1
|
Prowse R, Doan N, Philipneri A, Thielman J, Hack S, Harrington DW, Jessri M. Creating "Plates" to Evaluate Canadians' Dietary Intake in Relation to the 2019 Canada's Food Guide. CAN J DIET PRACT RES 2022; 83:152-159. [PMID: 35503904 DOI: 10.3148/cjdpr-2022-010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: Explore Canadians' dietary intake in relation to the 2019 Canada's Food Guide (CFG) Plate using novel volume-based food analyses, by age and meal occasion.Methods: Foods reported in 24-hour recalls by 20,456 Canadians in the 2015 Canadian Community Health Survey - Nutrition were classified as: Vegetables and Fruits, Whole Grain Foods, Protein Foods, Non-Whole Grain Foods or Other Foods (high in fat, sugar, sodium). Food volumes were used to calculate percent contributions of each grouping to total intake, stratified by age (1-6; 7-12; 13-17; 18-64; 65+years) and meal (breakfast, lunch, supper, snack), applying sample survey weights and bootstrapping.Results: By volume, the Canadian population diet included: 29% Vegetables and Fruits, 22% Protein Foods, 7% Whole Grains, 24% Non-Whole Grain Foods, and 18% Other Foods. Intakes of Protein Foods (1-6 years) and Other Foods (7-12; 13-17 years) were higher in children than adults by volume, relative to total intake. Whole Grains intake was highest at breakfast. Other Foods intake was highest at snack.Conclusions: The volume-based population diet of Canadians reported on a single day includes a substantial proportion of non-recommended foods. There are opportunities to design interventions that target specific foods, ages, and meals to align intake with recommendations.
Collapse
Affiliation(s)
- Rachel Prowse
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL
| | - Natalie Doan
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON
| | - Anne Philipneri
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON
| | - Justin Thielman
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON
| | - Salma Hack
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON
| | - Dan W Harrington
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON
| | - Mahsa Jessri
- Food, Nutrition and Health, Faculty of Land and Food Systems, University of British Columbia, Vancouver, BC
| |
Collapse
|
2
|
Alkhaldi AK, Alshiddi H, Aljubair M, Alzahrani S, Alkhaldi A, Al-khalifa KS, Gaffar B. Sex Differences in Oral Health and the Consumption of Sugary Diets in a Saudi Arabian Population. Patient Prefer Adherence 2021; 15:1121-1131. [PMID: 34079232 PMCID: PMC8165654 DOI: 10.2147/ppa.s308008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/01/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND PURPOSE Adolescence is a crucial period for developing healthy lifestyle and dietary habits. The growing consumption of high-sugar foods and beverages constitutes a serious public health concern. The aim of this study was to evaluate sex differences in the consumption of a sugary diet and oral health among Saudi adolescents. SUBJECTS AND METHODS This cross-sectional study was conducted in the Eastern Province of the Kingdom of Saudi Arabia between January and February 2019. A multistage sampling technique was used to recruit 2265 middle-school children aged 12-16 years. Data were collected via the Food Frequency Questionnaire and via an oral health examination, using the WHO criteria. The chi-squared test, Student's t-test, and Mann-Whitney U-test were used to investigate the associations between the study variables. RESULTS The most consumed foods and beverages reported were water, juices, and biscuits (90%), while the least consumed were energy drinks and jams. A significant difference was found between males and females in the frequency of consumed sugary foods (P=0.01) and the quantity of consumed sugary beverages (P=0.000); males over all consumption were greater than their counterpart. However, no differences were found between sexes in the frequency of sugary drink consumption (P=0.2). The decayed-missing-filled index score was significantly higher in females (4.29 ± 3.44) than in males (3.61 ± 3.14; P=0.001). The mean plaque index among males and females was 1.72 (±0.79) and 1.20 (±0.78), respectively, while the mean gingival index was 1.31 (±0.77) in males and 0.69 (±0.73) in females-a statistically significant difference (P=0.001). CONCLUSION Sex differences were found in sugary diet consumption and oral health status. Thus, policy makers are encouraged to consider sex-based differences when planning preventative programs and initiatives. Nevertheless, further research is needed on the dietary intake patterns of young adults.
Collapse
Affiliation(s)
| | | | | | | | - Adel Alkhaldi
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Khalifa S Al-khalifa
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Balgis Gaffar
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
- Correspondence: Balgis Gaffar Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam Costal Street, – B.O Box 1982, Dammam, 31441, Saudi ArabiaTel +966542269941 Email
| |
Collapse
|
3
|
Vehapoglu A, Ozgurhan G, Ustabas Kahraman F, Cakın ZE, Sumbul B. Association between Consumption of Cow's Milk and Iron Deficiency Anemia in Children: Are There Roles for Hepcidin-25/Ferroportin? A Case-Control Study. Pediatr Hematol Oncol 2020; 37:676-686. [PMID: 32705943 DOI: 10.1080/08880018.2020.1782547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Systemic iron homeostasis is regulated by the interaction of the peptide hormone, hepcidin and the iron exporter, ferroportin. The objective was to investigate the relationship between the consumption of cow's milk and iron deficiency anemia in children 2-10 years old and its association with the hepcidin-25 and ferroportin concentrations. The study population consisted of 187 prepubescent children of similar ideal body weight (IBW:90-120%); 82 children with iron deficiency anemia (37girls and 45boys; 4.27 ± 0.28 years) and 105 (47girls and 58boys; 4.25 ± 0.34 years) healthy age-sex-matched controls. Serum fasting hepcidin-25/ferroportin concentrations were measured by enzyme immunoassay in all subjects. Mean cow's milk consumption in the anemic group (373 ± 248 mL/d) tended to be higher than that in the control group (320 ± 226 mL/d), but the result was not statistically significant (p = 0.063).The mean hepcidin-25 level was significantly higher in the anemic group (19.5 ± 18.4 ng/mL) than in the healthy controls (11.0 ± 10.7, p < 0.001). The mean ferroportin level was lower in the anemic group (21.04 ± 5.74 ng/mL) than in the healthy controls (22.68 ± 4.77 ng/ml, p = 0.037). Consuming cow's milk was not associated with IDA in prepubertal children, provided that it was adequately supplemented with iron-enriched foods. We observed a significant increase in hepcidin-25 levels and a decrease in ferroportin levels in children with iron deficiency anemia compared with healthy controls. Children who consumed more cow's milk had higher levels of hepcidin-25. Iron deficiency anemia is not a concern when cow's milk is given to children if the complementary foods are rich in iron.
Collapse
Affiliation(s)
- Aysel Vehapoglu
- Department of Pediatrics, Bezmialem Vakıf University, Faculty of Medicine, Istanbul, Turkey
| | - Gamze Ozgurhan
- Department of Pediatrics, Süleymaniye Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Feyza Ustabas Kahraman
- Department of Pediatrics, Bezmialem Vakıf University, Faculty of Medicine, Istanbul, Turkey
| | - Zeynep Ebru Cakın
- Department of Pediatrics, Bezmialem Vakıf University, Faculty of Medicine, Istanbul, Turkey
| | - Bilge Sumbul
- Department of Infectious Diseases and Clinical Microbiology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey
| |
Collapse
|
4
|
Bayoumi I, Parkin PC, Birken CS, Maguire JL, Borkhoff CM. Association of Family Income and Risk of Food Insecurity With Iron Status in Young Children. JAMA Netw Open 2020; 3:e208603. [PMID: 32729920 DOI: 10.1001/jamanetworkopen.2020.8603] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Iron deficiency (ID) has the greatest prevalence in early childhood and has been associated with poor developmental outcomes. Previous research examining associations of income and food insecurity (FI) with ID is inconsistent. OBJECTIVE To examine the association of family income and family risk of FI with iron status in healthy young children attending primary care. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 1245 children aged 12 to 29 months who attended scheduled primary care supervision visits from 2008 to 2018 in Toronto, Canada, and the surrounding area. EXPOSURES Family income and risk of FI were collected from parent-reported questionnaires. Children whose parents provided an affirmative response to the 1-item FI screen on the Nutrition Screening Tool for Every Toddler or at least 1 item on the 2-item Hunger Vital Sign FI screening tool were categorized as having family risk of FI. MAIN OUTCOMES AND MEASURES Iron deficiency (serum ferritin level <12 ng/mL) and ID anemia (IDA; serum ferritin level <12 ng/mL and hemoglobin level <11.0 g/dL). All models were adjusted for age, sex, birth weight, body mass index z score, C-reactive protein level, maternal education, breastfeeding duration, bottle use, cow's milk intake, and formula feeding in the first year. RESULTS Of 1245 children (595 [47.8%] girls; median [interquartile range] age, 18.1 [13.3-24.0] months), 131 (10.5%) were from households with a family income of less than CAD $40 000 ($29 534), 77 (6.2%) were from families at risk of FI, 185 (14.9%) had ID, and 58 (5.3%) had IDA. The odds of children with a family income of less than CAD $40 000 having ID and IDA were 3 times higher than those of children in the highest family income group (ID: odds ratio [OR], 3.08; 95% CI, 1.66-5.72; P < .001; IDA: OR, 3.28; 95% CI, 1.22-8.87; P = .02). Being in a family at risk of FI, compared with all other children, was not associated with ID or IDA (ID: OR, 0.43; 95% CI, 0.18-1.02; P = .06; IDA: OR, 0.16; 95% CI, 0.02-1.23; P = .08). CONCLUSIONS AND RELEVANCE In this study, low family income was associated with increased risk of ID and IDA in young children. Risk of FI was not a risk factor for ID or IDA. These findings suggest that targeting income security may be more effective than targeting access to food to reduce health inequities in the prevention of iron deficiency.
