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Toulia I, Savvidou P, Ververi A, Grammatikopoulou MG, Kosta K, Tziaferi V, Antachopoulos C, Goulis DG, Sotiriadis A, Tsiroukidou K. Clinical and genetic diagnosis and management of Silver-Russell syndrome: Report of four cases. World J Clin Pediatr 2025; 14:100330. [DOI: 10.5409/wjcp.v14.i2.100330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 11/19/2024] [Accepted: 01/07/2025] [Indexed: 03/18/2025] Open
Abstract
BACKGROUND Silver-Russell syndrome (SRS) is a clinically heterogeneous entity characterized by intrauterine and postnatal growth restriction, relative macrocephaly at birth, distinct facial features, and body asymmetry combined with other malformations.
CASE SUMMARY Herein, we describe four individuals with SRS, focusing on their prenatal phenotype, postnatal presentation, diagnosis, and management. All cases had a typical phenotype, including postnatal growth failure, short stature (chronic malnutrition), and protruding forehead. Individually, they presented with feeding difficulties, leg length discrepancy, triangular face, or relative macrocephaly at birth, and each one exhibited distinct SRS features, including motor and/or speech delay, experiencing frequent hypoglycemic episodes. The fact that each patient exhibited a different combination of clinical findings underlines the heterogeneity of the syndrome.
CONCLUSION SRS is diagnosed clinically. However, only 60% of cases are genetically confirmed, while most are sporadic. Although SRS is a well-described syndrome, a delayed diagnosis can have grave consequences on a child’s growth. Recombinant human growth hormone treatment is often initiated shortly after the diagnosis. The follow-up requires a multidisciplinary approach.
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Affiliation(s)
- Ilektra Toulia
- Endocrine Unit, 3rd Pediatric Department, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki GR-54124, Kentrikí Makedonía, Greece
| | - Parthena Savvidou
- Endocrine Unit, 3rd Pediatric Department, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki GR-54124, Kentrikí Makedonía, Greece
| | - Athina Ververi
- Department of Genetics for Rare Diseases, Papageorgiou General Hospital, Thessaloniki GR-54124, Kentrikí Makedonía, Greece
| | - Maria G Grammatikopoulou
- Immunonutrition Unit, Department of Rheumatology & Clinical Immunology, University of Thessaly, Larissa University Hospital, Larissa GR-41223, Thessalía, Greece
| | - Konstantina Kosta
- Endocrine Unit, 3rd Pediatric Department, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki GR-54124, Kentrikí Makedonía, Greece
| | - Vaya Tziaferi
- Pediatric Endocrinology Clinic, Thessaloniki GR-55535, Kentrikí Makedonía, Greece
| | - Charalampos Antachopoulos
- 3rd Department of Pediatrics, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki GR-54124, Kentrikí Makedonía, Greece
| | - Dimitrios G Goulis
- First Department of Obstetrics and Gynecology, Medical School, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki GR-54601, Kentrikí Makedonía, Greece
| | - Alexandros Sotiriadis
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki GR-54124, Greece
| | - Kyriaki Tsiroukidou
- Endocrine Unit, 3rd Pediatric Department, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki GR-54124, Kentrikí Makedonía, Greece
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Aldana-Parra F, Olaya Vega G, Fewtrell M. Effectiveness of a new breastfeeding counselling intervention on breastfeeding prevalence, infant growth velocity and postpartum weight loss in overweight women: a randomized controlled trial. Int Breastfeed J 2025; 20:14. [PMID: 40051012 PMCID: PMC11887114 DOI: 10.1186/s13006-025-00703-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Accepted: 02/03/2025] [Indexed: 03/09/2025] Open
Abstract
BACKGROUND Maternal overweight is a risk factor for child obesity. Breastfeeding may decrease this risk, but breastfeeding prevalence is low in overweight or obese mothers. METHODS We conducted a randomized trial in 90 overweight/obese pregnant women in Bogotá-Colombia during 2019, to evaluate the effects of a new exclusive breastfeeding (EBF) counselling intervention for overweight/obese mothers, based on Carl Rogers' client-centered theory. The Intervention included individualized breastfeeding counseling, empowerment sessions, and a set of problem-solving strategies based on Carl Rogers' client-centered theory, conducted during late pregnancy, first week postpartum, 1 and 3 months postpartum. Primary outcomes were EBF during the last 24 h prevalence at 4 months postpartum, infant growth, and maternal weight loss at 4 months postpartum; secondary outcomes were serum and breast milk prolactin concentration, breast milk energy and macronutrient content, estimated breast milk volume at 1 and 4 months and EBF prevalence at interim time-points. Mothers were randomised in late pregnancy to intervention (new breastfeeding counselling; IG) or control group (standard breastfeeding support; CG). RESULTS The IG had significantly higher EBF prevalence at 4 months (82.8%) compared to the CG (30.6%) (Prevalence ratio or PR = 2.7; 95% CI = 1.6, 4.5). There were no intervention effects on infant growth velocity, maternal weight loss or secondary outcomes. DISCUSSION The intervention, which could be implemented in primary care settings, was highly effective for increasing the prevalence of EBF in overweight/obese mothers at 4 months postpartum. The results should, however, be interpreted in the context of the small sample size, short follow-up period and loss to follow-up. Further evaluation of the intervention is required in a larger sample including longer-term infant follow-up. TRIAL REGISTRATION (UTN) U1111-1228-9913 20 February 2019; ISRCTN15922904, retrospectively registered.
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Affiliation(s)
- Fanny Aldana-Parra
- Department of Nutrition and Biochemistry, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - Gilma Olaya Vega
- Department of Nutrition and Biochemistry, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Mary Fewtrell
- Childhood Nutrition Research group, Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
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Ribas SA, Medeiros FJ, Teixeira MT, Andrade PV, Rodrigues MCC, Ferreira FCPDADM, Villela LD, Neri D. Household food insecurity and its association with diet quality in high-risk children. CIENCIA & SAUDE COLETIVA 2025; 30:e10142023. [PMID: 39936685 DOI: 10.1590/1413-81232025302.10142023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/30/2023] [Indexed: 02/13/2025] Open
Abstract
The aim of this study was to evaluate the association between dietary practices and household food insecurity (HFI) status among high-risk children during the COVID-19 pandemic. This cross-sectional study was conducted with 147 children aged 1 to 9 attending at three reference health centers in the city of Rio de Janeiro. Diet quality data was assessed using Healthy Eating Indices. The Brazilian Scale of Food and Nutrition Insecurity measured HFI status. Associations between HFI and dietary practices were assessed using logistic regression models. Almost half of the children lived with food insecurity (47.6%). HFI was associated with deteriorated diet quality, evidenced by the increased weekly frequency of consumption of ultra-processed foods (UPF), such as sugar-sweetened beverages and processed meats, and reduced frequency of fruits and vegetables. Parents perceived a reduction in meat and milk consumption and an increase in the intake of UPF among households of children in HFI throughout the pandemic. Our results suggest that HFI status was associated with deterioration in diet quality during the critical phase of social isolation.
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Affiliation(s)
- Simone Augusta Ribas
- Departamento de Nutrição em Saúde Pública, Universidade Federal do Estado do Rio de Janeiro (Unirio). Av. Pasteur 296, Urca. 22290-240 Rio de Janeiro RJ Brasil.
| | | | | | - Patrícia Vieira Andrade
- Programa de Bolsas de Estudo e Treinamento em Pesquisa em Oncologia, Instituto Nacional do Câncer (INCA). Rio de Janeiro RJ Brasil
| | | | | | | | - Daniela Neri
- Departamento de Nutrição em Saúde Pública, Unirio. Rio de Janeiro RJ Brasil
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Alves M, Serra S, Costa T, Brás-Geraldes C, Papoila AL, Heleno B. Growth curve models for weight among infants: a scoping review protocol. JBI Evid Synth 2025; 23:401-407. [PMID: 39938531 DOI: 10.11124/jbies-24-00152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2025]
Abstract
OBJECTIVE This scoping review aims to provide a systematic overview of the literature on statistical models to estimate weight growth curves among infants, examining key features such as study design, sample size, and statistical approaches. INTRODUCTION Growth models were first developed to estimate individuals' growth curves by modeling each individual separately. Later, with the aim of estimating mean trajectories, approaches using mixed effects regression models were proposed. More flexible models were also applied in this context, enabling the estimation of more parameters (eg, Generalized Additive Models for Location, Scale, and Shape; SuperImposition by Translation and Rotation models). INCLUSION CRITERIA Studies of statistical/mathematical methodologies for estimating weight growth curves of infants under 24 months of age, based on prospective/retrospective cohorts, or cross-sectional studies will be included. Only studies published in English, Portuguese, or Spanish will be considered. Case series reports, reviews, short letter publications, books, and abstract-only papers, such as conference proceedings, will be excluded. METHODS This review will be conducted in accordance with the JBI methodology for scoping reviews. PubMed, Scopus, Web of Science Core Collection, SciELO, and LILACS will be searched for published studies, while ProQuest and RCAAP will be searched for unpublished studies. Search results will be imported into Rayyan to remove duplicates. Two reviewers will independently screen titles, abstracts, and full-text articles. Any disagreements will be resolved through discussion or with a third reviewer. The resulting data, namely mathematical/statistical approaches and models, will be summarized in tabular format, accompanied by a narrative summary. REVIEW REGISTRATION Open Science Framework https://osf.io/95udq.
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Affiliation(s)
- Marta Alves
- Epidemiology and Statistics Unit, Research Center, Unidade Local de Saúde São José, Centro Clínico Académico de Lisboa, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas da Universidade Nova de Lisboa (UNL), Lisbon, Portugal
- Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), Lisbon, Portugal
| | - Sofia Serra
- NOVA Medical School, Faculdade de Ciências Médicas da Universidade Nova de Lisboa (UNL), Lisbon, Portugal
- Centro de Estudos Clássicos, Faculdade de Letras, Universidade de Lisboa, Lisbon, Portugal
| | - Teresa Costa
- NOVA Medical School, Faculdade de Ciências Médicas da Universidade Nova de Lisboa (UNL), Lisbon, Portugal
- Centro de Estudos Clássicos, Faculdade de Letras, Universidade de Lisboa, Lisbon, Portugal
| | - Carlos Brás-Geraldes
- Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), Lisbon, Portugal
- Instituto Superior de Engenharia de Lisboa (ISEL) do Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Ana Luisa Papoila
- Epidemiology and Statistics Unit, Research Center, Unidade Local de Saúde São José, Centro Clínico Académico de Lisboa, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas da Universidade Nova de Lisboa (UNL), Lisbon, Portugal
- Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), Lisbon, Portugal
| | - Bruno Heleno
- NOVA Medical School, Faculdade de Ciências Médicas da Universidade Nova de Lisboa (UNL), Lisbon, Portugal
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Alvarez I, Tötterman K, Honkaniemi E, Sarman I, Bäck K, Forsberg L, Heinonen EW, Svedenkrans J. Breastfed infants exposed to lamotrigine faced a low risk of toxic effects. Acta Paediatr 2025; 114:346-354. [PMID: 39300873 PMCID: PMC11706751 DOI: 10.1111/apa.17432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 08/17/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024]
Abstract
AIM We aimed to investigate plasma lamotrigine concentrations and clinical effects in infants exposed to lamotrigine through breastfeeding. METHODS This was a retrospective study of mother-infant dyads in a clinical follow-up programme in Stockholm, Sweden. Data were collected from medical records. RESULTS We included 47 breastfed infants, born from 2011 to 2021, with a median gestational age of 39 + 6 weeks/days and a median birth weight of 3420 g. The median lamotrigine concentration in the infants' plasma was 2.5 (range 2.5-14.0) μmol/L. These concentrations correlated significantly with both the maternal plasma concentrations and the maternal doses (R = 0.79, p < 0.001 versus R = 0.54, p < 0.001). During the follow up, lamotrigine concentrations within the reference range for epilepsy treatment were detected in six (14%) infants and one had clinical symptoms that were probably related to lamotrigine exposure. Liver transaminases were elevated in three of 21 infants. All infants whose mothers had a dose of 150 mg or less had undetectable plasma concentrations and no symptoms during follow up. CONCLUSION Infants exposed to lamotrigine through breastfeeding had a low risk of toxic effects. All infants whose mothers had low lamotrigine doses had unmeasurable plasma concentrations and no symptoms of lamotrigine exposure. These low-risk infants might be offered a simplified follow up.
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Affiliation(s)
- Ingrid Alvarez
- Division of Paediatrics, Department of Clinical Science, Intervention and TechnologyKarolinska InstitutetStockholmSweden
- Department of NeonatologyKarolinska University HospitalStockholmSweden
| | | | - Emma Honkaniemi
- Liljeholmen Outpatient ClinicAstrid Lindgren Children's Hospital, Karolinska University HospitalStockholmSweden
| | - Ihsan Sarman
- Sachs' Children and Youth HospitalStockholmSweden
- Department of Clinical Science and EducationKarolinska InstitutetStockholmSweden
| | - Karin Bäck
- Department of NeonatologyCapio St Göran's HospitalStockholmSweden
| | - Lisa Forsberg
- Division of Paediatrics, Department of Clinical Science, Intervention and TechnologyKarolinska InstitutetStockholmSweden
| | - Essi Whaites Heinonen
- Division of Paediatrics, Department of Clinical Science, Intervention and TechnologyKarolinska InstitutetStockholmSweden
- Department of NeonatologyKarolinska University HospitalStockholmSweden
| | - Jenny Svedenkrans
- Division of Paediatrics, Department of Clinical Science, Intervention and TechnologyKarolinska InstitutetStockholmSweden
- Department of NeonatologyKarolinska University HospitalStockholmSweden
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Locks LM, Chembe M, Billima-Mulenga T, Lauer JM, Sizakawe D, Henderson S, Rockers PC, Parkerson D, Fink G. Predictors of Stunting and Pathway Analysis for Linear Growth among Children Aged Two to Three Years after a Trial of Small-Quantity Lipid-Based Nutrient Supplements and Home-Installed Growth Charts in Three Districts in Zambia. J Nutr 2025; 155:589-601. [PMID: 39542400 DOI: 10.1016/j.tjnut.2024.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 11/04/2024] [Accepted: 11/07/2024] [Indexed: 11/17/2024] Open
Abstract
BACKGROUND Globally, 148 million children aged <5 y are stunted, with risk factors varying by context. Our "Impact of Growth Charts and Nutritional Supplements on Child Growth in Zambia" (ZamCharts) trial observed persistently high rates of stunting in all treatment groups after 18-mo of intervention with monthly distributions of small-quantity lipid-based nutrient supplements (SQ-LNS) and/or installation of a wall-mounted growth chart in children's homes. OBJECTIVES We sought to identify determinants of stunting and height-for-age z-score in children aged 27-36 mo who participated in the ZamCharts endline survey (n = 1911). METHODS Multilevel, log-binomial models were used to estimate univariable and multivariable prevalence ratios for predictors of stunting. Multilevel models were also used to predict height-for-age z-score (HAZ) with and without baseline HAZ (assessed at ages 211 mo). We also conducted a path analysis using covariance analysis of linear structural equations to assess underlying and modifiable risk factors for impaired linear growth. RESULTS Significant predictors of stunting in the multivariable model included low asset ownership, being male, using biomass as cooking fuel, lower maternal height, a mother with ≤ primary education, lower baseline HAZ, and not being randomly assigned to SQ-LNS. Significant predictors of a lower mean HAZ in the full multivariable models included all the same risk factors that predicted stunting but also living in an urban area, having ≥1 child aged <5 y in the household, and diarrhea in the previous 2 wk. The multivariable model explained 48% of variability in endline HAZ; the strongest predictor was baseline HAZ, which explained 29% of endline HAZ variability in the univariable model. CONCLUSIONS Preventing stunting in Zambia will require investments in early life (pre- and postnatal) determinants of growth trajectory as well as improving complementary feeding practices and addressing risk factors for infectious diseases; SQ-LNS can also improve linear growth and reduce stunting.
