Impact of nutrition since early life on cardiovascular prevention

The dietary approaches to stop hypertension (DASH) dietary pattern in childhood in relation to cardiometabolic risk in adolescence and early adulthood in the ALSPAC birth cohort

OBJECTIVE

To investigate the relationship between the dietary approaches to stop hypertension (DASH)-style dietary patterns in childhood and cardiometabolic risk (CMR) in adolescence/early adulthood.

DESIGN

Data were obtained from the Avon Longitudinal Study of Parents and Children (ALSPAC) prospective cohort. Diet diary data collected at 7, 10 and 13 years were used to calculate DASH-style diet scores (DDS). Multivariable linear regression models were used to investigate the associations between the DDS at 7, 10 and 13 years and CMR scores, calculated at 17 and 24 years.

SETTING

The ALSPAC cohort included children born in south-west England in 1991-1992.

PARTICIPANTS

Children with complete dietary, covariate and cardiometabolic data at 17 (n 1,526) and 24 years (n 1,524).

RESULTS

A higher DDS at 7 and 10 years was negatively associated with CMR scores at 17 years (β = -0·64 (95 % CI -1·27, -0·006), Ptrend=0·027 for fifth v. first DDS quintile at 7 years; β = -0·73 (95 % CI -1·35, -0·12) and Ptrend=0·037 for fifth v. first DDS quintile at 10 years) and at 24 years (β = -0·92 (95 % CI -1·49, -0·34) Ptrend = 0·001 for fifth v. first DDS quintile at 7 years; β = -0·60 (95 % CI -1·20, -0·05) Ptrend = 0·092 for fifth v. first DDS quintile at 10 years). No associations were found between the DDS at 13 years and CMR score at 17 and 24 years.

CONCLUSION

Greater adherence with a DASH-style diet during childhood was associated with better cardiometabolic health in adolescence/adulthood in the ALSPAC cohort. The components of the DASH diet could be recommended to improve children's cardiometabolic health.

Effects of prenatal docosahexaenoic acid supplementation on offspring cardiometabolic health at 11 years differs by maternal single nucleotide polymorphism rs174602: follow-up of a randomized controlled trial in Mexico

BACKGROUND

There is limited evidence regarding long-term effects of prenatal docosahexaenoic acid (DHA) supplementation on offspring cardiometabolic health (CMH). Inconsistent results may be attributable to variants of fatty acid desaturase (FADS) genes.

OBJECTIVE

We aimed to evaluate the effect of prenatal DHA supplementation on offspring CMH and investigate effect modification by maternal FADS2 single nucleotide polymorphism (SNP) rs174602.

METHODS

We used follow-up data from a double-blind, randomized controlled trial in Mexico in which pregnant females received 400 mg/d of algal DHA or placebo from midgestation until delivery. The study sample included 314 offspring with data at age 11 y and maternal FADS genetic data (DHA: n = 160; Placebo: n = 154). We derived a Metabolic Syndrome (MetS) score from body mass index, HDL, triglycerides, fasting glucose concentrations, and systolic blood pressure. Generalized linear models were used to evaluate the effect of the intervention on offspring MetS score and test interactions between treatment group and genotype, adjusting for maternal, offspring, and household factors.

RESULTS

Offspring MetS score did not differ significantly by treatment group. We observed evidence of effect modification by maternal SNP rs174602 (P = 0.001); offspring of maternal TT genotype who received DHA had lower MetS score relative to the placebo group (DHA (mean ± standard error of the mean (SEM)): -0.21 ± 0.11, n = 21; Placebo: 0.05 ± 0.11, n = 23; Δ= -0.26 (95% CI: -0.55, 0.04), P = 0.09); among CC maternal genotype carriers, offspring of mothers who received DHA had higher MetS score (0.18 ± 0.06, n = 62) relative to the placebo group (-0.05 ± 0.06, n = 65, Δ=0.24 (0.06, 0.41), P < 0.01).

CONCLUSION

The effect of prenatal DHA supplementation on offspring MetS score differed by maternal FADS SNP rs174602. These findings further support incorporating genetic analysis of FADS polymorphisms in DHA supplementation trials.

CLINICAL TRIAL DETAILS

This trial was registered at clinicaltrials.gov as NCT00646360.