Collapse
Affiliation(s)
- Imaan Bayoumi
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
- Centre for Studies in Primary Care, Queen's University, Kingston, Ontario, Canada
| | - Patricia C Parkin
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario, Canada
| | - Catherine S Birken
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The Applied Health Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- St Michael's Hospital, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario, Canada
| | | |
Collapse
|
5
|
Gunaseelan V, Parkin PC, Wahi G, Birken CS, Maguire JL, Macarthur C, Borkhoff CM. Maternal ethnicity and iron status in early childhood in Toronto, Canada: a cross-sectional study. BMJ Paediatr Open 2020; 4:e000635. [PMID: 32509978 PMCID: PMC7254107 DOI: 10.1136/bmjpo-2020-000635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the association between maternal ethnicity and iron deficiency (ID) in early childhood, and to evaluate whether infant feeding practices linked to ID differ between maternal ethnic groups. METHODS This was a cross-sectional study of healthy children 1-3 years of age. Adjusted multivariable logistic regression analyses were used to evaluate the association between maternal ethnicity and ID (serum ferritin <12 µg/L) and the association between maternal ethnicity and five infant feeding practices (breastfeeding duration; bottle use beyond 15 months; current formula use; daily cow's milk intake >2 cups; meat consumption). RESULTS Of 1851 children included, 12.2% had ID. Compared with the European referent group, we found higher odds of ID among children of South Asian and West Asian/North African maternal ethnicities, and lower odds of ID among children of East Asian maternal ethnicity. Statistically significant covariates associated with higher odds of ID included longer breastfeeding duration and daily cow's milk intake >2 cups. Current infant formula use was associated with lower odds of ID. Children of South Asian maternal ethnicity had higher odds of bottle use beyond 15 months of age and lower odds of meat consumption. CONCLUSIONS We found increased odds of ID among children of South Asian and West Asian/Northern African maternal ethnicities. We found a higher odds of feeding practices linked to ID in children of South Asian maternal ethnicity, but not in children of West Asian/North African maternal ethnicity. Culturally tailored approaches to providing guidance to parents on healthy infant feeding practices may be important to prevent ID in early childhood. TRIAL REGISTRATION NUMBER NCT01869530.
Collapse
Affiliation(s)
- Vinusha Gunaseelan
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gita Wahi
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Catherine S Birken
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Sick Kids Research Institute, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Paediatrics, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Colin Macarthur
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sick Kids Research Institute, Toronto, Ontario, Canada
| | | |
Collapse
|
6
|
Carsley S, Fu R, Borkhoff CM, Reid N, Baginska E, Birken CS, Maguire JL, Hancock-Howard R, Parkin PC, Coyte PC. Iron deficiency screening for children at 18 months: a cost-utility analysis. CMAJ Open 2019; 7:E689-E698. [PMID: 31796510 PMCID: PMC6890493 DOI: 10.9778/cmajo.20190084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The peak prevalence of iron deficiency is in children 6 months to 3 years of age, a sensitive period for neurodevelopment. Our study objective was to examine the cost-utility of a proposed iron deficiency screening program for 18-month-old children. METHODS We used a decision tree model to estimate the costs in 2019 Canadian dollars and quality-adjusted life years (QALYs) associated with 3 iron deficiency screening strategies: no screening, universal screening and targeted screening for a high-risk population. We used a societal perspective and assessed lifetime QALY gains. We derived outcomes from the literature and prospectively collected data. We performed one-way and probabilistic sensitivity analyses to assess parameter uncertainty. RESULTS The incremental costs to society of universal and targeted screening programs compared to no screening were $2286.06/QALY and $1676.94/QALY, respectively. With a willingness-to-pay threshold of $50 000/QALY, both programs were cost-effective. Compared to a targeted screening program, a universal screening program would cost an additional $2965.96 to gain 1 QALY, which renders it a cost-effective option. The study findings were robust to extensive sensitivity analyses. INTERPRETATION A proposed universal screening program for iron deficiency would be cost-effective over the lifespan compared to both no screening (current standard of care) and a targeted screening program for children at high risk. Policy-makers and physicians may consider expanding the recommended 18-month enhanced well-baby visit to include screening for iron deficiency.
Collapse
Affiliation(s)
- Sarah Carsley
- Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Institute of Health Policy, Management and Evaluation (Fu, Borkhoff, Reid, Baginska, Birken, Maguire, Hancock-Howard, Parkin, Coyte), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences (Borkhoff, Birken, Parkin), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children; Division of Pediatric Medicine and the Pediatric Outcomes Research Team (Borkhoff, Birken, Maguire, Parkin), Department of Pediatrics, Faculty of Medicine, University of Toronto, The Hospital for Sick Children; Department of Pediatrics (Maguire), St. Michael's Hospital and Li Ka Shing Knowledge Institute; Department of Nutritional Sciences (Birken, Maguire), University of Toronto, Toronto, Ont.
| | - Rui Fu
- Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Institute of Health Policy, Management and Evaluation (Fu, Borkhoff, Reid, Baginska, Birken, Maguire, Hancock-Howard, Parkin, Coyte), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences (Borkhoff, Birken, Parkin), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children; Division of Pediatric Medicine and the Pediatric Outcomes Research Team (Borkhoff, Birken, Maguire, Parkin), Department of Pediatrics, Faculty of Medicine, University of Toronto, The Hospital for Sick Children; Department of Pediatrics (Maguire), St. Michael's Hospital and Li Ka Shing Knowledge Institute; Department of Nutritional Sciences (Birken, Maguire), University of Toronto, Toronto, Ont
| | - Cornelia M Borkhoff
- Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Institute of Health Policy, Management and Evaluation (Fu, Borkhoff, Reid, Baginska, Birken, Maguire, Hancock-Howard, Parkin, Coyte), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences (Borkhoff, Birken, Parkin), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children; Division of Pediatric Medicine and the Pediatric Outcomes Research Team (Borkhoff, Birken, Maguire, Parkin), Department of Pediatrics, Faculty of Medicine, University of Toronto, The Hospital for Sick Children; Department of Pediatrics (Maguire), St. Michael's Hospital and Li Ka Shing Knowledge Institute; Department of Nutritional Sciences (Birken, Maguire), University of Toronto, Toronto, Ont
| | - Nadine Reid
- Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Institute of Health Policy, Management and Evaluation (Fu, Borkhoff, Reid, Baginska, Birken, Maguire, Hancock-Howard, Parkin, Coyte), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences (Borkhoff, Birken, Parkin), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children; Division of Pediatric Medicine and the Pediatric Outcomes Research Team (Borkhoff, Birken, Maguire, Parkin), Department of Pediatrics, Faculty of Medicine, University of Toronto, The Hospital for Sick Children; Department of Pediatrics (Maguire), St. Michael's Hospital and Li Ka Shing Knowledge Institute; Department of Nutritional Sciences (Birken, Maguire), University of Toronto, Toronto, Ont
| | - Eva Baginska
- Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Institute of Health Policy, Management and Evaluation (Fu, Borkhoff, Reid, Baginska, Birken, Maguire, Hancock-Howard, Parkin, Coyte), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences (Borkhoff, Birken, Parkin), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children; Division of Pediatric Medicine and the Pediatric Outcomes Research Team (Borkhoff, Birken, Maguire, Parkin), Department of Pediatrics, Faculty of Medicine, University of Toronto, The Hospital for Sick Children; Department of Pediatrics (Maguire), St. Michael's Hospital and Li Ka Shing Knowledge Institute; Department of Nutritional Sciences (Birken, Maguire), University of Toronto, Toronto, Ont
| | - Catherine S Birken
- Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Institute of Health Policy, Management and Evaluation (Fu, Borkhoff, Reid, Baginska, Birken, Maguire, Hancock-Howard, Parkin, Coyte), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences (Borkhoff, Birken, Parkin), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children; Division of Pediatric Medicine and the Pediatric Outcomes Research Team (Borkhoff, Birken, Maguire, Parkin), Department of Pediatrics, Faculty of Medicine, University of Toronto, The Hospital for Sick Children; Department of Pediatrics (Maguire), St. Michael's Hospital and Li Ka Shing Knowledge Institute; Department of Nutritional Sciences (Birken, Maguire), University of Toronto, Toronto, Ont
