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Abrams SA, Albin JL, Landrigan PJ. Use of Genetically Modified Organism (GMO)-Containing Food Products in Children. Pediatrics 2024; 153:e2023064774. [PMID: 38073334 DOI: 10.1542/peds.2023-064774] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 01/02/2024] Open
Abstract
Families increasingly raise questions about the use of genetically modified organism (GMO)-containing food products. These products are widely found in the US food supply but originate from a narrow list of crops. Although GMO technology could be used to increase the micronutrient content of foods, this does not occur in the United States; instead, GMO technology has been used to make crops resistant to chemical herbicides. As a result, herbicide use has increased exponentially. The World Health Organization's International Agency on Research for Cancer has determined that glyphosate, an herbicide widely used in producing GMO food crops, is a probable human carcinogen. Measurable quantities of glyphosate are detected in some GMO foods. Families who wish to minimize GMO food products can do so by focusing on a dietary pattern of primarily whole, plant-based foods while minimizing ultra-processed foods. Pediatricians play a vital role in their efforts to minimize fear-based messaging and support families through shared decision-making. Pediatrician awareness of GMO labeling can guide individualized conversations, particularly that non-GMO labeling does not indicate organic status and that increased cost of some non-GMO foods, especially if also organic, may limit this choice for many families.
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Affiliation(s)
- Steven A Abrams
- Department of Pediatrics, The University of Texas at Austin Dell Medical School, Austin, Texas
| | - Jaclyn Lewis Albin
- Departments of Internal Medicine and Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Philip J Landrigan
- Department of Biology and Program for Global Public Health and the Common Good, Boston College, Chestnut Hill, Massachusetts
- Centre Scientifique de Monaco, Monaco
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Fuchs GJ, Abrams SA, Amevor AA. Older Infant-Young Child "Formulas". Pediatrics 2023; 152:e2023064050. [PMID: 37860831 DOI: 10.1542/peds.2023-064050] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 10/21/2023] Open
Abstract
The category of "formulas" directed at older infants and toddlers 6 to 36 months of age has increased in prominence over the last years but is characterized by lack of standardization in nomenclature and composition as well as questionable marketing practices. There has been uncertainty and misperception regarding some of the roles of these beverages in ensuring adequate childhood nutrition. The aim of this clinical report is to review the context, evidence, and rationale for older infant-young child formulas, followed by recommendations.
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Affiliation(s)
- George J Fuchs
- Department of Pediatrics, University of Kentucky College of Medicine and Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - A Adjowa Amevor
- Beverly Knight Olsen Children's Hospital, Atrium Health, Macon, Georgia
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3
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Abrams SA. A new editor for a unique globally focused journal. Adv Nutr 2023; 14:947. [PMID: 37536564 PMCID: PMC10509392 DOI: 10.1016/j.advnut.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
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Sidiqi A, Fariha F, Shanta SS, Dasiewicz A, Mahmud AA, Moore DR, Shankaran M, Hellerstein MK, Evans WJ, Gernand AD, Islam MM, Abrams SA, Harrington J, Nyangau E, Roth DE, O'Callaghan KM. Estimation of skeletal muscle mass in 4-year-old children using the D 3-creatine dilution method. Pediatr Res 2023; 94:1195-1202. [PMID: 37037953 PMCID: PMC10444613 DOI: 10.1038/s41390-023-02587-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/07/2023] [Accepted: 03/18/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Given limited experience in applying the creatine-(methyl-D3) (D3Cr) dilution method to measure skeletal muscle mass (SMM) in young children, the feasibility of deployment in a fielding setting and performance of the method was assessed in a cohort of 4-year-old children in Dhaka, Bangladesh. METHODS Following D3Cr oral dose (10 mg) administration, single fasting urine samples were collected at 2-4 days (n = 100). Twenty-four-hour post-dose collections and serial spot urine samples on days 2, 3 and 4 were obtained in a subset of participants (n = 10). Urinary creatine, creatinine, D3Cr and D3-creatinine enrichment were analyzed by liquid chromatography-tandem mass spectrometry. Appendicular lean mass (ALM) was measured by dual-energy x-ray absorptiometry and grip strength was measured by a hand-held dynamometer. RESULTS SMM was measured successfully in 91% of participants, and there were no adverse events. Mean ± SD SMM was greater than ALM (4.5 ± 0.4 and 3.2 ± 0.6 kg, respectively). Precision of SMM was low (intraclass correlation = 0.20; 95% CI: 0.02, 0.75; n = 10). Grip strength was not associated with SMM in multivariable analysis (0.004 kg per 100 g of SMM; 95% CI: -0.031, 0.038; n = 91). CONCLUSIONS The D3Cr dilution method was feasible in a community setting. However, high within-child variability in SMM estimates suggests the need for further optimization of this approach. IMPACT The D3-creatine (D3Cr) stable isotope dilution method was considered a feasible method for the estimation of skeletal muscle mass (SMM) in young children in a community setting and was well accepted among participants. SMM was weakly associated with both dual-energy x-ray absorptiometry-derived values of appendicular lean mass and grip strength. High within-child variability in estimated values of SMM suggests that further optimization of the D3Cr stable isotope dilution method is required prior to implementation in community research settings.
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Affiliation(s)
- Aysha Sidiqi
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Farzana Fariha
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shaila S Shanta
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Alison Dasiewicz
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Abdullah Al Mahmud
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Daniel R Moore
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Mahalakshmi Shankaran
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Marc K Hellerstein
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - William J Evans
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - M Munirul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Jennifer Harrington
- Department of Pediatrics, Women's and Children's Health Network and University of Adelaide, Adelaide, SA, Australia
| | - Edna Nyangau
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Daniel E Roth
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
- Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Karen M O'Callaghan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada.
- Department of Nutritional Sciences, King's College London, London, UK.
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Nichols AR, Haeri S, Rudine A, Burns N, Rathouz PJ, Hedderson MM, Abrams SA, Foster SF, Rickman R, McDonnold M, Widen EM. Prenatal Weight Change Trajectories and Perinatal Outcomes among Twin Gestations. Am J Perinatol 2023:10.1055/a-2091-1254. [PMID: 37164320 PMCID: PMC10782825 DOI: 10.1055/a-2091-1254] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Despite an increase in twin pregnancies in recent decades, the Institute of Medicine twin weight gain recommendations remain provisional and provide no guidance for the pattern or timing of weight change. We sought to characterize gestational weight change trajectory patterns and examine associations with birth outcomes in a cohort of twin pregnancies. STUDY DESIGN Prenatal and delivery records were examined for 320 twin pregnancies from a maternal-fetal medicine practice in Austin, TX 2011-2019. Prenatal weights for those with >1 measured weight in the first trimester and ≥3 prenatal weights were included in analyses. Trajectories were estimated to 32 weeks (mean delivery: 33.7 ± 3.3 weeks) using flexible latent class mixed models with low-rank thin-plate splines. Associations between trajectory classes and infant outcomes were analyzed using multivariable Poisson or linear regression. RESULTS Weight change from prepregnancy to delivery was 15.4 ± 6.3 kg for people with an underweight body mass index, 15.4 ± 5.8 kg for healthy weight, 14.7 ± 6.9 kg for overweight, and 12.5 ± 6.4 kg for obesity. Three trajectory classes were identified: low (Class 1), moderate (Class 2), or high gain (Class 3). Class 1 (24.7%) maintained weight for 15 weeks and then gained an estimated 6.6 kg at 32 weeks. Class 2 (60.9%) exhibited steady gain with 13.5 kg predicted total gain, and Class 3 (14.4%) showed rapid gain across pregnancy with 21.3 kg predicted gain. Compared to Class 1, Class 3 was associated with higher birth weight z-score (β = 0.63, 95% confidence interval [CI]: 0.31,0.96), increased risk for large for gestational age (IRR = 5.60, 95% CI: 1.59, 19.67), and birth <32 weeks (IRR = 2.44, 95%CI: 1.10, 5.4) that was attenuated in sensitivity analyses. Class 2 was associated with moderately elevated birth weight z-score (β = 0.24, 95%CI: 0.00, 0.48, p = 0.050). CONCLUSION Gestational weight change followed a low, moderate, or high trajectory; both moderate and high gain patterns were associated with increased infant size outcomes. Optimal patterns of weight change that balance risk during the prenatal, perinatal, and neonatal periods require further investigation, particularly in high-risk twin pregnancies. KEY POINTS · A majority gained weight below IOM twin recommendations.. · Three patterns of GWC across pregnancy were identified.. · Moderate or high GWC was associated with infant size..
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Affiliation(s)
- Amy R Nichols
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas
| | - Sina Haeri
- Women's Center of Texas, St. David's Healthcare, Austin, Texas
| | - Anthony Rudine
- Office of Research, St. David's Healthcare, Austin, Texas
| | - Natalie Burns
- Department of Statistics, University of Florida, Gainesville, Florida
| | - Paul J Rathouz
- Department of Population Health and Biomedical Data Science Hub, The University of Texas at Austin Dell Medical School, Austin, Texas
| | - Monique M Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Steven A Abrams
- Department of Pediatrics, The University of Texas at Austin Dell Medical School, Austin, Texas
| | - Saralyn F Foster
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas
| | - Rachel Rickman
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas
| | | | - Elizabeth M Widen
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas
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Chiang KV, Anstey EH, Abrams SA, Perrine CG. Infant burn injuries related to water heating for powdered infant formula preparation. Front Pediatr 2023; 11:1125112. [PMID: 37215595 PMCID: PMC10192855 DOI: 10.3389/fped.2023.1125112] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/17/2023] [Indexed: 05/24/2023] Open
Abstract
Background Guidance for preparing powdered infant formula (PIF) helps to ensure it meets the nutritional needs of infants and is safe to consume. Among safety concerns is Cronobacter sakazakii contamination which can lead to serious infections and death. PIF preparation guidance varies; there is a lack of consensus on whether there is a need to boil water to inactivate potential Cronobacter and for how long to let the water cool before reconstitution. We sought to quantify the burden of burn injuries among infants related to water heating for PIF preparation. Estimating this burden may help inform preparation recommendations. Methods Burn injuries among infants <18 months of age were identified from 2017 to 2019 National Electronic Injury Surveillance System data collected from sampled hospital emergency departments. Injuries were classified as related to PIF water heating, potentially related to PIF water heating but with undetermined causation, related to other infant feeding aspects, or unrelated to infant formula or breast milk feeding. Unweighted case counts for each injury classification were determined. Results Across sampled emergency departments, 7 PIF water heating injuries were seen among the 44,395 injuries reported for infants <18 months. No reported PIF water heating injuries were fatal, but 3 required hospitalization. Another 238 injuries potentially related to PIF water heating but with undetermined causation were also seen. Conclusion Preparation guidance should consider both the potential risk for Cronobacter infection and the potential risk for burns.
