smoking had no differences in mean IQ, teacher-rated behavioral problems, adiposity, or blood pressure. Children exposed to maternal postnatal smoking had slightly increased behavioral problems [0.9, 95% CI: 0.6, 1.2 for total difficulties], higher body mass index [0.2, 95% CI: 0.1, 0.3], greater total skinfold thickness [0.4, 95% CI: 0.04, 0.71], and higher odds of overweight or obesity [1.4, 95% CI; 1.1, 1.7]. Similar magnitudes of association were observed with postnatal paternal smoking. Conclusions No adverse cognitive, behavioral and developmental outcomes were associated with exposure to maternal prenatal smoking. Observed associations with postnatal smoking of both parents may reflect residual confounding by genetic and family environmental factors.
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143
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Geddes DT, Prescott SL. Developmental origins of health and disease: the role of human milk in preventing disease in the 21(st) century. J Hum Lact 2013; 29:123-7. [PMID: 23382596 DOI: 10.1177/0890334412474371] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Donna T Geddes
- School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia, Perth, Australia.
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144
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Hörnell A, Lagström H, Lande B, Thorsdottir I. Breastfeeding, introduction of other foods and effects on health: a systematic literature review for the 5th Nordic Nutrition Recommendations. Food Nutr Res 2013; 57:20823. [PMID: 23589711 PMCID: PMC3625706 DOI: 10.3402/fnr.v57i0.20823] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 03/06/2013] [Accepted: 03/08/2013] [Indexed: 01/01/2023] Open
Abstract
The present systematic literature review is part of the 5th revision of the Nordic Nutrition Recommendations. The overall aim was to review recent scientific data valid in a Nordic setting on the short- and long-term health effects of breastfeeding (duration of both any and exclusive breastfeeding) and introduction of foods other than breast milk. The initial literature search resulted in 2,011 abstracts; 416 identified as potentially relevant. Full paper review resulted in 60 quality assessed papers (6A, 48B, and 6C). A complementary search found some additional papers. The grade of evidence was classified as convincing, probable, limited-suggestive, and limited-no conclusion. The evidence was convincing of a protective dose/duration effect of breastfeeding against overweight and obesity in childhood and adolescence, overall infections, acute otitis media, and gastrointestinal and respiratory tract infections. The evidence was probable that exclusive breastfeeding for longer than 4 months is associated with slower weight gain during the second half of the first year which could be part of the reason behind the reduced risk of later overweight or obesity. There was also probable evidence that breastfeeding is a protective factor against inflammatory bowel disease, celiac disease, and diabetes (type 1 and 2), provides beneficial effects on IQ and developmental scores of children as well as a small reductive effect on blood pressure and blood cholesterol levels in adulthood. Other associations explored were limited-suggestive or inconclusive. In conclusion, convincing and probable evidence was found for benefits of breastfeeding on several outcomes. The recommendation in NNR2004 about exclusive breastfeeding for 6 months and continued partial breastfeeding thereafter can stand unchanged. The relatively low proportion of infants in the Nordic countries following this recommendation indicates that strategies that protect, support and promote breastfeeding should be enhanced, and should also recognize the benefits for long-term health.
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Affiliation(s)
- Agneta Hörnell
- Department of Food and Nutrition, Umeå, University, Umeå Sweden
| | - Hanna Lagström
- Turku Institute for Child and Youth Research, University of Turku, Turku, Finland
| | - Britt Lande
- Division of Public Health, Norwegian Directorate of Health, Oslo, Norway
| | - Inga Thorsdottir
- Unit for Nutrition Research, School of Health Sciences, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland
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145
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Jiang M, Foster EM. Duration of breastfeeding and childhood obesity: a generalized propensity score approach. Health Serv Res 2013; 48:628-51. [PMID: 22924637 PMCID: PMC3626344 DOI: 10.1111/j.1475-6773.2012.01456.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To estimate the effect of breastfeeding duration on childhood obesity. DATA SOURCE The Child Development Supplement (CDS) of the Panel Study of Income Dynamics (PSID). The PSID provides extensive data on the income and well-being of a representative sample of U.S. families from 1968 to the present. The CDS collects information on the children in PSID families ranging from cognitive, behavioral, and health status to their family and neighborhood environment. The first two waves of the CDS were conducted in 1997 and 2002, respectively. The data provide information on 3,271 children and their mothers. STUDY DESIGN We use the generalized propensity score to adjust for confounding based on continuous treatment, and the general additive model to analyze the adjusted association between treatment and the outcome conditional on the propensity score. The main outcome is the body mass index (BMI) directly assessed during the in-person interview in 2002. Covariates include family, maternal, and child characteristics, many of which were measured in the year the child was born. PRINCIPAL FINDINGS After using propensity scores to adjust for confounding, the relationship between breastfeeding duration and childhood BMI is trivially small across a range of model specifications, and none of them is statistically significant except the unadjusted model. CONCLUSIONS The causal link between duration of breastfeeding and childhood obesity has not been established. Any recommendation of promoting breastfeeding to reduce childhood obesity is premature.