| | - Jonathon L Maguire
- Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Institute of Health Policy, Management and Evaluation (Fu, Borkhoff, Reid, Baginska, Birken, Maguire, Hancock-Howard, Parkin, Coyte), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences (Borkhoff, Birken, Parkin), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children; Division of Pediatric Medicine and the Pediatric Outcomes Research Team (Borkhoff, Birken, Maguire, Parkin), Department of Pediatrics, Faculty of Medicine, University of Toronto, The Hospital for Sick Children; Department of Pediatrics (Maguire), St. Michael's Hospital and Li Ka Shing Knowledge Institute; Department of Nutritional Sciences (Birken, Maguire), University of Toronto, Toronto, Ont
| | - Rebecca Hancock-Howard
- Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Institute of Health Policy, Management and Evaluation (Fu, Borkhoff, Reid, Baginska, Birken, Maguire, Hancock-Howard, Parkin, Coyte), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences (Borkhoff, Birken, Parkin), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children; Division of Pediatric Medicine and the Pediatric Outcomes Research Team (Borkhoff, Birken, Maguire, Parkin), Department of Pediatrics, Faculty of Medicine, University of Toronto, The Hospital for Sick Children; Department of Pediatrics (Maguire), St. Michael's Hospital and Li Ka Shing Knowledge Institute; Department of Nutritional Sciences (Birken, Maguire), University of Toronto, Toronto, Ont
| | - Patricia C Parkin
- Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Institute of Health Policy, Management and Evaluation (Fu, Borkhoff, Reid, Baginska, Birken, Maguire, Hancock-Howard, Parkin, Coyte), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences (Borkhoff, Birken, Parkin), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children; Division of Pediatric Medicine and the Pediatric Outcomes Research Team (Borkhoff, Birken, Maguire, Parkin), Department of Pediatrics, Faculty of Medicine, University of Toronto, The Hospital for Sick Children; Department of Pediatrics (Maguire), St. Michael's Hospital and Li Ka Shing Knowledge Institute; Department of Nutritional Sciences (Birken, Maguire), University of Toronto, Toronto, Ont
| | - Peter C Coyte
- Health Promotion, Chronic Disease and Injury Prevention (Carsley), Public Health Ontario; Institute of Health Policy, Management and Evaluation (Fu, Borkhoff, Reid, Baginska, Birken, Maguire, Hancock-Howard, Parkin, Coyte), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences (Borkhoff, Birken, Parkin), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children; Division of Pediatric Medicine and the Pediatric Outcomes Research Team (Borkhoff, Birken, Maguire, Parkin), Department of Pediatrics, Faculty of Medicine, University of Toronto, The Hospital for Sick Children; Department of Pediatrics (Maguire), St. Michael's Hospital and Li Ka Shing Knowledge Institute; Department of Nutritional Sciences (Birken, Maguire), University of Toronto, Toronto, Ont
| |
Collapse
|
7
|
Production-related contaminants (pesticides, antibiotics and hormones) in organic and conventionally produced milk samples sold in the USA. Public Health Nutr 2019; 22:2972-2980. [PMID: 31238996 PMCID: PMC6792142 DOI: 10.1017/s136898001900106x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Consumption of cow's milk, which is associated with diet and health benefits, has decreased in the USA. The simultaneous increase in demand for more costly organic milk suggests consumer concern about exposure to production-related contaminants may be contributing to this decline. We sought to determine if contaminant levels differ by the production method used. DESIGN Half-gallon containers of organic and conventional milk (four each) were collected by volunteers in each of nine US regions and shipped on ice for analysis. Pesticide, antibiotic and hormone (bovine growth hormone (bGH), bGH-associated insulin-like growth factor 1 (IGF-1)) residues were measured using liquid or gas chromatography coupled to mass or tandem mass spectrometry. Levels were compared against established federal limits and by production method. SETTING Laboratory analysis of retail milk samples. RESULTS Current-use pesticides (5/15 tested) and antibiotics (5/13 tested) were detected in several conventional (26-60 %; n 35) but not in organic (n 34) samples. Among the conventional samples, residue levels exceeded federal limits for amoxicillin in one sample (3 %) and in multiple samples for sulfamethazine (37 %) and sulfathiazole (26 %). Median bGH and IGF-1 concentrations in conventional milk were 9·8 and 3·5 ng/ml, respectively, twenty and three times that in organic samples (P < 0·0001). CONCLUSIONS Current-use antibiotics and pesticides were undetectable in organic but prevalent in conventionally produced milk samples, with multiple samples exceeding federal limits. Higher bGH and IGF-1 levels in conventional milk suggest the presence of synthetic growth hormone. Further research is needed to understand the impact of these differences, if any, on consumers.
Collapse
|
8
|
Vitamin D Supplementation Modestly Reduces Serum Iron Indices of Healthy Arab Adolescents. Nutrients 2018; 10:nu10121870. [PMID: 30513812 PMCID: PMC6315440 DOI: 10.3390/nu10121870] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/21/2018] [Accepted: 11/27/2018] [Indexed: 01/17/2023] Open
Abstract
Vitamin D deficiency has been shown to affect iron status via decreased calcitriol production, translating to decreased erythropoiesis. The present study aimed to determine for the first time whether vitamin D supplementation can affect iron levels among Arab adolescents. A total of 125 out of the initial 200 Saudi adolescents with vitamin D deficiency (serum 25(OH)D < 50 nmol/L) were selected from the Vitamin D-School Project of King Saud University in Riyadh, Saudi Arabia. Cluster randomization was done in schools, and students received either vitamin D tablets (1000 IU/day) (N = 53, mean age 14.1 ± 1.0 years) or vitamin D-fortified milk (40IU/200mL) (N = 72, mean age 14.8 ± 1.4 years). Both groups received nutritional counseling. Anthropometrics, glucose, lipids, iron indices, and 25(OH)D were measured at baseline and after six months. Within group analysis showed that post-intervention, serum 25(OH)D significantly increased by as much as 50%, and a parallel decrease of −42% (p-values <0.001 and 0.002, respectively) was observed in serum iron in the tablet group. These changes were not observed in the control group. Between-group analysis showed a clinically significant increase in serum 25(OH)D (p = 0.001) and decrease in iron (p < 0.001) in the tablet group. The present findings suggest a possible inhibitory role of vitamin D supplementation in the iron indices of healthy adolescents whose 25(OH)D levels are sub-optimal but not severely deficient, implying that the causal relationship between both micronutrients may be dependent on the severity of deficiency, type of iron disorder, and other vascular conditions that are known to affect hematologic indices. Well-designed, randomized trials are needed to confirm the present findings.
Collapse
|
9
|
Benjeddou K, Qandoussi L, Mekkaoui B, Rabi B, El Hamdouchi A, Raji F, Saeid N, Belghiti H, Elkari K, Aguenaou H. Effect of multiple micronutrient fortified milk consumption on vitamin D status among school-aged children in rural region of Morocco. Appl Physiol Nutr Metab 2018; 44:461-467. [PMID: 30286303 DOI: 10.1139/apnm-2018-0368] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Vitamin D deficiency is a health problem in both developed and developing countries. The aim of this study was to determine the effect of multi-vitamin fortified milk consumption on vitamin D status among children living in the mountainous region of Morocco. Children aged 7 to 9 years (n = 239; 49% of girls vs 51% of boys) participated in a double-blind longitudinal study, where they were divided in 2 groups: a fortified group that received daily 200 mL of fortified ultra-high-temperature (UHT) milk enriched with 3 μg of vitamin D3 and a nonfortified group that received 200 mL of nonfortified UHT milk with a natural abundance of vitamin D3 (about 1.5 μg). Blood samples were collected 3 times (at baseline, then at the fourth and ninth months). The average weight, height, and z score of body mass index for age of participants were 22.8 ± 2.6 kg, 121.5 ± 5.2 cm, and -0.2 ± 0.6 kg/m2, respectively. At baseline, 47.5% of children had a concentration of 25-hydroxyvitamin D below 50 nmol/L. At the end of the study the prevalence of vitamin D <50 nmol/L decreased significantly by 37.6% in the fortified group. These results reveal prevalent vitamin D insufficiency (<50 nmol/L) during winter among rural Moroccan school-aged children, which seems to be better improved by consuming the fortified milk instead of the nonfortified one.