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Affiliation(s)
- Lindsey M Locks
- Boston University, Sargent College of Health and Rehabilitation Sciences. Department of Health Sciences, Boston, MA, United States; Boston University, School of Public Health. Department of Global Health, Boston, MA, United States.
| | - Mpela Chembe
- Innovations for Poverty Action Zambia, Lusaka, Zambia
| | | | - Jacqueline M Lauer
- Boston University, Sargent College of Health and Rehabilitation Sciences. Department of Health Sciences, Boston, MA, United States
| | | | | | - Peter C Rockers
- Boston University, School of Public Health. Department of Global Health, Boston, MA, United States
| | - Doug Parkerson
- Innovations for Poverty Action, Washington DC, United States
| | - Günther Fink
- University of Basel, Basel, Switzerland; Swiss TPH, Basel, Switzerland
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Goulart Lemos NBA, Carson V, da Silva Santos PG, de Aguiar Lemos F, Duncan M, de Lucena Martins CM. Adherence to the 24-h Movement Behaviors Guidelines and Associations With Cognitive and Behavioral Self-Regulation Among Brazilian Preschoolers. Am J Hum Biol 2025; 37:e24206. [PMID: 39760212 DOI: 10.1002/ajhb.24206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 11/13/2024] [Accepted: 12/16/2024] [Indexed: 01/07/2025] Open
Abstract
BACKGROUND Adherence to 24-h movement guidelines has been associated with early health benefits, including neurodevelopmental outcomes. However, the associations between these guidelines and Cognitive (CSR) and Behavioral (BSR) self-regulation in preschoolers are underexplored. This study investigated the associations between adherence to 24-h movement guidelines and CSR and BSR in Brazilian preschoolers. METHODS A total of 223 preschoolers (4.76 ± 0.32 years old; 50.67% boys) participated. Physical activity (PA) was assessed with Actigraph wGT3X. Parents reported children's sleep and screen time. CSR was evaluated through iPad games, and BSR was assessed using the Head, Toes, Knees, Shoulders test revised. RESULTS Boys showed higher adherence to the PA recommendation than girls (52.2% vs. 32.7%, χ2 = 0.003), whereas a higher percentage of girls did not adhere to any recommendations (23.6% vs. 12.4%, χ2 = 0.029). Positive association was found between adherence to combined PA and screen time with cognitive flexibility (β = 4.091 [95% CI: 0.699, 7.754]). Adherence to PA was associated with lower BSR scores (β = -7.104 [-13.52, -0.623]), as was adherence to combined PA and sleep duration (β = -8.813 [-15.794, -1.397]). CONCLUSION This study highlighted differences in adherence to movement behavior guidelines between boys and girls, as well as demonstrated that different combinations of these behaviors can affect preschoolers' cognitive and behavioral levels of self-regulation in distinct ways.
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Affiliation(s)
- Natália Batista Albuquerque Goulart Lemos
- Department of Physical Education, Federal University of Vale Do São Francisco, Petrolina, Brazil
- Associate Graduate Program in Physical Education, Federal University of Paraiba, João Pessoa, Brazil
| | - Valerie Carson
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | | | - Fernando de Aguiar Lemos
- Department of Physical Education, Federal University of Vale Do São Francisco, Petrolina, Brazil
| | - Michael Duncan
- Centre for Applied Biological and Exercise Sciences, Coventry University, Coventry, UK
| | - Clarice Maria de Lucena Martins
- Research Centre of Physical Activity, Health and Leisure, Faculty of Sports, Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
- Department of Physical Education, Federal University of Paraíba, João Pessoa, Brazil
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Norris SA, Nyati LH, Murphy-Alford A, Lucas N, Santos IS, Costa CS, Kuriyan R, Wickranasinghe VP, Ariff S, Jayasinghe S, Kurpad AV, Ismail LC, Hills AP. Infant growth and body composition from birth to 24 months: are infants developing the same? Eur J Clin Nutr 2024; 78:952-962. [PMID: 38172346 PMCID: PMC11537950 DOI: 10.1038/s41430-023-01386-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 11/18/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Given the importance of infancy for establishing growth trajectories, with later-life health consequences, we investigated longitudinal body composition among infants from six economically and ethnically diverse countries. METHODS We recruited mother-infant dyads using the WHO Multicenter Growth Reference Study criteria. We measured fat-free mass (FFM) in 1393 (49% female) infants from birth to 6 months of age (Australia, India, and South Africa; n = 468), 3-24 months of age (Brazil, Pakistan, South Africa, and Sri Lanka; n = 925), and derived fat mass (FM), fat mass index (FMI), and fat-free mass index (FFMI). Height-for-age (HAZ), weight-for-age (WAZ), and weight-for-length (WHZ) Z-scores were computed. Sex differences were assessed using a t-test, and country differences using a one-way analysis of covariance. We further compared subsamples of children with average (-0.25 > HAZ < +0.25), below-average (≤-0.25) and above-average (≥+0.25) HAZ. RESULTS HAZ performed well between 0 and 6 months, but less so between 3 and 24 months. The stunting prevalence peaked at 10.3% for boys and 7.8% for girls, at 24 months. By 24 months, girls had greater FMI (10%) than boys. There were significant differences in FFM (both sexes in all countries) and FM (Brazilian boys, Pakistani and South African girls) by 24 months of age between infants with average, above-average, and below-average HAZ. CONCLUSION In a multi-country sample representing more ideal maternal conditions, body composition was heterogeneous even among infants who exhibited ideal length. Having a mean HAZ close to the median of the WHO standard for length reduced FFM between-country heterogeneity but not FM, suggesting that other factors may influence adiposity.
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Affiliation(s)
- Shane A Norris
- SAMRC Developmental Pathways for Health Research Unit, Department of Pediatrics, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Development and Health, University of Southampton, Southampton, UK
| | - Lukhanyo H Nyati
- SAMRC Developmental Pathways for Health Research Unit, Department of Pediatrics, University of the Witwatersrand, Johannesburg, South Africa.
- Interprofessional Education Unit, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa.
| | | | - Nishani Lucas
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | | | - Rebecca Kuriyan
- Division of Nutrition, St John's Research Institute, Bengaluru, India
| | | | - Shabina Ariff
- Dept Pediatrics & Child Health, The Aga Khan University, Karachi, Pakistan
| | | | - Anura V Kurpad
- Division of Nutrition, St John's Research Institute, Bengaluru, India
| | - Leila Cheikh Ismail
- University of Sharjah, Sharjah, United Arab Emirates
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
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Postma JK, Harrison MA, Kutcher S, Webster RJ, Cloutier M, Bourque DK, Yu AC, Carter MT. The diagnostic yield of genetic and metabolic investigations in syndromic and nonsyndromic patients with autism spectrum disorder, global developmental delay, or intellectual disability from a dedicated neurodevelopmental disorders genetics clinic. Am J Med Genet A 2024; 194:e63791. [PMID: 39031819 DOI: 10.1002/ajmg.a.63791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/01/2024] [Accepted: 06/05/2024] [Indexed: 07/22/2024]
Abstract
First-tier genetic investigations for patients with neurodevelopmental disorders (NDDs) may include chromosomal microarray, Fragile X testing, and screening for inherited metabolic diseases, but most remain undiagnosed upon completion of testing. Here, we report the diagnostic yields of genetic testing for 537 patients with at least one of autism spectrum disorder, global developmental delay, and/or intellectual disability. Patients were assessed in a single neurodevelopmental genetics clinic, and each underwent a standardized history and physical examination. Each patient was characterized as syndromic or nonsyndromic based on clinical features. Our results demonstrate that multigene sequencing (with an NDD gene panel or exome) had a higher diagnostic yield (8%; 95% confidence interval [CI]: 5%, 13%) than chromosomal microarray and Fragile X testing combined (4%; 95% CI: 3%, 7%). Biochemical screening for inherited metabolic diseases had a diagnostic yield of zero. The diagnostic yield of genetic testing was significantly higher for syndromic patients than for nonsyndromic patients (odds ratio [OR] 3.09; 95% CI: 1.46, 6.83) and higher for female patients than for male (OR 3.21; 95% CI: 1.52, 6.82). These results add to the growing evidence supporting a comprehensive genetic evaluation that includes both copy number analysis and sequencing of known NDD genes for patients with NDDs.
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Affiliation(s)
| | | | | | | | | | - Danielle K Bourque
- Division of Metabolics and Newborn Screening, Department of Pediatrics, CHEO, Ottawa, Ontario, Canada
| | - Andrea C Yu
- Division of Metabolics and Newborn Screening, Department of Pediatrics, CHEO, Ottawa, Ontario, Canada
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Moletta FB, Lobe MCS, França SN, de Lacerda L, Pereira RM. Pubertal, Auxological, and Adult Height Outcomes in Children Treated for Adrenocortical Tumors: Half a Century Experience. Horm Res Paediatr 2024:1-10. [PMID: 39173606 DOI: 10.1159/000540706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/31/2024] [Indexed: 08/24/2024] Open
Abstract
INTRODUCTION Most children with adrenocortical tumors (ACTs) present with accelerated growth and skeletal maturation at diagnosis, which potentially compromises their adult heights (AHs). Knowledge about growth and pubertal patterns after ACT resection is scarce. This study presents the pubertal and auxological development of patients treated for ACT and followed up at a single pediatric endocrinology service in Brazil. METHODS Retrospective cohort study including 63 patients (47 girls) followed up between 1966 and 2021. Pubertal and auxological data from ACT diagnosis to AH were analyzed. RESULTS At diagnosis, the patients had median values of bone age (BA) more advanced than chronological age (CA), height standard deviation score greater than target height (TH-SDS), and predicted adult height (PAH-SDS) lower than TH-SDS. The difference between BA and CA decreased gradually during follow-up and the PAH-SDS moved closer to the TH-SDS 7 years after tumor resection. Puberty started at a median CA of 9.3 (8.3-11.3) years in girls and 9.9 (9.2-13.6) years in boys. Nine patients (6 girls) developed central precocious puberty (CPP), which was influenced by a CA >4 years at diagnosis. The difference between AH-SDS and TH-SDS was not significant (p = 0.3). The factors independently associated with AH below TH were CA >4 years at diagnosis, time between clinical manifestation and diagnosis >1 year, and development of CPP. CONCLUSION Most patients treated for ACT during childhood attained AH within the TH despite presenting with advanced skeletal maturation at diagnosis. Development of CPP was not infrequent.
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Affiliation(s)
- Fernanda Bora Moletta
- Serviço de Endocrinologia Pediátrica Professor Romolo Sandrini-Complexo Hospital de Clínicas da Universidade Federal do Paraná (CHC-UFPR), Curitiba, Brazil
| | | | - Suzana Nesi França
- Serviço de Endocrinologia Pediátrica Professor Romolo Sandrini-Complexo Hospital de Clínicas da Universidade Federal do Paraná (CHC-UFPR), Curitiba, Brazil
| | - Luiz de Lacerda
- Serviço de Endocrinologia Pediátrica Professor Romolo Sandrini-Complexo Hospital de Clínicas da Universidade Federal do Paraná (CHC-UFPR), Curitiba, Brazil
| | - Rosana Marques Pereira
- Serviço de Endocrinologia Pediátrica Professor Romolo Sandrini-Complexo Hospital de Clínicas da Universidade Federal do Paraná (CHC-UFPR), Curitiba, Brazil
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11
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Orkin S, Hitchcock K, Phillips J, Romantic E, Trauth A, Wessel J, Mouzaki M. Infant versus noninfant formulas and cow's milk: Transition based on age or weight? JPGN REPORTS 2024; 5:353-356. [PMID: 39149193 PMCID: PMC11322026 DOI: 10.1002/jpr3.12085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/07/2024] [Accepted: 03/29/2024] [Indexed: 08/17/2024]
Abstract
Infant formulas are meant to be used until 1 year of age, at which point children are transitioned to non-infant formulas or cow's milk, depending on their remaining dietary intake. Noninfant formulas and cow's milk are appropriate for children who have an average weight at that 1-year mark (9-9.5 kg); however, can contribute significant protein and/or electrolytes to children who are underweight for age, particularly if they still rely heavily on formula feeding for their caloric intake. In this short communication, we present several cases of patients who received excessive amounts of nutrients for age following the formula transition at the 1-year mark. We also provide recommendations for clinicians to consider when faced with underweight infants who are meant to be transitioning off infant formulas.
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Affiliation(s)
- Sarah Orkin
- Division of Gastroenterology, Hepatology and Nutrition, Department of PediatricsCincinnati Children's Hospital Medical Center, University of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Kathryn Hitchcock
- Division of Nutrition TherapyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Jennifer Phillips
- Division of Gastroenterology, Hepatology and Nutrition, Department of PediatricsCincinnati Children's Hospital Medical Center, University of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Emily Romantic
- Division of Nutrition TherapyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Amiee Trauth
- Division of Nutrition TherapyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Jacqueline Wessel
- Division of Nutrition TherapyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Marialena Mouzaki
- Division of Gastroenterology, Hepatology and Nutrition, Department of PediatricsCincinnati Children's Hospital Medical Center, University of Cincinnati College of MedicineCincinnatiOhioUSA
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12
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Guellec I, Simon L, Vayssiere C, Senat MV, Ego A, Zeitlin J, Subtil D, Verspyck E, Lapillonne A, Roze JC, Claris O, Picaud JC, Monier I, Geraldine G. Growth charts for use at birth and in the neonatal period: Recommendations of the French Neonatal Society. J Pediatr Gastroenterol Nutr 2024; 79:352-361. [PMID: 38808729 DOI: 10.1002/jpn3.12238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION The use of different growth charts can lead to confusion in discussions between professionals. There are obstetric charts (of fetal growth) and neonatal charts (of measurements at birth and of postnatal growth). These charts can be descriptive (derived from an unselected population) or prescriptive (derived from of a population at low risk and with optimal conditions for growth). OBJECTIVES (1) To describe available charts for infants at birth and in the neonatal period and compare them, and (2) to recommend one or more charts for use in neonatology in France. METHODS Bibliographic research was conducted on MEDLINE and completed by the guidelines of professional societies. RESULTS Antenatal information about fetal growth restriction or fetuses identified as small-for-gestational-age using Intrauterine charts must be integrated into the identification of newborns at risk, but the use of Intrauterine charts to evaluate birthweight is not recommended to allow consistency with postnatal charts used in neonatal practice. Z-score variations using the updated Fenton postnatal charts are the most appropriate for the assessment of birthweight and postnatal growth for infants born preterm. These charts are sex-specific, include the three measurements (length, weight, and head circumference) and enable longitudinal follow-up of growth up to 50 weeks of corrected age and are linked to the World Health Organization charts at term. The French Audipog charts, although are individualized, accessible online and can be used in maternity units to evaluate birthweight for term infants, but do not allow the follow-up of postnatal growth, while Fenton charts may be used to evaluate birthweight and postnatal growth in the first month for hospitalized term infants. CONCLUSION The updated Fenton charts are the neonatal charts that best suit the objectives of pediatricians in France for monitoring the growth of preterm newborns. The use of the Audipog charts at term remains an alternative in maternity wards, while Fenton charts can be used for hospitalized term newborns.