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Affiliation(s)
- Miao Jiang
- Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA.
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146
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Martin RM, Patel R, Kramer MS, Guthrie L, Vilchuck K, Bogdanovich N, Sergeichick N, Gusina N, Foo Y, Palmer T, Rifas-Shiman SL, Gillman MW, Smith GD, Oken E. Effects of promoting longer-term and exclusive breastfeeding on adiposity and insulin-like growth factor-I at age 11.5 years: a randomized trial. JAMA 2013; 309:1005-13. [PMID: 23483175 PMCID: PMC3752893 DOI: 10.1001/jama.2013.167] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Evidence that longer-term and exclusive breastfeeding reduces child obesity risk is based on observational studies that are prone to confounding. OBJECTIVE To investigate effects of an intervention to promote increased duration and exclusivity of breastfeeding on child adiposity and circulating insulin-like growth factor (IGF)-I, which regulates growth. DESIGN, SETTING, AND PARTICIPANTS Cluster-randomized controlled trial in 31 Belarusian maternity hospitals and their affiliated clinics, randomized into 1 of 2 groups: breastfeeding promotion intervention (n = 16) or usual practices (n = 15). Participants were 17,046 breastfeeding mother-infant pairs enrolled in 1996 and 1997, of whom 13,879 (81.4%) were followed up between January 2008 and December 2010 at a median age of 11.5 years. INTERVENTION Breastfeeding promotion intervention modeled on the WHO/UNICEF Baby-Friendly Hospital Initiative (World Health Organization/United Nations Children's Fund). MAIN OUTCOME MEASURES Body mass index (BMI), fat and fat-free mass indices (FMI and FFMI), percent body fat, waist circumference, triceps and subscapular skinfold thicknesses, overweight and obesity, and whole-blood IGF-I. Primary analysis was based on modified intention-to-treat (without imputation), accounting for clustering within hospitals and clinics. RESULTS The experimental intervention substantially increased breastfeeding duration and exclusivity when compared with the control (43% vs 6% exclusively breastfed at 3 months and 7.9% vs 0.6% at 6 months). Cluster-adjusted mean differences in outcomes at 11.5 years of age between experimental vs control groups were: 0.19 (95% CI, -0.09 to 0.46) for BMI; 0.12 (-0.03 to 0.28) for FMI; 0.04 (-0.11 to 0.18) for FFMI; 0.47% (-0.11% to 1.05%) for percent body fat; 0.30 cm (-1.41 to 2.01) for waist circumference; -0.07 mm (-1.71 to 1.57) for triceps and -0.02 mm (-0.79 to 0.75) for subscapular skinfold thicknesses; and -0.02 standard deviations (-0.12 to 0.08) for IGF-I. The cluster-adjusted odds ratio for overweight/obesity (BMI ≥ 85th vs <85th percentile) was 1.18 (95% CI, 1.01 to 1.39) and for obesity (BMI ≥ 95th vs <85th percentile) was 1.17 (95% CI, 0.97 to 1.41). CONCLUSIONS AND RELEVANCE Among healthy term infants in Belarus, an intervention that succeeded in improving the duration and exclusivity of breastfeeding did not prevent overweight or obesity, nor did it affect IGF-I levels at age 11.5 years. Breastfeeding has many advantages but population strategies to increase the duration and exclusivity of breastfeeding are unlikely to curb the obesity epidemic. TRIAL REGISTRATION isrctn.org: ISRCTN37687716; and clinicaltrials.gov: NCT01561612.
