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Makhani N, Lebrun-Frenay C, Siva A, Shabanova V, Wassmer E, Santoro JD, Narula S, Brenton JN, Mar S, Durand-Dubief F, Zephir H, Mathey G, Rojas JI, de Seze J, Tenembaum S, Stone RT, Casez O, Carra-Dallière C, Neuteboom RF, Ahsan N, Arroyo HA, Cabre P, Gombolay G, Inglese M, Louapre C, Margoni M, Palavra F, Pohl D, Reich DS, Ruet A, Thouvenot E, Timby N, Tintore M, Uygunoglu U, Vargas W, Venkateswaran S, Verhelst H, Wickstrom R, Azevedo CJ, Kantarci O, Shapiro ED, Okuda DT, Pelletier D. The diagnostic workup of children with the radiologically isolated syndrome differs by age and by sex. J Neurol 2024:10.1007/s00415-024-12289-1. [PMID: 38564056 DOI: 10.1007/s00415-024-12289-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/19/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) and spinal MRIs are often obtained in children with the radiologically isolated syndrome (RIS) for diagnosis and prognosis. Factors affecting the frequency and timing of these tests are unknown. OBJECTIVE To determine whether age or sex were associated with (1) having CSF or spinal MRI obtained or (2) the timing of these tests. METHODS We analyzed children (≤ 18 y) with RIS enrolled in an international longitudinal study. Index scans met 2010/2017 multiple sclerosis (MS) MRI criteria for dissemination in space (DIS). We used Fisher's exact test and multivariable logistic regression (covariates = age, sex, MRI date, MRI indication, 2005 MRI DIS criteria met, and race). RESULTS We included 103 children with RIS (67% girls, median age = 14.9 y). Children ≥ 12 y were more likely than children < 12 y to have CSF obtained (58% vs. 21%, adjusted odds ratio [AOR] = 4.9, p = 0.03). Pre-2017, girls were more likely than boys to have CSF obtained (n = 70, 79% vs. 52%, AOR = 4.6, p = 0.01), but not more recently (n = 30, 75% vs. 80%, AOR = 0.2, p = 0.1; p = 0.004 for interaction). Spinal MRIs were obtained sooner in children ≥ 12 y (median 11d vs. 159d, p = 0.03). CONCLUSIONS Younger children with RIS may be at continued risk for misdiagnosis and misclassification of MS risk. Consensus guidelines are needed.
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Affiliation(s)
- Naila Makhani
- Department of Pediatrics, Yale University, LMP 3088, 333 Cedar Street, New Haven, CT, 06520, USA.
- Department of Neurology, Yale University, New Haven, CT, USA.
| | - Christine Lebrun-Frenay
- CRCSEP Neurologie Pasteur 2, CHU de Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice, France
| | - Aksel Siva
- Neuroimmunology Unit, Neurology Department, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Veronika Shabanova
- Department of Pediatrics, Yale University, LMP 3088, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Evangeline Wassmer
- Neurology Department, Birmingham Children's Hospital, Aston University, Birmingham, UK
| | - Jonathan D Santoro
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, USA
- Division of Neurology, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, USA
| | - Sona Narula
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, USA
| | | | - Soe Mar
- Department of Neurology, Washington University School of Medicine, St. Louis, USA
| | - Francoise Durand-Dubief
- Service de sclérose en plaques, Pathologies de la myéline et Neuro-Inflammation, Hôpital Neurologique, Groupement Hospitalier Est, 59 Bd Pinel, 69677, BRON Cedex, France
| | - Helene Zephir
- Inserm UMR-S 1172 LilNcog, Lille University Hospital FHU Precise, Lille University, Lille, France
| | - Guillaume Mathey
- Department of Neurology, Nancy University Hospital, 54035, Nancy, France
| | - Juan I Rojas
- Hospital Universitario de CEMIC, Buenos Aires, Argentina
| | - Jerome de Seze
- Department of Neurology, Hospital Hautepierre, CHU de Strasbourg and Clinical Investigation Center (CIC) INSERM 1434, Strasbourg, France
| | - Silvia Tenembaum
- Department of Neurology, National Pediatric Hospital Dr. Juan P Garrahan, Buenos Aires, Argentina
| | | | - Olivier Casez
- Neurology MS Clinic Grenoble, Grenoble Alpes University Hospital, Grenoble, France
- T-RAIG, TIMC-IMAG, Grenoble Alpes University, Grenoble, France
| | - Clarisse Carra-Dallière
- Neurology MS Clinic, Montpellier University Hospital, 34295, Montpellier, France
- University of Montpellier (MUSE), 34295, Montpellier, France
| | - Rinze F Neuteboom
- Department of Neurology, Erasmus MC Rotterdam, Sophia's Children's Hospital, Rotterdam, The Netherlands
| | - Nusrat Ahsan
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, USA
- Division of Neurology, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, USA
| | - Hugo A Arroyo