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Affiliation(s)
- Katelyn V. Chiang
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Erica H. Anstey
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
- McKing Consulting Corporation, Atlanta, GA, United States
| | - Steven A. Abrams
- Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX, United States
| | - Cria G. Perrine
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
- Commissioned Corps of the U.S. Public Health Service, Rockville, MD, United States
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Abrams SA, Bergner EM. Is It Time to Revise the Current Nutrient Requirements for Infant Formulas Principally Established in 1980? Adv Nutr 2023; 14:426-431. [PMID: 36878358 DOI: 10.1016/j.advnut.2023.02.006] [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] [Received: 12/05/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023] Open
Abstract
Because of the production of nutrient-deficient infant formulas (IFs), the United States Congress passed regulations on the composition and production of IF, referred to as the Infant Formula Act (IFA), in 1980, which was amended in 1986. More detailed FDA rules have been created since then, specifying the ranges or minimum intakes of nutrients and providing details for the safe production and evaluation of infant formulas. Although generally effective in ensuring safe IF, recent events have made it clear that a re-evaluation of aspects of all the nutrient composition regulations for IF is needed, including consideration of adding requirements related to bioactive nutrients not mentioned in the IFA. We propose that, as principal examples, the requirement for iron content needs to be re-evaluated and that DHA and AA should be considered for addition to the nutrient requirements after scientific review by a panel such as those established by the National Academies of Sciences, Engineering, and Medicine. Additionally, there is no specific requirement in current FDA regulations for the energy density of IF, and this should be added alongside potential revisions of the protein requirement. It would also be ideal to have specific FDA rules on nutrient intakes for premature infants as these are exempted from the specific nutrient regulations of the amended IFA.
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Affiliation(s)
- Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas, Austin, TX, United States.
| | - Erynn M Bergner
- Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, OK, United States
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Donovan SM, Abrams SA, Azad MB, Belfort MB, Bode L, Carlson SE, Dallas DC, Hettinga K, Järvinen K, Kim JH, Lebrilla CB, McGuire MK, Sela DA, Neu J. Summary of the joint National Institutes of Health and the Food and Drug Administration workshop titled "exploring the science surrounding the safe use of bioactive ingredients in infant formula: Considerations for an assessment framework". J Pediatr 2022; 255:30-41.e1. [PMID: 36463938 PMCID: PMC10121942 DOI: 10.1016/j.jpeds.2022.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/20/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Sharon M Donovan
- Department of Food Science and Human Nutrition, University of Illinois, Urbana, IL
| | - Steven A Abrams
- Department of Pediatrics Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada; Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Mandy B Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Lars Bode
- Department of Pediatrics and Mother-Milk-Infant Center of Research Excellence (MOMI CORE), University of California, San Diego, La Jolla, CA
| | - Susan E Carlson
- Department of Dietetics and Nutrition, Kansas University Medical Center and The University of Kansas, Kansas City, KS
| | - David C Dallas
- Department of Nutrition, Oregon State University, Corvallis, OR
| | - Kasper Hettinga
- Department of Food Sciences and Agrotechnology, Wageningen University, Wageningen, Netherlands
| | - Kirsi Järvinen
- Department of Pediatrics, Golisano Children's Hospital and University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Jae H Kim
- Perinatal Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | | | | | - David A Sela
- Department of Food Science, University of Massachusetts, Amherst, Amherst, MA
| | - Josef Neu
- Department of Pediatrics, University of Florida, Gainesville, FL.
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Cornes R, Sintes C, Peña A, Albin S, O'Brien KO, Abrams SA, Donangelo CM. Daily Intake of a Functional Synbiotic Yogurt Increases Calcium Absorption in Young Adult Women. J Nutr 2022; 152:1647-1654. [PMID: 35411924 DOI: 10.1093/jn/nxac088] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/16/2022] [Accepted: 04/07/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Foods containing both prebiotics and probiotics (synbiotics) might enhance calcium bioavailability. OBJECTIVES We investigated the acute effect in young adult women on calcium absorption of consuming (185 mL) a synbiotic yogurt (SYN) containing inulin (4 g) and Lactobacillus rhamnosus GG (>1 × 107 CFU/mL) compared with a control yogurt (CON). METHODS Adult normal-weight women (25.0 ± 3.5 y, n = 30) participated in a 3-wk crossover study testing daily consumption of SYN compared with CON. Habitual dietary intake, bone mineral density (BMD), calcium biomarkers, and serum 25-hydroxyvitamin D were measured at baseline. Calcium absorption was tested after each phase of the study using a 42Ca oral tracer. Cumulative tracer recovery was measured in 0-4-h, 0-24-h, and 0-36-h urine pools collected postdosing. The SYN/CON tracer ratio from the timed urine pools was the primary outcome. A beneficial response to SYN was defined as 0-36-h SYN/CON tracer ratio >1. RESULTS Net 42Ca recovered increased over time in each of the SYN and CON urine pools postdosing (Friedman, P < 0.001), with a trend for higher 42Ca recovery in the 0-36-h urine pool postdosing in the SYN (1.14%) compared with the CON (0.90%) study (Wilcoxon, P = 0.07). For CON, the majority of total tracer was recovered in the 0-24-h pool (86%), whereas for SYN only 50% of total tracer was recovered in the 0-24-h pool (Friedman, P = 0.001). The SYN/CON tracer ratio in the 0-36-h pool (1.24) was >1 (Wilcoxon, P = 0.015). About two-thirds (n = 19) of women studied responded to the SYN treatment. Responders had higher vegetable intake (P = 0.03), tended to have higher potassium and calcium intakes (P ≤ 0.08), and had higher total body BMD (P = 0.09), than nonresponders. CONCLUSIONS Short-term daily consumption of a synbiotic yogurt enhanced calcium absorption relative to a control yogurt in adult women. Given the observed time delays in tracer recovery, enhancement of calcium absorption likely occurred in the large intestine.The study was registered at clinicaltrials.gov (study registration ID: NCT03420716).
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Affiliation(s)
- Rafael Cornes
- Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay
| | - Celia Sintes
- Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay
| | - Amparo Peña
- Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay
| | - Santiago Albin
- Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay
| | | | - Steven A Abrams
- Dell Medical School, University of Texas at Austin, Austin, TX, USA
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Abrams SA, Duggan CP. Infant and child formula shortages: now is the time to prevent recurrences. Am J Clin Nutr 2022; 116:289-292. [PMID: 35580593 PMCID: PMC9348970 DOI: 10.1093/ajcn/nqac149] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
An acute shortage of infant formulas in the United States occurred in early 2022, exacerbating a longer-standing, less severe shortage that has occurred over the last several years. The shortage has been particularly problematic for specialized formulas such as those needed for infants and children with food allergies, intestinal failure, kidney disease, and metabolic disorders. Although undoubtedly the magnitude of the current shortage will abate over time, it has affected many children and caused tremendous distress for thousands of families. We propose a series of interventions to be undertaken as soon as feasible to help ensure that the conditions that led to this problem do not recur and families regain confidence in the safety and supply reliability of formulas for infants and young children regardless of their medical needs.
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Affiliation(s)
| | - Christopher P Duggan
- Center for Nutrition, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Abstract
Intramuscular administration of vitamin K for prevention of vitamin K deficiency bleeding (VKDB) has been a standard of care since the American Academy of Pediatrics recommended it in 1961. Despite the success of prevention of VKDB with vitamin K administration, the incidence of VKDB appears to be on the rise. This increase in incidence of VKDB is attributable to parental refusal as well as lowered efficacy of alternate methods of administration. The aim of this statement is to discuss the current knowledge of prevention of VKDB with respect to the term and preterm infant and address parental concerns regarding vitamin K administration.
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Affiliation(s)
- Ivan Hand
- Department of Pediatrics, NYC Health + Hospitals Kings County, Brooklyn, New York.,Department of Pediatrics, SUNY-Downstate College of Medicine, Brooklyn, New York
| | - Lawrence Noble
- NYC Health + Hospitals Elmhurst, Elmhurst, New York.,Department of Pediatrics, Dell Medical School at the University of Texas-Austin, Austin, Texas
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas-Austin, Austin, Texas
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12
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Bourassa MW, Abrams SA, Belizán JM, Boy E, Cormick G, Quijano CD, Gibson S, Gomes F, Hofmeyr GJ, Humphrey J, Kraemer K, Lividini K, Neufeld LM, Palacios C, Shlisky J, Thankachan P, Villalpando S, Weaver CM. Interventions to improve calcium intake through foods in populations with low intake. Ann N Y Acad Sci 2022; 1511:40-58. [PMID: 35103316 PMCID: PMC9306636 DOI: 10.1111/nyas.14743] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/15/2021] [Accepted: 12/05/2021] [Indexed: 11/28/2022]
Abstract
Calcium intake remains inadequate in many low- and middle-income countries, especially in Africa and South Asia, where average intakes can be below 400 mg/day. Given the vital role of calcium in bone health, metabolism, and cell signaling, countries with low calcium intake may want to consider food-based approaches to improve calcium consumption and bioavailability within their population. This is especially true for those with low calcium intake who would benefit the most, including pregnant women (by reducing the risk of preeclampsia) and children (by reducing calcium-deficiency rickets). Specifically, some animal-source foods that are naturally high in bioavailable calcium and plant foods that can contribute to calcium intake could be promoted either through policies or educational materials. Some food processing techniques can improve the calcium content in food or increase calcium bioavailability. Staple-food fortification with calcium can also be a cost-effective method to increase intake with minimal behavior change required. Lastly, biofortification is currently being investigated to improve calcium content, either through genetic screening and breeding of high-calcium varieties or through the application of calcium-rich fertilizers. These mechanisms can be used alone or in combination based on the local context to improve calcium intake within a population.
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Affiliation(s)
| | | | - José M Belizán
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP), Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | | | - Gabriela Cormick
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP), Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina.,Departamento de Salud, Universidad Nacional de La Matanza UNLAM, San Justo, Argentina
| | | | - Sarah Gibson
- Children's Investment Fund Foundation, London, UK
| | - Filomena Gomes
- New York Academy of Sciences, New York, New York.,NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - G Justus Hofmeyr
- University of Botswana, Gaborone, Botswana.,University of the Witwatersrand and Walter Sisulu University, Mthatha, South Africa
| | - Jean Humphrey
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Klaus Kraemer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Sight and Life Foundation, Basel, Switzerland
| | | | | | | | | | | | | | - Connie M Weaver
- Purdue University, West Lafayette, Indiana.,San Diego State University, San Diego, California
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13
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Abstract
The maximum rate of bone mass accumulation is during early adolescence. As such, a focus on optimizing mineral nutrition in school age children, defined here as approximately 5 to 15 years of age, is crucial to minimize the risk of bone loss that occurs later in life leading to osteoporosis and fractures. Optimizing bone mass in this age group requires attention to an overall healthy diet including adequate calcium, phosphorus, magnesium, and vitamin D. Special concerns may exist related to children who follow a restricted diet such as a vegan diet, those with intolerance or allergies to dairy, and those with chronic health conditions including young adolescents with eating disorders. Public policy messages should focus on positive aspects of bone health nutrition in this age group and avoid overly specific statements about the exact amounts of foods needed for healthy bones. In this regard, dietary recommendations for minerals vary between North America and Europe and these are higher than the values that may be necessary in other parts of the world. The management of many children with chronic illnesses includes the use of medications that may affect their bone mineral metabolism. Routine lab testing for bone mineral metabolism including the serum 25-hydroxyvitamin D level is not indicated, but is valuable for at-risk children, especially those with chronic illnesses.