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Affiliation(s)
- Richard M Martin
- School of Social and Community Medicine, University of Bristol, Bristol, England.
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147
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Patel R, Oken E, Bogdanovich N, Matush L, Sevkovskaya Z, Chalmers B, Hodnett ED, Vilchuck K, Kramer MS, Martin RM. Cohort profile: The promotion of breastfeeding intervention trial (PROBIT). Int J Epidemiol 2013; 43:679-90. [PMID: 23471837 DOI: 10.1093/ije/dyt003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The PROmotion of Breastfeeding Intervention Trial (PROBIT) is a multicentre, cluster-randomized controlled trial conducted in the Republic of Belarus, in which the experimental intervention was the promotion of increased breastfeeding duration and exclusivity, modelled on the Baby-friendly hospital initiative. Between June 1996 and December 1997, 17,046 mother-infant pairs were recruited during their postpartum hospital stay from 31 maternity hospitals, of which 16 hospitals and their affiliated polyclinics had been randomly assigned to the arm of PROBIT investigating the promotion of breastfeeding and 15 had been assigned to the control arm, in which breastfeeding practices and policies in effect at the time of randomization was continued. Of the mother-infant pairs originally recruited for the study, 16,492 (96.7%) were followed at regular intervals until the infants were 12 months of age (PROBIT I) for the outcomes of breastfeeding duration and exclusivity; gastrointestinal and respiratory infections; and atopic eczema. Subsequently, 13,889 (81.5%) of the children from these mother-infant pairs were followed-up at age 6.5 years (PROBIT II) for anthropometry, blood pressure (BP), behaviour, dental health, cognitive function, asthma and atopy outcomes, and 13,879 (81.4%) children were followed to the age of 11.5 years (PROBIT III) for anthropometry, body composition, BP, and the measurement of fasted glucose, insulin, adiponectin, insulin-like growth factor-I, and apolipoproteins. The trial registration number for Current Controlled Trials is ISRCTN37687716 and that for ClinicalTrials.gov is NCT01561612. Proposals for collaboration are welcome, and enquires about PROBIT should be made to an executive group of the study steering committee (M.S.K., R.M.M., and E.O.). More information, including information about how to access the trial data, data collection documents, and bibliography, is available at the trial website (http://www.bristol.ac.uk/social-community-medicine/projects/probit/).
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Affiliation(s)
- Rita Patel
- School of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Emily Oken
- School of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Natalia Bogdanovich
- School of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Lidia Matush
- School of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Zinaida Sevkovskaya
- School of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Beverley Chalmers
- School of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Ellen D Hodnett
- School of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Konstantin Vilchuck
- School of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Michael S Kramer
- School of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Richard M Martin
- School of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UKSchool of Social and Community Medicine, University of Bristol, Bristol, UK, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA, The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus, Belarussian Ministry of Health, Minsk, Belarus, Department of Obstetrics and Gynaecology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada, Departments of Pediatrics & Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Bristol, UK
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148
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Anderson EL, Fraser A, Martin RM, Kramer MS, Oken E, Patel R, Tilling K. Associations of postnatal growth with asthma and atopy: the PROBIT Study. Pediatr Allergy Immunol 2013; 24:122-30. [PMID: 23374010 PMCID: PMC3711479 DOI: 10.1111/pai.12049] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND It has been hypothesised that postnatal weight and length/height gain are variously related to wheeze, asthma and atopy; however, supporting evidence is limited and inconsistent. METHODS Weights and lengths/heights of 12,171 term infants were measured from birth to 12 months and at 6.5 yr and extracted from polyclinic records prospectively obtained between 12 and 60 months. Atopic phenotypes were ascertained at 6.5 yr with the International Study of Asthma and Allergy in Childhood questionnaire and skin prick tests. Logistic regression models investigated whether rates of weight and length/height gain from infancy to mid-childhood were associated with atopy phenotypes that have occurred ever or in the last 12 months. RESULTS After controlling for confounders and prior weight and length/height gain, all weight gain variables except birth weight were positively associated with ever having wheezed (p < 0.1). A one s.d. increase in weight gain rate between 0 and 3 months was associated with a 12% increase (2-23%) in allergic rhinitis ever. No other consistent patterns of association were found for weight gain or length/height gain rate between 0 and 60 months with atopic outcomes at 6.5 yr. In contrast, all atopy outcomes except for ever having asthma were associated with current weight and height, even after controlling for prior growth. CONCLUSION Current height and weight are more strongly associated with the development of atopic phenotypes in childhood than patterns of infant and early childhood growth, which may well reflect reverse causality (atopy effects on growth) or residual confounding by an unknown common cause of growth and atopy.
