Developmental origins of health and adult disease: what should neonatologists/paediatricians be considering about the long-term health of their patients?

Clinical value of placental examination for paediatricians

The placenta contains valuable clinical information that is linked to fetal development, neonatal morbidity and mortality, and future health outcomes. Both gross inspection and histopathological examination of the placenta may identify intrinsic or secondary placental lesions, which can contribute directly to adverse neonatal outcomes or indicate the presence of an unfavourable intrauterine environment. Placental examination therefore forms an essential component of the care of high-risk neonates and at perinatal post-mortem examination. In this article, we describe the clinical value of placental examination for paediatricians and perinatal clinicians. We discuss common pathological findings on general inspection of the placenta with photographic examples and provide an overview of the placental pathological examination, including how to interpret key findings. We also address the medico-legal and financial implications of placental examinations and describe current and future clinical considerations for clinicians in regard to placental examination.

Preterm infant nutrition and growth with a human milk diet

Human milk is the preferred enteral diet for preterm infants. It provides macronutrients, micronutrients, and bioactive factors that support physical growth and neurodevelopment. Challenges of the human milk diet include the variability in its composition and a need for fortification to mirror placental nutrient delivery and prevent extrauterine growth restriction. Various strategies exist to attain target nutrient provision and optimize growth, including leveraging new technology for point-of-care human milk analysis. When maternal milk is unavailable or in short supply, pasteurized donor human milk is the preferred alternative. Infants fed donor milk may have slower weight gain than those fed exclusively maternal milk or formula, whereas infants fed fortified maternal milk have similar weight gain to preterm formula-fed infants. Future directions include more rigorous characterization of the variation in human milk, further investigation of the clinical benefits of non-nutrient bioactive factors in milk, and novel approaches to optimize fortification.

Paternal bisphenol A exposure induces testis and sperm pathologies in mice offspring: Possibly due to oxidative stress?

Bisphenol A (BPA), an endocrine and metabolic disruptor, is widely used to manufacture polycarbonate plastics and epoxy resins. Accumulating evidence suggests that paternal BPA exposure adversely affects male germlines and results in atypical reproductive phenotypes that might persist for generations to come. Our study investigated this exposure on testicular architecture and sperm quality in mouse offspring, and characterised underlying molecular mechanism(s). A total of 18 immature male Swiss albino mice (3.5 weeks old) were randomly divided into three groups and treated as follows: Group I, no treatment (sham control); Group II, sterile corn oil only (vehicle control); Group III, BPA (400 μg/kg) in sterile corn oil. At 9.5 weeks old, F0 males were mated with unexposed females. F0 offspring (F1 generation) were monitored for postnatal development for 10 weeks. At 11.5 weeks old, the animals were sacrificed to examine testicular architecture, sperm parameters, including DNA integrity, and oxidative stress biomarkers. Results showed that BPA significantly induced changes in the body and testis weights of the F0 and F1 generation BPA lineages compared to F0 and F1 generation control lineages. A decrease in sperm count and motility with further, increased sperm abnormalities, no or few sperm DNA alterations and elevated levels of MDA, PC and NO were recorded. Similar effects were found in BPA exposed F0 males, but were more pronounced in the F0 offspring. In addition, BPA caused alterations in the testicular architecture. These pathological changes extended transgenerationally to F1 generation males’ mice, but the pathological changes were more pronounced in the F1 generation. Our findings demonstrate that the biological and health BPA impacts do not end in paternal adults, but are passed on to offspring generations. Hence, linking observed testis and sperm abnormalities in the F1 generation to BPA exposure of their parental line was evident in this work. The findings also illustrate that oxidative stress appears to be a molecular component of the testis and sperm pathologies.

Macronutrient Intake from Human Milk, Infant Growth, and Body Composition at Term Equivalent Age: A Longitudinal Study of Hospitalized Very Preterm Infants

The variable macronutrient content of human milk may contribute to growth deficits among preterm infants in the neonatal intensive care unit (NICU). In a longitudinal study of 37 infants < 32 weeks gestation, we aimed to (1) determine the between-infant variation in macronutrient intake from human milk and (2) examine associations of macronutrient intake with growth outcomes. We analyzed 1626 human milk samples (median, 43 samples/infant) with mid infrared spectroscopy. Outcomes at term equivalent age were weight, length, head circumference, fat mass, and fat-free mass. Median (range) intakes from human milk were: protein 1.37 (0.88, 2.43) g/kg/day; fat 4.20 (3.19, 5.82) g/kg/day; carbohydrate 8.94 (7.72, 9.85) g/kg/day; and energy 82.5 (68.7, 99.3) kcal/kg/day. In median regression models adjusted for birth size and gestational age, and other covariates, greater intakes of fat and energy were associated with higher weight (0.61 z-scores per g/kg/day fat, 95% CI 0.21, 1.01; 0.69 z-scores per 10 kcal/kg/day, 95% CI 0.28, 1.10), whereas greater protein intake was associated with greater body length (0.84 z-scores per g/kg/day protein, 95% CI 0.09, 1.58). Higher fat intake was also associated with higher fat mass and fat-free mass. Macronutrient intakes from human milk were highly variable and associated with growth outcomes despite routine fortification.