Collapse
Affiliation(s)
- Kaoutar Benjeddou
- a Joint Research Unit in Nutrition and Food, URAC 39 (Ibn Tofaïl University-CNESTEN) Regional Designated Center of Nutrition (AFRA/IAEA) Rabat-Kénitra 14000, Morocco
| | - Latifa Qandoussi
- a Joint Research Unit in Nutrition and Food, URAC 39 (Ibn Tofaïl University-CNESTEN) Regional Designated Center of Nutrition (AFRA/IAEA) Rabat-Kénitra 14000, Morocco
| | - Bouchra Mekkaoui
- a Joint Research Unit in Nutrition and Food, URAC 39 (Ibn Tofaïl University-CNESTEN) Regional Designated Center of Nutrition (AFRA/IAEA) Rabat-Kénitra 14000, Morocco
| | - Baha Rabi
- a Joint Research Unit in Nutrition and Food, URAC 39 (Ibn Tofaïl University-CNESTEN) Regional Designated Center of Nutrition (AFRA/IAEA) Rabat-Kénitra 14000, Morocco
| | - Asmaa El Hamdouchi
- a Joint Research Unit in Nutrition and Food, URAC 39 (Ibn Tofaïl University-CNESTEN) Regional Designated Center of Nutrition (AFRA/IAEA) Rabat-Kénitra 14000, Morocco
| | - Fatiha Raji
- a Joint Research Unit in Nutrition and Food, URAC 39 (Ibn Tofaïl University-CNESTEN) Regional Designated Center of Nutrition (AFRA/IAEA) Rabat-Kénitra 14000, Morocco
| | - Naima Saeid
- a Joint Research Unit in Nutrition and Food, URAC 39 (Ibn Tofaïl University-CNESTEN) Regional Designated Center of Nutrition (AFRA/IAEA) Rabat-Kénitra 14000, Morocco
| | | | - Khalid Elkari
- a Joint Research Unit in Nutrition and Food, URAC 39 (Ibn Tofaïl University-CNESTEN) Regional Designated Center of Nutrition (AFRA/IAEA) Rabat-Kénitra 14000, Morocco
| | - Hassan Aguenaou
- a Joint Research Unit in Nutrition and Food, URAC 39 (Ibn Tofaïl University-CNESTEN) Regional Designated Center of Nutrition (AFRA/IAEA) Rabat-Kénitra 14000, Morocco
| |
Collapse
|
10
|
Bayoumi I, Parkin PC, Lebovic G, Patel R, Link K, Birken CS, Maguire JL, Borkhoff CM. Iron deficiency among low income Canadian toddlers: a cross-sectional feasibility study in a Community Health Centre and non-Community Health Centre sites. BMC FAMILY PRACTICE 2018; 19:161. [PMID: 30249193 PMCID: PMC6154825 DOI: 10.1186/s12875-018-0848-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/17/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Iron deficiency in early childhood has been associated with poor developmental outcomes. Little is known about the nutritional health of young children receiving care at Canadian Community Health Centres (CHCs). Our objectives were to describe iron deficiency among toddlers at an Ontario CHC, to compare young children attending CHCs and non-CHCs, and assess the feasibility of conducting research on children in CHC settings. METHODS One CHC, Kingston Community Health Centres (CHC) with two clinical sites and one community programming site was added to the nine non-CHC pediatric and primary care clinics in the existing TARGet Kids! research network. A cross-sectional feasibilitystudy was conducted.and. Healthy children, ages 12-36 months were Enrolled. iron deficiency without inflammation (ferritin< 14 μg/L and CRP < 10 mg/L) and serum ferritin were assessed. Adjusted multivariable regression analyses were used to evaluate an association between CHC enrolment and iron status. RESULTS The CHC cohort (n = 31) was older, had lower household income, lower maternal education, higher nutrition risk scores, higher cow's milk intake, shorter breastfeeding duration and higher prevalence of unhealthy weights compared with the non-CHC cohort (n = 875). There was no association between CHC status and serum ferritin (difference in median serum ferritin 4.78 μg/L, 95% confidence interval [CI] -2.5, 14.3, p = 0.22) or iron deficiency (OR 0.55, 95% CI 0.11, - 2.73, p = 0.46) using multivariable linear and logistic regression, respectively. CONCLUSION Despite differences in sociodemographic variables, we did not detect a difference in iron status between toddlers enrolled at CHCs compared to non-CHC settings. Further research is needed to understand the health effects of poverty generally, and iron deficiency specifically among children receiving care at CHCs.
Collapse
Affiliation(s)
- Imaan Bayoumi
- Department of Family Medicine, Queen’s University, 220 Bagot St., P.O. Bag 8888, Kingston, ON K7L5E9 Canada
| | - Patricia C. Parkin
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON Canada
- Sick Kids Research Institute, Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Canada
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Gerald Lebovic
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Canada
- Applied Health Research Centre (AHRC), Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
| | - Rupa Patel
- Department of Family Medicine, Queen’s University, 220 Bagot St., P.O. Bag 8888, Kingston, ON K7L5E9 Canada
- Kingston Community Health Centres, Kingston, Canada
| | - Kendra Link
- Kingston Community Health Centres, Kingston, Canada
| | - Catherine S. Birken
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON Canada
- Sick Kids Research Institute, Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Canada
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Jonathon L. Maguire
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Department of Paediatrics, St. Michael’s Hospital, Toronto, ON Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Cornelia M. Borkhoff
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON Canada
- Sick Kids Research Institute, Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Canada
| |
Collapse
|
11
|
Abstract
High protein intake in young children is associated with excess gains in weight and body fat, but the specific role of different protein sources has yet to be described. The study aimed to investigate the role of different types of protein in the post-weaning stage on weight, BMI and overweight/obesity at 60 months. Intakes of animal, dairy and plant protein and a dietary pattern characterising variation in protein types at 21 months of age were estimated using a 3-d diet diary in a cohort of 2154 twins; weight and height were recorded every 3 months from birth to 60 months. Longitudinal mixed-effect models investigated the associations between sources of protein intake or dietary pattern scores and BMI, weight and overweight/obesity from 21 months up to 60 months. Adjusting for confounders, dairy protein intake at 21 months was positively associated with greater weight (46 (95 % CI 21, 71) g and BMI up to 60 months (0·04 (95 % CI 0·004, 0·070) kg/m2) and the odds of overweight/obesity at 3 years (OR 1·12; 95 % CI 1·00, 1·24). Milk showed associations of similar magnitude. A dietary pattern low in dairy protein and high in plant protein was associated with lower weight gain up to 60 months, but not overweight/obesity. Intake of dairy products in early childhood is most strongly associated with weight gain, compared with other protein sources. A dietary pattern characterised by lower protein intake and greater protein source diversity at 2 years may confer a lower risk of excess weight gain.
Collapse
|
12
|
Bae JH, Obounou BWO. Presence of Dental Caries Is Associated with Food Insecurity and Frequency of Breakfast Consumption in Korean Children and Adolescents. Prev Nutr Food Sci 2018; 23:94-101. [PMID: 30018886 PMCID: PMC6047872 DOI: 10.3746/pnf.2018.23.2.94] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 05/01/2018] [Indexed: 02/04/2023] Open
Abstract
Dental caries remains one of the most common chronic diseases affecting children worldwide with a multi-factorial etiology. The objective of the study was to evaluate the association between socioeconomic status (SES), dietary intake, food insecurity (FI), and dental caries in Korean children and adolescents. The study utilized data from the 2-year Korean National Health and Nutrition Examination Survey (KNHANES) conducted with 1,559 Korean boys and 1,391 girls aged 2 to 18 years from 2012 to 2013. Fathers' education (P=0.017), mothers' education (P<0.001), and household income (P=0.049) were all significantly associated with dental caries among Korean boys. As for dietary practices, both eating breakfast (P<0.001) and frequency of eating out (P<0.001) were strongly associated with dental caries (P<0.001). Three models of FI were used and no differences were found regarding genders. In model 3, both food insecure male [odds ratio (OR)=1.682, 95% confidence interval (CI): 0.999~2.832] and female (OR=1.900, 95% CI: 1.094~3.299) subjects had higher odds of developing dental caries than food secure subjects after adjusting the confounding factors. The present study showed a strong association between FI mediated by SES and dental caries. Nutrition education programs targeting low-socioeconomic families are necessary as a tool to prevent dental caries in Korea.
Collapse
Affiliation(s)
- Ji-Hyun Bae
- Department of Food Science and Nutrition, Keimyung University, Daegu 41566, Korea
| | | |
Collapse
|
13
|
Chiu CY, Su KW, Tsai MH, Hua MC, Liao SL, Lai SH, Chen LC, Yao TC, Yeh KW, Huang JL. Longitudinal vitamin D deficiency is inversely related to mite sensitization in early childhood. Pediatr Allergy Immunol 2018; 29:254-259. [PMID: 29240264 DOI: 10.1111/pai.12846] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND There are few studies addressing the longitudinal analysis of vitamin D deficiency and its impact on the development of atopic diseases in early childhood. METHODS We investigated 155 children who regularly followed up at our clinic for 5 years as subjects enrolled in a birth cohort study. The pattern of vitamin D levels from birth to 5 years of age was clustered using K-means method in R software. Absolute eosinophil count (AEC), and total serum and specific immunoglobulin E antibodies against food (egg white, milk, and wheat) and inhalant allergens (Dermatophagoides pteronyssinus, Dermatophagoides farina, and Cladosporium herbarum) were measured at 1.5, 3, 4 and 5 years of age. RESULTS A total of 137 children with serum samples obtained over at least 3 time points during the follow-up period were recruited. Using K-means clustering, the dynamic changes in vitamin D levels were significantly stratified into 3 clusters (cluster A, ≥30 ng/mL, n = 61; cluster B, 20-29.9 ng/mL, n = 53; cluster C, <20 ng/mL, n = 23). Despite no statistical association with atopic diseases, a persistent vitamin D deficiency appeared to be associated with eosinophilia at age 3, and total serum and mite-specific immunoglobulin E (IgE) levels at age 4. Furthermore, an associated higher prevalence of mite sensitization at age 4 was significantly associated with the risk of allergic rhinitis and asthma. CONCLUSIONS Vitamin D deficiency is inversely associated with AEC and mite-specific IgE levels, which may potentially increase susceptibility to develop allergies including rhinitis and asthma in early childhood.
