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Jerome ML, Valcarce V, Lach L, Itriago E, Salas AA. Infant body composition: A comprehensive overview of assessment techniques, nutrition factors, and health outcomes. Nutr Clin Pract 2023; 38 Suppl 2:S7-S27. [PMID: 37721459 PMCID: PMC10513728 DOI: 10.1002/ncp.11059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/08/2023] [Accepted: 07/16/2023] [Indexed: 09/19/2023] Open
Abstract
Body composition assessment is a valuable tool for clinical assessment and research that has implications for long-term health. Unlike traditional measurements such as anthropometrics or body mass index, body composition assessments provide more accurate measures of body fatness and lean mass. Moreover, depending on the technique, they can offer insight into regional body composition, bone mineral density, and brown adipose tissue. Various methods of body composition assessment exist, including air displacement plethysmography, dual-energy x-ray absorptiometry, bioelectrical impedance, magnetic resonance imaging, D3 creatine, ultrasound, and skinfold thickness, each with its own strengths and limitations. In infants, several feeding practices and nutrition factors are associated with body composition outcomes, such as breast milk vs formula feeding, protein intake, breast milk composition, and postdischarge formulas for preterm infants. Longitudinal studies suggest that body composition in infancy predicts later body composition, obesity, and other cardiometabolic outcomes in childhood, making it a useful early marker of cardiometabolic health in both term and preterm infants. Emerging evidence also suggests that body composition during infancy predicts neurodevelopmental outcomes, particularly in preterm infants at high risk of neurodevelopmental impairment. The purpose of this narrative review is to provide clinicians and researchers with a comprehensive overview of body composition assessment techniques, summarize the links between specific nutrition practices and body composition in infancy, and describe the neurodevelopmental and cardiometabolic outcomes associated with body composition patterns in term and preterm infants.
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Affiliation(s)
| | | | - Laura Lach
- Medical University of South Carolina, Charleston, SC
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Itriago E, Trahan KF, Massieu LA, Garg PM, Premkumar MH. Current Practices, Challenges, and Recommendations in Enteral Nutrition After Necrotizing Enterocolitis. Clin Perinatol 2023; 50:683-698. [PMID: 37536772 DOI: 10.1016/j.clp.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Necrotizing enterocolitis (NEC) is a neonatal disease with high mortality and morbidity. There is a lack of evidence-based recommendations on nutritional rehabilitation following NEC, and much of the current practice is guided by institutional policies and expert opinions. After a diagnosis of NEC, infants are exposed to an extended period of bowel rest and a prolonged course of antibiotics. Recognizing the patient characteristics that predict nutritional tolerance, early initiation of enteral nutrition, minimizing periods of bowel rest and antibiotic exposure, and standardization of dietary practices are the mainstay of post-NEC nutrition.
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Affiliation(s)
- Elena Itriago
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Kimberly Fernandez Trahan
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Leonor Adriana Massieu
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Parvesh M Garg
- Wake Forest School of Medicine, Brenner Children's Hospital, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Muralidhar H Premkumar
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
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Salas A, Chetta K, Lach L, Katikaneni L, Itriago E, Hair AB, Moreira A, Bergner EM, Elabiad M, Ramel S. Differences in growth and body composition of preterm infants according to race. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00457-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Itriago E, Hair A, Varadaranjan R, Hagan J, Chu Z, Rhee C, Meoded A. Diffusion tensor imaging metrics as biomarkers of white matter development in premature infants fed human milk. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00736-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Lewis AN, de la Cruz D, Wynn JL, Frazer LC, Yakah W, Martin CR, Yang H, Itriago E, Unger J, Hair AB, Miele J, Sullivan BA, Husain A, Good M. Evaluation of the Neonatal Sequential Organ Failure Assessment and Mortality Risk in Preterm Infants with Necrotizing Enterocolitis. Neonatology 2022; 119:334-344. [PMID: 35313308 PMCID: PMC9117503 DOI: 10.1159/000522560] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/10/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The neonatal sequential organ failure assessment (nSOFA) score is a tool for calculating mortality risk of infants in the neonatal intensive care unit. The utility of the nSOFA in determining the risk of mortality or the association with surgical intervention among infants with necrotizing enterocolitis (NEC) has not been investigated. METHODS We performed a retrospective, cohort study of preterm (<37 weeks) infants with NEC Bell's stage ≥ IIA at six hospitals from 2008 to 2020. An nSOFA score (range 0-15) was assigned to each patient at nine time points from 48 h before or after clinical illness was suspected. RESULTS Of the 259 infants, nSOFA scores for infants who died (n = 39) or had the composite outcome of surgery or death (n = 114) were significantly higher (p < 0.05) early in the NEC course compared to nSOFA scores for infants who survived medical NEC. Twelve hours after evaluation, the area under the receiver operating characteristic curve was 0.87 (95% confidence interval [CI], 0.80-0.93) to discriminate for mortality and 0.84 (95% CI, 0.79-0.90) for surgery or death (p < 0.001). A maximum nSOFA score of ≥4 at -6, 0, 6, or 12 h following evaluation was associated with a 20-fold increase in mortality and 19-fold increase in surgery or death compared with a score of <4 (p < 0.001). CONCLUSION In this multicenter cohort, the nSOFA score was able to discriminate well for death as well as surgery or death among infants with NEC. The nSOFA is a clinical research tool that may be used in infants with NEC to improve classification by objective quantification of organ dysfunction.
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Affiliation(s)
- Angela N. Lewis
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis Children’s Hospital, 660 South Euclid, St. Louis, MO 63110, USA
| | - Diomel de la Cruz
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, UF Health Shands Children’s Hospital, 1600 SW Archer Rd, Gainesville, FL 32610, USA
| | - James L. Wynn
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, UF Health Shands Children’s Hospital, 1600 SW Archer Rd, Gainesville, FL 32610, USA
| | - Lauren C. Frazer
- Division of Newborn Medicine, Department of Pediatrics, Harvard Medical School, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - William Yakah
- Division of Newborn Medicine, Department of Pediatrics, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
| | - Camilia R. Martin
- Division of Newborn Medicine, Department of Pediatrics, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
- Division of Newborn Medicine, Department of Pediatrics, Harvard Medical School, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Heeju Yang
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Elena Itriago
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Jana Unger
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Amy B. Hair
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Jessica Miele
- University of Virginia School of Medicine, UVA Children’s Hospital, 200 Jeanette Lancaster Way, Charlottesville, VA 22903, USA
| | - Brynne A. Sullivan
- Division of Neonatology, Department of Pediatrics, University of Virginia School of Medicine, UVA Children’s Hospital, 200 Jeanette Lancaster Way, Charlottesville, VA 22903, USA
| | - Ameena Husain
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis Children’s Hospital, 660 South Euclid, St. Louis, MO 63110, USA
| | - Misty Good
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis Children’s Hospital, 660 South Euclid, St. Louis, MO 63110, USA
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Friedrich P, Itriago E, Rodriguez-Galindo C, Ribeiro K. Racial and Ethnic Disparities in the Incidence of Pediatric Extracranial Embryonal Tumors. J Natl Cancer Inst 2017; 109:4209520. [PMID: 29117360 DOI: 10.1093/jnci/djx050] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 02/27/2017] [Indexed: 02/07/2023] Open
Abstract
Background Few studies have comparatively assessed differences in the incidence of childhood cancer by race and ethnicity that could inform etiologic research. We aimed to identify disparities in the incidence of pediatric extracranial embryonal tumors by race and ethnicity in the United States using a population-based cancer registry. Methods Cases of extracranial embryonal tumors among children age 0 to 19 years diagnosed between 2000 and 2010 were retrieved from the Surveillance, Epidemiology, and End Results Program 18 (n = 8188). Age-standardized incidence rates and incidence rate ratios (IRRs) were obtained by race/ethnicity. Whites were the reference group. The percentage of families living below the poverty line by county was used to stratify by socioeconomic status (SES). Results All minority groups had a lower incidence of neuroblastoma (Hispanics: IRR = 0.53, 95% confidence interval [CI] = 0.47 to 0.59; blacks: IRR = 0.70, 95% CI = 0.61 to 0.81; Native-Hawaiian/Asian-Pacific-Islander (API): IRR = 0.56, 95% CI = 0.46 to 0.67; and American Indian/Alaska Native (AI/AN): IRR = 0.28, 95% CI = 0.15 to 0.48) while Hispanics had a higher incidence of retinoblastoma (IRR = 1.26, 95% CI = 1.07 to 1.48). Incidence of nephroblastoma was lower among Hispanics (IRR = 0.80, 95% CI = 0.71 to 0.91) and API (IRR = 0.43, 95% CI = 0.33 to 0.56) while equivalent for blacks. Similarly, incidence of rhabdomyosarcoma was low among Hispanics (IRR = 0.85, 95% CI = 0.74 to 0.98) and API (IRR = 0.61, 95% CI = 0.47 to 0.79) while equivalent for blacks. However, incidence of hepatoblastoma was low among blacks (IRR = 0.44, 95% CI = 0.28 to 0.68) while equivalent for Hispanics and API. Incidence of germ cell tumors was higher among Hispanics (IRR = 1.30, 95% CI = 1.19 to 1.42) and lower among blacks (IRR = 0.52, 95% CI = 0.44 to 0.61) and API (IRR = 0.79, 95% CI = 0.67 to 0.93). No effect modification by SES was observed. Conclusions Unique incidence patterns of childhood extracranial embryonal tumors exist by race and ethnicity in the United States. The interplay between race/ethnicity and genetics, epigenetics, and gene-environment interactions in the causation of these cancers deserves further investigation.
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Affiliation(s)
- Paola Friedrich
- Affiliations of authors: Department of Pediatric Oncology, Dana-Farber, Boston Children's Cancer and Blood Disorders Center, Boston, MA (PF, EI, CRG); Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil (KR) and Current affiliations: Department of Oncology and Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN (PF, CRG); Department of Pediatrics, Children's Medical Center Dallas, University of Texas Southwestern Medical Center, Dallas, TX (EI)
| | - Elena Itriago
- Affiliations of authors: Department of Pediatric Oncology, Dana-Farber, Boston Children's Cancer and Blood Disorders Center, Boston, MA (PF, EI, CRG); Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil (KR) and Current affiliations: Department of Oncology and Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN (PF, CRG); Department of Pediatrics, Children's Medical Center Dallas, University of Texas Southwestern Medical Center, Dallas, TX (EI)
| | - Carlos Rodriguez-Galindo
- Affiliations of authors: Department of Pediatric Oncology, Dana-Farber, Boston Children's Cancer and Blood Disorders Center, Boston, MA (PF, EI, CRG); Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil (KR) and Current affiliations: Department of Oncology and Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN (PF, CRG); Department of Pediatrics, Children's Medical Center Dallas, University of Texas Southwestern Medical Center, Dallas, TX (EI)
| | - Karina Ribeiro
- Affiliations of authors: Department of Pediatric Oncology, Dana-Farber, Boston Children's Cancer and Blood Disorders Center, Boston, MA (PF, EI, CRG); Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil (KR) and Current affiliations: Department of Oncology and Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN (PF, CRG); Department of Pediatrics, Children's Medical Center Dallas, University of Texas Southwestern Medical Center, Dallas, TX (EI)
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Choi JL, Kao PF, Itriago E, Zhan Y, Kozubek JA, Hoss AG, Banigan MG, Vanderburg CR, Rezvani AH, Latourelle JC, Cabral H, Delalle I. miR-149 and miR-29c as candidates for bipolar disorder biomarkers. Am J Med Genet B Neuropsychiatr Genet 2017; 174:315-323. [PMID: 28190298 DOI: 10.1002/ajmg.b.32518] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 11/30/2016] [Indexed: 11/11/2022]
Abstract
Bipolar disorder (BD) is a common, recurring psychiatric illness with unknown pathogenesis. Recent studies suggest that microRNA (miRNA) levels in brains of BD patients are significantly altered, and these changes may offer insight into BD pathology or etiology. Previously, we observed significant alterations of miR-29c levels in extracellular vesicles (EVs) extracted from prefrontal cortex (Brodmann area 9, BA9) of BD patients. In this study, we show that EVs extracted from the anterior cingulate cortex (BA24), a crucial area for modulating emotional expression and affect, have increased levels of miR-149 in BD patients compared to controls. Because miR-149 has been shown to inhibit glial proliferation, increased miR-149 expression in BA24-derived EVs is consistent with the previously reported reduced glial cell numbers in BA24 of patients diagnosed with either familial BD or familial major depressive disorder. qPCR analysis of laser-microdissected neuronal and glial cells from BA24 cortical samples of BD patients verified that the glial, but not neuronal, population exhibits significantly increased miR-149 expression. Finally, we report altered expression of both miR-149 and miR-29c in EVs extracted from brains of Flinders Sensitive Line rats, a well-validated animal model exhibiting depressive-like behaviors and glial (astrocytic) dysfunction. These findings warrant future investigations into the potential of using EV miRNA signatures as biomarkers to further enhance the biological definition of BD. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Jason L Choi