- Department of Neurology, Hospital de Pediatría SAMIC. Prof. Dr. J.P. Garrahan, Buenos Aires, Argentina
| | - Philippe Cabre
- Centre Hospitalo Universitaire, Fort-de-France, Martinique
| | - Grace Gombolay
- Division of Neurology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Department of Neuroscience (DINOGMI), University of Genova, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Celine Louapre
- Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Hôpital de la Pitié Salpêtrière, CIC Neurosciences, Sorbonne Université, Paris Brain Institute - ICM, Paris, France
| | - Monica Margoni
- Department of Neurosciences, Multiple Sclerosis Center of the Veneto Region, University Hospital-School of Medicine, Padua, Italy
| | - Filipe Palavra
- Center for Child Development - Neuropaediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Daniela Pohl
- Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, USA
| | - Aurélie Ruet
- Department of Neurology, CHU Bordeaux, Bordeaux, France
- INSERM, Neurocentre Magendie, University of Bordeaux, U1215, Bordeaux, France
| | - Eric Thouvenot
- Department of Neurology, Nîmes University Hospital, Nîmes, France
- IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Niklas Timby
- Department of Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden
| | - Mar Tintore
- Neurology Department, MS Center of Catalunya Cemcat, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), UVIC-Universitat Central de Catalunya, Barcelona, Spain
| | - Ugur Uygunoglu
- Neuroimmunology Unit, Neurology Department, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Wendy Vargas
- Department of Neurology, Columbia University Medical Center, New York, USA
| | | | - Helene Verhelst
- Division of Pediatric Neurology, Department of Pediatrics, University Hospital Ghent, Ghent, Belgium
| | - Ronny Wickstrom
- Neuropaediatric Unit, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Christina J Azevedo
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Orhun Kantarci
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Eugene D Shapiro
- Department of Pediatrics, Yale University, LMP 3088, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Darin T Okuda
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, USA
| | - Daniel Pelletier
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, USA
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Timby N, Adamsson M, Domellöf E, Grip T, Hernell O, Lönnerdal B, Domellöf M. Neurodevelopment and growth until 6.5 years of infants who consumed a low-energy, low-protein formula supplemented with bovine milk fat globule membranes: a randomized controlled trial. Am J Clin Nutr 2021; 113:586-592. [PMID: 33564853 DOI: 10.1093/ajcn/nqaa354] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/02/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We previously reported results from a randomized controlled trial in which we found that Swedish infants consuming an experimental low-energy, low-protein formula (EF) supplemented with bovine milk fat globule membranes (MFGMs) until 6 mo of age had several positive outcomes, including better performance in the cognitive domain of Bayley Scales of Infant and Toddler Development 3rd Edition at 12 mo of age, and higher plasma cholesterol concentrations during the intervention, than infants consuming standard formula (SF). OBJECTIVES We aimed to evaluate neurodevelopment, growth, and plasma cholesterol status at 6 and 6.5 y of age in the same study population. METHODS We assessed cognitive and executive functions using the Wechsler Intelligence Scale for Children 4th Edition (WISC-IV), Brown Attention-Deficit Disorder Scales for Children and Adolescents (Brown-ADD), and Quantified Behavior (Qb) tests, and behavior using the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF), at 6.5 y of age. Anthropometrics and plasma lipids were assessed at 6 y of age. RESULTS There were no differences between the EF and SF groups in any of the subscales in WISC-IV or Brown-ADD at 6.5 y of age, in the proportion of children with scores outside the normal range in the Qb test, nor in clinical or borderline indications of problems in adaptive functioning from parental and teacher's scoring using the CBCL and TRF. There were no differences between the EF and SF groups in weight, length, or head or abdominal circumferences, nor in plasma concentrations of homocysteine, lipids, insulin, or glucose. CONCLUSIONS Among children who as infants consumed a low-energy, low-protein formula supplemented with bovine MFGMs, there were no effects on neurodevelopment, growth, or plasma cholesterol status 6-6.5 y later.