The Correlation between Early Stages of Life Exposed to Chinese Famine and Cognitive Decline in Adulthood: Nutrition of Adulthood Plays an Important Role in the Link?

Objective: The aim of this study was to investigate whether people exposed to the Chinese Famine in fetal period or in multiple stages of childhood are associated with cognitive decline in adulthood. Furthermore, the nutritional environment of adulthood was explored as an important factor in this correlation.

Methods: 1162 adults born between 1952 and 1964 were recruited. They were divided into five groups which were non-exposed group, fetal-exposed group, early childhood-exposed group, mid childhood-exposed group and late childhood-exposed group. Cognitive function was measured by using a comprehensive neuropsychological battery test, including Montreal cognitive assessment-Beijing version, mini-mental state examination, auditory verbal learning test, digit span forward, digit span backward, trail making test, and digit symbol test. Semi-quantified food frequency questionnaire (FFQ) was used to assess the dietary nutrition in their adulthood. The dietary nutrient consumption pattern was identified by Two-step and K-means cluster analysis.

Results: The significant differences in cognitive function were manifested in different groups. Compared with non-exposed group, subjects in fetal-exposed group had a higher risk of mild cognitive impairment (MCI) (OR 1.51 95% CI 1.02–2.23, P = 0.039) and global cognitive decline (OR 1.68 59% CI 1.02–2.77, P = 0.044). The similar result was also observed in subjects of early childhood-exposed group. Otherwise, subjects who were classified in high nutrient consumption pattern had higher risk of cognitive decline. Moreover, the higher consumption of several nutrients such as fat, carbohydrate and manganese were associated with worse performance on digit span forward, digit span backward, trail making test A, trail making test B and digit symbol.

Conclusion: Early stages of life exposed to the Chinese Famine were associated with higher risk of cognitive decline in adulthood. The stronger associations were manifested in the people with high nutrient consumption pattern. The consumption of fat, carbohydrate and manganese were associated with multiple domains cognitive decline.

Does the early introduction of solids promote obesity?

Childhood obesity is a major public health challenge across the developed world, and it is vital to understand the modifiable factors that contribute to it. The influence of early-life nutrition on predisposition to later obesity and metabolic disease is now well established. Much research has concentrated on the preventative effects of breastfeeding in relation to childhood obesity risk, but the optimal timing of introducing solid foods has received far less attention. This remains a much-debated and contentious issue, and differing guidelines from international bodies have caused confusion among parents. There is no conclusive evidence from current research that introducing solids before six months of age is associated with an increased risk of obesity in infancy or childhood. Current studies suggest that the most clearly established risk factor for childhood obesity is maternal body mass index. There is a need for continued research in this area.

Kangaroo Mother Care 1: Alleviation of Physiological Problems in Premature Infants

Kangaroo mother care (KMC) involves placing the newborn infant into prolonged and continuous skin-to-skin contact with the mother as soon as possible after birth, exclusive breastfeeding, early discharge from the health facility, and supportive follow-up at home. Claimed benefits of KMC as an aid to the clinical mitigation of some detrimental features of prematurity need to be evidence based. This article, the first of two, provides an overview of the impact of prematurity on those features of neonates to which KMC may be directed. Specifically, the mitigation of some cardiorespiratory, neurophysiological, sensory, gastrointestinal, musculoskeletal, renal, metabolic, and immunological impacts are outlined. Relevant neurobehavioral, psychosocial, sociocultural, and economic perspectives are briefly reviewed in the companion article. These two articles provide scientific support for a wider upscaling of KMC education and its cautious use in physiologically stable preterm infants.