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Affiliation(s)
- Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas, Austin, TX, United States
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14
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O'Callaghan KM, Shanta SS, Fariha F, Harrington J, Mahmud AA, Emdin AL, Gernand AD, Ahmed T, Abrams SA, Moore DR, Roth DE. Effect of maternal prenatal and postpartum vitamin D supplementation on offspring bone mass and muscle strength in early childhood: follow-up of a randomized controlled trial. Am J Clin Nutr 2021; 115:770-780. [PMID: 34849536 PMCID: PMC8895216 DOI: 10.1093/ajcn/nqab396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Maternal vitamin D status during pregnancy and lactation is a modifiable factor that may influence offspring musculoskeletal outcomes. However, few randomized trials have tested the effects of prenatal or postpartum vitamin D supplementation on offspring bone and muscle development. OBJECTIVES The aim was to examine hypothesized effects of improvements in early-life vitamin D status on childhood musculoskeletal health in Dhaka, Bangladesh. METHODS In a previously completed, double-blind, dose-ranging trial, healthy pregnant women (n = 1300) were recruited at 17-24 weeks' gestation and randomly assigned to a prenatal/postpartum regimen of 0/0, 4200/0, 16,800/0, 28,000/0, or 28,000/28,000 IU cholecalciferol (vitamin D3)/wk until 26 wk postpartum. In this new report, we describe additional follow-up at 4 y of age (n = 642) for longer-term outcomes. Bone mineral content (BMC) and areal bone mineral density (aBMD) were measured by DXA. Grip strength was tested using a hand-held dynamometer. The primary comparison was children of women assigned to 28,000 IU/wk prenatally compared with placebo. Differences are expressed as means and 95% CIs. RESULTS Total-body-less-head (TBLH) BMC, TBLH aBMD, and grip strength were similar in the combined high-dose prenatal (28,000/0 and 28,000/28,000 IU/wk) compared with placebo groups (mean difference [95% CI] = 0.61 g [-10.90, 12.13], 0.0004 g/cm2 [-0.0089, 0.0097], and 0.02 kg [-0.26, 0.31], respectively). In dose-ranging analyses, TBLH BMC and aBMD, whole-body BMC and aBMD, and grip strength in each of the prenatal vitamin D groups were not significantly different from placebo (P > 0.05 for all comparisons). Only head aBMD was greater in children of women assigned to the 28,000/28,000-IU regimen compared with placebo (mean difference [95% CI] = 0.024 g/cm2 [0.0009, 0.047], P = 0.042); the effect was attenuated upon adjustment for child height, weight, and sex (P = 0.11). CONCLUSIONS Maternal prenatal, with or without postpartum, vitamin D supplementation does not improve child BMC, aBMD, or grip strength at 4 y of age. The MDIG trial and present follow-up study were registered prospectively at www.clinicaltrials.gov as NCT01924013 and NCT03537443, respectively.
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Affiliation(s)
- Karen M O'Callaghan
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shaila S Shanta
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Farzana Fariha
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jennifer Harrington
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Abdullah Al Mahmud
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Abby L Emdin
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, State College, PA, USA
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | | | - Daniel E Roth
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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15
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Abstract
Osteopenia and rickets remain a problem for high-risk infants, especially preterm infants <1500 g birthweight (very low birth weight, VLBW). The primary cause of osteopenia in VLBW infants is a low intake of calcium and phosphorus compared to requirements for the rapidly growing skeleton. Human milk is a relatively low mineral containing substance and cannot meet the bone mineral needs of very low birth weight infants. As such, most VLBW infants need additional bone minerals and in many neonatal care units these are provided as part of human milk fortificants or specialized infant formulas. In some nurseries, these are given to all infants < 1800-2000 g birthweight. Management of full-term infants who are small for gestational age at birth is less clear, but in general bone mineral content is associated more with body size than gestational age and supplementation is often provided to these infants. Although all infants, including preterm ones need a source of vitamin D, the benefits of providing high doses of vitamin D to healthy preterm neonates is unproven. Some evidence indicates that most calcium absorption is non-vitamin D dependent in the first weeks of life in both preterm and term infants. However, after achieving full feeds in the preterm infant, it is prudent to provide vitamin D at amounts comparable to that used in full-term infants. Higher doses increase serum 25-hydroxyvitamin D levels more rapidly, but evidence is inconclusive as to the relative benefits vs possible risks of higher doses. In healthy full-term infants, although vitamin D provision via supplement drops to the breastfed infant, high dose maternal supplementation to the lactating mother or infant formula is generally recommended, the current evidence only strongly supports its use in identified at-risk infants.
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Affiliation(s)
- Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas, Austin, TX, USA.
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16
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Tiosano D, Abrams SA, Weisman Y. Lessons Learned from Hereditary 1,25-Dihydroxyvitamin D-Resistant Rickets Patients on Vitamin D Functions. J Nutr 2021; 151:473-481. [PMID: 33438017 DOI: 10.1093/jn/nxaa380] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/19/2020] [Revised: 09/25/2020] [Accepted: 11/04/2020] [Indexed: 01/08/2023] Open
Abstract
We summarize here lessons learned from studies on skeletal and extra-skeletal functions of vitamin D in hereditary 1,25-dihydroxyvitamin D-resistant rickets (HVDRR) patients with a mutant, nonfunctioning vitamin D receptor (VDR). During childhood, HVDRR patients are dependent on intestinal VDR, demonstrate low intestinal fraction calcium absorption, and have a bone calcium accretion rate that leads to hypocalcemia and rickets. After puberty, there is recovery in intestinal calcium absorption and in bone calcium accretion and structure. HVDRR monocytes and lymphocytes show impairment in the expression of antimicrobial proteins and demonstrate a proinflammatory cytokine profile. However, HVDRR patients do not exhibit increased rates of infections or inflammatory diseases. Vitamin D deficiency is associated with asthmatic exacerbations. Surprisingly, HVDRR patients do not usually develop asthma. They have normal allergic tests and lung functions and are protected against provoked bronchial hyperactivity. HVDRR patients have decreased IL-5 levels in their exhaled breath condensate. Given that IL-5 is a key cytokine in the development of airway inflammation and hyperactivity and that VDR is important for IL-5 generation, it is plausible that low lung IL-5 protects HVDRR patients from asthma. Vitamin D metabolites have suppressive effects on the renin angiotensin system. However, no HVDRR patient showed hypertension or echocardiographic pathology, and their renin angiotensin metabolites were normal. The VDR is expressed throughout the reproductive system, suggesting a role in reproduction. However, the reproductive history of HVDRR patients is normal despite the lack of a normal VDR. HVDRR patients provide a unique opportunity to study the role of the VDR and the role of vitamin D in various human systems.
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Affiliation(s)
- Dov Tiosano
- Pediatric Endocrinology Unit, Ruth Rappaport Children's Hospital, Rambam Healthcare Campus, Haifa, Israel
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas-Austin, Austin, TX, USA
| | - Yoseph Weisman
- Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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17
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Abstract
BACKGROUND Vitamin D deficiency is common worldwide, contributing to nutritional rickets and osteomalacia which have a major impact on health, growth, and development of infants, children and adolescents. Vitamin D levels are low in breast milk and exclusively breastfed infants are at risk of vitamin D insufficiency or deficiency. OBJECTIVES To determine the effect of vitamin D supplementation given to infants, or lactating mothers, on vitamin D deficiency, bone density and growth in healthy term breastfed infants. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to 29 May 2020 supplemented by searches of clinical trials databases, conference proceedings, and citations. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs in breastfeeding mother-infant pairs comparing vitamin D supplementation given to infants or lactating mothers compared to placebo or no intervention, or sunlight, or that compare vitamin D supplementation of infants to supplementation of mothers. DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility and risk of bias and independently extracted data. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included 19 studies with 2837 mother-infant pairs assessing vitamin D given to infants (nine studies), to lactating mothers (eight studies), and to infants versus lactating mothers (six studies). No studies compared vitamin D given to infants versus periods of infant sun exposure. Vitamin D supplementation given to infants: vitamin D at 400 IU/day may increase 25-OH vitamin D levels (MD 22.63 nmol/L, 95% CI 17.05 to 28.21; participants = 334; studies = 6; low-certainty) and may reduce the incidence of vitamin D insufficiency (25-OH vitamin D < 50 nmol/L) (RR 0.57, 95% CI 0.41 to 0.80; participants = 274; studies = 4; low-certainty). However, there was insufficient evidence to determine if vitamin D given to the infant reduces the risk of vitamin D deficiency (25-OH vitamin D < 30 nmol/L) up till six months of age (RR 0.41, 95% CI 0.16 to 1.05; participants = 122; studies = 2), affects bone mineral content (BMC), or the incidence of biochemical or radiological rickets (all very-low certainty). We are uncertain about adverse effects including hypercalcaemia. There were no studies of higher doses of infant vitamin D (> 400 IU/day) compared to placebo. Vitamin D supplementation given to lactating mothers: vitamin D supplementation given to lactating mothers may increase infant 25-OH vitamin D levels (MD 24.60 nmol/L, 95% CI 21.59 to 27.60; participants = 597; studies = 7; low-certainty), may reduce the incidences of vitamin D insufficiency (RR 0.47, 95% CI 0.39 to 0.57; participants = 512; studies = 5; low-certainty), vitamin D deficiency (RR 0.15, 95% CI 0.09 to 0.24; participants = 512; studies = 5; low-certainty) and biochemical rickets (RR 0.06, 95% CI 0.01 to 0.44; participants = 229; studies = 2; low-certainty). The two studies that reported biochemical rickets used maternal dosages of oral D3 60,000 IU/day for 10 days and oral D3 60,000 IU postpartum and at 6, 10, and 14 weeks. However, infant BMC was not reported and there was insufficient evidence to determine if maternal supplementation has an effect on radiological rickets (RR 0.76, 95% CI 0.18 to 3.31; participants = 536; studies = 3; very low-certainty). All studies of maternal supplementation enrolled populations at high risk of vitamin D deficiency. We are uncertain of the effects of maternal supplementation on infant growth and adverse effects including hypercalcaemia. Vitamin D supplementation given to infants compared with supplementation given to lactating mothers: infant vitamin D supplementation compared to lactating mother supplementation may increase infant 25-OH vitamin D levels (MD 14.35 nmol/L, 95% CI 9.64 to 19.06; participants = 269; studies = 4; low-certainty). Infant vitamin D supplementation may reduce the incidence of vitamin D insufficiency (RR 0.61, 95% CI 0.40 to 0.94; participants = 334; studies = 4) and may reduce vitamin D deficiency (RR 0.35, 95% CI 0.17 to 0.72; participants = 334; studies = 4) but the evidence is very uncertain. Infant BMC and radiological rickets were not reported and there was insufficient evidence to determine if maternal supplementation has an effect on infant biochemical rickets. All studies enrolled patient populations at high risk of vitamin D deficiency. Studies compared an infant dose of vitamin D 400 IU/day with varying maternal vitamin D doses from 400 IU/day to > 4000 IU/day. We are uncertain about adverse effects including hypercalcaemia. AUTHORS' CONCLUSIONS For breastfed infants, vitamin D supplementation 400 IU/day for up to six months increases 25-OH vitamin D levels and reduces vitamin D insufficiency, but there was insufficient evidence to assess its effect on vitamin D deficiency and bone health. For higher-risk infants who are breastfeeding, maternal vitamin D supplementation reduces vitamin D insufficiency and vitamin D deficiency, but there was insufficient evidence to determine an effect on bone health. In populations at higher risk of vitamin D deficiency, vitamin D supplementation of infants led to greater increases in infant 25-OH vitamin D levels, reductions in vitamin D insufficiency and vitamin D deficiency compared to supplementation of lactating mothers. However, the evidence is very uncertain for markers of bone health. Maternal higher dose supplementation (≥ 4000 IU/day) produced similar infant 25-OH vitamin D levels as infant supplementation of 400 IU/day. The certainty of evidence was graded as low to very low for all outcomes.