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Affiliation(s)
- Niklas Timby
- Pediatrics, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Marie Adamsson
- Pediatrics, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Erik Domellöf
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Tove Grip
- Pediatrics, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Olle Hernell
- Pediatrics, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Bo Lönnerdal
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Magnus Domellöf
- Pediatrics, Department of Clinical Sciences, Umeå University, Umeå, Sweden
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Timby N, Domellöf M, Hernell O, Lönnerdal B, Nihlen C, Johanssson I, Weitzberg E. Effects of age, sex and diet on salivary nitrate and nitrite in infants. Nitric Oxide 2020; 94:73-78. [DOI: 10.1016/j.niox.2019.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/07/2019] [Accepted: 10/30/2019] [Indexed: 01/09/2023]
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He X, Parenti M, Grip T, Domellöf M, Lönnerdal B, Hernell O, Timby N, Slupsky CM. Publisher Correction: Metabolic phenotype of breast-fed infants, and infants fed standard formula or bovine MFGM supplemented formula: a randomized controlled trial. Sci Rep 2019; 9:12382. [PMID: 31434987 PMCID: PMC6704142 DOI: 10.1038/s41598-019-48858-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
- Xuan He
- Department of Nutrition, University of California Davis, One Shields Ave, Davis, CA, 95616, USA.,Department of Food Science and Technology, University of California Davis, One Shields Ave, Davis, CA, 95616, USA
| | - Mariana Parenti
- Department of Nutrition, University of California Davis, One Shields Ave, Davis, CA, 95616, USA
| | - Tove Grip
- Department of Clinical Sciences, Pediatrics, SE 901 85 Umeå University, Umeå, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, SE 901 85 Umeå University, Umeå, Sweden
| | - Bo Lönnerdal
- Department of Nutrition, University of California Davis, One Shields Ave, Davis, CA, 95616, USA
| | - Olle Hernell
- Department of Clinical Sciences, Pediatrics, SE 901 85 Umeå University, Umeå, Sweden
| | - Niklas Timby
- Department of Clinical Sciences, Pediatrics, SE 901 85 Umeå University, Umeå, Sweden
| | - Carolyn M Slupsky
- Department of Nutrition, University of California Davis, One Shields Ave, Davis, CA, 95616, USA. .,Department of Food Science and Technology, University of California Davis, One Shields Ave, Davis, CA, 95616, USA.
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He X, Parenti M, Grip T, Lönnerdal B, Timby N, Domellöf M, Hernell O, Slupsky CM. Fecal microbiome and metabolome of infants fed bovine MFGM supplemented formula or standard formula with breast-fed infants as reference: a randomized controlled trial. Sci Rep 2019; 9:11589. [PMID: 31406230 PMCID: PMC6690946 DOI: 10.1038/s41598-019-47953-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/12/2019] [Indexed: 02/06/2023] Open
Abstract
Human milk delivers an array of bioactive components that safeguard infant growth and development and maintain healthy gut microbiota. Milk fat globule membrane (MFGM) is a biologically functional fraction of milk increasingly linked to beneficial outcomes in infants through protection from pathogens, modulation of the immune system and improved neurodevelopment. In the present study, we characterized the fecal microbiome and metabolome of infants fed a bovine MFGM supplemented experimental formula (EF) and compared to infants fed standard formula (SF) and a breast-fed reference group. The impact of MFGM on the fecal microbiome was moderate; however, the fecal metabolome of EF-fed infants showed a significant reduction of several metabolites including lactate, succinate, amino acids and their derivatives from that of infants fed SF. Introduction of weaning food with either human milk or infant formula reduces the distinct characteristics of breast-fed- or formula-fed- like infant fecal microbiome and metabolome profiles. Our findings support the hypothesis that higher levels of protein in infant formula and the lack of human milk oligosaccharides promote a shift toward amino acid fermentation in the gut. MFGM may play a role in shaping gut microbial activity and function.