Associations between Perinatal Sleepiness and Breastfeeding Intentions and Attitudes and Infant Feeding Behaviors and Beliefs

Breastfeeding rates fall short of public health goals, but barriers are poorly understood. We examined whether excessive sleepiness during pregnancy and the postpartum period was associated with breastfeeding intentions, attitudes, initiation, and continuation in a tobacco-exposed sample participating in a randomized controlled trial to reduce smoke exposure (n = 399). We used the Epworth Sleepiness Scale (ESS) to examine associations between excessive sleepiness in early (12-16 weeks gestation) and late (32 weeks gestation) pregnancy and at 6 months postpartum, with breastfeeding attitudes using the Mitra index, intentions, initiation, and continuation, as well as other infant feeding practices using the Infant Feeding Questionnaire. Logistic regression models adjusted for age, racial/ethnic identity, parity, marital status, and maternal education showed that excessive sleepiness in late pregnancy was associated with less favorable attitudes toward breastfeeding. In addition, in unadjusted models, excessive sleepiness at 6 months postpartum was associated with less of a tendency to use feeding to calm a fussy infant. Excessive sleepiness was not associated with intent, initiation, or continuation of breastfeeding. Assessing excessive sleepiness in late pregnancy may assist in identifying individuals with negative attitudes to breastfeeding and lead to novel approaches to promoting breastfeeding in populations with lower breastfeeding rates.

Diastolic blood pressure and lipid profile in breastfed versus formula-fed infants as early indicators for CVD: a cross-sectional study

Background

Cardiovascular disease is one of the major causes of death in the world. Low-density lipoprotein cholesterol (LDL-C) is a major cause of cardiovascular disease. Longevity of breastfeeding and exclusiveness have both been proposed as possible moderators of the hazard of future CVD. Dyslipidemia, which includes high levels of triglycerides, low levels of high-density lipoprotein cholesterol (HDL-C), with higher levels of LDL-C, as well as hypertension, obesity, and insulin resistance, accelerates atherosclerotic progression and increases the danger of CVD. The consumption of infant formula has been linked to rapid growth, which raises fat accumulation in late infancy and programmed aberrant vascular biology linked to early CVD.

Objectives

This study aimed to compare the blood pressure and lipid profiles of breastfed and formula-fed infants in an effort to determine the cause of the differences.

Results

Both the breastfed and the formula-fed groups showed negligible differences in blood pressure, systolic blood pressure, and blood sugar. Regarding the lipid profile, breastfed newborns had significantly higher levels of Total cholesterol (P <0.001), Triglycerides (P 0.02), HDL-C (P <0.001), LDL-C (P 0.01) and Non-HDL (P <0.001). Newborns who were breastfed had greater levels of non-HDL cholesterol than infants who were fed formula.

Conclusion

Early infancy breastfeeding was linked to a higher lipid profile in breastfed infants, suggesting it may have long-term cardiovascular health benefits that should be supported. The molecular mechanism through which breastfeeding regulates lipid metabolism was revealed by further research.

Identifying Cardiovascular Risk Profiles Clusters among Mediterranean Adolescents across Seven Countries

Cardiovascular diseases (CVDs) are the number one cause of death globally and are partially due to the inability to control modifiable lifestyle risk factors. The aim of this study was to analyze the profiles of adolescents from seven Mediterranean countries (Greece, Israel, Italy, Macedonia, Malta, Portugal, Spain) according to their modifiable lifestyle risk factors for CVD (overweight/obesity, physical activity, smoking, alcohol consumption). The sample consisted of 26,110 adolescents (52.3% girls) aged 11, 13, and 15 years who participated in the Health Behavior in School-aged Children (HBSC) survey in 2018 across the seven countries. Sociodemographic characteristics (sex, age, country of residence, socioeconomic status) and CVD modifiable lifestyle risk factors (overweight/obesity, physical activity, smoking, alcohol consumption) were recorded. A two-step cluster analysis, one-way analysis of variance, and chi-square test were performed. Four different cluster groups were identified: two low-risk groups (64.46%), with risk among those with low physical activity levels; moderate-risk group (14.83%), with two risk factors (unhealthy weight and low physical activity level); and a high-risk group (20.7%), which presented risk in all modifiable lifestyle risk factors. Older adolescents reported a higher likelihood of being in the high-risk group. Given that the adolescence period constitutes an important time for interventions aimed at CVD prevention, identifying profiles of moderate- and high-risk adolescents is crucial.