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Affiliation(s)
- May Loong Tan
- Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly Penang Medical College), George Town, Malaysia
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - David A Osborn
- Central Clinical School, School of Medicine, The University of Sydney, Sydney, Australia
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18
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Abstract
Vitamin D is necessary for the active (transcellular) absorption of calcium and for skeletal health. Inadequate vitamin D in infants leads to increased risks of poor bone mineralization and ultimately rickets. Rickets is uncommon in full-term infants with a much higher risk in very premature infants. However, the primary cause of rickets in premature infants is a deficiency of calcium and phosphorus, not vitamin D. Available research, as well as most guidelines, recommend an intake of 400 IU daily of vitamin D as adequate for bone health in preterm and full-term infants. Higher doses have not been consistently shown to have specific clinical benefits for healthy infants. There are no strong data to support either routine testing of serum 25-hydroxyvitamin D or targeting high serum 25-hydroxyvitamin D levels (e.g., 30 ng/mL) in healthy preterm or full-term infants. Vitamin D is commonly provided to infants via drops for breastfed babies or via infant formula, although alternative dosing approaches exist for breastfed infants, which some families may prefer. These include the use of drops placed on the mother's breast, dissolvable doses, and high maternal doses (approximately 6,400 IU daily). Infant formula contains vitamin D, and most infants will reach an intake from formula of about 400 IU daily within the first 2 months of life if they are consuming routine cow milk-based formula. Although vitamin D toxicity is very uncommon, caution should be used to avoid extremely concentrated high doses found in some commercially available drops. Infants with liver or kidney disease may need special attention to vitamin D intake and status. Further research is needed to define the role of vitamin D in non-bone health outcomes of infants and to identify methods to enhance compliance with current recommendations for vitamin D intake in infants.
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Affiliation(s)
- Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas, Austin, Texas, USA,
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19
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Lucas A, Abrams SA. Comment on "Human Milk-Derived Fortifiers Compared with Bovine Milk-Derived Fortifiers in Preterm Infants: A Systematic Review and Meta-Analysis". Adv Nutr 2020; 11:1712-1713. [PMID: 33191434 PMCID: PMC7666967 DOI: 10.1093/advances/nmaa098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Alan Lucas
- Institute of Child Health, University College, London, London, United Kingdom
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20
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Abrams SA. Selected Micronutrient Needs of Children 1-3 Years of Age. Nestle Nutr Inst Workshop Ser 2020; 95:67-77. [PMID: 33147581 DOI: 10.1159/000511507] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/12/2020] [Indexed: 06/11/2023]
Abstract
Establishing dietary recommendations for micronutrients in young children is difficult. Techniques used to evaluate nutrient intake and bioavailability are hard to apply in this age group. Additionally, large variations in growth rates, dietary patterns, and nutrient losses in early childhood make determinations of dietary requirements difficult. Most recent studies have utilized stable isotopes to determine mineral absorption for iron, zinc, calcium, and magnesium. Vitamin D requirements have been established based on the dietary intake required to maintain a presumed adequate serum 25-hydroxyvitamin D concentration. Comparisons of nutrient requirements established using factorial methods involving absorption determinations and usual population intake are important to identify nutrients of concern related to deficient or excess intakes. Generally, in the USA, the intakes of calcium and magnesium are adequate to meet requirements in most toddler diets which include a milk source or a mineral-fortified milk alternative. Zinc and iron intakes can be below requirements in a substantial proportion of toddlers throughout the world, especially those with minimal meat consumption. Dietary vitamin D is generally below dietary recommendations, but clearly deficient serum 25-hydroxyvitamin D concentrations are less common, and the global role for routine vitamin D supplementation or fortification of the diet remains uncertain.
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Affiliation(s)
- Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas, Austin, Texas, USA,
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21
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Delaney KM, Guillet R, Pressman EK, Caulfield LE, Zavaleta N, Abrams SA, O'Brien KO. Iron absorption during pregnancy is underestimated when iron utilization by the placenta and fetus is ignored. Am J Clin Nutr 2020; 112:576-585. [PMID: 32614379 PMCID: PMC7458780 DOI: 10.1093/ajcn/nqaa155] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 02/27/2020] [Accepted: 05/22/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Maternal iron absorption during pregnancy can be evaluated using RBC incorporation of orally administered stable iron isotope. This approach underestimates true maternal absorption of iron as it does not account for absorbed iron that is transferred to the fetus or retained within the placenta. OBJECTIVE Our objective was to re-evaluate maternal iron absorption after factoring in these losses and identify factors associated with iron partitioning between the maternal, neonatal, and placental compartments. METHODS This study utilized data from stable iron isotope studies carried out in 68 women during the third trimester of pregnancy. Iron status indicators and stable iron isotopic enrichment were measured in maternal blood, umbilical cord blood, and placental tissue when available. Factors associated with iron isotope partitioning between the maternal, neonatal, and placental compartments were identified. RESULTS On average, true maternal absorption of iron increased by 10% (from 19% to 21%) after accounting for absorbed iron present in the newborn (P < 0.001), and further increased by 7%, (from 39% to 42%, P < 0.001) after accounting for iron retained within the placenta. On average, 2% of recovered tracer was present in the placenta and 6% was found in the newborn. Net transfer of iron to the neonate was higher in women with lower total body iron (standardized β = -0.48, P < 0.01) and lower maternal hepcidin (standardized β = -0.66, P < 0.01). In women carrying multiple fetuses, neonatal hepcidin explained a significant amount of observed variance in net placental transfer of absorbed iron (R = 0.95, P = 0.03). CONCLUSIONS Maternal RBC iron incorporation of an orally ingested tracer underestimated true maternal iron absorption. The degree of underestimation was greatest in women with low body iron. Maternal hepcidin was inversely associated with maternal RBC iron utilization, whereas neonatal hepcidin explained variance in net transfer of iron to the neonatal compartment.These trials were registered at clinicaltrials.gov as NCT01019096 and NCT01582802.
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Affiliation(s)
| | - Ronnie Guillet
- Division of Neonatology, Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY, USA
| | - Eva K Pressman
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine, Rochester, NY, USA
| | - Laura E Caulfield
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Steven A Abrams
- Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX
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22
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Lucas A, Abrams SA. Human milk fortifiers: corrigenda. Am J Clin Nutr 2020; 111:1301-1302. [PMID: 32488256 DOI: 10.1093/ajcn/nqaa093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alan Lucas
- From the Institute of Child Health, University College, London, United Kingdom
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas, Austin, TX, USA
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23
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Bergner EM, Shypailo R, Visuthranukul C, Hagan J, O'Donnell AR, Hawthorne KM, Abrams SA, Hair AB. Growth, Body Composition, and Neurodevelopmental Outcomes at 2 Years Among Preterm Infants Fed an Exclusive Human Milk Diet in the Neonatal Intensive Care Unit: A Pilot Study. Breastfeed Med 2020; 15:304-311. [PMID: 32298596 PMCID: PMC7360515 DOI: 10.1089/bfm.2019.0210] [Citation(s) in RCA: 13] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Long-term outcomes of preterm infants fed an exclusive human milk-based (EHM) diet using a donor human milk-based fortifier are not well defined. Materials and Methods: Infants ≤1,250 g birth weight (BW) were studied prospectively at two outpatient visits: 12-15 and 18-22 months corrected age (CA). Dual-energy X-ray absorptiometry and Bayley Scales of Infant and Toddler Development III (BSID-III) were performed at 18-22 months CA. Results: In this pilot study, 51 preterm infants (gestational age 27.8 ± 2.6 weeks and BW 893 ± 204 g) were evaluated. While anthropometric z-scores were significantly lower at discharge compared with birth, z-scores returned to birth levels by 12-15 months CA (length and head circumference [HC]) and 18-22 months CA (weight). Body composition at 2 years of age was similar to term-matched controls. Inpatient growth was significantly correlated with bone density, lean mass (LM), and fat-free mass at 18-22 months CA. Increased mother's own milk (MOM) was significantly correlated with decreased fat mass indices. BSID-III showed that 0% of cognitive composite scores were <70. Conclusions: In addition to returning to BW, length, and HC z-scores by 2 years of age, body composition analysis revealed that increase in body size was appropriate as reflected by LM and bone density similar to matched term controls without an increase in fat mass. No child had severe cognitive developmental delay using a cutoff score of 70. Inpatient growth and increased receipt of MOM correlated with favorable growth and body composition outcomes. Positive outcomes as shown in this study to confirm postdischarge safety of an EHM diet during hospitalization.