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Affiliation(s)
- Xuan He
- Department of Nutrition, University of California Davis, One Shields Ave, Davis, CA, 95616, USA
- Department of Food Science and Technology, University of California Davis, One Shields Ave, Davis, CA, 95616, USA
| | - Mariana Parenti
- Department of Nutrition, University of California Davis, One Shields Ave, Davis, CA, 95616, USA
| | - Tove Grip
- Department of Clinical Sciences, Pediatrics, Umeå University, SE901 85, Umeå, Sweden
| | - Bo Lönnerdal
- Department of Nutrition, University of California Davis, One Shields Ave, Davis, CA, 95616, USA
| | - Niklas Timby
- Department of Clinical Sciences, Pediatrics, Umeå University, SE901 85, Umeå, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, SE901 85, Umeå, Sweden
| | - Olle Hernell
- Department of Clinical Sciences, Pediatrics, Umeå University, SE901 85, Umeå, Sweden
| | - Carolyn M Slupsky
- Department of Nutrition, University of California Davis, One Shields Ave, Davis, CA, 95616, USA.
- Department of Food Science and Technology, University of California Davis, One Shields Ave, Davis, CA, 95616, USA.
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Hernell O, Domellöf M, Grip T, Lönnerdal B, Timby N. Physiological Effects of Feeding Infants and Young Children Formula Supplemented with Milk Fat Globule Membranes. Nestle Nutr Inst Workshop Ser 2019; 90:35-42. [PMID: 30865975 DOI: 10.1159/000490291] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Dietary supplementation with bovine milk fat globule membrane (MFGM) concentrates has recently emerged as a possible means to improve the health of infants and young children. Formula-fed infants are of special interest since infant formulas traditionally have lower concentrations of biologically active MFGM components than human milk. We identified 6 double-blind randomized controlled trials (DBRCT) exploring the effects of supplementing the diet of infants and children with bovine MFGM concentrates. Two studies found a positive effect on cognitive development in formula-fed infants. Three studies found a protective effect against infections at different ages during infancy and early childhood. We conclude that supplementation with MFGM during infancy and childhood appears safe, and the studies indicate positive effects on both neurodevelopment and defense against infections, especially in formula-fed infants. However, due to the small number of studies and the heterogeneity of interventions and outcomes, more high-quality DBRCTs are needed before firm conclusions can be drawn on the likely health benefits of MFGM supplementation to infants and children.
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Grip T, Dyrlund TS, Ahonen L, Domellöf M, Hernell O, Hyötyläinen T, Knip M, Lönnerdal B, Orešič M, Timby N. Serum, plasma and erythrocyte membrane lipidomes in infants fed formula supplemented with bovine milk fat globule membranes. Pediatr Res 2018; 84:726-732. [PMID: 30120403 DOI: 10.1038/s41390-018-0130-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/05/2018] [Accepted: 07/11/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Supplementation of formula with bovine milk fat globule membranes has been shown to narrow the gap in immunological and cognitive development between breast-fed and formula-fed infants. METHOD In a double-blinded randomized controlled trial 160 formula-fed infants received an experimental formula (EF), supplemented with bovine milk fat globule membranes, or standard formula until 6 months of age. A breast-fed reference group was recruited. Lipidomic analyses were performed on plasma and erythrocyte membranes at 6 months and on serum at 4 and 12 months of age. RESULTS At 6 months of age, we observed a significant separation in the plasma lipidome between the two formula groups, mostly due to differences in concentrations of sphingomyelins (SM), phosphatidylcholines (PC), and ceramides, and in the erythrocyte membrane lipidome, mostly due to SMs, PEs and PCs. Already at 4 months, a separation in the serum lipidome was evident where SMs and PCs contributed. The separation was not detected at 12 months. CONCLUSIONS The effect of MFGM supplementation on the lipidome is likely part of the mechanisms behind the positive cognitive and immunological effects of feeding the EF previously reported in the same study population.
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Affiliation(s)
- Tove Grip
- Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden
| | | | - Linda Ahonen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Olle Hernell
- Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden
| | | | - Mikael Knip
- Children´s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Folkhälsan Research Institute, Helsinki, Finland
| | - Bo Lönnerdal
- Department of Nutrition, University of California, Davis, United States
| | - Matej Orešič
- Turku Centre for Biotechnology, University of Turku and Åbo Academy University, Turku, Finland.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Niklas Timby
- Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden.