Collapse
Affiliation(s)
- Chih-Yung Chiu
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan.,Division of Pediatric Pulmonology, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.,Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kuan-Wen Su
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan.,Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan.,Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Han Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan.,Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Man-Chin Hua
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan.,Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Sui-Ling Liao
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan.,Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shen-Hao Lai
- Division of Pediatric Pulmonology, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.,Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Li-Chen Chen
- Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan.,Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsung-Chieh Yao
- Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan.,Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kuo-Wei Yeh
- Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan.,Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jing-Long Huang
- Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan.,Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| |
Collapse
|
14
|
Abstract
Iron deficiency (ID) is common in young children aged 6-36 mo. Although the hazards associated with iron deficiency anemia (IDA) are well known, concerns about risks associated with excess iron intake in young children are emerging. To characterize iron status in Europe, we describe the prevalence of ID, IDA, iron repletion, and excess stores with the use of published data from a systematic review on iron intake and deficiency rates, combined with other selected iron status data in young European children. Various definitions for ID and IDA were applied across studies. ID prevalence varied depending on socioeconomic status and type of milk fed (i.e., human or cow milk or formula). Without regard to these factors, ID was reported in 3-48% of children aged ≥12 mo across the countries. For 6- to 12-mo-old infants, based on studies that did not differentiate these factors, ID prevalence was 4-18%. IDA was <5% in most studies in Northern and Western Europe but was considerably higher in Eastern Europe (9-50%). According to current iron status data from a sample of healthy Western European children aged 12-36 mo, 69% were iron replete, and the 97.5th percentile for serum ferritin (SF) was 64.3 μg/L. In another sample, 79% of 24-mo-old children were iron replete, and the 97.5th percentile for SF was 57.3 μg/L. Average iron intake in most countries studied was close to or below the UK's Recommended Dietary Allowance. In conclusion, even in healthy European children aged 6-36 mo, ID is still common. In Western European populations for whom data were available, approximately three-quarters of children were found to be iron replete, and excess iron stores (SF >100 μg/L) did not appear to be a concern. Consensus on the definitions of iron repletion and excess stores, as well as on ID and IDA, is needed.
Collapse
Affiliation(s)
| | - Simone R Eussen
- Nutricia Advanced Medical Nutrition, Nutricia Research, Utrecht, Netherlands
| |
Collapse
|
15
|
Low vitamin D deficiency in Irish toddlers despite northerly latitude and a high prevalence of inadequate intakes. Eur J Nutr 2016; 57:783-794. [DOI: 10.1007/s00394-016-1368-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 12/18/2016] [Indexed: 10/20/2022]
|
16
|
Vanderhout SM, Birken CS, Parkin PC, Lebovic G, Chen Y, O'Connor DL, Maguire JL. Relation between milk-fat percentage, vitamin D, and BMI z score in early childhood. Am J Clin Nutr 2016; 104:1657-1664. [PMID: 27852618 DOI: 10.3945/ajcn.116.139675] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 10/11/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Fortified cow milk is a material contributor of vitamin D and dietary fat in children. Recommendations for children >2 y of age advise reduced milk-fat consumption to reduce childhood obesity, yet the relation between lower milk fat, vitamin D stores, and body mass index (BMI) is unclear. OBJECTIVES The primary objective was to explore the association between milk-fat percentage and both BMI z score (zBMI) and venous 25-hydroxyvitamin D [25(OH)D]; the secondary objective was to assess whether milk volume consumed modified this relation. DESIGN This was a cross-sectional analysis. Healthy urban children aged 12-72 mo were recruited from 9 primary health care practices within The Applied Research Group for Kids (TARGet Kids!) research group in Toronto, Canada. We used adjusted bivariate linear regression to examine the relation between milk-fat percentage and child 25(OH)D and zBMI concurrently. Effect modification by milk volume consumed on the evaluated relations was explored with the use of an interaction term in the statistical model. RESULTS Among the 2745 included children there was a positive association between milk-fat percentage and 25(OH)D (P = 0.006) and a negative association between milk-fat percentage and zBMI (P < 0.0001). Participants who drank whole milk had a 5.4-nmol/L (95% CI: 4.32, 6.54) higher median 25(OH)D concentration and a 0.72 lower (95% CI: 0.68, 0.76) zBMI score than children who drank 1% milk. Milk volume consumed modified the effect of milk-fat percentage on 25(OH)D (P = 0.003) but not on zBMI (P = 0.77). CONCLUSIONS Whole milk consumption among healthy young children was associated with higher vitamin D stores and lower BMI. Longitudinal and interventional studies are needed to confirm these findings. TARGet Kids! was registered at clinicaltrials.gov as NCT01869530.
Collapse
Affiliation(s)
- Shelley M Vanderhout
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Paediatrics, and.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine S Birken
- Department of Paediatrics, and.,Division of Paediatric Medicine and the Paediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, Ontario, Canada; and.,Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Department of Paediatrics, and.,Division of Paediatric Medicine and the Paediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, Ontario, Canada; and.,Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Gerald Lebovic
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Yang Chen
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; .,Department of Paediatrics, and.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Paediatrics, and.,Division of Paediatric Medicine and the Paediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, Ontario, Canada; and.,Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | | |
Collapse
|
17
|
Cox KA, Parkin PC, Anderson LN, Chen Y, Birken CS, Maguire JL, Macarthur C, Borkhoff CM, Anderson LN, Bayoumi I, Birken CS, Borkhoff CM, Carsley S, Chen Y, Katz-Lavigne M, Kavikondala K, Koroshegyi C, Kowal C, Lee GJ, Maguire JL, Mason D, Omand J, Parkin PC, Persaud N, van den Heuvel M, Wong P, Zabih W, Baker J, Barozzino T, Bonifacio J, Campbell D, Cheema S, Chisamore B, Danayan K, Das P, Derocher MB, Do A, Dorey M, Freeman S, Fung K, Guiang C, Handford C, Hatch H, Jacobson S, Kiran T, Knowles H, Kwok B, Lakhoo S, Lam-Antoniades M, Lau E, Leung FH, Loo J, Mahmoud S, Moodie R, Morinis J, Naymark S, Neelands P, Owen J, Peer M, Perlmutar M, Persaud N, Pinto A, Porepa M, Ramji N, Ramji N, Rosenthal A, Saunderson J, Saxena R, Sgro M, Shepherd S, Smiltnieks B, Taylor C, Weisdors T, Wijayasinghe S, Wong P, Ying E, Young E, Barozzino T, Chisamore B, Feldman M, Ipp M, Abreo K, Dalwadi D, Malhi T, Pugliese A, Smith M, Thompson L. Association Between Meat and Meat-Alternative Consumption and Iron Stores in Early Childhood. Acad Pediatr 2016; 16:783-791. [PMID: 26804490 DOI: 10.1016/j.acap.2016.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 01/04/2016] [Accepted: 01/11/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To prevent iron deficiency, 2014 Canadian recommendations for healthy term infants from 6 to 24 months recommend iron-rich complementary foods such as meat and meat alternatives 2 or more times a day. The purpose of our study was to evaluate the association between meat and meat-alternative consumption and iron status in young children and the association between red meat consumption and iron status among children meeting recommendations. METHODS Healthy children aged 12 to 36 months were recruited. A cross-sectional study was conducted. Meat and meat-alternative consumption was measured using the NutriSTEP questionnaire. Adjusted multivariable regression analyses were used to evaluate an association between meat consumption and serum ferritin, and iron deficiency (serum ferritin <14 μg/L). RESULTS A total of 1043 children were included. Seventy-three percent of children met the recommended daily intake of meat and meat alternatives, and 66% ate red meat in the past 3 days. Eating meat and meat alternatives was not associated with serum ferritin (0.13 μg/L, 95% confidence interval -0.05, 0.31, P = .16), but it was associated with a decreased odds of iron deficiency (odds ratio 0.97, 95% confidence interval 0.94, 0.99, P = .03). Associations between red meat consumption and iron status were not statistically significant. Statistically significant covariates associated with increased odds of iron deficiency included longer breast-feeding duration, daily cow's milk intake of >2 cups, and a higher body mass index z score. CONCLUSIONS Daily cow's milk intake of >2 cups, longer breast-feeding duration, and a higher body mass index z score were modifiable risk factors associated with iron deficiency. Eating meat according to recommendations may be a promising additional target for the prevention of iron deficiency in early childhood.
Collapse
Affiliation(s)
- Kelly Anne Cox
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario Canada
| | - Patricia C Parkin
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada; Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario Canada
| | - Laura N Anderson
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario Canada
| | - Yang Chen
- The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario Canada
| | - Catherine S Birken
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada; Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario Canada
| | - Jonathon L Maguire
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada; The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario Canada; Department of Paediatrics, St. Michael's Hospital, Toronto, Ontario Canada
| | - Colin Macarthur
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada; Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario Canada
| | - Cornelia M Borkhoff
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada; Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Grewal NK, Andersen LF, Kolve CS, Kverndalen I, Torheim LE. Food and Nutrient Intake among 12-Month-Old Norwegian-Somali and Norwegian-Iraqi Infants. Nutrients 2016; 8:nu8100602. [PMID: 27690092 PMCID: PMC5083990 DOI: 10.3390/nu8100602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/12/2016] [Accepted: 09/19/2016] [Indexed: 11/16/2022] Open
Abstract
The aim of the present paper was to describe food and nutrient intake among 12-month-old Norwegian-Somali and Norwegian-Iraqi infants, with a focus on iron and vitamin D intake. A cross-sectional survey was conducted from August 2013 through September 2014. Eighty-nine mothers/infants of Somali origin and 77 mothers/infants of Iraqi origin residing in Eastern Norway participated in the study. Data were collected using two 24-h multiple-pass recalls. Forty percent of the Norwegian-Somali infants and 47% of the Norwegian-Iraqi infants were breastfed at 12 months of age (p = 0.414). Median energy percentages (E%) from protein, fat and carbohydrates were within the recommended intake ranges, except the level of saturated fats (12-13 E%). Median intakes of almost all micronutrients were above the recommended daily intakes. Most of the infants consumed iron-enriched products (81%) and received vitamin D supplements (84%). The median intakes of iron and vitamin D were significantly higher among infants receiving iron-enriched products and vitamin D supplements compared to infants not receiving such products (p < 0.001). The findings indicate that the food and nutrient intake of this group of infants in general seems to be in accordance with Norwegian dietary recommendations. Foods rich in iron and vitamin D supplements were important sources of the infants' intake of iron and vitamin D and should continue to be promoted.