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Affiliation(s)
- Isabelle Guellec
- Neonatal Intensive Care Unit, Nice University Hospital, Nice, France
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France
| | - Laure Simon
- Neonatal Intensive Care Unit, Nantes University Hospital, Nantes, France
| | | | - Marie-Victoire Senat
- Obstetrics Department, Kremlin Bicêtre University Hospital, AP-HP, Paris, France
| | - Anne Ego
- Public Health Department, Univ. Grenoble Alpes, CNRS, Grenoble Alpes University Hospital, Grenoble INP Institute of Engineering Univ. Grenoble Alpes, TIMC-IMAG, Grenoble, France
| | - Jennifer Zeitlin
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France
| | - Damien Subtil
- Obstetrics Department, Lille University Hospital, Lille, France
| | - Eric Verspyck
- Obstetrics Department, Rouen University Hospital, Rouen, France
| | - Alexandre Lapillonne
- Neonatal Intensive Care Unit, Necker Enfants Malades Hospital, APHP, Paris, France
| | | | - Olivier Claris
- Neonatal Intensive Care Unit, Lyon Civil Hospices University Hospital, Lyon, France
| | - Jean-Charles Picaud
- Neonatal Intensive Care Unit, Lyon Civil Hospices University Hospital, Lyon, France
| | - Isabelle Monier
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France
| | - Gascoin Geraldine
- Neonatal Intensive Care Unit, Toulouse University Hospital, Toulouse, France
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13
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Vray M, Tondeur L, Hedible BG, Randremanana RV, Manirakiza A, Lazoumar RH, Platen CV, Vargas A, Briend A, Jambou R. Three-arm clinical trial of improved flour targeting intestinal microbiota (MALINEA). MATERNAL & CHILD NUTRITION 2024; 20:e13649. [PMID: 38599819 PMCID: PMC11168351 DOI: 10.1111/mcn.13649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 02/28/2024] [Accepted: 03/11/2024] [Indexed: 04/12/2024]
Abstract
The main objective of this project was to compare in the field conditions two strategies of re-nutrition of children with moderate acute malnutrition (MAM) aged from 6 to 24 months, targeting the microbiota in comparison with a standard regimen. A three-arm, open-label, pragmatic randomised trial was conducted in four countries (Niger, CAR, Senegal and Madagascar). Children received for 12 weeks either fortified blended flour (FBF control) = arm 1, or FBF + azithromycin (oral suspension of 20 mg/kg/day daily given with a syringe) for the first 3 days at inclusion = arm 2 or mix FBF with inulin/fructo-oligosaccharides (6 g/day if age ≥12 months and 4 g if age <12 months) = arm 3. For each arm, children aged from 6 to 11 months received 100 g x 2 per day of flours and those aged from 12 to 24 months received 100 g × 3 per day of FBF. The primary endpoint was nutritional recovery, defined by reaching a weight-for-height z-score (WHZ) ≥ -1.5 within 12 weeks. Overall, 881 children were randomised (297, 290 and 294 in arm 1, arm 2 and arm 3, respectively). Three hundred and forty-four children were males (39%) and median/mean age were 14.6/14.4 months (SD = 4.9, IQR = 10.5-18.4). At inclusion, the three arms were comparable for all criteria, but differences were observed between countries. Overall, 44% (390/881) of the children recovered at week 12 from MAM, with no significant difference between the three arms (41.4%, 45.5% and 45.9%, in arm 1, arm 2 and arm 3, respectively, p = 0.47). This study did not support the true advantages of adding a prebiotic or antibiotic to flour. When using a threshold of WHZ ≥ -2 as an exploratory endpoint, significant differences were observed between the three arms, with higher success rates in arms with antibiotics or prebiotics compared to the control arm (66.9%, 66.0% and 55.2%, respectively, p = 0.005).
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Affiliation(s)
- Muriel Vray
- Emerging Diseases Epidemiology Unit, Institut de PasteurUniversité Paris‐CitéParisFrance
| | - Laura Tondeur
- Emerging Diseases Epidemiology Unit, Institut de PasteurUniversité Paris‐CitéParisFrance
| | | | | | - Alexandre Manirakiza
- Epidemiology and Clinical Research UnitInstitut Pasteur de BanguiBanguiCentral African Republic
| | | | | | - Antonio Vargas
- Nutrition and Health Unit, Action Against HungerMadridSpain
| | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of ScienceUniversity of CopenhagenFrederiksbergDenmark
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health TechnologyTampere University and Tampere University HospitalTampereFinland
| | - Ronan Jambou
- Direction Scientifique, Centre de Recherche Médicale et Sanitaire (CERMES)NiameyNiger
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Martins C, Mota J, Goulart N, Silva M, Silva T, Carvalho F, Mota J, Bandeira PF, Lemos L. Compliance with the 24-h movement behaviors guidelines among urban and rural Brazilian preschoolers. Am J Hum Biol 2024; 36:e24045. [PMID: 38284305 DOI: 10.1002/ajhb.24045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND The importance of movement behaviors for health is well-known, although few studies have examined the compliance with movement guidelines in preschoolers from different living contexts. This study reported the compliance with the 24-h movement behaviors guidelines among low-income Brazilian preschoolers from rural and urban areas, according to age. METHODS A total of 453 preschoolers (n = 222 urban), aged between 3 and 5 years, provided physical activity (PA) data (Actigraph wGT3X). Sleep duration, and screen time were parent-reported. Preschoolers were classified as compliant/non- compliant with the 24-h movement guidelines, according to age. The association between prevalence of compliance with the recommendations and the children's living setting were estimated (SPSS; 27.0). RESULTS Preschoolers were active (mean = 299.19 ± 76.42; and 369.76 ± 95.56 min/day in urban and rural areas, respectively), though moderate-to-vigorous physical activity (MVPA) time was below the 60 daily minutes recommended in both urban and rural settings (mean = 38.39 ± 21.36; and 47.32 ± 24.28, respectively). None of the urban children complied with the three recommendations simultaneously, while in the rural area, only 2.6% were compliant. Single movement behaviors compliances in the urban setting were 6.8%, 28.8% and 5.4% for PA, sleep, and screen time, respectively; while for rural settings were 16.5%, 21.2%, and 7.4%. Living in the rural area was related to the compliance with PA recommendation for the 5-year-old preschoolers. CONCLUSION In both urban and rural Brazilian areas, very few preschoolers are compliant with the guidelines, and more than one third of the children do not comply with any of the recommendations. Strategies and programs to promote compliance with movement behaviors guidelines should consider children's living setting and their age groups.
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Affiliation(s)
- Clarice Martins
- Research Centre in Physical activity, Health and Leisure, and Laboratory for Integrative and Translational Research in Population Health, University of Porto, Porto, Portugal
- Department of Physical Education, Federal University of Paraíba, João Pessoa, Brazil
| | - Jéssica Mota
- Ciência e Tecnologia da Paraíba, Campus Itaporanga, Instituto Federal de Educação, João Pessoa, Brazil
| | - Natália Goulart
- Department of Physical Education, Universidade Federal do Vale do São Francisco, Petrolina, Brazil
| | - Morgana Silva
- Department of Physical Education, Universidade Federal do Vale do São Francisco, Petrolina, Brazil
| | - Tamires Silva
- Department of Physical Education, Universidade Federal do Vale do São Francisco, Petrolina, Brazil
| | - Ferdinando Carvalho
- Department of Physical Education, Universidade Federal do Vale do São Francisco, Petrolina, Brazil
| | - Jorge Mota
- Research Centre in Physical activity, Health and Leisure, and Laboratory for Integrative and Translational Research in Population Health, University of Porto, Porto, Portugal
| | - Paulo Felipe Bandeira
- Department of Physical Education, Universidade Federal do Vale do São Francisco, Petrolina, Brazil
- Department of Physical Education, Universidade Regional do Cariri, Crato, Brazil
| | - Luís Lemos
- Faculdade de Desporto e Educação Física, Universidade Lusófona, Porto, Portugal
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Christifano DN, Gustafson KM, Carlson SE, Mathis NB, Brown A, Onuoha O, Taylor MK. The Role of Fresh Beef Intake and Mediterranean Diet Adherence during Pregnancy in Maternal and Infant Health Outcomes. Nutrients 2024; 16:1436. [PMID: 38794674 PMCID: PMC11124296 DOI: 10.3390/nu16101436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/26/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Beef is an excellent source of nutrients important for maternal health and fetal development. It is also true that the Mediterranean diet is beneficial for the health of both the mother and offspring; however, the relative value of fresh beef intake within Mediterranean diet patterns during pregnancy is unknown. The objective of this project was two-fold: (1) assess the relationship between beef intake and nutrient intake in a pregnant population; (2) assess the relationship between maternal beef consumption among varying degrees of Mediterranean diet adherence with maternal risk of anemia and infant health outcomes. This is a secondary analysis of an existing cohort of pregnant women (n = 1076) who participated in one of two completed clinical trials examining the effect of a docosahexaenoic acid supplementation on birth and offspring outcomes. Women were enrolled between 12 and 20 weeks of gestation and were followed throughout their pregnancies to collect maternal and infant characteristics, food frequency questionnaires [providing beef intake and Mediterranean diet (MedD) adherence], and supplement intake. Women with the highest fresh beef intake had the highest intake of many micronutrients that are commonly deficient among pregnant women. Fresh beef intake alone was not related to any maternal or infant outcomes. There was a reduced risk of anemia among women with medium to high MedD quality and higher fresh beef intake. Women in the medium MedD group had 31% lower odds of anemia, and women in the high MedD group had 38% lower odds of anemia with every one-ounce increase in fresh beef intake, suggesting that diet quality indices may be misrepresenting the role of fresh beef within a healthy diet. These findings show that beef intake increases micronutrient intake and may be protective against maternal anemia when consumed within a healthy Mediterranean diet pattern.
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Affiliation(s)
- Danielle Nicole Christifano
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS 66160, USA; (S.E.C.); (N.B.M.); (O.O.); (M.K.T.)
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS 66103, USA;
| | - Kathleen M. Gustafson
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS 66103, USA;
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Susan E. Carlson
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS 66160, USA; (S.E.C.); (N.B.M.); (O.O.); (M.K.T.)
| | - Nicole B. Mathis
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS 66160, USA; (S.E.C.); (N.B.M.); (O.O.); (M.K.T.)
| | - Alexandra Brown
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Obianuju Onuoha
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS 66160, USA; (S.E.C.); (N.B.M.); (O.O.); (M.K.T.)
| | - Matthew K. Taylor
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS 66160, USA; (S.E.C.); (N.B.M.); (O.O.); (M.K.T.)
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Megersa BS, Andersen GS, Abera M, Abdissa A, Zinab B, Ali R, Admassu B, Kedir E, Nitsch D, Filteau S, Girma T, Yilma D, Wells JC, Friis H, Wibaek R. Associations of early childhood body mass index trajectories with body composition and cardiometabolic markers at age 10 years: the Ethiopian infant anthropometry and body composition (iABC) birth cohort study. Am J Clin Nutr 2024; 119:1248-1258. [PMID: 38458400 DOI: 10.1016/j.ajcnut.2024.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/17/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Variability in body mass index (BMI) (kg/m2) trajectories is associated with body composition and cardiometabolic markers in early childhood, but it is unknown how these associations track to later childhood. OBJECTIVES We aimed to assess associations of BMI trajectories from 0 to 5 y with body composition and cardiometabolic markers at 10 y. METHODS In the Ethiopian infant anthropometry and body composition (iABC) birth cohort, we previously identified 4 distinct BMI trajectories from 0 to 5 y: stable low BMI (19.2%), normal BMI (48.8%), rapid growth to high BMI (17.9%), and slow growth to high BMI (14.1%). At 10 y, we obtained data from 320 children on anthropometry, body composition, abdominal subcutaneous and visceral fat, and cardiometabolic markers. Associations of BMI trajectories and 10-y outcomes were analyzed using multiple linear regression. RESULTS Compared with children with the normal BMI trajectory, those with rapid growth to high BMI had 1.7 cm (95% CI: 0.1, 3.3) larger waist circumference and those with slow growth to high had 0.63 kg/m2 (95% CI: 0.09, 1.17) greater fat mass index and 0.19 cm (95% CI: 0.02, 0.37) greater abdominal subcutaneous fat, whereas those with stable low BMI had -0.28 kg/m2 (95% CI: -0.59, 0.03) lower fat-free mass at 10 y. Although the confidence bands were wide and included the null value, children with rapid growth to high BMI trajectory had 48.6% (95% CI: -1.4, 123.8) higher C-peptide concentration and those with slow growth to high BMI had 29.8% (95% CI: -0.8, 69.8) higher insulin and 30.3% (95% CI: -1.1, 71.6) higher homeostasis model assessment of insulin resistance, whereas those with rapid growth to high BMI had -0.23 mmol/L (95% CI: -0.47, 0.02) lower total cholesterol concentration. The trajectories were not associated with abdominal visceral fat, blood pressure, glucose, and other lipids at 10 y. CONCLUSIONS Children with rapid and slow growth to high BMI trajectories before 5 y tend to show higher measures of adiposity and higher concentrations of markers related to glucose metabolism at 10 y. CLINICAL TRIAL REGISTRY ISRCTN46718296 (https://www.isrctn.com/ISRCTN46718296).
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Affiliation(s)
- Bikila S Megersa
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark.
| | | | - Mubarek Abera
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | | | - Beakal Zinab
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark; Department of Nutrition and Dietetics, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Rahma Ali
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark; Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Bitiya Admassu
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Elias Kedir
- Department of Radiology, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tsinuel Girma
- Department of Pediatrics and Child Health, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Daniel Yilma
- Department of Internal Medicine, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Jonathan Ck Wells
- Childhood Nutrition Research Center, Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Rasmus Wibaek
- Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
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17
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Wells JCK, Desoye G, Leon DA. Reconsidering the developmental origins of adult disease paradigm: The 'metabolic coordination of childbirth' hypothesis. Evol Med Public Health 2024; 12:50-66. [PMID: 38380130 PMCID: PMC10878253 DOI: 10.1093/emph/eoae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/18/2023] [Indexed: 02/22/2024] Open
Abstract
In uncomplicated pregnancies, birthweight is inversely associated with adult non-communicable disease (NCD) risk. One proposed mechanism is maternal malnutrition during pregnancy. Another explanation is that shared genes link birthweight with NCDs. Both hypotheses are supported, but evolutionary perspectives address only the environmental pathway. We propose that genetic and environmental associations of birthweight with NCD risk reflect coordinated regulatory systems between mother and foetus, that evolved to reduce risks of obstructed labour. First, the foetus must tailor its growth to maternal metabolic signals, as it cannot predict the size of the birth canal from its own genome. Second, we predict that maternal alleles that promote placental nutrient supply have been selected to constrain foetal growth and gestation length when fetally expressed. Conversely, maternal alleles that increase birth canal size have been selected to promote foetal growth and gestation when fetally expressed. Evidence supports these hypotheses. These regulatory mechanisms may have undergone powerful selection as hominin neonates evolved larger size and encephalisation, since every mother is at risk of gestating a baby excessively for her pelvis. Our perspective can explain the inverse association of birthweight with NCD risk across most of the birthweight range: any constraint of birthweight, through plastic or genetic mechanisms, may reduce the capacity for homeostasis and increase NCD susceptibility. However, maternal obesity and diabetes can overwhelm this coordination system, challenging vaginal delivery while increasing offspring NCD risk. We argue that selection on viable vaginal delivery played an over-arching role in shaping the association of birthweight with NCD risk.