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Affiliation(s)
- Erynn M Bergner
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.,Department of Pediatrics, Section of Neonatology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Roman Shypailo
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Chonnikant Visuthranukul
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.,USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Department of Pediatrics, Section of Nutrition, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.,Pediatric Nutrition STAR, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Joseph Hagan
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Andrea R O'Donnell
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Keli M Hawthorne
- Department of Pediatrics, Dell Medical School, Dell Pediatric Research Institute, University of Texas at Austin, Austin, Texas, USA
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School, Dell Pediatric Research Institute, University of Texas at Austin, Austin, Texas, USA
| | - Amy B Hair
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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24
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Abstract
Objective: An increasingly common practice is to feed preterm infants a base diet comprising only human milk (HM), usually fortified with a cow's milk (CM)-derived fortifier (CMDF). We evaluated the safety of CMDF in a diet of 100% mother's own milk (MOM) against a HM-derived fortifier (HMDF). To date, this has received little research attention. Study Design: We reanalyzed a 12-center randomized trial, originally comparing exclusive HM feeding, including MOM, donor milk (DM), and HMDF, versus a CM exposed group fed MOM, preterm formula (PTF), and CMDF1. However, for the current study, we performed a subgroup analysis (n = 114) selecting only infants receiving 100% MOM base diet plus fortification, and fed no DM or PTF. This allowed for an isolated comparison of fortifier type: CMDF versus HMDF to evaluate the primary outcomes: necrotizing enterocolitis (NEC) and a severe morbidity index of NEC surgery or death; and several secondary outcomes. Results: CMDF and HMDF groups had similar baseline characteristics. CMDF was associated with higher risk of NEC; relative risk (RR) 4.2 (p = 0.038), NEC surgery or death (RR 5.1, p = 0.014); and reduced head circumference gain (p = 0.04). Conclusions: In neonates fed, as currently recommended with a MOM-based diet, the safety of CMDF when compared to HMDF has been little researched. We conclude that available evidence points to an increase in adverse outcomes with CMDF, including NEC and severe morbidity comprising NEC surgery or death.
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Affiliation(s)
- Alan Lucas
- Institute of Child Health, University College, London, United Kingdom
| | - John Boscardin
- Department of Medicine and University of California, San Francisco, California, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School, The University of Texas, Austin, Texas, USA
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25
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Abrams SA. Long-Term Growth and Body Composition Consequences of Using Fortified Donor Milk or Preterm Formula for Very-Low-Birth-Weight Infants. J Nutr 2020; 150:188-189. [PMID: 31618419 DOI: 10.1093/jn/nxz264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas, Austin, TX, USA
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26
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Shamshirsaz AA, Lee TC, Hair AB, Erfani H, Espinoza J, Shamshirsaz AA, Fox KA, Gandhi M, Nassr AA, Abrams SA, Mccullough LB, Chervenak FA, Olutoye OO, Belfort MA. Elective delivery at 34 weeks vs routine obstetric care in fetal gastroschisis: randomized controlled trial. Ultrasound Obstet Gynecol 2020; 55:15-19. [PMID: 31503365 DOI: 10.1002/uog.21871] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/26/2019] [Accepted: 08/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate whether elective preterm delivery (ED) at 34 weeks is of postnatal benefit to infants with isolated gastroschisis compared with routine obstetric care (RC). METHODS Between May 2013 and September 2015, all women with a sonographic diagnosis of fetal gastroschisis referred to a single tertiary center, before 34 weeks' gestation, were invited to participate in this study. Eligible patients were randomized to ED (induction of labor at 34 weeks) or RC (spontaneous labor or delivery by 37-38 weeks, based on standard obstetric indications). The primary outcome measure was length of time on total parenteral nutrition (TPN). Secondary outcomes were time to closure of gastroschisis and length of stay in hospital. Outcome variables were compared using appropriate statistical methods. Analysis was based on intention-to-treat. RESULTS Twenty-five women were assessed for eligibility, of whom 21 (84%; 95% CI, 63.9-95.5%) agreed to participate in the study; of these, 10 were randomized to ED and 11 to RC. The trial was stopped at the first planned interim analysis due to patient safety concerns and for futility; thus, only 21 of the expected 86 patients (24.4%; 95% CI, 15.8-34.9%) were enrolled. Median gestational age at delivery was 34.3 (range, 34-36) weeks in the ED group and 36.7 (range, 27-38) weeks in the RC group. One patient in the ED group delivered at 36 weeks following unsuccessful induction at 34 weeks. Neonates of women who underwent ED, compared to those in the RC group, showed no difference in the median number of days on TPN (54 (range, 17-248) vs 21 (range, 9-465) days; P = 0.08), number of days to closure of gastroschisis (7 (range, 0-15) vs 5 (range, 0-8) days; P = 0.28) and length of stay in hospital (70.5 (range, 22-137) vs 31 (range, 19-186) days; P = 0.15). However, neonates in the ED group were significantly more likely to experience late-onset sepsis compared with those in the RC group (40% (95% CI, 12.2-73.8%) vs 0%; P = 0.03). CONCLUSION This study demonstrates no benefit of ED of fetuses with gastroschisis when postnatal gastroschisis management is similar to that used in routine care. Rather, the data suggest that ED is detrimental to infants with gastroschisis. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A A Shamshirsaz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - T C Lee
- Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - A B Hair
- Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - H Erfani
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - J Espinoza
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - A A Shamshirsaz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - K A Fox
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - M Gandhi
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - A A Nassr
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - S A Abrams
- University of Texas at Austin, Austin, TX, USA
| | - L B Mccullough
- Department of Obstetrics and Gynecology, Weill Medical College of Cornell University/New York Presbyterian Hospital, New York, NY, USA
| | - F A Chervenak
- Department of Obstetrics and Gynecology, Weill Medical College of Cornell University/New York Presbyterian Hospital, New York, NY, USA
| | - O O Olutoye
- Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - M A Belfort
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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Abrams SA, Daniels SR. Reply. J Pediatr 2020; 216:251. [PMID: 31570152 DOI: 10.1016/j.jpeds.2019.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas, Austin, Texas
| | - Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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Affiliation(s)
- Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas, Austin, TX.
| | - Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
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Abstract
BACKGROUND Neonatal sepsis and necrotizing enterocolitis (NEC) cause significant neonatal mortality and morbidity despite appropriate antibiotic therapy. Enhancing host defense and modulating inflammation by using lactoferrin as an adjunct to antibiotics in the treatment of sepsis, NEC, or both, may improve clinical outcomes. OBJECTIVES The primary objective was to assess safety and efficacy of oral lactoferrin as an adjunct to antibiotics in the treatment of neonates with suspected or confirmed sepsis, NEC, or both. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 9), MEDLINE via PubMed, PREMEDLINE, (1966 to 20 September 2018) Embase (1980 to 20 September 2018), and CINAHL (1982 to 20 September 2018). We also searched clinical trial databases, conference proceedings, the reference lists of retried articles and clinical trials, and the authors' personal files. SELECTION CRITERIA We included randomized or quasi-randomized controlled trials evaluating enteral lactoferrin (at any dose or duration), used as an adjunct to antibiotic therapy, compared with antibiotic therapy alone (with or without placebo) or other adjuncts to antibiotic therapy to treat neonates at any gestational age up to 44 weeks' postmenstrual age with confirmed or suspected sepsis or necrotizing enterocolitis (Bell's Stage II or III). DATA COLLECTION AND ANALYSIS We used the standardized methods of Cochrane Neonatal for conducting a systematic review and for assessing the methodological quality of studies (neonatal.cochrane.org/en/index.html). The titles and the abstracts of studies identified by the search strategy were independently assessed by the two review authors and full text versions were obtained for assessment if necessary. Forms were designed to record trial inclusion/exclusion and data extraction. We used the GRADE approach to assess the quality of evidence. MAIN RESULTS We did not identify any eligible trials evaluating lactoferrin for the treatment of neonatal sepsis or NEC. AUTHORS' CONCLUSIONS Implications for practice: currently there is no evidence to support or refute the use of enteral lactoferrin, as an adjunct to antibiotic therapy, for the treatment of neonatal sepsis or necrotizing enterocolitis. IMPLICATIONS FOR RESEARCH given the lack of efficacy of enteral lactoferrin for preventing late-onset sepsis and necrotizing enterocolitis, evaluation of enteral lactoferrin as an adjunctive agent for treatment of sepsis or necrotizing enterocolitis does not appear to be a research priority.
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Affiliation(s)
- Mohan Pammi
- Baylor College of MedicineSection of Neonatology, Department of Pediatrics6621, Fannin, MC.WT 6‐104HoustonTexasUSA77030
| | - Steven A Abrams
- Dell Medical School, The University of Texas at AustinDepartment of PediatricsAustinTexasUSA
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Visuthranukul C, Abrams SA, Hawthorne KM, Hagan JL, Hair AB. Premature small for gestational age infants fed an exclusive human milk-based diet achieve catch-up growth without metabolic consequences at 2 years of age. Arch Dis Child Fetal Neonatal Ed 2019; 104:F242-F247. [PMID: 30425116 PMCID: PMC6764250 DOI: 10.1136/archdischild-2017-314547] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 07/10/2018] [Accepted: 10/13/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare postdischarge growth, adiposity and metabolic outcomes of appropriate for gestational age (AGA) versus small for gestational age (SGA) premature infants fed an exclusive human milk (HM)-based diet in the neonatal intensive care unit. DESIGN Premature infants (birth weight ≤1250 g) fed an exclusive HM-based diet were examined at 12-15 months corrected gestational age (CGA) (visit 1) for anthropometrics, serum glucose and non-fasting insulin, and at 18-22 months CGA (visit 2) for body composition by dual-energy X-ray absorptiometry. RESULTS Of 51 children, 33 were AGA and 18 were SGA at birth. The SGA group had weight gain (g/day) equal to AGA group during the follow-up period. SGA had a significantly greater body mass index (BMI) z-score gain from visit 1 to visit 2 (0.25±1.10 vs -0.21±0.84, p=0.02) reflecting catch-up growth. There were no significant differences in total fat mass (FM) and trunk FM between groups. SGA had significantly lower insulin level (5.0±3.7 vs 17.3±15.1 µU/mL, p=0.02) and homeostatic model of assessment-insulin resistance (1.1±0.9 vs 4.3±4.1, p=0.02). Although regional trunk FM correlated with insulin levels in SGA (r=0.893, p=0.04), they had lower insulin level compared with AGA and no difference in adiposity. CONCLUSIONS SGA premature infants who received an exclusive HM-based diet exhibited greater catch-up growth without increased adiposity or elevated insulin resistance compared with AGA at 2 years of age. An exclusive HM-based diet may improve long-term body composition and metabolic outcomes of premature infants with ≤1250 g birth weight, specifically SGA.