Heart Mitochondrial Metabolic Flexibility and Redox Status Are Improved by Donkey and Human Milk Intake

The biological mechanisms linking nutrition and antioxidants content of the diet with cardiovascular protection are subject of intense investigation. It has been demonstrated that dietary supplementation with cow, donkey or human milk, characterized by distinct nutritional properties, triggers significant differences in the metabolic and inflammatory status through the modulation of hepatic and skeletal muscle mitochondrial functions. Cardiac mitochondria play a key role for energy-demanding heart functions, and their disfunctions is leading to pathologies. Indeed, an altered heart mitochondrial function and the consequent increased reactive oxygen species (ROS) production and inflammatory state, is linked to several cardiac diseases such as hypertension and heart failure. In this work it was investigated the impact of the milk consumption on heart mitochondrial functions, inflammation and oxidative stress. In addition, it was underlined the crosstalk between mitochondrial metabolic flexibility, lipid storage and redox status as control mechanisms for the maintenance of cardiovascular health.

Prospective association between a Mediterranean-style dietary score in childhood and cardiometabolic risk in young adults from the ALSPAC birth cohort

PURPOSE

To investigate the prospective association between a children's relative Mediterranean-style diet score (C-rMED) in childhood and a Cardiometabolic Risk (CMR) score in adolescence/young adulthood in the Avon Longitudinal Study of Parents and Children (ALSPAC).

METHODS

A C-rMED was calculated at 7, 10 and 13 years from diet diary data. Anthropometric and biochemical data at 17 (N = 1940) and 24 years (N = 1961) were used to calculate CMR scores (sum of sex-specific log-transformed z-scores from triacylglycerol, HDL cholesterol, LDL cholesterol, mean arterial blood pressure, homeostatic model assessment of insulin resistance (HOMA-IR) and fat mass index (FMI)). Adjusted logistic regression models examined associations between C-rMED (categorical and 2-unit increments) and a high CMR score (≥ 80th percentile) and individual CMR components (≥ 80th percentile).

RESULTS

A high C-rMED at 13 was associated with a 32% (OR 0.68 (95% CI: 0.49, 0.94)) decreased adjusted odds of having a high CMR score at 24 years, compared to participants with a low C-rMED. No associations were evident at other ages. Tracking of the C-rMED across the three ages showed a stronger negative association between C-rMED and CMR at 24 years when children had at least two high C-rMED scores from 7 to 13 years (adjusted OR: 0.49, 95% CI: 0.29, 0.85), compared to all low scores. FMI and HOMA-IR were the main CMR components contributing to this association.

CONCLUSION

Higher Mediterranean-style diet scores in early adolescence were associated with a better CMR profile in young adults (24 year olds). This underscores the importance of establishing healthy eating habits early in life for future cardiometabolic health.

World trends in sugar-sweetened beverage and dietary sugar intakes in children and adolescents: a systematic review

OBJECTIVE

To provide a systematic overview of world dietary sugar and sugar-sweetened beverage (SSB) intake trends in children and adolescents.

DATA SOURCES

Medline, Embase, and the Cochrane Central Register of Controlled Trials in the Cochrane Library were searched through January 2019 to identify longitudinal follow-up studies with time-trend data and repeated cross-sectional studies.

DATA EXTRACTION

Data from studies reporting ≥ 2 measurements (sugars, SSB, or sweets/candy) over ≥ 2 years and included ≥ 20 healthy, normal- or overweight children or adolescents aged 1-19 years.

DATA ANALYSIS

Data from 43 articles (n = 4 prospective cohort studies; n = 39 repeated cross-sectional studies) from 15 countries (n = 8 European countries plus Australia, Canada, China, South Korea, Mexico, Russia, and the United States) are presented narratively. According to the risk of bias in nonrandomized studies of interventions tool, 34 studies were judged to have a moderate risk of bias, and 5 to have a serious risk of bias.

CONCLUSIONS

Consumption among US children and adolescents increased substantially in the decades preceding 2000, followed by a faster and continued decline. As a whole, other international intake trends did not reveal drastic increases and decreases in SSB and dietary sugars; they tended to change only slightly across 3 decades.