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Bjellvi J, Timby N, Flink R. [Status epilepticus in children and adults]. Lakartidningen 2018; 115:E4XY. [PMID: 29786808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Status epilepticus, a condition with prolonged or repeated seizures, is a common neurological emergency with significant morbidity and mortality. This text outlines the treatment and initial work-up for convulsive and non-convulsive status epilepticus in adults and children. The most serious form is convulsive (tonic-clonic) status epilepticus, which requires rapid treatment and work-up. Bensodiazepines are the preferred initial treatment, while antiepileptic drugs and anesthetics are added if seizures continue. For other forms of status epilepticus, the treatment depends on the type of seizures and the patient's general condition. Etiological work-up is essential in any case of status epilepticus. Effective treatment and work-up in status epilepticus requires a defined treatment protocol and multidisciplinary cooperation.
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Affiliation(s)
- Johan Bjellvi
- Sahlgrenska universitetssjukhuset - Goteborg, Sweden - Neurosjukvården, Sahlgrenska Universitetssjukhuset Göteborg, Sweden
| | - Niklas Timby
- Norrlands universitetssjukhus - Umea, Sweden Norrlands universitetssjukhus - Umea, Sweden
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Abstract
Studies have shown that supplementation of infant formula with bovine milk fat globule membranes (MFGMs) may substantially narrow the gap in health outcomes between formula-fed and breastfed infants. In one study, consumption of a formula supplemented with a lipid-rich MFGM concentrate between 2 and 6 mo of age improved cognitive performance at 24 wk of age. In another study, a formula supplemented with a protein-rich MFGM concentrate given between 2 and 6 mo of age improved cognitive performance at 12 mo of age, decreased infectious morbidity until 6 mo of age, and yielded serum cholesterol concentrations closer to those of breastfed infants. A third study that assessed the safety of supplementing infant formula with a lipid-rich or a protein-rich MFGM concentrate found a noninferior weight gain for both groups compared with a nonsupplemented formula. In this study, there was an increased risk of eczema in the protein-rich group, but no serious adverse events. Infant formulas with supplemental MFGMs have been launched on the market in several countries. However, the evidence base must still be considered quite limited. Based on 3 randomized controlled trials that are not comparable, the intervention seems safe, but there is not enough evidence for a general recommendation on which MFGM fraction to use and at what concentration as formula supplement for a given outcome.
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Affiliation(s)
- Niklas Timby
- Department of Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden; and
| | - Magnus Domellöf
- Department of Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden; and
| | - Bo Lönnerdal
- Department of Nutrition, University of California, Davis, Davis, CA
| | - Olle Hernell
- Department of Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden; and
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Timby N, Domellöf M, Holgerson PL, West CE, Lönnerdal B, Hernell O, Johansson I. Oral Microbiota in Infants Fed a Formula Supplemented with Bovine Milk Fat Globule Membranes - A Randomized Controlled Trial. PLoS One 2017; 12:e0169831. [PMID: 28099499 PMCID: PMC5242539 DOI: 10.1371/journal.pone.0169831] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/21/2016] [Indexed: 01/10/2023] Open
Abstract
Background In a recent study, supplementation of infant formula with milk fat globule membranes (MFGM) decreased the incidence of otitis media in infants <6 months of age. Objectives The aim of the present study was to characterize the oral microbiota in infants fed MFGM-supplemented formula and compare it to that of infants fed standard formula or breast milk. Methods In a prospective double-blinded randomized controlled trial, exclusively formula-fed infants <2 months of age were randomized to be fed experimental formula (EF, n = 80) with reduced energy and protein and supplemented with a bovine MFGM concentrate, or standard formula (SF, n = 80) until 6 months of age. A breast-fed reference (BFR, n = 80) group was also recruited. The oral microbiota was analyzed at 4 (n = 124) and 12 (n = 166) months of age using Illumina MiSeq multiplex sequencing and taxonomic resolution against the HOMD 16S rDNA database of oral bacteria. Results Species richness in the oral samples did not differ between the EF and SF groups, but partial least square modeling identified a few taxa that were significantly associated with being in either group, e.g. lower level of Moraxella catarrhalis in the EF group. Infants in the BFR group had significantly lower species richness at 4 months of age and their microbiota pattern differed markedly from the formula-fed groups. Conclusions Supplementation of infant formula with MFGM yielded moderate effects on the oral microbiome. Moraxella catarrhalis was less prevalent in infants fed EF than in those fed SF and may be associated with the decrease in otitis media seen in the same group.