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Affiliation(s)
- Chonnikant Visuthranukul
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA,USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA,Section of Nutrition, Department of Pediatrics, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand,Pediatric Nutrition STAR, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Keli M Hawthorne
- Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Joseph L Hagan
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA
| | - Amy B Hair
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA
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Muth ND, Dietz WH, Magge SN, Johnson RK, Bolling CF, Armstrong SC, Haemer MA, Rausch JC, Rogers VW, Abrams SA, Kim JH, Schwarzenberg SJ, Fuchs GJ, Lindsey CW, Rome ES. Public Policies to Reduce Sugary Drink Consumption in Children and Adolescents. Pediatrics 2019; 143:peds.2019-0282. [PMID: 30910915 DOI: 10.1542/peds.2019-0282] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [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] [Indexed: 11/24/2022] Open
Abstract
Excess consumption of added sugars, especially from sugary drinks, poses a grave health threat to children and adolescents, disproportionately affecting children of minority and low-income communities. Public policies, such as those detailed in this statement, are needed to decrease child and adolescent consumption of added sugars and improve health.
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Affiliation(s)
- Natalie D. Muth
- Children’s Primary Care Medical Group, Carlsbad, California
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - William H. Dietz
- Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Sheela N. Magge
- Division of Pediatric Endocrinology and Diabetes, School of Medicine, Johns Hopkins University, Baltimore, Maryland; and
| | - Rachel K. Johnson
- Department of Nutrition and Food Sciences, University of Vermont, Burlington, Vermont
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32
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Greer FR, Sicherer SH, Burks AW, Abrams SA, Fuchs GJ, Kim JH, Lindsey CW, Magge SN, Rome ES, Schwarzenberg SJ, Matsui EC, Bird JA, Davis CM, Hernandez-Trujillo VP, Mahr TA, Orange JS, Pistiner M, Wang J, Williams PV. The Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Hydrolyzed Formulas, and Timing of Introduction of Allergenic Complementary Foods. Pediatrics 2019; 143:peds.2019-0281. [PMID: 30886111 DOI: 10.1542/peds.2019-0281] [Citation(s) in RCA: 206] [Impact Index Per Article: 41.2] [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] [Indexed: 11/24/2022] Open
Abstract
This clinical report updates and replaces a 2008 clinical report from the American Academy of Pediatrics, which addressed the roles of maternal and early infant diet on the prevention of atopic disease, including atopic dermatitis, asthma, and food allergy. As with the previous report, the available data still limit the ability to draw firm conclusions about various aspects of atopy prevention through early dietary interventions. Current evidence does not support a role for maternal dietary restrictions during pregnancy or lactation. Although there is evidence that exclusive breastfeeding for 3 to 4 months decreases the incidence of eczema in the first 2 years of life, there are no short- or long-term advantages for exclusive breastfeeding beyond 3 to 4 months for prevention of atopic disease. The evidence now suggests that any duration of breastfeeding ≥3 to 4 months is protective against wheezing in the first 2 years of life, and some evidence suggests that longer duration of any breastfeeding protects against asthma even after 5 years of age. No conclusions can be made about the role of breastfeeding in either preventing or delaying the onset of specific food allergies. There is a lack of evidence that partially or extensively hydrolyzed formula prevents atopic disease. There is no evidence that delaying the introduction of allergenic foods, including peanuts, eggs, and fish, beyond 4 to 6 months prevents atopic disease. There is now evidence that early introduction of peanuts may prevent peanut allergy.
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Affiliation(s)
- Frank R. Greer
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Scott H. Sicherer
- Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - A. Wesley Burks
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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33
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Roth DE, Abrams SA, Aloia J, Bergeron G, Bourassa MW, Brown KH, Calvo MS, Cashman KD, Combs G, De-Regil LM, Jefferds ME, Jones KS, Kapner H, Martineau AR, Neufeld LM, Schleicher RL, Thacher TD, Whiting SJ. Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries. Ann N Y Acad Sci 2018; 1430:44-79. [PMID: 30225965 DOI: 10.1111/nyas.13968] [Citation(s) in RCA: 273] [Impact Index Per Article: 45.5] [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: 08/20/2018] [Accepted: 08/23/2018] [Indexed: 12/15/2022]
Abstract
Vitamin D is an essential nutrient for bone health and may influence the risks of respiratory illness, adverse pregnancy outcomes, and chronic diseases of adulthood. Because many countries have a relatively low supply of foods rich in vitamin D and inadequate exposure to natural ultraviolet B (UVB) radiation from sunlight, an important proportion of the global population is at risk of vitamin D deficiency. There is general agreement that the minimum serum/plasma 25-hydroxyvitamin D concentration (25(OH)D) that protects against vitamin D deficiency-related bone disease is approximately 30 nmol/L; therefore, this threshold is suitable to define vitamin D deficiency in population surveys. However, efforts to assess the vitamin D status of populations in low- and middle-income countries have been hampered by limited availability of population-representative 25(OH)D data, particularly among population subgroups most vulnerable to the skeletal and potential extraskeletal consequences of low vitamin D status, namely exclusively breastfed infants, children, adolescents, pregnant and lactating women, and the elderly. In the absence of 25(OH)D data, identification of communities that would benefit from public health interventions to improve vitamin D status may require proxy indicators of the population risk of vitamin D deficiency, such as the prevalence of rickets or metrics of usual UVB exposure. If a high prevalence of vitamin D deficiency is identified (>20% prevalence of 25(OH)D < 30 nmol/L) or the risk for vitamin D deficiency is determined to be high based on proxy indicators (e.g., prevalence of rickets >1%), food fortification and/or targeted vitamin D supplementation policies can be implemented to reduce the burden of vitamin D deficiency-related conditions in vulnerable populations.
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Affiliation(s)
- Daniel E Roth
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - John Aloia
- NYU Winthrop Hospital, Mineola, New York
| | - Gilles Bergeron
- The Sackler Institute for Nutrition Science, The New York Academy of Sciences, New York, New York
| | - Megan W Bourassa
- The Sackler Institute for Nutrition Science, The New York Academy of Sciences, New York, New York
| | | | - Mona S Calvo
- Retired, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Kevin D Cashman
- Cork Centre for Vitamin D and Nutrition Research, University College Cork, Cork, Ireland
| | | | | | | | - Kerry S Jones
- MRC Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | | | - Adrian R Martineau
- Blizard Institute, Queen Mary University of London, London, United Kingdom
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34
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O'Brien KO, Abrams SA. Using stable isotope tracers to study bone metabolism in children. J Physiol 2018; 597:1311-1319. [PMID: 29869788 DOI: 10.1113/jp275452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 03/26/2018] [Accepted: 05/08/2018] [Indexed: 11/08/2022] Open
Abstract
Skeletal mineralization is initiated in utero and continues throughout childhood and adolescence. During these key periods of the life cycle, calcium retention must increase significantly to provide sufficient mineral for bone deposition and skeletal growth. Stable calcium isotopes have served as a fundamental tool to non-invasively characterize the dynamic changes in calcium physiology that occur from infancy through adolescence. These approaches have helped define the dynamics of calcium absorption and utilization in healthy children and in children with chronic diseases. As data in this area have accumulated, new areas of emphasis are beginning to characterize the determinants of variability in mineral retention, the genetic determinants of bone turnover and calcium flux and the impact of the gut microbiome on whole body and niche specific calcium dynamics. Advances in these areas will help define calcium utilization in paediatric populations and provide information that may be useful in maximizing bone acquisition across this critical phase of the life cycle.
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Affiliation(s)
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas at Austin, Austin, TX, 78723, USA
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Tan ML, Abrams SA, Osborn DA. Vitamin D supplementation for term breastfed infants to prevent vitamin D deficiency and improve bone health. Cochrane Database of Systematic Reviews 2018. [DOI: 10.1002/14651858.cd013046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- May Loong Tan
- RCSI & UCD Malaysia Campus (formerly Penang Medical College); Department of Paediatrics; 4 Jalan Sepoy Lines Georgetown Penang Malaysia 10450
| | - Steven A Abrams
- Dell Medical School, The University of Texas at Austin; Department of Pediatrics; Austin Texas USA
| | - David A Osborn
- Central Clinical School, School of Medicine, The University of Sydney; Sydney Australia 2006
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36
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Cao F, Lu L, Abrams SA, Hawthorne KM, Tam A, Jin W, Dawson B, Shypailo R, Liu H, Lee B, Nagamani SCS, Wang LL. Generalized metabolic bone disease and fracture risk in Rothmund-Thomson syndrome. Hum Mol Genet 2018; 26:3046-3055. [PMID: 28486640 DOI: 10.1093/hmg/ddx178] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 05/03/2017] [Indexed: 01/05/2023] Open
Abstract
Rothmund-Thomson syndrome (RTS) is a rare autosomal recessive disorder characterized by poikiloderma, small stature, sparse hair, skeletal abnormalities, increased risk of osteosarcoma, and decreased bone mass. To date, there has not been a comprehensive evaluation of the prevalence and extent of metabolic bone disease in RTS. Furthermore, the mechanisms that result in this phenotype are largely unknown. In this report, we provide a detailed evaluation of 29 individuals with RTS with respect to their metabolic bone status including bone mineral density, calcium kinetics studies, and markers of bone remodeling. We show that individuals with RTS have decreased areal bone mineral density. Additionally, we demonstrate that the presence of pathogenic variants in RECQL4 and low bone mineral density correlate with the history of increased risk of fractures. Using a RECQL4-deficient mouse model that recapitulates skeletal abnormalities seen in individuals with RTS, we demonstrate that generalized skeletal involvement is likely due to decreased osteogenesis. Our findings are clinically relevant as they may help in the risk stratification of patients with RTS and also in the identification of individuals who may benefit from additional surveillance and management of metabolic bone disease.