Association of Protein Intake during the Second Year of Life with Weight Gain-Related Outcomes in Childhood: A Systematic Review

There is accumulating evidence that early protein intake is related with weight gain in childhood. However, the evidence is mostly limited to the first year of life, whereas the high-weight-gain-velocity period extends up to about 2 years of age. We aimed to investigate whether protein intake during the second year of life is associated with higher weight gain and obesity risk later in childhood. We conducted a systematic review with searches in both PubMed®/MEDLINE® and the Cochrane Central Register of Controlled Trials. Ten studies that assessed a total of 46,170 children were identified. We found moderate-quality evidence of an association of protein intake during the second year of life with fat mass at 2 years and at 7 years. Effects on other outcomes such as body mass index (BMI), obesity risk, or adiposity rebound onset were inconclusive due to both heterogeneity and low evidence. We conclude that higher protein intakes during the second year of life are likely to increase fatness in childhood, but there is limited evidence regarding the association with other outcomes such as body mass index or change in adiposity rebound onset. Further well-designed and adequately powered clinical trials are needed since this issue has considerable public health relevance.

VITAMIN E INTAKE AND FOOD SOURCES IN ADOLESCENT DIET: A CROSS-SECTIONAL POPULATION-BASED STUDY

Objective:

To assess vitamin E intake and its relationship with sociodemographic variables, and to identify the main dietary sources of the nutrient in the diet of adolescents.

Methods:

This is a population-based cross-sectional study that used data from 891 adolescents living in Campinas, SP, participating in ISACamp 2014/15 (Health Survey) and ISACamp-Nutri 2015/16 (Food Consumption and Nutritional Status Survey). The nutrient intake averages were estimated using the Generalized Linear Model, adjusted for the total energy of the diet. Dietary sources of vitamin E were identified from the calculation of the relative contribution.

Results:

The average vitamin E intake was 3.2 mg for adolescents aged 10 to 13 years and 3.5 mg for those aged 14 to 19 years, results far below the recommended values of 9 and 12 mg, respectively. The prevalence of inadequacy was 92.5%. ­Ten ­foods/­food groups represented 85.7% of vitamin E present in the adolescents’ diet; the vegetable oils group accounted for more than a quarter of the contribution (25.5%), followed by cookies (9.1%) and beans (8.9%).

Conclusions:

There were a low intake and a high prevalence of inadequate vitamin E intake among adolescents in Campinas, with vegetable oil as the main source. For the total number of adolescents, almost 33% of the nutrient content was derived from foods of poor nutritional quality such as cookies, packaged snacks, and margarine. The results of this study can guide public health actions that aim to improve the quality of adolescents’ diets.

Complementary Feeding: Pitfalls for Health Outcomes

The term complementary feeding is defined as the period in which a progressive reduction of breastfeeding or infant-formula feeding takes place, while the infant is gradually introduced to solid foods. It is a crucial time in the infant's life, not only because of the rapid changes in nutritional requirements and the consequent impact on infant growth and development, but also for a generation of lifelong flavor preferences and dietary habits that will influence mid and long-term health. There is an increasing body of evidence addressing the pivotal role of nutrition, especially during the early stages of life, and its link to the onset of chronic non-communicable diseases, such as obesity, hypertension, diabetes, and allergic diseases. It is clear that the way in which a child is introduced to complementary foods may have effects on the individual's entire life. The aim of this review is to discuss the effects of complementary feeding timing, composition, and mode on mid and long-term health outcomes, in the light of the current evidence. Furthermore, we suggest practical tips for a healthy approach to complementary feeding, aiming at a healthy future, and highlight gaps to be filled.

Folate deficiency promotes differentiation of vascular smooth muscle cells without affecting the methylation status of regulated genes

Elevated serum homocysteine, an intermediate of cellular one-carbon metabolism, is an independent risk factor for cardiovascular disease (CVD). Folate deficiency increases serum homocysteine and may contribute to CVD progression. Vascular smooth muscle cells (VSMCs) regulate vascular contractility, but also contribute to repair processes in response to vascular injury. Nutritional deficiencies, like folate deficiency, are thought to impact on this phenotypic plasticity, possibly by epigenetic mechanisms. We have investigated the effect of folate deficiency on VSMCs in two cell culture systems representing early and late stages of smooth muscle cells differentiation. We find that folate deficiency promotes differentiation towards a more contractile phenotype as indicated by increased expression of respective marker genes. However, microarray analysis identified markers of striated muscle as the predominant gene expression change elicited by folate deficiency. These changes are not merely a reflection of cell cycle arrest, as foetal calf serum restriction or iron deficiency do not replicate the gene expression changes observed in response to folate deficiency. Folate deficiency only has a marginal effect on global DNA methylation. DNA methylation of CpG islands associated with genes regulated by folate deficiency remains unaffected. This supports our earlier findings in a mouse model system which also did not show any changes in global DNA methylation in response to folate and vitamin B6/B12 deficiency. These data suggest that folate deficiency enhances the expression of smooth muscle marker gene expression, promotes a shift towards a skeletal muscle phenotype, and does not regulate gene expression via DNA methylation.