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Affiliation(s)
- Jonathan C K Wells
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Gernot Desoye
- Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - David A Leon
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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18
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Gaupšienė A, Vainauskaitė A, Baglajeva J, Stukas R, Ramašauskaitė D, Paliulytė V, Istomina N. Associations between maternal health literacy, neonatal health and breastfeeding outcomes in the early postpartum period. Eur J Midwifery 2023; 7:25. [PMID: 37794862 PMCID: PMC10546471 DOI: 10.18332/ejm/170161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/28/2023] [Accepted: 08/22/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Maternal health literacy is a social skill that is relevant to successful postnatal newborn adaptation, neonatal feeding, and neonatal health outcomes, given the importance of maternal health literacy in newborn healthcare. The study aims to identify and assess the associations between maternal health literacy, neonatal health, and breastfeeding outcomes during the early postpartum period. METHODS Five hundred women who gave birth to full-term newborns at Vilnius University Hospital were invited to the study from 1 May to 30 September 2022. The 47 questions of the European Health Literacy Questionnaire (HLS-EU-Q47) were used to assess maternal health literacy on days 2 and 3 after birth. Each subject's health literacy indices were divided into four categories: inadequate, problematic, sufficient, and excellent. The neonatal health indicators were birth weight and height, along with the APGAR score and the outcomes of feeding either exclusively with breast milk or with adapted formula in addition to breastfeeding. RESULTS Most women who participated in the survey had insufficient or problematic health literacy (69%). The study showed that women's higher health literacy is associated with a lower risk of obesity, a healthier diet, regular physical activity, and a higher birth weight and height of their newborns (p<0.05). Mothers with inadequate/problematic health literacy were more likely to feed their newborns with adapted formula in addition to breastfeeding. CONCLUSIONS Women's health literacy is a factor that affects women's healthy lifestyle choices before and during pregnancy and is significant for newborns' health indicators.
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Affiliation(s)
- Alma Gaupšienė
- Department of Public Health of Institute of Health Sciences of Medical Faculty of Vilnius University, Vilnius, Lithuania
- Department of Nursing of Institute of Health Sciences of Medical Faculty of Vilnius University, Vilnius, Lithuania
- Center of Obstetrics and Gynecology of Institute of Clinical Medicine of Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Aistė Vainauskaitė
- Center of Obstetrics and Gynecology of Institute of Clinical Medicine of Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Jekaterina Baglajeva
- Center of Obstetrics and Gynecology of Institute of Clinical Medicine of Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Rimantas Stukas
- Department of Public Health of Institute of Health Sciences of Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Diana Ramašauskaitė
- Center of Obstetrics and Gynecology of Institute of Clinical Medicine of Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Virginija Paliulytė
- Center of Obstetrics and Gynecology of Institute of Clinical Medicine of Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Natalja Istomina
- Department of Nursing of Institute of Health Sciences of Medical Faculty of Vilnius University, Vilnius, Lithuania
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Bracken JM, Pappas L, Wilkins J, Tracy K, Al-Rajabi TR, Abdelhadi RA. Measuring growth in critically ill neonates and children. Nutr Clin Pract 2023; 38 Suppl 2:S28-S38. [PMID: 37721462 DOI: 10.1002/ncp.11057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 09/19/2023] Open
Abstract
Critical illness increases the risk of malnutrition in both infants and children. Malnutrition risk is multifactorial and includes premorbid factors as well as changes in nutrient metabolism and energy demands during critical illness. Inadequate nutrition has been linked to poor health outcomes and prolonged length of stay in the intensive care unit, demonstrating the importance of both recognizing and addressing malnutrition in this population. Assessing growth and identifying malnutrition requires methodical measurement of growth and a collaborative, multimodal approach to nutrition assessment. Among the nutrition assessment and growth evaluation tools, neonatal, preterm, pediatric, and disease-specific growth charts remain an important component of growth assessment and should be used along with a nutrition-focused physical examination. Routine measurement promotes the identification of potential growth delays that may require interventions. Indirect calorimetry adds an additional layer of detail for a complete picture of each infant or child's unique nutrition status and progress. Quality improvement research on a national level is urgently needed to assess the adequacy and availability of resources in neonatal and pediatric critical care units and to further the development of standard clinical outcome measures for nutrition assessment and intervention in the critically ill neonate and child.
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Affiliation(s)
- Julia M Bracken
- Department of Pediatrics, Division of Gastroenterology, Children's Mercy Hospital, Kansas City, Missouri, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Lucy Pappas
- Department of Nutrition, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Jamie Wilkins
- Department of Nutrition, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Kelly Tracy
- Department of Nutrition, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Taiseer R Al-Rajabi
- College of Liberal Arts and Sciences, University of Kansas, Lawrence, Kansas, USA
| | - Ruba A Abdelhadi
- Department of Pediatrics, Division of Gastroenterology, Children's Mercy Hospital, Kansas City, Missouri, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
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Teji Roba K, Brewis A, Manning M, Hassen JY. Parental khat use and early childhood growth status in Eastern Ethiopia. Nutr Health 2023; 29:389-393. [PMID: 36591937 DOI: 10.1177/02601060221148898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Adult chewing of the stimulant plant khat (Catha edulis) has an unclear relationship with child growth outcomes. Contradictory study conclusions because habitual khat chewing covary with increased household income from khat production. AIM Disentangling the association of parental khat use, household khat production, and child nutritional status and growth markers. METHODS Bayesian analysis was applied to survey data for 2340 households containing 2760 children aged 24-60 months in a population-representative geographic sampling of two districts in Eastern Ethiopia, a khat chewing and producing region. RESULTS Stunting effects were more evident than wasting; the negative child growth effect of khat chewing persisted regardless of household khat production; maternal chewing particularly mattered for child growth delays. CONCLUSIONS This exploratory analysis suggests that future studies should target the interactions of khat chewing practices with gendered performances of child care/feeding responsibilities.
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Affiliation(s)
- Kedir Teji Roba
- Haramaya University College of Health and Medical Sciences, Haramaya, Ethiopia
| | - Alexandra Brewis
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA
| | - Mason Manning
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA
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21
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Nyati LH, Norris SA, Micklesfield LK, Adair LS, Fall C, Lee NR, Martorell R, Osmond C, Richter LM, Sachdev HS, Horta B, Stein AD. Growth in Infancy and Childhood and Age at Menarche in Five Low- or Middle-Income Countries: Consortium of Health Orientated Research in Transitional Societies (COHORTS). J Nutr 2023; 153:2736-2743. [PMID: 37451558 PMCID: PMC10517227 DOI: 10.1016/j.tjnut.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Earlier age at menarche is associated with behavioral and noncommunicable disease risks. The influence of birth weight (BW) (intrauterine) and postnatal growth on age at menarche is not well studied in low- and middle-income countries (LMICs). OBJECTIVE Therefore, we investigated these associations in 5 LMIC birth cohorts. METHODS We analyzed data from Brazil, Guatemala, India, the Philippines, and South Africa (n = 3983). We derived stunting (< -2 SD scores) at 24 mo using the WHO child growth standards. We generated interaction terms with categorized BW and conditional weight (lighter < 0 or heavier ≥ 0), and height (shorter < 0 or taller ≥ 0) z-scores. We categorized early-, modal-, and late-onset menarche and used multilevel ordinal regression. We used multilevel linear regression on continuous age at menarche. RESULTS Mean age at menarche was 12.8 y (95% CI: 12.7 12.9). BW was not associated with age at menarche. Conditional height at 24 mo and mid-childhood (OR: 1.35; 95% CI: 1.27, 1.44 and 1.32; 1.25, 1.41, respectively) and conditional weight at 24 mo and mid-childhood (OR: 1.15; 1.08, 1.22 and 1.18; 1.11, 1.25, respectively) were associated with increased likelihood of early-onset menarche. Being heavier at birth and taller at 24 mo was associated with a 4-mo (95% CI: 0.8, 7.6) earlier age at menarche than being lighter at birth and shorter at 24 mo. Being heavier at birth but lighter in mid-childhood was associated with a 3-mo (95% CI: 0.8, 4.8) later age at menarche than being lighter at birth and mid-childhood. Age at menarche was 7 mo later in stunted than nonstunted girls. CONCLUSION Age at menarche is inversely related to relative weight gain but also to rapid linear growth among those born shorter but remained stunted, and those born taller and grew excessively. These findings do not deter the global health goal to reduce growth faltering but emphasize the potential adverse effects of an obesogenic environment on adolescent development.
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Affiliation(s)
- Lukhanyo H Nyati
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Interprofessional Education Unit, Faculty of Community and Health Sciences, University of Western Cape, Cape Town, South Africa
| | - Shane A Norris
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Human Development and Health and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, United Kingdom.
| | - Lisa K Micklesfield
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda S Adair
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, United States
| | - Caroline Fall
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Nanette R Lee
- USC-Office of Population Studies Foundation, Inc., and Department of Anthropology, Sociology, and History, University of San Carlos, Cebu City, Philippines
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Clive Osmond
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Linda M Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Bernardo Horta
- Post-Graduate Program in Health and Behaviour, Universidade Católica de Pelotas, Pelotas, Brazil
| | - Aryeh D Stein
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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22
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Diaz-Thomas AM, Golden SH, Dabelea DM, Grimberg A, Magge SN, Safer JD, Shumer DE, Stanford FC. Endocrine Health and Health Care Disparities in the Pediatric and Sexual and Gender Minority Populations: An Endocrine Society Scientific Statement. J Clin Endocrinol Metab 2023; 108:1533-1584. [PMID: 37191578 PMCID: PMC10653187 DOI: 10.1210/clinem/dgad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Indexed: 05/17/2023]
Abstract
Endocrine care of pediatric and adult patients continues to be plagued by health and health care disparities that are perpetuated by the basic structures of our health systems and research modalities, as well as policies that impact access to care and social determinants of health. This scientific statement expands the Society's 2012 statement by focusing on endocrine disease disparities in the pediatric population and sexual and gender minority populations. These include pediatric and adult lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) persons. The writing group focused on highly prevalent conditions-growth disorders, puberty, metabolic bone disease, type 1 (T1D) and type 2 (T2D) diabetes mellitus, prediabetes, and obesity. Several important findings emerged. Compared with females and non-White children, non-Hispanic White males are more likely to come to medical attention for short stature. Racially and ethnically diverse populations and males are underrepresented in studies of pubertal development and attainment of peak bone mass, with current norms based on European populations. Like adults, racial and ethnic minority youth suffer a higher burden of disease from obesity, T1D and T2D, and have less access to diabetes treatment technologies and bariatric surgery. LGBTQIA youth and adults also face discrimination and multiple barriers to endocrine care due to pathologizing sexual orientation and gender identity, lack of culturally competent care providers, and policies. Multilevel interventions to address these disparities are required. Inclusion of racial, ethnic, and LGBTQIA populations in longitudinal life course studies is needed to assess growth, puberty, and attainment of peak bone mass. Growth and development charts may need to be adapted to non-European populations. In addition, extension of these studies will be required to understand the clinical and physiologic consequences of interventions to address abnormal development in these populations. Health policies should be recrafted to remove barriers in care for children with obesity and/or diabetes and for LGBTQIA children and adults to facilitate comprehensive access to care, therapeutics, and technological advances. Public health interventions encompassing collection of accurate demographic and social needs data, including the intersection of social determinants of health with health outcomes, and enactment of population health level interventions will be essential tools.
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Affiliation(s)
- Alicia M Diaz-Thomas
- Department of Pediatrics, Division of Endocrinology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Sherita Hill Golden
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Dana M Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Adda Grimberg
- Department of Pediatrics, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sheela N Magge
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Joshua D Safer
- Department of Medicine, Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10001, USA
| | - Daniel E Shumer
- Department of Pediatric Endocrinology, C.S. Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - Fatima Cody Stanford
- Massachusetts General Hospital, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA 02114, USA
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de Fátima Guimarães R, Barnett TA, Reid RER, Tremblay A, Henderson M, Mathieu ME. Trajectories of cardiorespiratory fitness from childhood to adolescence: Findings from the QUALITY cohort. J Sports Sci 2023; 41:895-902. [PMID: 37599614 DOI: 10.1080/02640414.2023.2245262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/30/2023] [Indexed: 08/22/2023]
Abstract
Estimate the shape and number of cardiorespiratory fitness (CRF) trajectories from childhood to adolescence; and verify whether CRF trajectory membership can be predicted by sex, biological maturation, body weight, body composition and physical activity (PA) in childhood. Data from QUALITY were used. Participants attended baseline (8-10 y old, n = 630) and follow-ups 2 years (n = 564) and 7 years (n = 359) after baseline. Group-based trajectory analysis for relative peak oxygen consumption (VO2peak, ml·kg-1·min-1) was performed. A multinomial logistic regression model was used to estimate the associations between baseline predictors and trajectory membership. Mean age of the 454 participants was 9.7 ± 0.9 years at baseline. Three distinct VO2peak trajectories were identified and all tended to decrease. They were labelled according to the starting point and slope. High-Decreasers were mostly boys, had lower body weight and fat-free mass index and higher PA levels at baseline (p < 0.05). Female sex and higher weight were associated with higher odds of being classified in the Low-Decreaser trajectory (OR = 74.03, 95%CI = 27.06-202.54; OR = 1.48, 95%CI = 1.36-1.60). Those with higher PA were less likely to be Low-Decreasers (OR = 0.96, 95%CI = 0.94-0.97). Sex, body weight and PA in childhood are important influencing factors of VO2peak (ml·kg-1·min-1) trajectories across adolescence.