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Affiliation(s)
- Felicia Cao
- Interdepartmental Program in Translational Biology and Molecular Medicine.,Medical Scientist Training Program
| | - Linchao Lu
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas at Austin, Austin, TX 78712, USA
| | - Keli M Hawthorne
- Department of Pediatrics, Dell Medical School at the University of Texas at Austin, Austin, TX 78712, USA
| | | | - Weidong Jin
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, TX 77030, USA
| | | | - Roman Shypailo
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics
| | - Hao Liu
- Division of Biostatistics, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | | | - Sandesh C S Nagamani
- Department of Molecular and Human Genetics.,Texas Children's Hospital, Houston, TX 77030, USA
| | - Lisa L Wang
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, TX 77030, USA.,Texas Children's Hospital, Houston, TX 77030, USA
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Shamshirsaz AA, Lee TC, Hair AB, Erfani H, Espinoza J, Shamshirsaz AA, Fox KA, Gandhi M, Nassr AA, Abrams SA, Olutoye OO, Belfort MA. 40: Early delivery in fetal gastroschisis: a randomized controlled trial of elective 34 week delivery versus routine obstetrical care. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.10.451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abrams SA, Daniels SR, Heyman MB. Authors' Response. Pediatrics 2017; 140:peds.2017-2301B. [PMID: 28970343 DOI: 10.1542/peds.2017-2301b] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Heyman MB, Abrams SA, Heitlinger LA, Cabana MD, Gilger MA, Gugig R, Hill ID, Lightdale JR, Daniels SR, Corkins MR, de Ferranti SD, Golden NH, Magge SN, Schwarzenberg SJ. Fruit Juice in Infants, Children, and Adolescents: Current Recommendations. Pediatrics 2017; 139:peds.2017-0967. [PMID: 28562300 DOI: 10.1542/peds.2017-0967] [Citation(s) in RCA: 190] [Impact Index Per Article: 27.1] [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] [Indexed: 11/24/2022] Open
Abstract
Historically, fruit juice was recommended by pediatricians as a source of vitamin C and as an extra source of water for healthy infants and young children as their diets expanded to include solid foods with higher renal solute load. It was also sometimes recommended for children with constipation. Fruit juice is marketed as a healthy, natural source of vitamins and, in some instances, calcium. Because juice tastes good, children readily accept it. Although juice consumption has some benefits, it also has potential detrimental effects. High sugar content in juice contributes to increased calorie consumption and the risk of dental caries. In addition, the lack of protein and fiber in juice can predispose to inappropriate weight gain (too much or too little). Pediatricians need to be knowledgeable about juice to inform parents and patients on its appropriate uses.
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Affiliation(s)
- Melvin B. Heyman
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of California, San Francisco, California
- UCSF Benioff Children’s Hospital, San Francisco, California; and
| | - Steven A. Abrams
- Department of Pediatrics, Dell Pediatric Research Institute, University of Texas at Austin, Austin, Texas
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40
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Affiliation(s)
- Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas at Austin, Austin, Texas; and
| | - Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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41
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Affiliation(s)
- Steven A Abrams
- Department of Pediatrics and Dell Pediatric Research Institute, Dell Medical School at the University of Texas at Austin, Austin, TX
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42
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Abstract
To support food security for current and future generations, there is a need to understand the relation between sustainable diets and the health of a population. In recent years, a number of studies have investigated and compared different dietary patterns to better understand which foods and eating patterns have less of an environmental impact while meeting nutritional needs and promoting health. This systematic review (SR) of population-level dietary patterns and food sustainability extends and updates the SR that was conducted by the 2015 US Dietary Guidelines Advisory Committee, an expert committee commissioned by the federal government to inform dietary guidance as it relates to the committee's original conclusions. In the original SR, 15 studies met the criteria for inclusion; since then, an additional 8 studies have been identified and included. The relations between dietary intake patterns and both health and environmental outcomes were compared across studies, with methodologies that included modeling, life cycle assessment, and land use analysis. Across studies, consistent evidence indicated that a dietary pattern higher in plant-based foods (e.g., vegetables, fruits, legumes, seeds, nuts, whole grains) and lower in animal-based foods (especially red meat), as well as lower in total energy, is both healthier and associated with a lesser impact on the environment. This dietary pattern differs from current average consumption patterns in the United States. Our updated SR confirms and strengthens the conclusions of the original US Dietary Guidelines Advisory Committee SR, which found that adherence to several well-characterized dietary patterns, including vegetarian (with variations) diets, dietary guidelines-related diets, Mediterranean-style diets, the Dietary Approaches to Stop Hypertension (DASH) diet, and other sustainable diet scenarios, promotes greater health and has a less negative impact on the environment than current average dietary intakes.
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Affiliation(s)
- Miriam E Nelson
- Sustainability Institute, University of New Hampshire, Durham, NH;
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Michael W Hamm
- Department of Community Sustainability, Michigan State University, East Lansing, MI
| | - Frank B Hu
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Timothy S Griffin
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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Ware NA, Oni L, O'Brien KO, Abrams SA, Rees L. The dual-tracer stable isotope method to measure calcium absorption in children on dialysis: a new use for an old technique. Pediatr Nephrol 2016; 31:1713-4. [PMID: 27344561 DOI: 10.1007/s00467-016-3435-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 05/25/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Nicholas A Ware
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Louise Oni
- Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP, UK
| | | | - Steven A Abrams
- Dell Medical School, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Lesley Rees
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
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Cusick SE, Opoka RO, Abrams SA, John CC, Georgieff MK, Mupere E. Delaying Iron Therapy until 28 Days after Antimalarial Treatment Is Associated with Greater Iron Incorporation and Equivalent Hematologic Recovery after 56 Days in Children: A Randomized Controlled Trial. J Nutr 2016; 146:1769-74. [PMID: 27358418 PMCID: PMC4997284 DOI: 10.3945/jn.116.233239] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/18/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Iron therapy begun concurrently with antimalarial treatment may not be well absorbed because of malaria-induced inflammation. Delaying the start of iron therapy may permit better iron absorption and distribution. OBJECTIVE We compared erythrocyte iron incorporation in children who started iron supplementation concurrently with antimalarial treatment or 28 d later. We hypothesized that delayed iron supplementation would be associated with greater incorporation and better hematologic recovery. METHODS We enrolled 100 children aged 6-59 mo with malaria and hemoglobin concentrations of 50.0-99.9 g/L who presented to Mulago Hospital, Kampala, into a randomized trial of iron therapy. All children were administered antimalarial treatment. Children with zinc protoporphyrin (ZPP) ≥80 μmol/mol heme were randomly assigned to start iron supplementation concurrently with the antimalarial treatment [immediate iron (I) group] or 28 d later [delayed iron (D) group]. All children were administered iron-stable isotope (57)Fe on day 0 and (58)Fe on day 28. We compared the percentage of iron incorporation at the start of supplementation (I group at day 0 compared with D group at day 28, aim 1) and hematologic recovery at day 56 (aim 2). RESULTS The percentage of iron incorporation (mean ± SE) was greater at day 28 in the D group (16.5% ± 1.7%) than at day 0 in the I group (7.9% ± 0.5%; P < 0.001). On day 56, concentrations of hemoglobin and ZPP and plasma ferritin, soluble transferrin receptor (sTfR), hepcidin, and C-reactive protein did not differ between the groups. On day 28, the hemoglobin (mean ± SD) and plasma iron markers (geometric mean; 95% CI) reflected poorer iron status in the D group than in the I group at this intervening time as follows: hemoglobin (105 ± 15.9 compared with 112 ± 12.4 g/L; P = 0.04), ferritin (39.3 μg/L; 23.5, 65.7 μg/L compared with 79.9 μg/L; 58.3, 110 μg/L; P = 0.02), sTfR (8.9 mg/L; 7.4, 10.7 mg/L compared with 6.7 mg/L; 6.1, 7.5 mg/L; P = 0.01), and hepcidin (13.3 ng/mL; 8.3, 21.2 ng/mL compared with 38.8 ng/mL; 28.3, 53.3 ng/mL; P < 0.001). CONCLUSIONS Delaying the start of iron improves incorporation but leads to equivalent hematologic recovery at day 56 in Ugandan children with malaria and anemia. These results do not demonstrate a clear, short-term benefit of delaying iron. This trial was registered at clinicaltrials.gov as NCT01754701.
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Affiliation(s)
- Sarah E Cusick
- Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN;
| | - Robert O Opoka
- Departament of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Steven A Abrams
- Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, TX; and
| | - Chandy C John
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Michael K Georgieff
- Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN
| | - Ezekiel Mupere
- Departament of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Hair AB, Chetta KE, Bruno AM, Hawthorne KM, Abrams SA. Delayed Introduction of Parenteral Phosphorus Is Associated with Hypercalcemia in Extremely Preterm Infants. J Nutr 2016; 146:1212-6. [PMID: 27146915 DOI: 10.3945/jn.115.228254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 12/07/2015] [Accepted: 03/30/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Early parenteral nutrition (PN) provides essential macro- and micronutrients for extremely low birth weight (ELBW) infants <1000 g. Frequent cases of hypercalcemia [whole blood ionized calcium (iCa) > 1.45 mmol/L] in the first week of life while receiving PN solutions at our large quaternary center prompted investigation and 2 plan-do-study-act (PDSA) cycles to reduce rates of hypercalcemia. OBJECTIVE We compared 2 cohorts of ELBW infants separated by PDSA cycles to evaluate and reduce the incidence of abnormal iCa concentration. METHODS Data were recorded for 150 premature infants with mean birth weight of 726 ± 164 g, 48% male, and mean gestational age of 26 ± 2.1 wk. This process included an internal practice analysis and PDSA cycles monitored prospectively over 3 y. From December 2011 to September 2012, 66 infants received 0-1.2 mmol parenteral phosphorus supplementation/(kg ⋅ d) beginning at 72 h of life. In the second protocol, 84 infants born September 2012 to July 2013 received earlier phosphorus supplementation within 24 h of life. The peak whole blood iCa and serum phosphorus concentrations in the first week of life were monitored. RESULTS Early introduction of phosphorus was significantly associated with a decreased mean peak iCa (1.64 ± 0.27 mmol/L to 1.50 ± 0.23 mmol/L, P = 0.001), and the incidence of severe hypercalcemia (iCa > 1.60 mmol/L) decreased from 50.0% to 21.4% (P = 0.002) in the first week of life. There was no difference in mortality, bronchopulmonary dysplasia, renal calcifications, seizures within 7 d of birth, brain calcifications, or intracranial hemorrhage between cohorts. CONCLUSION Early introduction of phosphorus in PN solutions is associated with reduced incidence of whole blood iCa abnormalities in the first week of life and should be considered for ELBW infants. Ongoing evaluation of optimal mineral provision to this population after birth should be performed.
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Affiliation(s)
- Amy B Hair
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX; and
| | - Katherine E Chetta
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX; and
| | - Ann M Bruno
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX; and
| | - Keli M Hawthorne
- Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX
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Hair AB, Bergner EM, Lee ML, Moreira AG, Hawthorne KM, Rechtman DJ, Abrams SA, Blanco CL. Premature Infants 750-1,250 g Birth Weight Supplemented with a Novel Human Milk-Derived Cream Are Discharged Sooner. Breastfeed Med 2016; 11:133-7. [PMID: 26982282 PMCID: PMC4827298 DOI: 10.1089/bfm.2015.0166] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Infants may benefit from early nutritional intervention to decrease hospital stay. To evaluate the effects of adding a human milk (HM)-derived cream (Cream) product to a standard feeding regimen in preterm infants. MATERIALS AND METHODS In a prospective multicenter randomized study, infants with birth weights 750-1,250 g were assigned to a Control or Cream group. The Control group received a standard feeding regimen consisting of mother's own milk or donor HM with donor HM-derived fortifier. The Cream group received the standard feeding regimen along with an additional HM-derived cream supplement when the HM they received was <20 kcal/oz. Primary outcomes of this secondary analysis included comorbidities, length of stay (LOS), and postmenstrual age (PMA) at discharge. RESULTS We enrolled 75 infants (Control n = 37, Cream n = 38) with gestational age 27.7 ± 1.8 weeks and birth weight 973 ± 145 g (mean ± SD). After adjusting for gestational age, birth weight, and presence of bronchopulmonary dysplasia (BPD), the Cream group had a decreased PMA at discharge (39.9 ± 4.8 versus 38.2 ± 2.7 weeks, p = 0.03) and LOS (86 ± 39 versus 74 ± 22 days, p = 0.05). For 21 infants with BPD, these values trended toward significance for PMA at discharge (44.2 ± 6.1 versus 41.3 ± 2.7 weeks, p = 0.08) and LOS (121 ± 49 versus 104 ± 23 days, p = 0.08). CONCLUSIONS Very preterm infants who received an HM-derived cream supplement were discharged earlier. Infants with BPD may have benefited the most.