Lifestyles and Cardiovascular Prevention in Childhood and Adolescence

Pathology studies demonstrated that coronary fatty streaks develop early in life and that even more advanced fibrous plaques are present in a proportion of adolescents. The presence and extent of atherosclerosis in children and adolescents can be correlated with the same risk factors present in adults; as well as, childhood levels of these risk factors predict adult cardiovascular diseases. Children are born with ideal cardiovascular health but, unfortunately, most of them develop over time modifiable behavioral risk factors. Achieving sustained lifestyle changes initiated too late in adults is difficult, and pharmacologic risk factor control cannot fully restore a low-risk state. Therefore, it seems eminently reasonable to initiate healthful lifestyle training as early in life, decreasing the prevalence of cardiovascular risk factors to retard atherogenic processes and reduce the future burden of cardiovascular diseases. Many guideline recommendations encourage universal adoption of healthier lifestyles, identification of children with cardiovascular risk factors, and their treatment using targeted lifestyle modification and, rarely, pharmacotherapy. Major gains will likely accrue from public health strategies targeting incorrect diet, physical activity, and cigarette smoking. Individualized strategies, however, will initially focus on the highest risk children such as those with familial hyperlipidaemia, diabetes, hypertension, and obesity. The primary purpose of this article is to provide a broad overview on the long-term cardiovascular effects of risk factors in children and youth and to outline various lines of evidence for the efficacy of primordial and primary prevention in young people, as well as recommendations for population- and individual-level strategies and evidence-based interventions.

Pediatric Integrative Medicine in Academia: Stanford Children's Experience

Pediatric integrative medicine is an emerging field which, to date, has not been described in detail in academic medical centers in the United States. Early research of pediatric integrative medicine modalities shows promise for the treatment of common pediatric conditions such as irritable bowel syndrome, acute and chronic pain, headache, and allergy, among others. In light of the growing prevalence of pediatric illnesses and patient complexity, it is crucial to emphasize the patient's overall well-being. As academic centers around the world start to develop pediatric integrative medicine programs, the aim of this manuscript is to briefly highlight evidence of effective integrative treatments in pediatric subspecialties, to describe the establishment of our integrative medicine program, to summarize its early efforts, and to discuss potential barriers and keys to success.

Macronutrient and fibre intake of young Spanish children with reference to their in utero growth status: Are they eating a healthy diet?

AIM

To compare macronutrient and fibre intake by pre-school children born with intra-uterine growth restriction (IUGR) or as appropriate for gestational age (AGA) and to compare their intake with paediatric nutritional recommendations for identification of potential areas of modification during early life.

METHODS

A parental 3-day dietary record was obtained for children of age 1-6 years, born at Hospital Clinic, Barcelona, Spain (2002-2007) with IUGR (n = 37) or AGA (n = 53). Mean nutrient intake (adjusted for body mass index), nutrient adequacy ratios (NAR) and percentage of energy intake (EI%) were compared.

RESULTS

Macronutrient and fibre intake of the two groups did not differ significantly. However, IUGR children showed significantly higher than the recommended levels of protein EI% (18 (95% confidence interval (CI) 16-19)), NAR for saturated fatty acids (SFAs) (1.2 (95% CI 1.1-1.5)) and NAR for carbohydrate (1.4 (95% CI 1.2-1.6)) and significantly lower than the recommended levels of NAR for unsaturated fatty acids (UFAs) (0.6 (95% CI 0.5-0.8)) and for fibre (0.6 (95% CI 0.5-0.8)). Likewise, children born with AGA showed similar pattern compared to the recommended levels for protein EI% (17 (95% CI 16-18)), NAR for SFAs (1.3 (95% CI 1.2-1.4)), NAR for UFAs (0.6 (95% CI 0.5-0.7)) and NAR for fibre (0.8 (95% CI 0.7-0.9)).

CONCLUSION

Spanish pre-school children consume proteins and SFAs in abundance and UFAs and fibre in moderation. Reinforcement of healthy eating is recommended for long-term health benefits, especially for at-risk children born with IUGR, whose consumption of carbohydrate is additionally greater than that recommended.