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Affiliation(s)
- Roseane de Fátima Guimarães
- School of Kinesiology and Physical Activity Sciences, Université de Montréal, Montreal, QC, Canada
- CHU Sainte-Justine Research Center, Montreal, QC, Canada
| | - Tracie Ann Barnett
- CHU Sainte-Justine Research Center, Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Ryan E R Reid
- Human Kinetics Department, St Francis Xavier University, Antigonish, NS, Canada
| | - Angelo Tremblay
- Department of Kinesiology, Laval University,' Quebec, QC, Canada
| | - Mélanie Henderson
- CHU Sainte-Justine Research Center, Montreal, QC, Canada
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Marie-Eve Mathieu
- School of Kinesiology and Physical Activity Sciences, Université de Montréal, Montreal, QC, Canada
- CHU Sainte-Justine Research Center, Montreal, QC, Canada
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Lu Z, Hu Y, Tse LA, Yu J, Xia Z, Lei X, Zhang Y, Shi R, Tian Y, Gao Y. Urinary neonicotinoid insecticides and adiposity measures among 7-year-old children in northern China: A cross-sectional study. Int J Hyg Environ Health 2023; 251:114188. [PMID: 37229902 DOI: 10.1016/j.ijheh.2023.114188] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Neonicotinoid insecticides (NEOs) are emerging synthetic insecticides used in various pest management regimens worldwide. Toxicology studies have indicated the obesogenic potential of NEOs, but their associations with adiposity measures are largely unknown. OBJECTIVES We aimed to assess urinary levels of NEOs/metabolites and their associations with children's adiposity measures, and to further investigate the potential role of oxidative stress. METHODS This study included 380 children who participated in the 7th year's follow-up of the Laizhou Wan Birth Cohort in northern China. Urinary levels of seven NEOs and two metabolites and a biomarker of lipid peroxidation named 8-iso-prostaglandin-F2α (8-iso-PGF2α) were detected. A total of nine indicators of adiposity were measured. Body mass index (BMI) z-score ≥85th percentile was defined as overweight/obesity, and waist-to-height ratio (WHtR) ≥0.5 was considered as abdominal obesity. Multiple linear regression, binary logistic regression and mediation analysis were performed. RESULTS Six NEOs [imidacloprid (IMI, 99.7%), clothianidin (CLO, 98.9%), dinotefuran (DIN, 97.6%), thiamethoxam (THM, 95.5%), acetamiprid (ACE, 82.9%), thiacloprid (THD, 77.6%)] and two metabolites [N-desmethyl-acetamiprid (N-DMA, 100.0%), 6-chloronicotinic acid (6-CINA, 97.9%)] exhibited high detection rates. Multiple linear regressions showed positive associations of waist circumference with urinary levels of IMI and THM, of WHtR with IMI and THM levels, and of body fat percentage with 6-CINA levels. In contrast, exposure to N-DMA was negatively associated with body fat percentage and fat mass index. Binary logistic regressions further revealed that higher IMI levels were associated with overweight/obesity (OR = 1.556, 95% CI: 1.100, 2.201) and abdominal obesity (OR = 1.478, 95% CI: 1.078, 2.026) in children. 8-iso-PGF2α demonstrated 27.92%, 69.52% and 35.37% mediating effects in the positive associations of IMI, THD and THM with WHtR, respectively. Sex modified the associations of DIN with body fat mass (pint = 0.032), body fat percentage (pint = 0.009), fat mass index (pint = 0.037) and the overweight/obesity rate (pint = 0.046), with negative associations in girls and nonsignificant positive associations in boys. CONCLUSIONS School-age children in northern China were widely exposed to NEOs/metabolites. Urinary levels of NEOs/metabolites were associated with adiposity measures through the mediating role of 8-iso-PGF2α. These associations were mixed, and a sex-specific effect might exist.
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Affiliation(s)
- Zhenping Lu
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Hu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lap Ah Tse
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Jinxia Yu
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Zhuanning Xia
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoning Lei
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Zhang
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Shi
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Tian
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China; MOE-Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yu Gao
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Guo M, Xiao C, Yan H, Yu B, Zhai M, Wei L, Yin X, Gesang Q. Association of air pollution exposure during gestational and the first year of life with physical growth in preschoolers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2023; 33:337-347. [PMID: 35098822 DOI: 10.1080/09603123.2022.2029829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
This study explored the association of exposure to air pollutants during gestational and the first year of life with physical growth in preschoolers. The linear and logistic regression models were used to estimate the associations between air pollution and childhood growth. After adjusting for confounders, z-scores of body mass index (zBMI, and 95% confidence intervals, 95%CI) increased by 1.164(1.054,1.285), 1.136(1.050,1.228) and 1.165(1.041,1.303), associated with per interquartile range (IQR) increase in NO2 (nitrogen dioxide), PM2.5 and PM10 (particulate matter with aerodynamic diameters ≤2.5 μm and 10 μm) during gestational, respectively. The odds ratios (and 95%CI) of childhood overweight/obesity associated with per IQR increase in NO2, PM2.5 and PM10 during gestational were 1.425(1.168,1.737), 1.255(1.087,1.450) and 1.332(1.104,1.605). Positive associations were found between air pollution during the first year of life and zBMI or overweight/obesity. Our findings suggest exposure to air pollution were associated with childhood growth, and improving air quality is beneficial for childhood growth.
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Affiliation(s)
- Menglan Guo
- Department of Preventive Medicine, School of Public Health, Wuhan University, Wuhan, PR China
| | - Chenchang Xiao
- Department of Medicine, City College, Wuhan University of Science and Technology, Wuhan, PR China
| | - Hong Yan
- Department of Preventive Medicine, School of Public Health, Wuhan University, Wuhan, PR China
| | - Bin Yu
- Department of Preventive Medicine, School of Public Health, Wuhan University, Wuhan, PR China
| | - Mengxi Zhai
- Department of Preventive Medicine, School of Public Health, Wuhan University, Wuhan, PR China
| | - Liqing Wei
- Department of Preventive Medicine, School of Public Health, Wuhan University, Wuhan, PR China
| | - Xiaohong Yin
- Department of Preventive Medicine, School of Public Health, Wuhan University, Wuhan, PR China
| | - Quzhen Gesang
- Department of Preventive Medicine, School of Public Health, Wuhan University, Wuhan, PR China
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Lisanti AJ, Golfenshtein N, Min J, Medoff-Cooper B. Early growth trajectory is associated with psychological stress in parents of infants with congenital heart disease, but moderated by quality of partner relationship. J Pediatr Nurs 2023; 69:93-100. [PMID: 36696826 PMCID: PMC10106376 DOI: 10.1016/j.pedn.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/13/2022] [Accepted: 12/18/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE To explore the relationships between growth trajectory, parenting stress and parent post-traumatic stress (PTS), in infants with congenital heart disease, and the moderating role of parents' dyadic adjustment on those associations. DESIGN AND METHODS A secondary analysis of data from the REACH Telehalth home monitoring multi-site randomized clinical trial. Parents completed the Parenting Stress Index (PSI), Post-traumatic diagnostic scale, and the Dyadic Adjustment Scale. Multivariate logistic regression models were used to examine the associations of interest. RESULTS During 4-month follow-up after hospital discharge, parents of infants with 'Never recovered' and 'Partially recovered' growth trajectories had 2-5 times higher odds of experiencing higher stress on the Parent Domain (OR = 4.8, CI = 1.3-18.0; OR = 2.5, CI = 1.0-5.9, respectively) than those with stably grown infants. Parents of "Never recovered" infants had 4 times higher odds of PTS symptoms (OR = 3.9; CI = 1.6-9.9). Parental dyadic adjustment moderated the relationships. Parents of 'Partially recovered' infants and having low dyadic adjustment had 3-5 times higher odds of high stress on all PSI domains, while parents with high dyadic adjustment did not have increased stress due to poor infant growth. Parents of "Never recovered" infants had four times higher odds of PTS symptom, even with high dyadic adjustment. CONCLUSIONS Infant growth trajectory over the first four months is associated with parenting stress and PTS. Quality of partner relationship moderates some of these associations. PRACTICE IMPLICATIONS Infant growth should serve as a screening aid for identifying parents at psychological risk. Interventions targeting the quality of partner relationship may support parental coping and mitigate stress. CLINICAL TRIAL REGISTRATION NCT01941667.
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Affiliation(s)
- Amy Jo Lisanti
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, United States of America; Research Institute, Children's Hospital of Philadelphia, United States of America.
| | - Nadya Golfenshtein
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, United States of America; University of Haifa, Department of Nursing, Israel
| | - Jungwon Min
- Department of Biomedical and Health Informatics, Research Institute, Children's Hospital of Philadelphia, United States of America
| | - Barbara Medoff-Cooper
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, United States of America; Research Institute, Children's Hospital of Philadelphia, United States of America
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Lescure J, Martín-Turrero I, López-Ejeda N, Vargas A, Marrodán MD. Differences in wasting assessment through Middle-Upper Arm Circumference (MUAC) adjusted by sex, age and geographic origin for children aged 6-59 months: New reference based on anthropometric surveys from 22 low-and-middle-income countries. Am J Hum Biol 2023; 35:e23837. [PMID: 36382876 DOI: 10.1002/ajhb.23837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 09/14/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The Middle Upper Arm Circumference (MUAC) bracelet is a widely used instrument in public health assessments and humanitarian assistance projects. The WHO guidelines present a universal cut-off point of 115 mm to determine whether a child has severe acute malnutrition. The objective of this study is to analyze the existing differences in the MUAC for boys and girls aged between 6 and 59 months, from 22 countries distributed in three different continents, in contrast to the use of this single cut-off point. In addition, the creation of MUAC growth charts is presented for reference use. MATERIALS AND METHODS This study was carried out with a database developed by Action Against Hunger, composed, after the data pre-processing phase, of 97 921 individuals without anthropometric failure from African, Asian, and American continents. MUAC measurements were compared between countries, dividing by sex and age groups. A k-means method was used to create country clusters to allow comparisons and the variability was resumed using a Principal Component Analysis. For each cluster, growth curves were created and smoothed using the LOESS method. RESULTS Our research has revealed the existence of differences in the MUAC between countries in both, males and females, although with different trends. The evidence was confirmed with the creation of two clusters using the k-means method, which, when graphically represented by the Principal Component Analysis, showed that the MUAC was clearly different. There were also differences between males and females within each cluster, where growth curves did not overlap in any age group. CONCLUSIONS All statistical analysis indicate that there are differences in the MUAC values for children without anthropometric failure between countries, but also between sexes. With this research, a new reference is proposed that consider the existing variability between human populations to improve the precision in the determination of severe acute malnutrition in children.
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Affiliation(s)
- Javier Lescure
- Physical Anthropology Unit, Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, Madrid, Spain.,EPINUT Research Group (Ref. 920325), Complutense University of Madrid, Madrid, Spain
| | - Irene Martín-Turrero
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcala, Alcala de Henares, Madrid, Spain
| | - Noemí López-Ejeda
- Physical Anthropology Unit, Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, Madrid, Spain.,EPINUT Research Group (Ref. 920325), Complutense University of Madrid, Madrid, Spain
| | - Antonio Vargas
- Department of Nutrition and Health, Action Against Hunger, Madrid, Spain
| | - María Dolores Marrodán
- Physical Anthropology Unit, Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, Madrid, Spain.,EPINUT Research Group (Ref. 920325), Complutense University of Madrid, Madrid, Spain
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Friesen VM, Miller JC, Bitantes RB, Reario MFD, Arnold CD, Mbuya MNN, Neufeld LM, Wieringa FT, Stormer A, Capanzana MV, Cabanilla CVD, Lietz G, Haskell MJ, Engle-Stone R. Comparing two simplified questionnaire-based methods with 24-h recalls for estimating fortifiable wheat flour and oil consumption in Mandaluyong City, Philippines. MATERNAL & CHILD NUTRITION 2023:e13486. [PMID: 36815231 DOI: 10.1111/mcn.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/25/2022] [Accepted: 01/23/2023] [Indexed: 02/24/2023]
Abstract
Information on fortifiable food consumption is essential to design, monitor and evaluate fortification programmes, yet detailed methods like 24-h recalls (24HRs) that provide such data are rarely conducted. Simplified questionnaire-based methods exist but their validity compared with 24HRs has not been shown. We compared two simplified methods (i.e., a household food acquisition and purchase questionnaire [FAPQ] and a 7-day semiquantitative food frequency questionnaire [SQ-FFQ]) against 24HRs for estimating fortifiable food consumption. We assessed the consumption of fortifiable wheat flour and oil using a FAPQ and, for wheat flour only, a 7-day SQ-FFQ and compared the results against 24HRs. The participants included children 12-18 months (n = 123) and their mothers 18-49 years selected for a study assessing child vitamin A intake and status in Mandaluyong City, Philippines. For fortifiable wheat flour, the FAPQ estimated considerably lower mean intakes compared to 24HRs for children and mothers (2.2 vs. 14.1 g/day and 5.1 vs. 42.3 g/day, respectively), while the SQ-FFQ estimated slightly higher mean intakes (15.7 vs. 14.1 g/day and 51.5 vs. 42.3 g/day, respectively). For fortifiable oil, the FAPQ estimated considerably higher mean intakes compared to 24HRs for children and mothers (4.6 vs. 1.8 g/day and 12.5 vs. 6.1 g/day, respectively). The SQ-FFQ, but not the FAPQ, generated useful information on fortifiable food consumption that can inform fortification programme design and monitoring decisions in the absence of more detailed individual-level data. Potential adaptations to improve the FAPQ, such as additional questions on foods prepared away from home and usage patterns, merit further research.
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Affiliation(s)
- Valerie M Friesen
- Global Alliance for Improved Nutrition, Geneva, Switzerland.,Alimentation, Nutrition, Santé, UMR QualiSud, French National Research Institute for Sustainable Development (IRD), Montpellier, France.,UMR QualiSud, Université de Montpellier, Avignon Université, CIRAD, Institut Agro, IRD, Université de La Réunion, Montpellier, France
| | - Jody C Miller
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | | | | | - Charles D Arnold
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, California, USA
| | - Mduduzi N N Mbuya
- Global Alliance for Improved Nutrition, Washington, District of Columbia, USA
| | | | - Frank T Wieringa
- Alimentation, Nutrition, Santé, UMR QualiSud, French National Research Institute for Sustainable Development (IRD), Montpellier, France.,UMR QualiSud, Université de Montpellier, Avignon Université, CIRAD, Institut Agro, IRD, Université de La Réunion, Montpellier, France
| | - Ame Stormer
- Helen Keller International, Malate, Manila, Philippines
| | - Mario V Capanzana
- Department of Science and Technology, Food and Nutrition Research Institute, Taguig City, Philippines
| | - Carl V D Cabanilla
- Department of Science and Technology, Food and Nutrition Research Institute, Taguig City, Philippines
| | - Georg Lietz
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Marjorie J Haskell
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, California, USA
| | - Reina Engle-Stone
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, California, USA
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de Fátima Guimarães R, Barnett TA, Reid RER, Tremblay A, Henderson M, Mathieu ME. Determinants of mechanical efficiency trajectories from childhood to adolescence: Findings from the QUALITY cohort. Hum Mov Sci 2023; 87:103040. [PMID: 36495687 DOI: 10.1016/j.humov.2022.103040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To estimate the shape and number of mechanical efficiency (ME) trajectories from childhood to adolescence; and verify whether ME trajectory membership can be predicted by sex, biological maturation, body weight, body composition and physical activity (PA) in childhood. METHODS Data from QUALITY, an ongoing cohort study on the natural history of obesity, were used. Participants attended a baseline visit (8-10 years, n = 630) and follow-up visits two years (n = 564), and seven years (n = 377) later. ME was assessed by an incremental cycling test at 50w (ME50w, %) and at VO2peak (MEVO2peak, %). Group-based trajectory analysis for ME and a logistic regression were performed. RESULTS Mean age of the 454 participants (boys = 54%) was 9.7 ± 0.9 years at baseline. Two distinct ME50w trajectories were identified and all tended to decrease. No distinct trajectories emerged for MEVO2peak; average MEVO2peak increased over time. Thus, the difference between MEVO2peak (∆) at baseline and follow-up was calculated for correlation analysis. Trajectory groups were labeled "Low-Decreaser" and "High-Decreaser" (Reference) for ME50w, describing the starting point and slope. High-Decreasers were mostly prepubertal girls, had lower body weight and fat free mass index, lower PA and lower VO2peak at baseline (χ2or t-test, p < 0.05). Girls were less likely to be Low-Decreasers (OR = 0.56, 95%CI = 0.42-0.74), while having overweight/obesity predicted a greater likelihood of classification in the Low-Decreaser trajectory (OR = 2.38, 95%CI = 1.16-4.88). Those with higher PA were more likely to be Low-Decreasers (OR = 1.02, 95%CI = 1.01-1.04). Finally, concerning MEVO2peak, sex, biological maturation, body weight, zBMI, fat free mass index, PA and VO2peak were positively correlated with ∆ MEVO2peak. CONCLUSIONS We found evidence that excess weight at baseline predicts low levels of ME in childhood and adolescence. Additionally, higher PA at baseline is not related to higher ME50w levels. More research is needed to identify different approaches to explore this measure in transition to adulthood.