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Affiliation(s)
- Amy B Hair
- 1 Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital , Houston, Texas
| | - Erynn M Bergner
- 1 Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital , Houston, Texas
| | | | - Alvaro G Moreira
- 3 Department of Pediatrics, University of Texas Health Science Center , San Antonio, Texas
| | - Keli M Hawthorne
- 4 Department of Pediatrics, Dell Medical School at the University of Texas at Austin , Austin, Texas
| | | | - Steven A Abrams
- 4 Department of Pediatrics, Dell Medical School at the University of Texas at Austin , Austin, Texas
| | - Cynthia L Blanco
- 3 Department of Pediatrics, University of Texas Health Science Center , San Antonio, Texas
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Hair AB, Peluso AM, Hawthorne KM, Perez J, Smith DP, Khan JY, O'Donnell A, Powers RJ, Lee ML, Abrams SA. Beyond Necrotizing Enterocolitis Prevention: Improving Outcomes with an Exclusive Human Milk-Based Diet. Breastfeed Med 2016; 11:70-4. [PMID: 26789484 PMCID: PMC4782036 DOI: 10.1089/bfm.2015.0134] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to compare outcomes of infants pre and post initiation of a feeding protocol providing an exclusive human milk-based diet (HUM). MATERIALS AND METHODS In a multicenter retrospective cohort study, infants with a birth weight <1,250 g who received a bovine-based diet (BOV) of mother's own milk fortified with bovine fortifier and/or preterm formula were compared to infants who received a newly introduced HUM feeding protocol. Infants were excluded if they had major congenital anomalies or died in the first 12 hours of life. Data were collected 2-3 years prior to and after introduction of an exclusive HUM diet. Primary outcomes were necrotizing enterocolitis (NEC) and mortality. Secondary outcomes included late-onset sepsis, retinopathy of prematurity (ROP), and bronchopulmonary dysplasia (BPD). RESULTS A total of 1,587 infants were included from four centers in Texas, Illinois, Florida, and California. There were no differences in baseline demographics or growth of infants. The HUM group had significantly lower incidence of proven NEC (16.7% versus 6.9%, p < 0.00001), mortality (17.2% versus 13.6%, p = 0.04), late-onset sepsis (30.3% versus 19.0%, p < 0.00001), ROP (9% versus 5.2%, p = 0.003), and BPD (56.3% versus 47.7%, p = 0.0015) compared with the BOV group. CONCLUSIONS Extremely premature infants who received an exclusive HUM diet had a significantly lower incidence of NEC and mortality. The HUM group also had a reduction in late-onset sepsis, BPD, and ROP. This multicenter study further emphasizes the many benefits of an exclusive HUM diet, and demonstrates multiple improved outcomes after implementation of such a feeding protocol.
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Affiliation(s)
- Amy B Hair
- 1 USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital , Houston, Texas
| | - Allison M Peluso
- 1 USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital , Houston, Texas
| | - Keli M Hawthorne
- 1 USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital , Houston, Texas
| | - Jose Perez
- 2 Department of Neonatology, Winnie Palmer Hospital for Women and Babies , Orlando, Florida
| | - Denise P Smith
- 2 Department of Neonatology, Winnie Palmer Hospital for Women and Babies , Orlando, Florida
| | - Janine Y Khan
- 3 Department of Pediatrics, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Andrea O'Donnell
- 4 Department of Clinical Nutrition Services, Northwestern Memorial Hospital , Chicago, Illinois
| | - Richard J Powers
- 5 Department of Neonatology, Good Samaritan Hospital , San Jose, California
| | | | - Steven A Abrams
- 1 USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital , Houston, Texas
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Aloia J, Dhaliwal R, Mikhail M, Shieh A, Stolberg A, Ragolia L, Fazzari M, Abrams SA. Free 25(OH)D and Calcium Absorption, PTH, and Markers of Bone Turnover. J Clin Endocrinol Metab 2015; 100:4140-5. [PMID: 26312580 PMCID: PMC4702446 DOI: 10.1210/jc.2015-2548] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
CONTEXT It has been proposed that serum free 25-hydroxyvitamin D [25(OH)D] may better reflect vitamin D action than total 25(OH)D. An ELISA for serum free 25(OH)D has recently become available, permitting direct assay. OBJECTIVE To determine whether serum free 25(OH)D provides additional information in relation to calcium absorption and other biomarkers of vitamin D action compared to total serum 25(OH)D. SETTING Ambulatory research setting in a teaching hospital. OUTCOME Serum free 25(OH)D measured in a previously performed study of varied doses of vitamin D3 (placebo and 800, 2000, and 4000 IU) on calcium absorption, PTH, procollagen type 1 N-terminal propeptide, and C-terminal telopeptides of type I collagen. Free 25(OH)D was measured by ELISA. Calcium absorption was measured at baseline and at 10 weeks using stable dual calcium isotopes. RESULTS Seventy-one subjects completed this randomized, placebo-controlled trial. Baseline group mean free and total 25(OH)D varied from 4.7 ± 1.8 to 5.4 ± 1.5 pg/mL, and from 23.7 ± 5.9 to 25.9 ± 6.1 ng/mL, respectively. Participants assigned to the 4000-IU dose arm achieved free 25(OH)D levels of 10.4 pg/mL and total 25(OH)D levels of 40.4 ng/mL. Total and free 25(OH)D were highly correlated at baseline and after increasing vitamin D dosing (r = 0.80 and 0.85, respectively). Free 25(OH)D closely reflected changes in total 25(OH)D. PTH was similarly correlated at baseline and follow-up with total and free 25(OH)D. Serum C-terminal telopeptides of type I collagen had a moderate positive correlation with total and free 25(OH)D at follow-up. The serum 1,25-dihydroxyvitamin D change increased significantly with the change in 25(OH)D but not with the change in free 25(OH)D. CONCLUSION There was no advantage from measuring free over total 25(OH)D in assessing the response of calcium absorption, PTH, and markers of bone turnover to vitamin D. Free 25(OH)D responded to increasing doses of vitamin D in a similar fashion to total 25(OH)D.
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Affiliation(s)
- John Aloia
- Winthrop University Hospital, Mineola, New York 11501
| | | | | | - Albert Shieh
- Winthrop University Hospital, Mineola, New York 11501
| | | | - Louis Ragolia
- Winthrop University Hospital, Mineola, New York 11501
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Chetta KE, Hair AB, Hawthorne KM, Abrams SA. Serum phosphorus levels in premature infants receiving a donor human milk derived fortifier. Nutrients 2015; 7:2562-73. [PMID: 25912036 PMCID: PMC4425161 DOI: 10.3390/nu7042562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/13/2014] [Revised: 03/11/2015] [Accepted: 03/30/2015] [Indexed: 11/16/2022] Open
Abstract
An elevated serum phosphorus (P) has been anecdotally described in premature infants receiving human milk fortified with donor human milk-derived fortifier (HMDF). No studies have prospectively investigated serum P in premature infants receiving this fortification strategy. In this single center prospective observational cohort study, extremely premature infants ≤ 1250 grams (g) birth weight (BW) were fed an exclusive human milk-based diet receiving HMDF and serum P levels were obtained. We evaluated 93 infants with a mean gestational age of 27.5 ± 2.0 weeks (Mean ± SD) and BW of 904 ± 178 g. Seventeen infants (18.3%) had at least one high serum P level with a mean serum P of 9.2 ± 1.1 mg/dL occurring at 19 ± 11 days of life. For all infants, the highest serum P was inversely correlated to the day of life of the infant (p < 0.001, R2 = 0.175) and positively correlated with energy density of HMDF (p = 0.035). Serum P was not significantly related to gender, BW, gestational age, or days to full feeds. We conclude that the incidence of hyperphosphatemia was mild and transient in this population. The risk decreased with infant age and was unrelated to gender, BW, or ethnicity.
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Affiliation(s)
- Katherine E Chetta
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA.
| | - Amy B Hair
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA.
| | - Keli M Hawthorne
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA.
| | - Steven A Abrams
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
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Abrams SA, Hawthorne KM, Pammi M. A systematic review of controlled trials of lower-protein or energy-containing infant formulas for use by healthy full-term infants. Adv Nutr 2015; 6:178-88. [PMID: 25770256 PMCID: PMC4352176 DOI: 10.3945/an.114.006379] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Infant formulas have historically been developed based on providing macronutrients at intake concentrations approximately matching the composition of human milk. In most countries, targets of 1.4-1.5 g of protein/dL and 20 kcal/oz (67-68 kcal/dL) have been set as the protein and energy concentrations for formulas during the first year of life, although this may be an overestimation of these contents. Recent introduction of lower-protein and -energy formulas in full-term infants led us to systematically review the literature for its effects on growth. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, our inclusion criteria were studies that enrolled healthy full-term infants and evaluated lower-protein or lower-energy formula, reported anthropometric outcomes including weight and length, and followed infants for at least 6 mo. Six studies were eligible for inclusion. These studies varied in the content of nutrients provided in the intervention and control groups, by additional dietary components in the study groups, and the timing and length of the intervention, which limit their usefulness for interpreting newly introduced lower-protein and -energy formulas in the United States. These studies suggest adequate growth during infancy and early childhood with infant formulas with concentrations of protein and energy slightly below historical standards in the United States. Further long-term research is needed to assess the impact of the use of lower-protein and/or lower-energy products, especially for nutritionally at-risk populations such as preterm infants and infants who are born small for gestational age.
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Affiliation(s)
- Steven A Abrams
- USDA/Agricultural Research Service, Children's Nutrition Research Center, Department of Pediatrics, and
| | - Keli M Hawthorne
- USDA/Agricultural Research Service, Children's Nutrition Research Center, Department of Pediatrics, and
| | - Mohan Pammi
- Section of Neonatology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
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