Parental Perceptions of Family Centered Care in Medical Homes of Children with Neurodevelopmental Disabilities

Life course theory sets the framework for strong inclusion of family centered care (FCC) in quality medical homes of children with neurodevelopmental disabilities (CNDD). The purpose of this study was to explore the perceptions of families with their experiences of FCC in medical homes for CNDD. Using a structured questionnaire, the Family-Centered Care Self-Assessment Tool developed by Family Voices, this study surveyed 122 parents of CNDD in a large urban area during 2010-2012. Data collected information on FCC in the provision of primary health care services for CNDD and focused on family-provider partnerships, care setting practices and policies, and community services. Frequency analysis classified participants' responses as strengths in the "most of the time" range, and weaknesses in the "never" range. Only 31 % of parents were satisfied with the primary health care their CNDD received. Based on an accepted definition of medical home services, 16 % of parents reported their CNDD had most aspects of a medical home, 64 % had some, and 20 % had none. Strengths in FCC were primarily evident in the family-provider partnership and care settings when focused on meeting the medical care needs of the child. Weaknesses in FCC were noted in meeting the needs of families, coordination, follow-up, and support with community resources. Improvements in key pediatric health care strategies for CNDD are recommended. CNDD and their families have multifaceted needs that require strong partnerships among parents, providers, and communities. Quality medical homes must include FCC and valued partnerships with diverse families and community-based providers.

Longitudinal Intergenerational Birth Cohort Designs: A Systematic Review of Australian and New Zealand Studies

BACKGROUND

The longitudinal birth cohort design has yielded a substantial contribution to knowledge of child health and development. The last full review in New Zealand and Australia in 2004 identified 13 studies. Since then, birth cohort designs continue to be an important tool in understanding how intrauterine, infant and childhood development affect long-term health and well-being. This updated review in a defined geographical area was conducted to better understand the factors associated with successful quality and productivity, and greater scientific and policy contribution and scope.

METHODS

We adopted the preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach, searching PubMed, Scopus, Cinahl, Medline, Science Direct and ProQuest between 1963 and 2013. Experts were consulted regarding further studies. Five inclusion criteria were used: (1) have longitudinally tracked a birth cohort, (2) have collected data on the child and at least one parent or caregiver (3) be based in Australia or New Zealand, (4) be empirical in design, and (5) have been published in English.

RESULTS

10665 records were initially retrieved from which 23 birth cohort studies met the selection criteria. Together these studies recruited 91,196 participants, with 38,600 mothers, 14,206 fathers and 38,390 live births. Seventeen studies were located in Australia and six in New Zealand. Research questions initially focused on the perinatal period, but as studies matured, longer-term effects and outcomes were examined.

CONCLUSIONS

This review demonstrates the significant yield from this effort both in terms of scientific discovery and social policy impact. Further opportunities have been recognised with cross-study collaboration and pooling of data between established and newer studies and international studies to investigate global health determinants.

Association of serum lead and mercury level with cardiometabolic risk factors and liver enzymes in a nationally representative sample of adolescents: the CASPIAN-III study

This study aims to determine the difference of serum Pb and Hg levels in adolescents with or without metabolic syndrome (MetS) and the association of serum levels of these heavy metals with cardiometabolic risk factors and liver enzymes in Iranian adolescents. The study population consisted of 320 adolescents (160 with MetS and 160 healthy controls). The relationship between serum heavy metals and cardiometabolic risk factors was assessed by linear regression. The odds ratios (OR) of having metabolic syndrome across Pb and Hg quartiles were determined by multiple logistic regression analysis. The mean (SD) of Pb and Hg concentrations were higher in adolescents with MetS than in those without it (0.83 (0.27) and 0.17 (0.01) vs. 0.65 (0.15) and 0.10 (0.08) μg/L, P = 0.01 and 0.0001, respectively). Increase in serum Pb and Hg was associated with increase in some cardiometabolic risk factors. Among boys and girls, diastolic blood pressure (DBP), fasting blood glucose, total cholesterol (TC), triglycerides (TG), and alanine aminotransaminase increased significantly across quartiles of serum Pb. Among girls, SBP, DBP, TC, and TG had a significant increase across Hg quartiles. The corresponding figure among boys was significant for SBP, DBP, and TG. Higher quartiles of Pb increased the risk of having MetS (OR 95 % CI 3.10, 2.25-4.27), the corresponding figure was 2.03, 1.75-3.16, across Hg quartiles. Our study showed significant associations between serum Pb and Hg levels with cardiometabolic risk factors in adolescents. In future surveys, the role of potential confounders should be considered more extensively. The clinical significance of these findings needs to be confirmed in longitudinal studies. By considering the origins of chronic diseases from early life, controlling environmental pollutants should be considered as a health priority for primordial or primary prevention of noncommunicable diseases.