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Affiliation(s)
- Roseane de Fátima Guimarães
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières, 3351, boulevard des Forges, Trois-Rivières, QC G8Z 4M3, Canada; École de kinésiologie et des sciences de l'activité physique de la Faculté de médecine, Université de Montréal, 2100 Edouard Montpetit Blvd. #6219, Montreal, QC H3T 1J4, Canada; Centre de recherche du CHU Sainte-Justine, 5858 Côte-des-Neiges Rd, Montreal, QC H3S 1Z1, Canada.
| | - Tracie Ann Barnett
- Centre de recherche du CHU Sainte-Justine, 5858 Côte-des-Neiges Rd, Montreal, QC H3S 1Z1, Canada; Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Rd, Montreal, QC H3S 1Z1, Canada.
| | - Ryan E R Reid
- Human Kinetics Department, St Francis Xavier University, 4130 University Ave, Antigonish, NS B2G 2W5, Canada.
| | - Angelo Tremblay
- Département de kinésiologie, Université Laval, 2300, rue de la Terrasse, Quebec, QC G1V 0A6, Canada.
| | - Mélanie Henderson
- Centre de recherche du CHU Sainte-Justine, 5858 Côte-des-Neiges Rd, Montreal, QC H3S 1Z1, Canada; Département de Pédiatrique, Faculté de médecine, Université de Montréal, 3175, chemin Côte Sainte-Catherine, Montréal, QC H3T 1C5, Canada
| | - Marie-Eve Mathieu
- École de kinésiologie et des sciences de l'activité physique de la Faculté de médecine, Université de Montréal, 2100 Edouard Montpetit Blvd. #6219, Montreal, QC H3T 1J4, Canada; Centre de recherche du CHU Sainte-Justine, 5858 Côte-des-Neiges Rd, Montreal, QC H3S 1Z1, Canada.
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Sobik S, Sims CR, Crimmins M, Bimali M, Williams DK, Andres A. Associations Between Maternal Physical Activity, Maternal Lipid Levels, and Infant Anthropometric Outcomes at Two Weeks of Age. Matern Child Health J 2023; 27:168-177. [PMID: 36352287 DOI: 10.1007/s10995-022-03558-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 07/15/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study determined the relationship between physical activity (PA), circulating lipids throughout pregnancy and infant anthropometric outcomes at birth and 2 weeks of age. METHODS Women (N = 234) with normal weight (NW, BMI 18.5-24.9 kg/m2) and with overweight and class I obesity (OW/OB, BMI 25-35 kg/m2) were categorized into high and low PA based on average cohort steps during pregnancy (8099 steps/day). Circulating fasting lipids were measured at each trimester. Standardized methods were used to obtain anthropometrics measures. Infant body composition was estimated by quantitative nuclear magnetic resonance (EchoMRI-AH small; ECHO Medical Systems). RESULTS Women with NW who had higher activity had lower circulating triglycerides (TG) and total cholesterol (TC) levels at 12 weeks compared to women with NW and low activity (p < 0.05). Women with OW/OB and high activity level throughout pregnancy had lower circulating TG, and low density lipoprotein (LDL), at 12 weeks, lower LDL at 24 weeks, and lower TG at 36 weeks compared to the women with OW/OB who had low activity levels (p < 0.05). For children born to women with OW/OB, maternal circulating TG and LDL were most associated with infant anthropometrics at 2 weeks of age. CONCLUSION This study supports that higher PA during pregnancy is associated with lower lipid levels throughout pregnancy with a greater effect size in women with OW/OB. Maternal lipids were associated with anthropometrics and infant body composition at two weeks of life in women with OW/OB.
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Affiliation(s)
- Sarah Sobik
- Arkansas Children's Nutrition Center, Little Rock, Arkansas, USA. .,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
| | - Clark R Sims
- Arkansas Children's Nutrition Center, Little Rock, Arkansas, USA.,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Meghan Crimmins
- Arkansas Children's Nutrition Center, Little Rock, Arkansas, USA
| | - Milan Bimali
- Nexus Institute for Research and Innovation, Lalitpur, Nepal
| | - D Keith Williams
- Arkansas Children's Nutrition Center, Little Rock, Arkansas, USA.,Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Aline Andres
- Arkansas Children's Nutrition Center, Little Rock, Arkansas, USA.,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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31
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Aragón-Vela J, Alcalá-Bejarano Carrillo J, Moreno-Racero A, Plaza-Diaz J. The Role of Molecular and Hormonal Factors in Obesity and the Effects of Physical Activity in Children. Int J Mol Sci 2022; 23:15413. [PMID: 36499740 PMCID: PMC9737554 DOI: 10.3390/ijms232315413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/27/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Obesity and overweight are defined as abnormal fat accumulations. Adipose tissue consists of more than merely adipocytes; each adipocyte is closely coupled with the extracellular matrix. Adipose tissue stores excess energy through expansion. Obesity is caused by the abnormal expansion of adipose tissue as a result of adipocyte hypertrophy and hyperplasia. The process of obesity is controlled by several molecules, such as integrins, kindlins, or matrix metalloproteinases. In children with obesity, metabolomics studies have provided insight into the existence of unique metabolic profiles. As a result of low-grade inflammation in the system, abnormalities were observed in several metabolites associated with lipid, carbohydrate, and amino acid pathways. In addition, obesity and related hormones, such as leptin, play an instrumental role in regulating food intake and contributing to childhood obesity. The World Health Organization states that physical activity benefits the heart, the body, and the mind. Several noncommunicable diseases, such as cardiovascular disease, cancer, and diabetes, can be prevented and managed through physical activity. In this work, we reviewed pediatric studies that examined the molecular and hormonal control of obesity and the influence of physical activity on children with obesity or overweight. The purpose of this review was to examine some orchestrators involved in this disease and how they are related to pediatric populations. A larger number of randomized clinical trials with larger sample sizes and long-term studies could lead to the discovery of new key molecules as well as the detection of significant factors in the coming years. In order to improve the health of the pediatric population, omics analyses and machine learning techniques can be combined in order to improve treatment decisions.
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Affiliation(s)
- Jerónimo Aragón-Vela
- Department of Health Sciences, Area of Physiology, Building B3, Campus s/n “Las Lagunillas”, University of Jaén, 23071 Jaén, Spain
| | - Jesús Alcalá-Bejarano Carrillo
- Department of Health, University of the Valley of Mexico, Robles 600, Tecnologico I, San Luis Potosí 78220, Mexico
- Research and Advances in Molecular and Cellular Immunology, Center of Biomedical Research, University of Granada, Avda, del Conocimiento s/n, 18016 Armilla, Spain
| | - Aurora Moreno-Racero
- Research and Advances in Molecular and Cellular Immunology, Center of Biomedical Research, University of Granada, Avda, del Conocimiento s/n, 18016 Armilla, Spain
| | - Julio Plaza-Diaz
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, University of Granada, 18071 Granada, Spain
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
- Instituto de Investigación Biosanitaria IBS, Granada, Complejo Hospitalario Universitario de Granada, 18014 Granada, Spain
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Okhovat F, Okhovat S, Karimiankakolaki Z, Yoshany N. The effect of educational support intervention including peer groups for infant care on the growth rates of infants, breastfeeding self-efficacy and quality of life of their mothers in Iran: study protocol. Reprod Health 2022; 19:214. [PMID: 36457123 PMCID: PMC9714132 DOI: 10.1186/s12978-022-01523-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 11/04/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Mothers' knowledge about the infant's problems and will provide the necessary care can increase the mother's confidence in providing care for her infant and eliminate misconceptions in primiparous mothers. The present study will be conducted to evaluate the effect of educational support intervention including peer groups for infant care on the growth rates of infants, breastfeeding self-efficacy and quality of life of their mothers in Iran. METHODS This quasi-experimental study is an educational support intervention protocol for infant care which will be conducted in two phases. The educational support program will be designed in the first phase. The program includes educational sessions on breastfeeding, growth and development of infants and care for children under 1 year of age in a virtual group where a physician, a nurse, a midwife and a healthcare provider are also present. Using the opinions of the experts, the peer group will discuss various points and the research team will finalize the program based on priorities. The second phase of the educational intervention will be conducted experimentally as a pretest-posttest design for the intervention and control groups. DISCUSSION The present study will provide useful protocol about the effect of educational support intervention for infant care and the sharing of peer group experiences on infants' growth rates, breastfeeding self-efficacy, and quality of life of their mothers. The current educational package not only combines virtual education and peer experiences in strengthening the education of mothers, but also it can improve mothers' physical and mental health and reduce medical costs by using telephone follow-up in supporting of the mothers of infants. TRIAL REGISTRATION Registration of this randomized control trial has been completed with the Iranian Registry of Clinical Trials, IRCT20210913052457N1, registered 9/10/2021, https://www.irct.ir/trial/59093 .
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Affiliation(s)
- Forogh Okhovat
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Science, Tehran, Iran
| | - Shirin Okhovat
- Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Nooshin Yoshany
- Department of Health Education and Health Promotion, Social Determinants of Health Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Wu Y, Li Z, Du B, Ye Y, Wang H, Niu Y, Chen S, Wu Y, Jin H, Zhang X, Wang J, Sun K. Different Associations of Systolic Blood Pressure and Body Mass Index With Cardiac Structure and Function in Young Children. Hypertension 2022; 79:2583-2592. [DOI: 10.1161/hypertensionaha.122.19396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Both elevated systolic blood pressure (SBP) and excess weight can lead to early cardiovascular organ damage in children. In this study, we investigated whether there is a difference in the associations of SBP and body mass index (BMI) with cardiovascular structure and function in 4-year-old children.
Methods:
In 1474 children (52.3% males) from the Shanghai Birth Cohort, physical examination and echocardiography were performed. Standardized linear regression models were used to evaluate the associations of BMI
Z
score and SBP
Z
score with cardiovascular parameters and to compare the strengths of these associations.
Results:
The incidence of SBP elevation significantly increased in overweight children. SBP was positively related to heart rate, left ventricular (LV) ejection fraction and fraction shortening (β=1.824 [95% CI, 1.014–2.634], 0.579 [0.294–0.864], and 0.480 [0.257–0.704], respectively). BMI
Z
score was positively associated with LV mass index (β=1.225 [0.863–1.587]) and the risk of LV hypertrophy (odds ratio=1.428 [1.157–1.761]) but negatively related to measures of systolic function, including LV ejection fraction, LV fraction short, and global longitudinal strain (β=−0.417 [−0.735 to −0.099], −0.302 [−0.551 to −0.053], and −0.392 [−0.621 to −0.163], respectively). No noteworthy additive or multiplicative interactions between BMI and SBP were detected.
Conclusions:
Elevations in both BMI and SBP were related to cardiac structure and function in children as young as 4 years old. Elevated SBP was associated with increased heart rate and LV ejection at the early stage of BP elevation. BMI showed a closer relationship with left heart diameters and geometry than SBP.
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Affiliation(s)
- Yujian Wu
- Department of Pediatric Cardiology (Yujian Wu, Z.L., B.D., H.W., Y.N., S.C., Yurong Wu, J.W., K.S.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Zhuoyan Li
- Department of Pediatric Cardiology (Yujian Wu, Z.L., B.D., H.W., Y.N., S.C., Yurong Wu, J.W., K.S.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Bowen Du
- Department of Pediatric Cardiology (Yujian Wu, Z.L., B.D., H.W., Y.N., S.C., Yurong Wu, J.W., K.S.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Yujiao Ye
- Children's Heart Center, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, China (Y.Y.)
| | - Hualin Wang
- Department of Pediatric Cardiology (Yujian Wu, Z.L., B.D., H.W., Y.N., S.C., Yurong Wu, J.W., K.S.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Yiwei Niu
- Department of Pediatric Cardiology (Yujian Wu, Z.L., B.D., H.W., Y.N., S.C., Yurong Wu, J.W., K.S.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Sun Chen
- Department of Pediatric Cardiology (Yujian Wu, Z.L., B.D., H.W., Y.N., S.C., Yurong Wu, J.W., K.S.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Yurong Wu
- Department of Pediatric Cardiology (Yujian Wu, Z.L., B.D., H.W., Y.N., S.C., Yurong Wu, J.W., K.S.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Hong Jin
- Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health (H.J.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Xi Zhang
- Clinical Research Unit (X.Z.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Jian Wang
- Department of Pediatric Cardiology (Yujian Wu, Z.L., B.D., H.W., Y.N., S.C., Yurong Wu, J.W., K.S.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Kun Sun
- Department of Pediatric Cardiology (Yujian Wu, Z.L., B.D., H.W., Y.N., S.C., Yurong Wu, J.W., K.S.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
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Amberntsson A, Bärebring L, Winkvist A, Lissner L, Meltzer HM, Brantsæter AL, Papadopoulou E, Augustin H. Maternal vitamin D status in relation to infant BMI growth trajectories up to 2 years of age in two prospective pregnancy cohorts. Obes Sci Pract 2022; 8:670-681. [PMID: 36238227 PMCID: PMC9535664 DOI: 10.1002/osp4.602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/10/2022] [Accepted: 03/24/2022] [Indexed: 11/20/2022] Open
Abstract
Background Early childhood growth can affect the child's health status later in life. Maternal vitamin D status has been suggested to affect early childhood growth. However, there is a lack of studies investigating the role of maternal vitamin D status on growth trajectories during infancy. By using growth mixture modeling (GMM), maternal vitamin D status during pregnancy can be investigated in relation to different classes of infant growth trajectories. Objectives To examine the association between maternal 25-hydroxyvitamin D (25OHD) and classes of infant body mass index (BMI) growth trajectories. Methods Mother-child pairs were included from the Norwegian Mother, Father, and Child Cohort Study (MoBa, n = 2522) and the Swedish GraviD cohort (n = 862). Maternal 25OHD in pregnancy was analyzed by liquid chromatography tandem mass spectrometry. Children's weights and heights were registry-based. GMM identified classes of infant BMI growth trajectories up to 2 years. The association between maternal 25OHD and infant BMI class by cohort was estimated using a log-link generalized linear model. Mixed model analysis estimated the pooled association including both cohorts. Results Two infant BMI classes were identified, stable normal and stable high. In MoBa, maternal 25OHD <50 and 50-75 nmol/L were associated (RR 2.70, 95% CI 1.26-5.77 and RR 2.56, 95% CI 1.20-5.47) with a higher risk of the infant stable high BMI class, compared with 25OHD >75 nmol/L. In GraviD, no association was found. In pooled analysis, maternal 25OHD ≤75 nmol/L was non-significantly associated with a higher risk of the stable high BMI growth class. Conclusions Maternal 25OHD ≤75 nmol/L may be associated with a higher class of BMI growth trajectory during infancy.