Collapse
Affiliation(s)
- Navnit Kaur Grewal
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, P.O. Box 4 St. Olavs Plass, 0130 Oslo, Norway.
| | - Lene Frost Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O. Box 1046 Blindern, 0317 Oslo, Norway.
| | - Cathrine Solheim Kolve
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, P.O. Box 4 St. Olavs Plass, 0130 Oslo, Norway.
| | - Ingrid Kverndalen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, P.O. Box 4 St. Olavs Plass, 0130 Oslo, Norway.
| | - Liv Elin Torheim
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, P.O. Box 4 St. Olavs Plass, 0130 Oslo, Norway.
| |
Collapse
|
19
|
Iron and Vitamin D Deficiency in Healthy Young Children in Western Europe Despite Current Nutritional Recommendations. J Pediatr Gastroenterol Nutr 2016; 62:635-42. [PMID: 26488124 DOI: 10.1097/mpg.0000000000001015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIM Iron deficiency (ID) and vitamin D deficiency (VDD) are the 2 most common micronutrient deficiencies in young children worldwide and may lead to impaired neurodevelopment and rickets, respectively. Risk factors for ID and VDD differ between populations. The objective of this study was to determine the prevalence of and risk factors for ID and VDD in 12- to 36-month-old children in Western Europe. METHODS This study took place in Germany, the Netherlands, and the United Kingdom from 2012 to 2014. A venous blood sample was taken to establish iron and vitamin D status. ID was defined as serum ferritin <12 μg/L in the absence of infection (high sensitivity C-reactive protein <10 mg/L). VDD was defined as serum 25-hydroxyvitamin D <50 nmol/L (20 ng/mL). Furthermore, parents were asked to fill out a questionnaire regarding their child's demographic- and socioeconomic characteristics, food intake, sun exposure, and medical history. RESULTS In 325 children (white race 95%, boys 56%, mean age 20.7 months) the overall prevalence of ID and VDD was 11.8% and 22.8%, respectively. The use of primarily cow's milk as major type of milk was associated with ID (odds ratio [OR] 3.20, 95% confidence interval [CI] 1.12-8.53) and VDD (OR 7.17, 95% CI 3.10-16.57). The use of vitamin D supplements (OR 0.20, 95% CI 0.07-0.56) was associated with a lower prevalence of VDD. CONCLUSION Despite current nutritional recommendations, ID and VDD are common in healthy young white children. Health programs focusing on adequate iron and vitamin D intake at an early age should be implemented to prevent deficiencies.
Collapse
|
20
|
Dugan CE, Aguilar D, Park YK, Lee JY, Fernandez ML. Dairy Consumption Lowers Systemic Inflammation and Liver Enzymes in Typically Low-Dairy Consumers with Clinical Characteristics of Metabolic Syndrome. J Am Coll Nutr 2015; 35:255-61. [DOI: 10.1080/07315724.2015.1022637] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
21
|
Abstract
AbstractObjectivesFe-deficiency anaemia (IDA) occurs in 1–2 % of infants in developed countries, peaks at 1–3 years of age and is associated with later cognitive deficits. The objectives of the present study were to describe the characteristics of young children with severe IDA and examine modifiable risk factors in a developed-country setting.DesignTwo prospective samples: a national surveillance programme sample and a regional longitudinal study sample.SettingCanada, 2009–2011.SubjectsTwo samples of young children recruited from community-based health-care practices: a national sample with severe anaemia (Hb<80 g/l) due to Fe deficiency and a regional sample with non-anaemic Fe sufficiency.ResultsChildren with severe IDA (n201, mean Hb 55·1 g/l) experienced substantial morbidity (including developmental delay, heart failure, cerebral thrombosis) and health-care utilization (including a 42 % hospitalization rate). Compared with children with Fe sufficiency (n597, mean Hb 122·4 g/l), children with severe IDA consumed a larger volume of cow’s milk daily (median 1065 mlv. 500 ml,P<0·001) and were more likely to be using a bottle during the day (78 %v. 43 %, OR=6·0; 95 % CI 4·0, 8·9) and also in bed (60 %v. 21 %, OR=6·5; 95 % CI 4·4, 9·5).ConclusionsSevere IDA is associated with substantial morbidity and may be preventable. Three potentially modifiable feeding practices are associated with IDA: (i) cow’s milk consumption greater than 500 ml/d; (ii) daytime bottle use beyond 12 months of age; and (iii) bottle use in bed. These feeding practices should be highlighted in future recommendations for public health and primary-care practitioners.
Collapse
|
22
|
Chiu CY, Huang SY, Peng YC, Tsai MH, Hua MC, Yao TC, Yeh KW, Huang JL. Maternal vitamin D levels are inversely related to allergic sensitization and atopic diseases in early childhood. Pediatr Allergy Immunol 2015; 26:337-43. [PMID: 25847488 DOI: 10.1111/pai.12384] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND There are few studies addressing the impact of maternal vitamin D status on the vitamin D levels in offspring, their sensitization to common allergens and atopic disease development. METHODS Children aged 0 through 4 yr from a birth cohort in the Prediction of Allergies in Taiwanese Children (PATCH) study were enrolled. Time series of serum 25-hydroxyvitamin D (25(OH)D) levels were measured in maternal blood before delivery, cord blood, and at age 1.5, 3, and 4 using an electrochemiluminescence-based assay. Specific IgE antibodies against food and inhalant allergens were measured at 6 months, and 1, 1.5, 2, 3, and 4 yr of age. RESULTS A total of 164 mother-child pairs from a birth cohort were recruited in this study. The mean levels of maternal 25(OH)D were 23.2 ± 7.7 ng/ml with a high (up to 80%) prevalence of insufficient vitamin D status (< 30 ng/ml). A significant correlation was seen between maternal and cord blood 25(OH)D levels (p < 0.001), and a persistent lower 25(OH)D level was found in children born to mothers with deficient 25(OH)D levels. Deficient maternal 25(OH)D levels (<20 ng/ml) appeared to be associated with a higher prevalence of allergen sensitization before age 2. Higher maternal 25(OH)D levels were significantly associated with lower risk of eczema (OR 0.12; 95% CI 0.02-0.63; p = 0.012) and asthma (OR 0.22; 95% CI 0.06-0.92; p = 0.038) at age 4. CONCLUSIONS Low maternal 25(OH)D levels appear not only to be associated with an increase in the prevalence of allergic sensitization but also the risk of eczema and asthma in early childhood.
Collapse
Affiliation(s)
- Chih-Yung Chiu
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan.,Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan.,Division of Pediatric Pulmonology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Yin Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Chieh Peng
- Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ming-Han Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan.,Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Man-Chin Hua
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan.,Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Tsung-Chieh Yao
- Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan.,Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kuo-Wei Yeh
- Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan.,Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jing-Long Huang
- Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan.,Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| |
Collapse
|
23
|
Contreras JJ, Hiestand B, O'Neill JC, Schwartz R, Nadkarni M. Vitamin D deficiency in children with fractures. Pediatr Emerg Care 2014; 30:777-81. [PMID: 25343741 DOI: 10.1097/pec.0000000000000258] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study aimed to determine whether healthy children with fractures resulting from minor accidental trauma have a higher prevalence of vitamin D deficiency than that of healthy children without fractures. METHODS This was a prospective case-control study of ambulatory children younger than 18 years with and without fractures in a pediatric emergency department. Evaluation included serum 25-hydroxyvitamin D (25(OH)D) level, complete metabolic panel, and phosphorus level. Vitamin D deficiency was defined as a 25(OH)D level of less than 20 ng/mL and insufficiency less than 30 ng/mL but 20 ng/mL or greater. A level of 30 ng/mL or greater was considered sufficient. Fisher exact test was used to test for association between 25(OH)D level and fracture status. Logistic regression was used to examine the relationship between 25(OH)D levels and the odds of fracture, conditioned on season, age, race, body weight percentile, history of fracture, multivitamin use, and estimated daily milk intake. RESULTS The sample included 100 case and 100 control patients. There was no statistical difference in median 25(OH)D levels between fracture and control groups (26.7 vs 25.45 ng/mL, P = 0.84). There was no difference in the proportion of patients with sufficient 25(OH)D levels or in the distribution of sufficient, insufficient, and deficient. After adjusting for male sex and season of enrollment, vitamin D sufficiency was not a significant predictor of fracture status in a multiple variable logistic model (odds ratio, 0.94; 95% confidence interval, 0.51-1.77; Wald P = 0.859). CONCLUSIONS We found no relationship between vitamin D deficiency and fracture risk in our study population.