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Affiliation(s)
- Niklas Timby
- Department of Clinical Sciences/Unit of Pediatrics, Umeå University, Umeå, Sweden
- * E-mail:
| | - Magnus Domellöf
- Department of Clinical Sciences/Unit of Pediatrics, Umeå University, Umeå, Sweden
| | | | - Christina E. West
- Department of Clinical Sciences/Unit of Pediatrics, Umeå University, Umeå, Sweden
| | - Bo Lönnerdal
- Department of Nutrition, University of California, Davis, United States of America
| | - Olle Hernell
- Department of Clinical Sciences/Unit of Pediatrics, Umeå University, Umeå, Sweden
| | - Ingegerd Johansson
- Department of Odontology/Unit of Cariology, Umeå University, Umeå, Sweden
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Abstract
The milk fat globule membrane (MFGM) in breast milk contains many bioactive components. Infant formulas traditionally have been devoid of the MFGM fraction, but dairy technology now has made the addition of bovine MFGM technically feasible. We identified 6 double-blinded randomized controlled trials exploring the effects of MFGM supplementation on the diets of infants or children. Results suggest that supplementation is safe and indicate positive effects on both neurodevelopment and defense against infections. MFGM supplementation of infant formula may narrow the gap in cognitive performance and infection rates between breastfed and formula-fed infants. Because of the small number of studies and the heterogeneity of interventions, more high-quality double-blinded randomized controlled trials are needed, with well characterized and clearly defined MFGM fractions, before firm conclusions on the effects of MFGM supplementation on the health and development of infants can be drawn.
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Affiliation(s)
- Olle Hernell
- Department of Clinical Sciences, Umeå University, Umeå, Sweden.
| | - Niklas Timby
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Bo Lönnerdal
- Department of Nutrition, University of California, Davis, CA
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Timby N, Domellöf M, Lönnerdal B, Hernell O. Comment on "Safety and Tolerance Evaluation of Milk Fat Globule Membrane-Enriched Infant Formulas: A Randomized Controlled Multicenter Non-Inferiority Trial in Healthy Term Infants". Clin Med Insights Pediatr 2015; 9:63-4. [PMID: 26124694 PMCID: PMC4474336 DOI: 10.4137/cmped.s27185] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/30/2015] [Indexed: 12/03/2022]
Affiliation(s)
- Niklas Timby
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Bo Lönnerdal
- Department of Nutrition, University of California, Davis, CA, USA
| | - Olle Hernell
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
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Timby N, Hernell O, Lönnerdal B, Domellöf M. Parental feeding control in relation to feeding mode and growth pattern during early infancy. Acta Paediatr 2014; 103:1072-7. [PMID: 24948384 DOI: 10.1111/apa.12721] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 04/28/2014] [Accepted: 06/16/2014] [Indexed: 11/29/2022]
Abstract
AIM A high level of parental control of feeding and disturbed energy self-regulation has previously been suggested as a mechanism for the accelerated growth observed in formula-fed compared with breast-fed infants. This study explored factors associated with parental control of feeding in a population of formula-fed infants with high levels of self-regulation. METHODS We included 141 formula-fed and 72 breast-fed infants from a randomised controlled trial, who were prospectively followed from under 2 months of age to 12 months of age. Anthropometry was recorded at baseline, 4, 6 and 12 months of age. Parental feeding control was assessed using a Child Feeding Questionnaire at 4 and 12 months. RESULTS The formula-fed groups fully compensated for different energy and protein densities by regulating their volume intakes. Parents of formula-fed infants had a lower pressure to eat score at 12 months than parents of breast-fed infants. A high parental restrictive score at 12 months was associated with weight at 12 months and high parental pressure to eat score at 12 months with body mass index at 12 months. Neither were associated with feeding mode. CONCLUSION Formula-fed infants had a high level of energy self-regulation and were subjected to low parental control. Parental control of feeding was mainly influenced by infant growth.