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Patricia F Kao
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Elena Itriago
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Yougen Zhan
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - James A Kozubek
- Broad Institute, Cambridge, Boston, Massachusetts.,Brigham and Women's Hospital, Boston, Massachusetts
| | - Andrew G Hoss
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Meredith G Banigan
- Advanced Tissue Resource Center, Harvard NeuroDiscovery Center, Charlestown, Massachusetts
| | - Charles R Vanderburg
- Advanced Tissue Resource Center, Harvard NeuroDiscovery Center, Charlestown, Massachusetts
| | - Amir H Rezvani
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Jeanne C Latourelle
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health and Boston University Clinical and Translational Science Institute, Boston, Massachusetts
| | - Ivana Delalle
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
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Abstract
BACKGROUND Treatment abandonment (TxA) is recognized as a leading cause of treatment failure for children with cancer in low-and-middle-income countries (LMC). However, its global frequency and burden have remained elusive due to lack of global data. This study aimed to obtain an estimate using survey and population data. METHODS Childhood cancer clinicians (medical oncologists, surgeons, and radiation therapists), nurses, social workers, and psychologists involved in care of children with cancer were approached through an online survey February-May 2012. Incidence and population data were obtained from public sources. Descriptive, univariable, and multivariable analyses were conducted. RESULTS 602 responses from 101 countries were obtained from physicians (84%), practicing pediatric hematology/oncology (83%) in general or children's hospitals (79%). Results suggested, 23,854 (15%) of 155,088 children <15 years old newly diagnosed with cancer annually in the countries analyzed, abandon therapy. Importantly, 83% of new childhood cancer cases and 99% of TxA were attributable to LMC. The annual number of cases of TxA expected in LMC worldwide (26,166) was nearly equivalent to the annual number of cancer cases in children <15 years expected in HIC (26,368). Approximately two thirds of LMC had median TxA ≥ 6%, but TxA ≥ 6% was reported in high- (9%), upper-middle- (41%), lower-middle- (80%), and low-income countries (90%, p<0.001). Most LMC centers reporting TxA > 6% were outside the capital. Lower national income category, higher reliance on out-of-pocket payments, and high prevalence of economic hardship at the center were independent contextual predictors for TxA ≥ 6% (p<0.001). Global survival data available for more developed and less developed regions suggests TxA may account for at least a third of the survival gap between HIC and LMC. CONCLUSION Results show TxA is prevalent (compromising cancer survival for 1 in 7 children globally), confirm the suspected high burden of TxA in LMC, and illustrate the negative impact of poverty on its occurrence. The present estimates may appear small compared to the global burden of child death from malnutrition and infection (measured in millions). However, absolute numbers suggest the burden of TxA in LMC is nearly equivalent to annually losing all kids diagnosed with cancer in HIC just to TxA, without even considering deaths from disease progression, relapse or toxicity-the main causes of childhood cancer mortality in HIC. Results document the importance of monitoring and addressing TxA as part of childhood cancer outcomes in at-risk settings.
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Affiliation(s)
- Paola Friedrich
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, United States of America
| | - Catherine G. Lam
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
- International Outreach Program, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Elena Itriago
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, United States of America
| | - Rafael Perez
- Villa Victoria Center for the Arts, Boston, Massachusetts, United States of America
| | - Raul C. Ribeiro
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
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