Collapse
Affiliation(s)
- Jamie Jaqua Contreras
- From the Departments of *Emergency Medicine, and †Pediatrics, Wake Forest University Health Sciences, Winston-Salem, NC
| | | | | | | | | |
Collapse
|
24
|
Lee GJ, Birken CS, Parkin PC, Lebovic G, Chen Y, L'Abbé MR, Maguire JL. Consumption of non-cow's milk beverages and serum vitamin D levels in early childhood. CMAJ 2014; 186:1287-93. [PMID: 25332367 DOI: 10.1503/cmaj.140555] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Vitamin D fortification of non-cow's milk beverages is voluntary in North America. The effect of consuming non-cow's milk beverages on serum 25-hydroxyvitamin D levels in children is unclear. We studied the association between non-cow's milk consumption and 25-hydroxyvitamin D levels in healthy preschool-aged children. We also explored whether cow's milk consumption modified this association and analyzed the association between daily non-cow's milk and cow's milk consumption. METHODS In this cross-sectional study, we recruited children 1-6 years of age attending routinely scheduled well-child visits. Survey responses, and anthropometric and laboratory measurements were collected. The association between non-cow's milk consumption and 25-hydroxyvitamin D levels was tested using multiple linear regression and logistic regression. Cow's milk consumption was explored as an effect modifier using an interaction term. The association between daily intake of non-cow's milk and cow's milk was explored using multiple linear regression. RESULTS A total of 2831 children were included. The interaction between non-cow's milk and cow's milk consumption was statistically significant (p = 0.03). Drinking non-cow's milk beverages was associated with a 4.2-nmol/L decrease in 25-hydroxyvitamin D level per 250-mL cup consumed among children who also drank cow's milk (p = 0.008). Children who drank only non-cow's milk were at higher risk of having a 25-hydroxyvitamin D level below 50 nmol/L than children who drank only cow's milk (odds ratio 2.7, 95% confidence interval 1.6 to 4.7). INTERPRETATION Consumption of non-cow's milk beverages was associated with decreased serum 25-hydroxyvitamin D levels in early childhood. This association was modified by cow's milk consumption, which suggests a trade-off between consumption of cow's milk fortified with higher levels of vitamin D and non-cow's milk with lower vitamin D content.
Collapse
Affiliation(s)
- Grace J Lee
- Departments of Nutritional Sciences (Lee, L'Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael's Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont
| | - Catherine S Birken
- Departments of Nutritional Sciences (Lee, L'Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael's Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont
| | - Patricia C Parkin
- Departments of Nutritional Sciences (Lee, L'Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael's Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont
| | - Gerald Lebovic
- Departments of Nutritional Sciences (Lee, L'Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael's Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont
| | - Yang Chen
- Departments of Nutritional Sciences (Lee, L'Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael's Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont
| | - Mary R L'Abbé
- Departments of Nutritional Sciences (Lee, L'Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael's Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont
| | - Jonathon L Maguire
- Departments of Nutritional Sciences (Lee, L'Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael's Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont.
| | | |
Collapse
|
25
|
Carsley S, Borkhoff CM, Maguire JL, Birken CS, Khovratovich M, McCrindle B, Macarthur C, Parkin PC. Cohort Profile: The Applied Research Group for Kids (TARGet Kids!). Int J Epidemiol 2014; 44:776-88. [PMID: 24982016 DOI: 10.1093/ije/dyu123] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Applied Research Group for Kids (TARGet Kids!) is an ongoing open longitudinal cohort study enrolling healthy children (from birth to 5 years of age) and following them into adolescence. The aim of the TARGet Kids! cohort is to link early life exposures to health problems including obesity, micronutrient deficiencies and developmental problems. The overarching goal is to improve the health of Canadians by optimizing growth and developmental trajectories through preventive interventions in early childhood. TARGet Kids!, the only child health research network embedded in primary care practices in Canada, leverages the unique relationship between children and families and their trusted primary care practitioners, with whom they have at least seven health supervision visits in the first 5 years of life. Children are enrolled during regularly scheduled well-child visits. To date, we have enrolled 5062 children. In addition to demographic information, we collect physical measurements (e.g. height, weight), lifestyle factors (nutrition, screen time and physical activity), child behaviour and developmental screening and a blood sample (providing measures of cardiometabolic, iron and vitamin D status, and trace metals). All data are collected at each well-child visit: twice a year until age 2 and every year until age 10. Information can be found at: http://www.targetkids.ca/contact-us/.
Collapse
Affiliation(s)
- Sarah Carsley
- Pediatric Outcomes Research Team, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Cornelia M Borkhoff
- Pediatric Outcomes Research Team, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Jonathon L Maguire
- Pediatric Outcomes Research Team, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada, Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, ON, Canada, Department of Pediatrics, St. Michael's Hospital, Toronto, ON, Canada, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada and
| | - Catherine S Birken
- Pediatric Outcomes Research Team, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada, Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, ON, Canada, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada and
| | - Marina Khovratovich
- Pediatric Outcomes Research Team, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Brian McCrindle
- Division of Cardiology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Colin Macarthur
- Pediatric Outcomes Research Team, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada and
| | - Patricia C Parkin
- Pediatric Outcomes Research Team, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada and
| | | |
Collapse
|
26
|
Anderson A, Burggren A. Cognitive and neurodevelopmental benefits of extended formula-feeding in infants: re: Deoni et al. 2013. Neuroimage 2014; 100:706-9. [PMID: 24836012 DOI: 10.1016/j.neuroimage.2014.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 05/02/2014] [Indexed: 11/16/2022] Open
Abstract
The recent Deoni et al. (2013) manuscript proposed that breastfeeding was associated with increased cognitive ability and white-matter in older children (over 26 months), using ms-DESPOT MRI imaging to indirectly measure white matter in children who were either breastfed, formula fed, or combined breast+formula fed. In this response, we identify limitations in drawing causal inference among white matter, cognitive ability, and breastfeeding. We propose that the observed cognitive and neurodevelopmental differences between breastfed and formula-fed infants might actually be caused by the premature introduction of cow's milk in the second year of life, among other contributing factors. The implication of a causal relationship between intelligence and white matter metrics, especially in a developmentally young population, is premature given the recency of this field. The original analyses did not control for important covariates; when comparing both white matter and test scores, mothers were not controlled for age and socio-economic status (SES) and their children were not controlled for gender. Raw test scores, instead of age-adjusted test scores, were used even though the children were of different ages. Mothers were not controlled for reason(s) not to breastfeed, even though many prenatal factors are known to predict this such as stress, parity, obesity, and smoking habits. The observed cognitive ability and white matter benefits identified primarily within the long-term breastfed children are at least partially attributable to other factors such as age, gender, and SES. We suggest methodological approaches to removing such ambiguity, and ways to dissociate cause from effect. The formula and breastfeeding groups didn't show differences until the "formula fed" children likely had been fed cow's milk for longer than they had been fed formula, at 2.2 years. The greatest cognitive differences however were observed within the high SES breastfed infants depending on breastfeeding duration; infants who were breastfed over 15 months showed increased cognitive ability compared to those breastfed less than months. This implicates the source of dairy during the second year of life, and not other SES factors or infant formula, as the most likely nutritional factor responsible for the observed differences within the breastfed children. Given the known nutritional deficiencies of cow's milk, these findings imply infants who received cow's milk during the second year of life were at a disadvantage compared to those who were breastfed, independent of whether they were fed formula or breast milk during the first year of life. This evidence suggests that infants should receive formula in lieu of cow's milk when breast milk is unavailable as a dairy source, until roughly 2 years of age.
Collapse
Affiliation(s)
- Ariana Anderson
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 760 Westwood Plaza, CHS Suite C8-734, Los Angeles, CA 90095, USA.
| | - Alison Burggren
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 760 Westwood Plaza, CHS Suite C8-734, Los Angeles, CA 90095, USA
| |
Collapse
|
27
|
Riverin B, Dewailly E, Côté S, Johnson-Down L, Morin S, Dodin S. Prevalence of vitamin D insufficiency among healthy school-age Cree children. Paediatr Child Health 2014; 19:e15-9. [PMID: 24665228 DOI: 10.1093/pch/19.3.e15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND First Nations children are at higher risk for vitamin D deficiency and rickets. OBJECTIVE To assess the prevalence of vitamin D deficiency and the correlations between fat mass, parathyroid hormone and dietary habits with serum vitamin D level in a random sample of Cree children eight to 14 years of age. METHODS Serum 25-hydroxyvitamin D (25[OH]D) levels and additional information regarding anthropometrics and dietary habits were obtained from participants in two Cree communities. Vitamin D deficiency and insufficiency was defined as serum 25(OH)D levels <30 nmol/L and <50 nmol/L, respectively. Proportions to estimate the vitamin D status were weighted to account for the complex sampling design, and Pearson's correlation coefficients were used to estimate the associations of milk and fish intake, parathyroid hormone and fat mass with serum 25(OH)D levels. RESULTS Data from 52 healthy Cree children (mean [± SD] age 11.1±2.0 years; 27 boys) were included in the analyses. The median serum 25(OH)D level was 52.4 nmol/L (range 22.1 nmol/L to 102.7 nmol/L). Forty-three percent (95% CI 29% to 58%) and 81% (95% CI 70% to 92%) of Cree children had vitamin D levels <50 nmol/L and <75 nmol/L, respectively. Vitamin D intake was positively associated with serum 25(OH)D levels. Obese children had lower vitamin D levels; however, the difference was nonsignificant. CONCLUSION There may be a substantial proportion of Cree children who are vitamin D deficient. Increasing age, lower dietary vitamin D intake and, possibly, higher body mass index were associated with decreased vitamin D levels; however, causality cannot be inferred.