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Affiliation(s)
- Anna Amberntsson
- Department of Internal Medicine and Clinical NutritionInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGoteborgSweden
| | - Linnea Bärebring
- Department of Internal Medicine and Clinical NutritionInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGoteborgSweden
| | - Anna Winkvist
- Department of Internal Medicine and Clinical NutritionInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGoteborgSweden
| | - Lauren Lissner
- School of Public Health and Community MedicineInstitute of Medicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Helle Margrete Meltzer
- Department of Food SafetyDivision of Climate and Environmental Health, Norwegian Institute of Public HealthOsloNorway
| | - Anne Lise Brantsæter
- Department of Food SafetyDivision of Climate and Environmental Health, Norwegian Institute of Public HealthOsloNorway
| | - Eleni Papadopoulou
- Global Health ClusterDivision of Health Services, Norwegian Institute of Public HealthOsloNorway
| | - Hanna Augustin
- Department of Internal Medicine and Clinical NutritionInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGoteborgSweden
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Lisanti AJ, Min J, Golfenshtein N, Ravishankar C, Costello JM, Huang L, Fleck D, Medoff-Cooper B. New insights on growth trajectory in infants with complex congenital heart disease. J Pediatr Nurs 2022; 66:23-29. [PMID: 35598589 PMCID: PMC9427721 DOI: 10.1016/j.pedn.2022.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE We aimed to describe the weight-for-age Z-score growth trajectory (WAZ-GT) of infants with complex congenital heart disease (cCHD) after neonatal cardiac surgery in the first 4 months of life and assess potential risk factors. METHODS We utilized data from a previously reported trial of the REACH telehealth home monitoring (NCT01941667) program which evaluated 178 infants with cCHD from 2012 to 2017. Over the first 4 months of life, weekly infant weights were converted to WAZ. WAZ-GT classes were identified using latent class growth modeling. Multinomial logistic regression models were used to examine the associations between potential risk factors and WAZ-GT classes. RESULTS Four distinct classes of WAZ-GT were identified: maintaining WAZ > 0, 14%; stable around WAZ = 0, 35%; partially recovered, 28%; never recovered, 23%. Compared with reference group "stable around WAZ=0," we identified clinical and sociodemographic determinants of class membership for the three remaining groups. "Maintaining WAZ > 0" had greater odds of having biventricular physiology, borderline appetite, and a parent with at least a college education. "Partially recovered" had greater odds of hospital length of stay>14 days and being a single child in the household. "Never recovered" had greater odds hospital length of stay >14 and > 30 days, tube feeding at discharge, and low appetite. CONCLUSIONS This study described distinct classes of WAZ-GT for infants with cCHD early in infancy and identified associated determinants. PRACTICE IMPLICATIONS Findings from this study can be used in the identification of infants at risk of poor WAZ-GT and in the design of interventions to target growth in this vulnerable patient population.
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Affiliation(s)
- Amy Jo Lisanti
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104, United States of America; Research Institute, Children's Hospital of Philadelphia, 734 Schuylkill Ave, Philadelphia, PA 19146, United States of America.
| | - Jungwon Min
- Department of Biomedical and Health informatics, Research Institute, Children's Hospital of Philadelphia, 734 Schuylkill Ave, Philadelphia, PA 19146, United States of America
| | - Nadya Golfenshtein
- University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa 3498838, Israel
| | - Chitra Ravishankar
- Division of Cardiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States of America
| | - John M Costello
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, 135 Rutledge Avenue, MSC 56, Charleston, SC 29425, United States of America
| | - Liming Huang
- Office of Nursing Research, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104, United States of America
| | - Desiree Fleck
- Department of Behavioral Health Sciences, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104, United States of America
| | - Barbara Medoff-Cooper
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104, United States of America; Research Institute, Children's Hospital of Philadelphia, 734 Schuylkill Ave, Philadelphia, PA 19146, United States of America
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Hu Y, Lu Q, Huang C, Gao Y, Tian Y, Fan L, Liu S. Associations between prenatal exposure to polybrominated diphenyl ethers and physical growth in a seven year cohort study. CHEMOSPHERE 2022; 303:135049. [PMID: 35618052 DOI: 10.1016/j.chemosphere.2022.135049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/03/2022] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
Although evidence suggests that prenatal exposure to polybrominated diphenyl ethers (PBDEs) alter offspring's physical growth, most studies rely upon physical growth at a single timepoint, and little is known regarding their longitudinal effects over time. In the current study, we determined the associations between prenatal PBDEs exposure and child physical growth by following up 207 mother-child pairs from the Laizhou Wan Birth Cohort (LWBC) from pregnancy until the children were seven years old. Child physical growth including weight, height, and body mass index (BMI) was assessed at birth, and at one, two and seven years of age. Prenatal exposure to PBDEs was quantified by measuring eight PBDE congeners (BDE-28, BDE-47, BDE-85, BDE-99, BDE-100, BDE-153, BDE-154, and BDE-183) in maternal serum samples collected upon hospital admission for delivery. Linear mixed models were applied to examine the associations between prenatal PBDEs exposure and repeated measures of child physical growth, and to determine whether these associations were modified by child's sex. Our findings indicated that BDE-28, BDE-85, BDE-153, BDE-183, and Σ7PBDEs were positively associated with child weight z-score; and that BDE-28, BDE-47, BDE-85, BDE-99, BDE-153, and Σ7PBDEs were positively associated with child height z-score. In addition, these associations were modified by the child's sex as reflected by pronounced positive associations among boys, while negative associations were noted among girls. In conclusion, our findings indicated the sex-specific associations between prenatal PBDE exposures and child physical growth during the first seven years of life.
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Affiliation(s)
- Yi Hu
- Department of Pediatrics, Hainan Women and Children's Medical Center, Haikou, China; Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Lu
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuican Huang
- Department of Child Health Care, Hainan Women and Children's Medical Center, Haikou, China
| | - Yu Gao
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Tian
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Hainan Women and Children's Medical Center, Haikou, China.
| | - Lichun Fan
- Department of Child Health Care, Hainan Women and Children's Medical Center, Haikou, China.
| | - Shijian Liu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Llorca-Colomer F, Murillo-Llorente MT, Legidos-García ME, Palau-Ferré A, Pérez-Bermejo M. Differences in Classification Standards For the Prevalence of Overweight and Obesity in Children. A Systematic Review and Meta-Analysis. Clin Epidemiol 2022; 14:1031-1052. [PMID: 36071986 PMCID: PMC9444235 DOI: 10.2147/clep.s375981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
The prevalence of childhood obesity has increased dramatically all over the world in recent years. While obesity in adults can be easily measured using the BMI calculation, determining overweight and obesity in children is more controversial. The aim was to compare the three most used international classification systems (WHO 2007, CDC 2000 and Cole-IOTF) to determine overweight and obesity in infant and adolescent populations. We performed a systematic review in accordance with the PRISMA 2020 guidelines of articles comparing any of the three classification systems. The main findings were that the WHO 2007 criteria show the highest prevalence of overweight and obesity in the child and youth population. The prevalence of childhood overweight and obesity was determined to be higher in boys than in girls in most studies, when analysing the classifications of the WHO 2007, CDC 2000 and Cole-IOTF together. However, there was a higher prevalence of overweight and obesity in girls than in boys when only the CDC 2000 and Cole-IOTF criteria were considered. Both the results of the review and the great heterogeneity found in the meta-analysis show that it is necessary to unify the criteria for the classification of childhood overweight and obesity. International standards are insufficient for working with the current population. A working group should be created to address this issue and agree on the unification of a gold standard, taking into account the geographical region, the ethnic groups and the age groups of the child and youth population and above all, the secular growth.
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Affiliation(s)
- Francisco Llorca-Colomer
- SONEV Research Group, School of Medicine and Health Sciences, Catholic University of Valencia, Valencia, Spain
- Doctoral School, Health Program. Catholic University of Valencia, Valencia, Spain
| | | | - María Ester Legidos-García
- SONEV Research Group, School of Medicine and Health Sciences, Catholic University of Valencia, Valencia, Spain
| | - Alma Palau-Ferré
- SONEV Research Group, School of Medicine and Health Sciences, Catholic University of Valencia, Valencia, Spain
| | - Marcelino Pérez-Bermejo
- SONEV Research Group, School of Medicine and Health Sciences, Catholic University of Valencia, Valencia, Spain
- Correspondence: Marcelino Pérez-Bermejo, SONEV Research Group, School of Medicine and Health Sciences, Catholic University of Valencia, C/Quevedo N° 2, Valencia, 46001, Spain, Tel/Fax +34 620984639, Email
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Kinlin LM, Oreskovich SM, Dubrowski R, Ball GD, Barwick M, Dettmer E, Haines J, Hamilton J, Kim TH, Klaassen M, Luca P, Maguire JL, Moretti ME, Stasiulis E, Toulany A, Birken CS. Managing Obesity in Young Children: A Multiple Methods Study Assessing Feasibility, Acceptability, and Implementation of a Multicomponent, Family-Based Intervention. Child Obes 2022; 18:409-421. [PMID: 35085455 PMCID: PMC9492792 DOI: 10.1089/chi.2021.0221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: We developed a multicomponent, family-based intervention for young children with obesity consisting of parent group sessions, home nursing visits, and multidisciplinary clinical encounters. Our objective was to assess intervention feasibility, acceptability, and implementation. Methods: From 2017 to 2020, we conducted a multiple methods study in the obesity management clinic at a tertiary children's hospital (Toronto, Canada). We included 1-6 year olds with a body mass index ≥97th percentile and their parents; we also included health care providers (HCPs) who delivered the intervention. To assess feasibility, we performed a pilot randomized controlled trial (RCT) comparing the intervention to usual care. To explore acceptability, we conducted parent focus groups. To explore implementation, we examined contextual factors with HCPs using the Consolidated Framework for Implementation Research. Results: There was a high level of ineligibility (n = 34/61) for the pilot RCT. Over 21 months, 11 parent-child dyads were recruited; of 6 randomized to the intervention, 3 did not participate in group sessions or home visits. In focus groups, themes identified by parents (n = 8) related to information provided at referral; fit between the intervention and patient needs; parental gains from participating in the intervention; and feasibility of group sessions. HCPs (n = 10) identified contextual factors that were positively and negatively associated with intervention implementation. Conclusions: We encountered challenges related to intervention feasibility, acceptability, and implementation. Lessons learned from this study will inform the next iteration of our intervention and are relevant to intervention development and implementation for young children with obesity. Clinical Trial Registration number: NCT03219658.
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Affiliation(s)
- Laura M. Kinlin
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Stephan M. Oreskovich
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Raluca Dubrowski
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Geoff D.C. Ball
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Melanie Barwick
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Dettmer
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Jill Hamilton
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Theresa H.M. Kim
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | | | - Paola Luca
- Section of Pediatric Endocrinology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Jonathon L. Maguire
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Myla E. Moretti
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Clinical Trials Unit, Ontario Child Health Support Unit, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elaine Stasiulis
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alene Toulany
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Catherine S. Birken
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Address correspondence to: Catherine S. Birken, MD, MSc, FRCPC, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto M5G 1X8, Ontario, Canada
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Chaima D, Hart J, Pickering H, Burr S, Maleta K, Kalua K, Bailey R, Holland M. Association between intestinal bacterial carriage, biomarkers of environmental enteric dysfunction, and stunting in rural Malawian children. Gates Open Res 2022. [DOI: 10.12688/gatesopenres.13671.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background. Available data from murine studies suggest that intestinal bacteria may have a role in modulating growth phenotypes in the host. We investigated the prevalence of four gut bacteria known in murine models to impair growth (Bifidobacterium longum, Faecalibacterium prausnitzii, Dorea formicigenerans, and Akkermansia muciniphila), the level of fecal biomarkers of environmental enteric dysfunction (EED) and stunting in rural Malawian children. Methods. DNA and protein were extracted from fecal samples of rural Malawian children (aged 1-59 months) at a baseline cross-sectional survey in the Mangochi district of Malawi conducted within the framework of the Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance (MORDOR) trial. Intestinal carriage of bacteria was measured by PCR. Neopterin (NEO), myeloperoxidase (MPO), and alpha-1 antitrypsin (AAT), biomarkers of EED, were measured by an enzyme-linked immunosorbent assay (ELISA) test. Height-for-age Z (HAZ) score <-2 defined stunting. Tests of proportions and regression models were used to explore the relationship between bacterial carriage, EED, and stunting. Results. Fecal samples from 613 children were available for laboratory analyses. F. prausnitzii and D. formicigenerans were prevalent in over 70% of children while B. longum was the least prevalent. B. longum carriage in younger children was associated with elevated EED biomarkers. Two thirds of children had elevated NEO, 33% had elevated MPO, and 16% had elevated AAT. Stunting was found in 38%. No significant associations were found between EED biomarkers or intestinal bacteria carriage and stunting. Conclusion. Intestinal carriage of these four bacteria was not associated with stunting in Malawian children. Carriage was also not associated with EED, nor EED biomarker levels associated with stunting. Further factors acting in concert are necessary to impact EED, perturb growth, and alter gut bacterial carriage.
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Wang J, Zhu D, Cheng X, Liuzhou Y, Zhu B, Montgomery S, Cao Y. Maternal perception of child weight and concern about child overweight mediates the relationship between child weight and feeding practices. Public Health Nutr 2022; 25:1780-1789. [PMID: 35000661 PMCID: PMC9991628 DOI: 10.1017/s1368980022000040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 10/28/2021] [Accepted: 01/06/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the mediating effects of maternal perception of child weight (weight perception) and concern about overweight (weight concern) on the paths between child weight and maternal feeding practices. SETTING Pudong District, Shanghai, China. PARTICIPANTS A convenience sample of 1164 mothers who were primary caregivers of preschool children. RESULTS Sixty per cent of the mothers perceived their overweight/obese children as normal weight or even underweight. The disagreement between actual child weight and maternal weight perception was statistically significant (Kappa = 0·212, P < 0·001). Structural equation modelling indicated that weight perception fully mediated the relationship between child BMI Z-scores and pressure to eat. Weight concern fully mediated the relationships between child BMI Z-scores and the other three feeding practices. The serial mediating effects of weight perception and concern were statistically significant for the paths between child BMI Z-score and monitoring (β = 0·035, P < 0·001), restriction (β = 0·022, P < 0·001), and food as a reward (β = -0·017, P < 0·05). CONCLUSION Child weight may influence maternal feeding practices through weight perception and concern. Thus, interventions are needed to increase the accuracy of weight perception, which may influence several maternal feeding practices and thereby contribute to child health.
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Affiliation(s)
- Jian Wang
- Shanghai Jiao Tong University School of Nursing, 200025Shanghai, People’s Republic of China
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
| | - Daqiao Zhu
- Shanghai Jiao Tong University School of Nursing, 200025Shanghai, People’s Republic of China
| | - Xuwen Cheng
- Department of Children’s Disease Prevention, Jinyang Community Health Service Center, Shanghai, People’s Republic of China
| | - Yicong Liuzhou
- Department of Nursing, Shanghai Children’s Medical Center, Shanghai, People’s Republic of China
| | - Bingqian Zhu
- Shanghai Jiao Tong University School of Nursing, 200025Shanghai, People’s Republic of China
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
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Hu Y, Ding G, Lv C, Zhang Q, Zhang Y, Yuan T, Ao J, Gao Y, Xia Y, Yu X, Tian Y. Association between triclosan exposure and obesity measures among 7-year-old children in northern China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 239:113610. [PMID: 35569301 DOI: 10.1016/j.ecoenv.2022.113610] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/25/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Triclosan (TCS) is a widely used synthetic antibacterial compound with ubiquitous human exposure. Animal studies have suggested the obesogenic effect of TCS exposure, but knowledge regarding its impacts on childhood obesity was limited. OBJECTIVE To investigate the associations of TCS exposure with childhood obesity in northern China. METHODS This study included 423 children who participated in the 7-year-old follow-up visits of Laizhou Wan Birth Cohort in Shandong, northern China. Children's TCS exposure were determined in spot urine samples via high performance liquid chromatography-tandem mass. Their height, weight, waist circumference, body fat percentage, body mass index (BMI), and waist-to-height ratio (WHtR) were measured or calculated. BMI z-score ≥ 85th percentile was defined as overweight/obesity, and WHtR ≥ 0.5 was considered to be abdominal obesity. Multivariable linear regressions, generalized linear models (GLMs), and multivariable logistic regressions were performed to examine the associations between TCS exposure and obesity measures in children. RESULTS Linear regressions showed that TCS concentrations, when treated as continuous variables, were positively associated with BMI z-score (β = 0.12, 95% CI: 0.01, 0.24) and body fat percentage (β = 0.82, 95% CI: 0.13, 1.52). When TCS concentrations were categorized as a four-level ordinal variable, the results of GLMs were similar those of continuous variables and both of the positive trends were significant (p-trend = 0.049 for BMI z-score; p-trend = 0.023 for body fat percentage). Moreover, the higher TCS levels versus reference group were associated with an approximate 2-3 fold increased risk of abdominal obesity (p-trend = 0.044). CONCLUSION Exposure to TCS was positively associated with obesity measures among 7-year-old children in northern, China. Given to the cross-sectional study design, a large prospective study is warranted to confirm our findings.