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Affiliation(s)
- Emma L Anderson
- MRC Centre for Causal Analyses in Translational Epidemiology, School of Social and Community Medicine, University of Bristol, Bristol, UK.
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149
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Abstract
Worldwide, breastfeeding saves the lives of infants and reduces their disease burden. Breastfeeding also reduces the disease burden for mothers. This article examines who chooses to breastfeed and for how long in the United States. It also reviews the latest evidence about the consequences of breastfeeding for the health of the infant and mother. This review provides support for current national and international recommendations that support breastfeeding.
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Affiliation(s)
- Christine M. Dieterich
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14850; tel: 415-609-5438
| | - Julia P. Felice
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14850; tel: 617-797-8618
| | - Elizabeth O’Sullivan
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14850; tel: 607-379-5624
| | - Kathleen M. Rasmussen
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14850; tel: 607-255-2290
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150
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Yang Z, Huffman SL. Nutrition in pregnancy and early childhood and associations with obesity in developing countries. MATERNAL AND CHILD NUTRITION 2013; 9 Suppl 1:105-19. [PMID: 23167588 DOI: 10.1111/mcn.12010] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Concerns about the increasing rates of obesity in developing countries have led many policy makers to question the impacts of maternal and early child nutrition on risk of later obesity. The purposes of the review are to summarise the studies on the associations between nutrition during pregnancy and infant feeding practices with later obesity from childhood through adulthood and to identify potential ways for preventing obesity in developing countries. As few studies were identified in developing countries, key studies in developed countries were included in the review. Poor prenatal dietary intakes of energy, protein and micronutrients were shown to be associated with increased risk of adult obesity in offspring. Female offspring seem to be more vulnerable than male offspring when their mothers receive insufficient energy during pregnancy. By influencing birthweight, optimal prenatal nutrition might reduce the risk of obesity in adults. While normal birthweights (2500-3999 g) were associated with higher body mass index (BMI) as adults, they generally were associated with higher fat-free mass and lower fat mass compared with low birthweights (<2500 g). Low birthweight was associated with higher risk of metabolic syndrome and central obesity in adults. Breastfeeding and timely introduction of complementary foods were shown to protect against obesity later in life in observational studies. High-protein intake during early childhood however was associated with higher body fat mass and obesity in adulthood. In developed countries, increased weight gain during the first 2 years of life was associated with a higher BMI in adulthood. However, recent studies in developing countries showed that higher BMI was more related to greater lean body mass than fat mass. It appears that increased length at 2 years of age was positively associated with height, weight and fat-free mass, and was only weakly associated with fat mass. The protective associations between breastfeeding and obesity may differ in developing countries compared to developed countries because many studies in developed countries used formula feeding as a control. Future research on the relationship between breastfeeding, timely introduction of complementary feeding or rapid weight gain and obesity are warranted in developing countries. The focus of interventions to reduce risk of obesity in later life in developing countries could include: improving maternal nutritional status during pregnancy to reduce low birthweight; enhancing breastfeeding (including durations of exclusive and total breastfeeding); timely introduction of high-quality complementary foods (containing micronutrients and essential fats) but not excessive in protein; further evidence is needed to understand the extent of weight gain and length gain during early childhood are related to body composition in later life.
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Affiliation(s)
- Zhenyu Yang
- National Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, China.
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