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Affiliation(s)
- Niklas Timby
- Department of Clinical Sciences, Pediatrics; Umeå University; Umeå Sweden
| | - Olle Hernell
- Department of Clinical Sciences, Pediatrics; Umeå University; Umeå Sweden
| | - Bo Lönnerdal
- Department of Nutrition; University of California; Davis CA USA
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics; Umeå University; Umeå Sweden
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Lönnerdal B, Timby N, Domellöf M, Domellöf E, Hernell O. Supplementation of infant formula with milk fat globule membranes improves cognitive performance and reduces infections in formula‐fed infants (38.2). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.38.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bo Lönnerdal
- NutritionUniversity of California DavisDavisCAUnited States
| | - Niklas Timby
- Clinical Sciences/Pediatrics Umeå University UmeåSweden
| | | | | | - Olle Hernell
- Clinical SciencesPediatrics Umeå University UmeåSweden
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Timby N, Domellöf E, Hernell O, Lönnerdal B, Domellöf M. Neurodevelopment, nutrition, and growth until 12 mo of age in infants fed a low-energy, low-protein formula supplemented with bovine milk fat globule membranes: a randomized controlled trial. Am J Clin Nutr 2014; 99:860-8. [PMID: 24500150 DOI: 10.3945/ajcn.113.064295] [Citation(s) in RCA: 219] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Observational studies have indicated that differences in the composition of human milk and infant formula yield benefits in cognitive development and early growth for breastfed infants. OBJECTIVE The objective was to test the hypothesis that feeding an infant formula with reduced energy and protein densities and supplemented with bovine milk fat globule membrane (MFGM) reduces differences in cognitive development and early growth between formula-fed and breastfed infants. DESIGN In a prospective, double-blind, randomized controlled trial, 160 infants <2 mo of age were randomly assigned to be fed an MFGM-supplemented, low-energy, low-protein experimental formula (EF) or a standard formula (SF) until 6 mo of age. The energy and protein contents of the EF and SF were 60 and 66 kcal/100 mL and 1.20 and 1.27 g/100 mL, respectively. A breastfed reference (BFR) group consisted of 80 infants. RESULTS At 12 mo of age, the cognitive score (mean ± SD) on testing with the Bayley Scales of Infant and Toddler Development, Third Edition, was significantly higher in the EF group than in the SF group (105.8 ± 9.2 compared with 101.8 ± 8.0; P = 0.008) but was not significantly different from that in the BFR group (106.4 ± 9.5; P = 0.73). The EF group ingested larger volumes of formula than did the SF group (864 ± 174 compared with 797 ± 165 mL/d; P = 0.022), fully compensating for the lower energy density. No significant differences in linear growth, weight gain, body mass index, percentage body fat, or head circumference were found between the EF and SF groups. CONCLUSIONS MFGM supplementation to infant formula narrows the gap in cognitive development between breastfed and formula-fed infants. Between 2 and 6 mo of age, formula-fed term infants have the capacity to upregulate their ingested volumes when the energy density of formula is reduced from 66 to 60 kcal/100 mL.