Is air quality index associated with cardiometabolic risk factors in adolescents? The CASPIAN-III Study

OBJECTIVE

This study aims to evaluate the association of air quality index (AQI) with cardiometabolic risk factors in a nationally representative sample of healthy adolescents.

METHODS

This nationwide survey was conducted among a stratified multi-stage probability sample of students, aged 10-18 years, from 27 provinces of Iran. Those students with history of any acute or chronic diseases, any medication use, as well as active or passive smoking were not included to the current study. Dietary and physical activity habits were documented by valid questionnaires. Physical examination and blood sampling were conducted under standard protocols. AQI data were obtained from air pollution monitoring sites from the entire country by considering air pollutants concentration, which includes all provincial counties containing different clusters.

RESULTS

The study participants consisted of 1413 students (48.8% boys) with a mean (SD) age of 14.81±2.48 years. The mean AQI level was 285.37±30.11 at national levels. After adjustment for confounding factors including age, sex, and anthropometric measures, as well as for dietary and physical activity habits, multiple linear regressions based on correlation of coefficients of the AQI with cardiometabolic risk factors showed significant positive correlations of AQI with systolic blood pressure, fasting blood glucose, total cholesterol, LDL-cholesterol, and triglycerides, as well as significant negative correlations with HDL-cholesterol. After adjustment for abovementioned confounding factors, binary logistic regressions analyses showed that AQI increased the risk of abnormal levels of some risk factors as elevated levels of systolic blood pressure, total cholesterol, and triglycerides.

CONCLUSION

The associations of low air quality with some cardiometabolic factors in the current survey, although not strong, might be considered as an evidence of the adverse cardiometabolic consequences of exposure to air pollutants in the pediatric age group, and predisposing them to earlier development of non-communicable diseases.

Optimizing health and health care systems for children with special health care needs using the life course perspective

To date, life course research in maternal and child health has largely focused on elucidating fetal and early life influences on adult health and less on promoting the health of children with special health care needs (CSHCN). Consideration of life course theory (LCT) for CSHCN is especially important given their increasing prevalence and comorbidity, their disproportionate vulnerability to weaknesses or instability in the health care system, and the growing evidence linking child and adult health and quality of life. In this commentary we seek to advance the consideration of LCT for CSHCN. We (1) briefly summarize key issues and the importance of a life course approach for CSHCN; (2) present illustrative findings from population-based cross-sectional data that serve to generate hypotheses that can be more rigorously examined when population-based longitudinal data become available; and (3) discuss the application of life course principles as a driving force in the continued implementation and improvement of integrated systems of care for CSHCN.

Perinatal BPA exposure induces hyperglycemia, oxidative stress and decreased adiponectin production in later life of male rat offspring

The main object of the present study was to explore the effect of perinatal bisphenol A (BPA) exposure on glucose metabolism in early and later life of male rat offspring, and to establish the potential mechanism of BPA-induced dysglycemia. Pregnant rats were treated with either vehicle or BPA by drinking water at concentrations of 1 and 10 µg/mL BPA from gestation day 6 through the end of lactation. We measured the levels of fasting serum glucose, insulin, adiponectin and parameters of oxidative stress on postnatal day (PND) 50 and PND100 in male offspring, and adiponectin mRNA and protein expression in adipose tissue were also examined. Our results showed that perinatal exposure to 1 or 10 µg/mL BPA induced hyperglycemia with insulin resistance on PND100, but only 10 µg/mL BPA exposure had similar effects as early as PND50. In addition, increased oxidative stress and decreased adiponectin production were also observed in BPA exposed male offspring. Our findings indicated that perinatal exposure to BPA resulted in abnormal glucose metabolism in later life of male offspring, with an earlier and more exacerbated effect at higher doses. Down-regulated expression of adiponectin gene and increased oxidative stress induced by BPA may be associated with insulin resistance.

A review on the genetic, environmental, and lifestyle aspects of the early-life origins of cardiovascular disease

This article is a comprehensive review on developmental origins of health and disease regarding various factors related to the origins of cardiovascular diseases from early life. It presents a summary of the impacts of various factors such as epigenetics; gene-environment interaction; ethnic predisposition to cardiovascular diseases and their underlying risk factors; prenatal factors; fetal programming; maternal weight status and weight gain during pregnancy; type of feeding during infancy; growth pattern during childhood; obesity; stunting; socioeconomic status; dietary and physical activity habits; active, secondhand, and thirdhand smoking, as well as environmental factors including air pollution and global climate change on the development and progress of cardiovascular diseases and their risk factors. The importance of early identification of predisposing factors for cardiovascular diseases for primordial and primary prevention of cardiovascular diseases from early life is highlighted.