Collapse
Affiliation(s)
- Bruno Riverin
- Faculty of Medicine, Department of Social and Preventive Medicine, Laval University, Quebec City
| | - Eric Dewailly
- Faculty of Medicine, Department of Social and Preventive Medicine, Laval University, Quebec City; ; Public Health Research Unit of the Laval University Medical Center, Quebec City
| | - Suzanne Côté
- Public Health Research Unit of the Laval University Medical Center, Quebec City
| | - Louise Johnson-Down
- McGill University, Center for Indigenous Peoples' Nutrition, School of Dietetics and Human Nutrition, Ste Anne De Bellevue
| | - Suzanne Morin
- McGill University Health Center, Department of Medicine, Division of General Internal Medicine, Montreal
| | - Sylvie Dodin
- Faculty of Medicine, Department of Social and Preventive Medicine, Laval University, Quebec City; ; St-François d'Assise Hospital Research Center, Department of Obstetrics and Gynecology, Quebec City, Quebec
| |
Collapse
|
28
|
Raiten DJ, Raghavan R, Porter A, Obbagy JE, Spahn JM. Executive summary: Evaluating the evidence base to support the inclusion of infants and children from birth to 24 mo of age in the Dietary Guidelines for Americans--"the B-24 Project". Am J Clin Nutr 2014; 99:663S-91S. [PMID: 24500158 PMCID: PMC3927696 DOI: 10.3945/ajcn.113.072140] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The Dietary Guidelines for Americans (DGA) are the cornerstone of US government efforts to promote health and prevent disease through diet and nutrition. The DGA currently provides guidelines for ages ≥ 2 y. In an effort to determine the strength of the evidence to support the inclusion of infants and children from birth to age 24 mo, the partner agencies led by the Department of Health and Human Services Office of Disease Prevention and Health Promotion and the USDA Center for Nutrition Program and Policy initiated the project entitled "Evaluating the evidence base to support the inclusion of infants and children from birth to 24 months of age in the Dietary Guidelines for Americans--the B-24 Project." This project represents the first step in the process of applying systematic reviews to the process of deciding whether the evidence is sufficient to include this age group in future editions of the DGA. This supplement includes the B-24 Executive Summary, which describes the B-24 Project and the deliberations of the 4 working groups during the process of developing priority topics for the systematic review, and a research agenda to address the critical gaps. Also included in this supplement issue is an article on the Nutrition Evidence Library methodology for developing systematic review questions and articles from the invited content presenters at the B-24 Prime meeting.
Collapse
Affiliation(s)
- Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (DJR, RR, and AP); and the US Department of Agriculture, Center for Nutrition Policy and Promotion, Evidence Analysis Library Division, Alexandria, VA (JEO and JMS)
| | | | | | | | | |
Collapse
|
29
|
Bacharier LB. Vitamin D status at birth: An important and potentially modifiable determinant of atopic disease in childhood? J Allergy Clin Immunol 2014; 133:154-5. [DOI: 10.1016/j.jaci.2013.07.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 07/29/2013] [Accepted: 07/30/2013] [Indexed: 11/25/2022]
|
30
|
Stagi S, Pelosi P, Strano M, Poggi G, Manoni C, de Martino M, Seminara S. Determinants of Vitamin D Levels in Italian Children and Adolescents: A Longitudinal Evaluation of Cholecalciferol Supplementation versus the Improvement of Factors Influencing 25(OH)D Status. Int J Endocrinol 2014; 2014:583039. [PMID: 25435877 PMCID: PMC4243588 DOI: 10.1155/2014/583039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/06/2014] [Accepted: 08/25/2014] [Indexed: 12/29/2022] Open
Abstract
Objective. This paper aims to assess 25(OH)D levels in Italian children and adolescents identifying risk factors for 25(OH)D deficiency and to evaluate whether a normal 25(OH)D value can be restored in 25(OH)D-deficient patients. Methods. We evaluated 25(OH)D levels in 679 Italian children and adolescents (≤10, 11-20, 21-30, and >30 ng/mL were defined as severe deficiency, deficiency, insufficiency, and sufficiency, resp.). Of these, 365 25(OH)D-deficient were followed up for 1 year; 205 were treated with cholecalciferol (Arm A: 400 I.U.) and 160 by improving the environmental variables influencing 25(OH)D levels (Arm B). Results. At cross-sectional evaluation, 11.3% showed sufficiency, 30.0% insufficiency, and 58.7% 25(OH)D deficiency. Mean 25(OH)D was 19.08 ± 8.44 ng/mL. At the enrollment time (T 0), no difference was found between Arms A and B with respect to distribution and 25(OH)D levels. At end time (T 1) 26.0% (29.7% in Arm A versus 20.6% in Arm B) showed sufficiency, 38.4% (42.0% versus 34.4%) insufficiency, and 35.6% (28.3% versus 45.0%) 25(OH)D deficiency. Mean 25(OH)D level was 23.71 ± 6.83 ng/mL. Conclusions. Neither changes of lifestyle nor 400 I.U. cholecalciferol supplementation alone appears to be sufficient to restore adequate 25(OH)D levels.
Collapse
Affiliation(s)
- Stefano Stagi
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, 50139 Florence, Italy
- Pediatric Endocrinology Unit, Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
- *Stefano Stagi:
| | - Paola Pelosi
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, 50139 Florence, Italy
| | - Massimo Strano
- Pediatric Unit, Mugello Hospital, Borgo San Lorenzo, 50032 Florence, Italy
| | - Giovanni Poggi
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, 50139 Florence, Italy
| | - Cristina Manoni
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, 50139 Florence, Italy
| | - Maurizio de Martino
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, 50139 Florence, Italy
| | - Salvatore Seminara
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, 50139 Florence, Italy
| |
Collapse
|
31
|
Schroth RJ, Levi JA, Sellers EA, Friel J, Kliewer E, Moffatt MEK. Vitamin D status of children with severe early childhood caries: a case-control study. BMC Pediatr 2013; 13:174. [PMID: 24160554 PMCID: PMC4231606 DOI: 10.1186/1471-2431-13-174] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 10/23/2013] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Severe Early Childhood Caries (S-ECC) affects the health and well-being of young children. There is limited research in this area, though evidence suggests that children with S-ECC are at an increased risk of malnutrition. The purpose of this study was to determine the association between vitamin D (25(OH)D) levels and S-ECC. METHODS This case-control study was conducted from 2009 to 2011 in the city of Winnipeg, Manitoba, Canada. 144 preschool children with S-ECC were recruited from a local health centre on the day of their slated dental surgery under general anesthetic. 122 caries-free controls were recruited from the community. Children underwent a blood draw for vitamin D (25(OH)D), calcium, parathyroid hormone, and albumin levels. Parents completed an interviewed questionnaire assessing the child's nutritional habits, oral health, and family demographics. Analyses included descriptive and bivariate statistics as well as multiple and logistic regression. A p value ≤ 0.05 was significant. RESULTS The mean age of participants was 40.8 ± 14.1 months. Children with S-ECC had significantly lower mean 25(OH)D (68.9 ± 28.0 nmol/L vs. 82.9 ± 31.1, p < 0.001), calcium (p < 0.001), and albumin (p < 0.001) levels, and significantly higher parathyroid hormone (p < 0.001) levels than those caries-free. Children with S-ECC were significantly more likely to have vitamin D levels below recognized thresholds for optimal and adequate status (i.e. < 75 and < 50 nmol/L, respectively). Multiple regression analysis revealed that S-ECC, infrequent milk consumption, and winter season were significantly associated with lower 25(OH)D concentrations. Low 25(OH)D levels, low household income, and poorer ratings of the child's general health were significantly associated with S-ECC on logistic regression. CONCLUSION Children with S-ECC appear to have relatively poor nutritional health compared to caries-free controls, and were significantly more likely to have low vitamin D, calcium, and albumin concentrations and elevated PTH levels.
Collapse
Affiliation(s)
- Robert J Schroth
- The University of Manitoba, Winnipeg, Canada
- The Manitoba Institute of Child Health, Winnipeg, Canada
- Department of Preventive Dental Science, Faculty of Dentistry, Department of Pediatrics & Child Health, Faculty of Medicine, University of Manitoba, 507 – 715 McDermot Avenue, Winnipeg MB R3E 3P4, Canada
| | - Jeremy A Levi
- The University of Manitoba, Winnipeg, Canada
- The Manitoba Institute of Child Health, Winnipeg, Canada
| | - Elizabeth A Sellers
- The University of Manitoba, Winnipeg, Canada
- The Manitoba Institute of Child Health, Winnipeg, Canada
| | - James Friel
- The University of Manitoba, Winnipeg, Canada
- The Manitoba Institute of Child Health, Winnipeg, Canada
| | - Eleonore Kliewer
- The University of Manitoba, Winnipeg, Canada
- The Manitoba Institute of Child Health, Winnipeg, Canada
| | - Michael EK Moffatt
- The University of Manitoba, Winnipeg, Canada
- The Manitoba Institute of Child Health, Winnipeg, Canada
- Winnipeg Regional Health Authority, Winnipeg, Canada
| |
Collapse
|
32
|
|
33
|
Greenhill C. Nutrition: drinking cow's milk alters vitamin D and iron stores in young children. Nat Rev Endocrinol 2013; 9:126. [PMID: 23318232 DOI: 10.1038/nrendo.2013.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|