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Affiliation(s)
- Niklas Timby
- Department of Clinical Sciences, Pediatrics (NT, OH, and MD) and the Department of Psychology (ED), Umeå University, Umeå, Sweden, and the Department of Nutrition, University of California, Davis, Davis, CA (BL)
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Vestman NR, Timby N, Holgerson PL, Kressirer CA, Claesson R, Domellöf M, Öhman C, Tanner ACR, Hernell O, Johansson I. Characterization and in vitro properties of oral lactobacilli in breastfed infants. BMC Microbiol 2013; 13:193. [PMID: 23945215 PMCID: PMC3751747 DOI: 10.1186/1471-2180-13-193] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 08/08/2013] [Indexed: 12/20/2022] Open
Abstract
Background Lactobacillus species can contribute positively to general and oral health and are frequently acquired by breastfeeding in infancy. The present study aimed to identify oral lactobacilli in breast and formula-fed 4 month-old infants and to evaluate potential probiotic properties of the dominant Lactobacillus species detected. Saliva and oral swab samples were collected from 133 infants who were enrolled in a longitudinal study (n=240) examining the effect of a new infant formula on child growth and development. Saliva was cultured and Lactobacillus isolates were identified from 16S rRNA gene sequences. Five L. gasseri isolates that differed in 16S rRNA sequence were tested for their ability to inhibit growth of selected oral bacteria and for adhesion to oral tissues. Oral swab samples were analyzed by qPCR for Lactobacillus gasseri. Results 43 (32.3%) infants were breastfed and 90 (67.7%) were formula-fed with either a standard formula (43 out of 90) or formula supplemented with a milk fat globule membrane (MFGM) fraction (47 out of 90). Lactobacilli were cultured from saliva of 34.1% breastfed infants, but only in 4.7% of the standard and 9.3% of the MFGM supplemented formula-fed infants. L. gasseri was the most prevalent (88% of Lactobacillus positive infants) of six Lactobacillus species detected. L. gasseri isolates inhibited Streptococcus mutans binding to saliva-coated hydroxyapatite, and inhibited growth of S. mutans, Streptococcus sobrinus, Actinomyces naeslundii, Actinomyces oris, Candida albicans and Fusobacterium nucleatum in a concentration dependent fashion. L. gasseri isolates bound to parotid and submandibular saliva, salivary gp340 and MUC7, and purified MFGM, and adhered to epithelial cells. L. gasseri was detected by qPCR in 29.7% of the oral swabs. Breastfed infants had significantly higher mean DNA levels of L. gasseri (2.14 pg/uL) than infants fed the standard (0.363 pg/uL) or MFGM (0.697 pg/uL) formula. Conclusions Lactobacilli colonized the oral cavity of breastfed infants significantly more frequently than formula-fed infants. The dominant Lactobacillus was L. gasseri, which was detected at higher levels in breastfed than formula-fed infants and displayed probiotic traits in vitro.
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Timby N, Stattin EL, Kristiansen I, Eriksson U, Erikson A. Early onset autosomal dominant spinocerebellar ataxia with miosis: four cases. Eur J Paediatr Neurol 2008; 12:38-40. [PMID: 17584505 DOI: 10.1016/j.ejpn.2007.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Revised: 02/15/2007] [Accepted: 03/06/2007] [Indexed: 10/23/2022]
Abstract
Previously, at least 29 different forms of autosomal dominant spinocerebellar ataxias (SCAs) have been described. We describe a family with four members through three generations with autosomal dominant ataxia in combination with miosis and hyperreflexia. This family's ataxia does not match any of the previously described SCAs and is probably a novel form of SCA. To continue with the search for the genetic background of this disease, more cases are needed.
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Affiliation(s)
- Niklas Timby
- Department of Pediatrics, Umeå University Hospital, Sweden.
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Timby N, Sjogren H, Bjornstig U, Eriksson A. Crash Responsibility Versus Drug and Alcohol Use Among Fatally Injured and Hospitalized Motor Vehicle Drivers in Sweden. Alcohol Clin Exp Res 1998. [DOI: 10.1111/j.1530-0277.1998.tb03990.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Timby N, Sjögren H, Björnstig U, Eriksson A. Crash responsibility versus drug and alcohol use among fatally injured and hospitalized motor vehicle drivers in Sweden. Alcohol Clin Exp Res 1998; 22:1838-41. [PMID: 9835305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The present study was aimed at determining whether drivers testing positive for drugs and/or alcohol were more often responsible for the crash than the test-negative ones. Data on 241 fatally injured and 102 hospitalized motor-vehicle drivers was collected in Northern and Western Sweden. Blood samples were taken from these drivers and screened for the presence of alcohol, licit drugs, and illicit drugs. A judgment of responsibility, and assessment of the traffic situation and crash characteristics were based on police reports. Alcohol-positive drivers (n = 49) were more often (96% vs. 70%, p < 0.0001) judged to be responsible for the crash than test-negative drivers. Ninety-three percent of the drug-positive drivers were judged to be responsible, but they were not significantly more often responsible than the test-negative drivers. Drug-positive drivers differed from the alcohol-positive drivers in that they more often crossed over to the wrong side of the road and crashed into an oncoming vehicle. The findings support previous studies that reducing the number of drug-positive drivers in traffic is bound to lead to a reduction in crashes resulting in injury. Further analysis with a larger sample is needed to elucidate the association between crash responsibility and drugs other than alcohol.
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Affiliation(s)
- N Timby
- Department of Forensic Medicine, Umeå University, Sweden
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