Human Milk and Donkey Milk, Compared to Cow Milk, Reduce Inflammatory Mediators and Modulate Glucose and Lipid Metabolism, Acting on Mitochondrial Function and Oleylethanolamide Levels in Rat Skeletal Muscle

Scope: Milk from various species differs in nutrient composition. In particular, human milk (HM) and donkey milk (DM) are characterized by a relative high level of triacylglycerol enriched in palmitic acid in sn-2 position. These dietary fats seem to exert beneficial nutritional properties through N-acylethanolamine tissue modulation. The aim of this study is to compare the effects of cow milk (CM), DM, and HM on inflammation and glucose and lipid metabolism, focusing on mitochondrial function, efficiency, and dynamics in skeletal muscle, which is the major determinant of resting metabolic rate. Moreover, we also evaluated the levels of endocannabinoids and N-acylethanolamines in liver and skeletal muscle, since tissue fatty acid profiles can be modulated by nutrient intervention.

Procedures: To this aim, rats were fed with CM, DM, or HM for 4 weeks. Then, glucose tolerance and insulin resistance were analyzed. Pro-inflammatory and anti-inflammatory cytokines were evaluated in serum and skeletal muscle. Skeletal muscle was also processed to estimate mitochondrial function, efficiency, and dynamics, oxidative stress, and antioxidant/detoxifying enzyme activities. Fatty acid profiles, endocannabinoids, and N-acylethanolamine congeners were determined in liver and skeletal muscle tissue.

Results: We demonstrated that DM or HM administration reducing inflammation status, improves glucose disposal and insulin resistance and reduces lipid accumulation in skeletal muscle. Moreover, HM or DM administration increases redox status, and mitochondrial uncoupling, affecting mitochondrial dynamics in the skeletal muscle. Interestingly, HM and DM supplementation increase liver and muscle levels of the N-oleoylethanolamine (OEA), a key regulator of lipid metabolism and inflammation.

Conclusions: HM and DM have a healthy nutritional effect, acting on inflammatory factors and glucose and lipid metabolism. This beneficial effect is associated to a modulation of mitochondrial function, efficiency, and dynamics and to an increase of OEA levels in skeletal muscle.

Adequacy of Usual Vitamin and Mineral Intake in Spanish Children and Adolescents: ENALIA Study

Background: The National Dietary Survey on the Child and Adolescent Population in Spain (ENALIA) provides data to assess the usual micronutrient intake among Spanish infants, children, and adolescents. Methods: Cross-sectional survey (November 2012-July 2014) of a representative sample of Spanish children and adolescents (six months-17 years) (n = 1862). Dietary information was collected using two non-consecutive one-day food diaries (six months-10 years old) or two 24 h dietary recalls (11 years and older) separated by at least 14 days. Estimates were calculated using the Iowa State University method and PC-SIDE software (version 1.0, department of statistics, center for agricultural and rural development, Ames, IA, USA) to account for within- and between-person variation. Results: Usual intake of vitamin D was insufficient in practically all individuals. Vitamin E, folate, and calcium were insufficient, especially from nine years of age, and magnesium and iodine from 14 years of age. The percentage of subjects with insufficient intakes was higher among females. Sodium intake was excessive in a considerable percentage of the population, especially in males, and it increased with age. Finally, over half of children under four years of age had zinc usual intakes that exceeded the Tolerable Upper Level. Conclusion: Vitamin and mineral intake in Spain should be improved, especially in late childhood and adolescence. Nutritional intervention and educational strategies are needed to promote healthy eating habits and correct micronutrient inadequacies in Spanish children and adolescents.

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.

Lower levels of human milk adiponectin predict offspring weight for age: a study in a lean population of Filipinos

Prior studies have reported a significant, inverse association between adiponectin in human milk and offspring growth velocity. Less is known about this association in populations characterised by a loss of weight for age z-scores (WAZs) in early life. We investigated the association between maternal body composition and milk adiponectin in a sample of Filipino mothers. We then tested for an association between milk adiponectin and size for age in their infants. A total of 117 Filipino mothers nursing infants from 0 to 24 months were recruited from Cebu, Philippines. Anthropometrics, interviews and milk samples were collected and analysed using standard protocols. Mean milk adiponectin in this sample was 7.47 ± 5.75 ng mL(-1) . Mean infant WAZ and weight for length (WLZ) decreased with age. Maternal body composition was not associated with milk adiponectin content. Milk adiponectin had a significant, positive association with infant WAZ and WLZ. Prior reports have found an inverse association between milk adiponectin and infant WAZ. Here, we report that in lean populations with lower milk adiponectin, there is a positive association with infant WAZ, possibly reflecting pleiotropic biological functions of adiponectin for post-natal growth. This study increases the understanding of normal biological variation in milk adiponectin and the consequences of low levels of milk adiponectin for offspring growth.

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

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

Adiponectin oligomers are similarly distributed in adequate-for-gestational-age obese children irrespective of feeding in their first year

BACKGROUND

Nutrition and growth in early postnatal life have a role in future diseases. Our aim was to investigate adiponectin oligomers in adequate-for-gestational-age obese children with respect to type and duration of feeding in the first year of life.

METHODS

Adiponectin oligomers and cardiometabolic risk factors were measured in 113 adequate-for-gestational-age obese children, divided into group A (prolonged breast feeding, >6 mo), group B (short breast feeding, 1-6 mo), and group C (formula feeding from birth).

RESULTS

All the parameters were similar among the groups. Adiponectin oligomers did not correlate with gestational age, months of breast feeding, and time of weaning. Total and high-molecular weight adiponectin were differently distributed across gender and pubertal stages (P < 0.02), being lower in males from the start of puberty. Prepregnancy BMI and at the end of the pregnancy were negatively associated (P < 0.04) with total and medium-molecular weight adiponectin in female and male offspring, respectively.

CONCLUSIONS

Adiponectin oligomers and metabolic characteristics are similarly distributed in adequate-for-gestational-age obese children, irrespective of the type and duration of the feeding in the first year of life. Gender and mother's BMI in pregnancy are contributors to adiponectin regulation. Further studies will explain whether breastfeeding protects against metabolic impairment later in life.

Recommendations on complementary feeding for healthy, full-term infants

Weaning (or introduction of complementary feeding) is a special and important moment in the growth of a child, both for the family and the infant itself, and it can play a major role in the child’s future health. Throughout the years, various weaning modes have come in succession, the latest being baby-led weaning; the timing for introducing foods and the requirements of which sort of nutrient for weaning have also changed over time. Furthermore, the role played by nutrition, especially in the early stages of life, for the onset of later non-communicable disorders, such as diabetes, obesity or coeliac disease has also been increasingly highlighted.

Members of Italian Society of Gastroenterology, Hepathology and Pediatric Nutrition (SIGENP) and the Italian Society of Allergology and Pediatric Immunology (SIAIP) Emilia Romagna here propose a practical approach for pediatricians to deal with daily practice. The four main areas for discussion were weaning in relation with the onset of allergic diseases, coeliac disease, diabetes and metabolic syndrome, the nutrition requirements to take into account for assessing the diet of infants under one year of age and about the practice of baby-led weaning focusing on limits and benefits, respectively.

Childhood overweight and obesity in a region of Italian immigration in Southern Brazil: a cross-sectional study

Background

The main modifiable risk factors for obesity are related to lifestyle and significantly influenced by the family, environment and culture. We aimed to estimate the prevalence of overweight/obesity and associated lifestyle factors in children from Bento Gonçalves, a southern Brazil city with strong Italian immigration influence. Italian traditional foods were locally adapted since the immigrants’ arrival in the XIX century, to include more fat and fewer vegetables, and physical activity levels have decreased.

Methods

Cross-sectional study of a population-based cluster sample with students aged 9–18 years. We assessed time spent in sedentary behaviors, hours of physical activity, food frequency and family history. All children underwent physical examination with anthropometric and blood pressure measurements. Overweight and obesity were classified according to WHO percentile curves.

Results

A total of 590 students were evaluated. Mean age was 12.45 ± 1.49 years. The prevalence of overweight and obesity was 16.3% and 8.3%, respectively. Boys were more frequently overweight and obese than girls (16.3% and 12.2% versus 16.2% and 5.5%, respectively). Vegetables and fruits were consumed less than 4 times per week in 49% and 36.8%, while soft drinks, fast food and sweets were consumed more than 4 times a week by 71%, 70.3% and 42.7%, respectively. The habit of omitting breakfast was associated with overweight (p = 0.007). The average screen time was 5.38 ± 2.88 hours/day. Overweight/obesity was present in 12.2% (n = 5), 24.8% (n = 122) and 36.8% (n = 14) children with low birth weight, normal birth weight and high birth weight respectively (p = 0.04). The prevalence of high blood pressure was higher in obese (30.6%) and overweight (21.2%) children, comparing to eutrophic children (6.8%; p < 0.001). Excess weight was more frequent among fathers (62.8%) than in mothers (46.3%), but excess weight in mothers was positively associated with excess weight in children (p 0.048).

Conclusion

The city showed high prevalence of overweight and obesity. These findings reinforce the importance of implementing prevention strategies aimed at children and their families, considering that health habits are shared and transmitted along generations.

Validation of oscillometric pulse wave analysis measurements in children

BACKGROUND

Pulse wave analysis (PWA) has emerged as a noninvasive, valid, reliable, and widely used technique to investigate central blood pressures and systemic arterial wave reflection (augmentation index). The gold-standard technique is tonometry, but this technique can be challenging, especially when used on children. The purpose of this study was to validate oscillometric PWA for use in children.

METHODS

Fifty-seven healthy children were recruited for participation. Central blood pressures and peripheral augmentation index (pAIx) were measured objectively using oscillometric (Pulsecor R7) and tonometric (SphygmaCor) devices. All measurements were made during the same visit under standardized conditions between the hours of 8 am and 10 am in the fasted state.

RESULTS

Tonometric measurements were unsuccessful on 1 child. Comparisons were made on 56 children (mean age = 9.8±1.0 y; 57% male). A very strong relationship was found between devices for central systolic (r = 0.94; P < 0.001), diastolic (r = 0.99; P < 0.001) and mean (r = 0.96; P < 0.001) blood pressures. However, Bland-Altman analysis indicated a bias toward greater systolic blood pressures with the oscillometric monitor (mean difference = 4.5mm Hg; 95% confidence interval (CI) = -5.16 to -3.89). A good relationship was found for pAIx (r = 0.71; P < 0.001); the mean difference between devices was -1.70% (95% CI = -4.47% to 1.08%), which is not significantly different from zero.

CONCLUSIONS

Findings from this study suggest that oscillometric PWA provides valid measures of central blood pressure and arterial wave reflection in children aged 8-10 years.

Progress in Pediatrics in 2012: choices in allergy, endocrinology, gastroenterology, hematology, infectious diseases, neurology, nutrition and respiratory tract illnesses

In this review, we summarize the progresses in allergy, endocrinology, gastroenterology, hematology, infectious diseases, neurology, nutrition and respiratory tract illnesses that have been published in The Italian Journal of Pediatrics in 2012. The induction of Treg activity by probiotics might be effective for promoting tolerance towards food allergens. Nasal cytology is useful in patients with rhinitis for diagnosing chronic non-allergic non-infectious diseases. Atopic eczema is associated both with an aberrant skin matrix and impaired systemic immune response. Therefore, isolated topical treatment may have suboptimal effect. Diagnostic work-up of exercise-induced anaphylaxis, including exercise challenge test, is necessary to reach a diagnosis. Studies may support a role for nutrition on prevention of asthma and cardiovascular diseases. Clinicians need to early identify adolescent menstrual abnormalities to minimize sequelae, and to promote health information. In Multiple Endocrine Neoplasia type 2B investigations include acetylcholinesterase study of rectal mucosa followed by the molecular analysis of RET mutation. Low adherence to gluten-free diet and osteopenia are common problems in children with diabetes mellitus type 1 and celiac disease. In infantile colic, laboratory tests are usually unnecessary and the treatment is based on reassurance. Prevalence of obesity and stunting is elucidated by several studies. Evidences are growing that dietetic measures are needed to prevent obesity in children with acute leukemia. Treatment studies for infectious diseases show promise for probiotics along with standard triple therapy in children with Helicobacter pilori infection, while zinc has no effect on pneumonia. Educational programs about the proper management of the febrile child are warranted. A new hour-specific total serum bilirubin nomogram has been shown to be able to predict newborns without hyperbilirubinemia after 48 to 72 hours of life. Newborns with hypoxic-ischemic encephalopathy present ECG and cardiac enzymes alterations leading to reduced neonatal survival. Rehabilitation programs including sensory integration therapy and motor performance, may improve activities of daily life in children with developmental coordination disorder. Aerobic exercise training in addition to chest physiotherapy might be useful in children with cystic fibrosis. Studies on effectiveness of leukotriene receptor antagonists, alone or with other drugs in preschool wheezing are needed.