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Affiliation(s)
- Yi Hu
- MOE and Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; Center for Medical Bioinformatics, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, China
| | - Guodong Ding
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, China
| | - Cheng Lv
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Qianlong Zhang
- MOE and Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Yan Zhang
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Tao Yuan
- School of Environmental Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Junjie Ao
- MOE and Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Yu Gao
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yankai Xia
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Xiaodan Yu
- MOE and Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
| | - Ying Tian
- MOE and Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
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Ea C, Hennocq Q, Picard A, Polak M, Collet C, Legeai-Mallet L, Arnaud É, Paternoster G, Khonsari RH. Growth charts in FGFR2- and FGFR3-related faciocraniosynostoses. Bone Rep 2022; 16:101524. [PMID: 35372644 PMCID: PMC8965158 DOI: 10.1016/j.bonr.2022.101524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/26/2022] Open
Abstract
Objective Faciocraniosynostoses (FCS) are malformations affecting the development of the bones of the skull and face, due to the premature closure of one or more craniofacial sutures, mostly secondary to activating Fibroblast Growth Factor Receptor (FGFR) 1–3 mutations. Gain-of-function FGFR3 mutations are also responsible for various conditions referred to as osteochondrodysplasia (OCD), characterized by structural and functional abnormalities of growth plate cartilages. We hypothesized that patients with FGFR-related faciocraniosynostoses may present extra-cranial growth anomalies. Study design We retrospectively collected height and weight data from a cohort of 70 patients. Included patients were admitted for FGFR-related FCS between 2000 and 2021 at the Craniofacial Unit of Necker – Enfants Malades University Hospital in Paris, France. Results We showed that FGFR-related faciocraniosynostoses had significantly reduced heights and weights relative to controls, and that two specific time periods (1–3 years and > 8 years of age) were associated with lower height and weight values. Four patients had received growth hormone treatment but remained below normal values for growth in height and weight. Conclusions Patients with FGFR-related faciocraniosynostoses have clinically significant extra-cranial anomalies which are not currently investigated and managed in usual protocols; these patients could benefit from a systematic pre-pubertal endocrine assessment. More generally, our results extend the scope of extracranial anomalies in FGFR-related faciocraniosynostoses and support the hypothesis that all conditions with activating FGFR mutations affect both membranous ossification and long bones.
FGFR mutations can cause syndromic faciocraniosynostoses (FCS) and are also responsible for osteochondrodysplasia. Patients with FCS present with significant delays in development compared to the standard French population. Patients with FCS could benefit from a systematic pre-pubertal endocrine assessment and hormonotherapy but more data is required to establish guidelines. FCS and achondroplasia both affect membranous and endochondral ossification processes.
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DNA methylation mediates a randomized controlled trial home-visiting intervention during pregnancy and the Bayley infant's cognitive scores at 12 months of age. J Dev Orig Health Dis 2022; 13:556-565. [PMID: 35256034 DOI: 10.1017/s2040174421000738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The crosstalk between maternal stress exposure and fetal development may be mediated by epigenetic mechanisms, including DNA methylation (DNAm). To address this matter, we collect 32 cord blood samples from low-income Brazilian pregnant adolescents participants of a pilot randomized clinical intervention study (ClinicalTrials.gov, Identifier: NCT02807818). We hypothesized that the association between the intervention and infant neurodevelopmental outcomes at 12 months of age would be mediated by DNAm. First, we searched genome methylation differences between cases and controls using different approaches, as well as differences in age acceleration (AA), represented by the difference of methylation age and birth age. According to an adjusted p-value ≤ 0.05 we identified 3090 differentially methylated positions- CpG sites (DMPs), 21 differentially methylated regions (DMRs) and one comethylated module weakly preserved between groups. The intervention group presented a smaller AA compared to the control group (p = 0.025). A logistic regression controlled by sex and with gestational age indicated a coefficient of -0.35 towards intervention group (p = 0.016) considering AA. A higher cognitive domain score from Bayley III scale was observed in the intervention group at 12 months of age. Then, we performed a potential causal mediation analysis selecting only DMPs highly associated with the cognitive domain (adj. R2 > 0.4), DMRs and CpGs of hub genes from the weakly preserved comethylated module and epigenetic clock as raw values. DMPs in STXBP6, and PF4 DMR, mediated the association between the maternal intervention and the cognitive domain at 12 months of age. In conclusion, DNAm in different sites and regions mediated the association between intervention and cognitive outcome.
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Walton K, McGee M, Sato J, Law N, Hopperton KE, Bando N, Kiss A, Unger S, O'Connor DL. Social-Emotional Functioning and Dietary Intake among Children Born with a Very Low Birth Weight. Appl Physiol Nutr Metab 2022; 47:737-748. [PMID: 35196153 DOI: 10.1139/apnm-2021-0434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Very low birth weight infants (VLBW, <1500g) are at elevated risk of neurodevelopmental disorders, later obesity and cardiometabolic disease; if and how neurodevelopmental disorders impact chronic disease risk is poorly understood. The most common neurodevelopmental disorders experienced by VLBW children are those of social-emotional functioning. We compared dietary patterns and body composition between VLBW children with poor vs. typical social-emotional functioning using linear mixed models adjusted for sex, gestational age, cognitive impairment, parental education and BMI. VLBW children (n=158) attending the Donor Milk for Improved Neurodevelopmental Outcomes trial 5.5-year follow-up participated. Poor social-emotional functioning was based on standardized parent-rated questionnaires and/or parent-reported physician diagnosis of autism spectrum or attention-deficit/hyperactivity disorders. Most children had diets categorized as 'needs improvement' (67%) or 'poor' (27%) and 29% of children exhibited poor social-emotional functioning. Poor social-emotional functioning was positively associated with 100% fruit juice (β=0.3 cup equivalents/day; 95% CI 0.1, 0.5) and energy intake (β=118.1 kcals/day; 95% CI 0.9, 235.2). Children with poor social-emotional functioning were more likely to have a limited food repertoire (p=0.02), but less likely to exceed dietary fat recommendations (p=0.04). No differences in overall diet quality or body composition were observed. Diet counselling and research are essential to improving the nutrition of VLBW children to mitigate chronic disease risk. Novelty: • Overall diet quality and body composition did not differ between VLBW children with poor vs. typical social-emotional functioning. • Most had diets "needing improvement" or "poor" according to the HEI 2010. • Diet counselling may help mitigate chronic disease risk in this vulnerable population.
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Affiliation(s)
- Kathryn Walton
- The Hospital for Sick Children, 7979, Translational Medicine, Toronto, Ontario, Canada;
| | - Meghan McGee
- The Hospital for Sick Children, 7979, Translational Medicine, Toronto, Ontario, Canada.,University of Toronto Dalla Lana School of Public Health, 274071, Toronto, Ontario, Canada.,University of Toronto Temerty Faculty of Medicine, 12366, Nutritional Sciences, Toronto, Ontario, Canada;
| | - Julie Sato
- The Hospital for Sick Children, 7979, Neurosciences & Mental Health, Toronto, Ontario, Canada.,The Hospital for Sick Children, 7979, Diagnostic Imaging , Toronto, Ontario, Canada.,University of Toronto, 7938, Psychology, Toronto, Ontario, Canada;
| | - Nicole Law
- The Hospital for Sick Children, 7979, Translational Medicine, Toronto, Ontario, Canada;
| | - Kathryn E Hopperton
- The Hospital for Sick Children, 7979, Translational Medicine, Toronto, Ontario, Canada;
| | - Nicole Bando
- The Hospital for Sick Children, 7979, Translational Medicine, Toronto, Ontario, Canada.,University of Toronto Temerty Faculty of Medicine, 12366, Nutritional Sciences, Toronto, Ontario, Canada;
| | - Alex Kiss
- University of Toronto Institute of Health Policy Management and Evaluation, 206712, Toronto, Ontario, Canada.,Sunnybrook Research Institute, 282299, Evaluative and Clinical Sciences, Toronto, Ontario, Canada;
| | - Sharon Unger
- Sinai Health System, 518775, Department of Paediatrics, Toronto, Ontario, Canada.,University of Toronto Temerty Faculty of Medicine, 12366, Department of Pediatrics, Toronto, Ontario, Canada.,The Hospital for Sick Children, 7979, Neonatology, Toronto, Ontario, Canada;
| | - Deborah L O'Connor
- The Hospital for Sick Children, 7979, Translational Medicine, Toronto, Ontario, Canada.,University of Toronto Temerty Faculty of Medicine, 12366, Nutritional Sciences, Toronto, Ontario, Canada.,Sinai Health System, 518775, Paediatrics, Toronto, Ontario, Canada;
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Fuller A, Siddiqi A, Shahidi FV, Anderson LN, Hildebrand V, Keown-Stoneman CDG, Maguire JL, Birken C. Understanding income-related differences in distribution of child growth, behaviour and development using a cross-sectional sample of a clinical cohort study. BMJ Open 2022; 12:e056991. [PMID: 35168982 PMCID: PMC8852748 DOI: 10.1136/bmjopen-2021-056991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Children from low-income households are at an increased risk of social, behavioural and physical health problems. Prior studies have generally relied on dichotomous outcome measures. However, inequities may exist along the range of outcome distribution. Our objective was to examine differences in distribution of three child health outcomes by income categories (high vs low): body mass index (BMI), behaviour difficulties and development. DESIGN AND SETTING This was a cross-sectional study using data from a primary care-based research network with sites in three Canadian cities, and 15 practices enrolling participants. PARTICIPANTS, INDEPENDENT VARIABLE AND OUTCOMES The independent variable was annual household income, dichotomised at the median income for Toronto (<$C80 000 or ≥$C80 000). Outcomes were: (1) growth (BMI z-score (zBMI) at 5 years, 1628 participants); (2) behaviour (Strengths and Difficulties Questionnaire (SDQ) at 3-5 years, 649 participants); (3) development (Infant Toddler Checklist (ITC) at 18 months, 1405 participants). We used distributional decomposition to compare distributions of these outcomes for each income group, and then to construct a counterfactual distribution that describes the hypothetical distribution of the low-income group with the predictor profile of the higher-income group. RESULTS We included data from 1628 (zBMI), 649 (SDQ) and 1405 (ITC) children. Children with lower family income had a higher risk distribution for all outcomes. For all outcomes, thecounterfactual distribution, which represented the distribution of children with lower-income who were assigned the predictor profile of the higher-income group, was more favourable than their observed distributions. CONCLUSION Comparing the distributions of child health outcomes and understanding different risk profiles for children from higher-income and lower-income groups can offer a deeper understanding of inequities in child health outcomes. These methods may offer an approach that can be implemented in larger datasets to inform future interventions.
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Affiliation(s)
- Anne Fuller
- Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Faraz V Shahidi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Work and Health, Toronto, Ontario, Canada
| | - Laura N Anderson
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Vincent Hildebrand
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Economics, York University - Glendon Campus, Toronto, Ontario, Canada
| | - Charles D G Keown-Stoneman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Paediatrics, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Birken
- Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
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McNelis K, Poindexter A, Goddard G, Riddle S, Wessel J, Helmrath M. Body Composition of Infants With Congenital Gastroschisis. J Pediatr Gastroenterol Nutr 2022; 74:e35-e38. [PMID: 34406999 DOI: 10.1097/mpg.0000000000003288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
ABSTRACT Infants born with congenital gastroschisis are at risk for intrauterine growth restriction, small for gestational size at birth, and growth failure during the newborn period despite advanced care. Body composition provides a more complete picture of proportional growth than weight and length alone. Fat-free mass (FFM) represents organ growth, and in preterm infants without gastroschisis, improved FFM deposition is associated with improved neurodevelopmental outcomes. There is limited literature regarding the body composition of infants with gastroschisis. This case series describes the body composition of 10 infants with gastroschisis.
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Affiliation(s)
- Kera McNelis
- Division of Neonatology, Cincinnati Children's Hospital Medical Center
- College of Medicine, University of Cincinnati
| | | | - Gillian Goddard
- Division of Pediatric and General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Surgery, Boston Medical Center, Boston, MA
| | - Stefanie Riddle
- Division of Neonatology, Cincinnati Children's Hospital Medical Center
- College of Medicine, University of Cincinnati
| | - Jacqueline Wessel
- Division of Pediatric and General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Michael Helmrath
- College of Medicine, University of Cincinnati
- Division of Pediatric and General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Gut Microbiota Diversity and Overweight/Obesity in Infancy: Results from a Nested Case-control Study. Curr Med Sci 2022; 42:210-216. [PMID: 34985609 DOI: 10.1007/s11596-021-2476-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/09/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Childhood obesity is a major health concern worldwide. Previous studies have explored the relationship between obesity and gut microbiota. However, the results from such studies remain contradictory. METHODS In the present nested case-control study, based on a twin birth cohort study, the relationship between gut microbiota diversity and overweight/obesity in 1- and 6-month-old infants was explored. Twins were enrolled when one child had normal weight and the other child was overweight/obese at six months old. For both infants, stool samples were collected at 1 and 6 months of age. Finally, 12 twins were enrolled in the study. The gut microbiota was identified by 16S rRNA gene sequencing in the V3-V4 area. Six of the twins were monozygotic. RESULTS The results revealed that the microbiota communities of monozygotic twins were similar to those of dizygotic twins. The relative abundance (RA) of microbiota of 1-month-old twins was significantly higher than that of 6-month-old twins. However, the microbiota diversity of 1-month-old twins was significantly lower than that of 6-month-old twins. In addition, 6-month-old twins had significantly higher RA levels of Bifidobacterium and Lachnospiracea incertae sedis than 1-month-old twins. The 6-month-old group had significantly lower RA levels of Veillonella, Klebsiella, Akkermansia, Streptococcus, or Staphylococcus than the 1-month-old group. At six months, the RA level of Clostridium sensu stricto was higher in the overweight/obesity group than the normal-weight group. CONCLUSION These findings imply that changes in gut microbiota diversity during infancy may contribute to the development of obesity in early infancy.
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Pre-pregnancy body mass index and gestational weight-gain predict maternal hemoglobin levels and are jointly associated with neonatal outcomes in a Mexican birth cohort. NUTR HOSP 2022; 39:852-862. [DOI: 10.20960/nh.03999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Ferrantini G, Coratti G, Onesimo R, Lucibello S, Bompard S, Turrini I, Cicala G, Caprarelli M, Pera MC, Bravetti C, Berti B, Giorgio V, Bruno C, Brolatti N, Panicucci C, D’Amico A, Longo A, Leoni C, Sansone VA, Albamonte E, Messina S, Sframeli M, Bertini E, Pane M, Mercuri E, the Italian ISMAC study group. Body mass index in type 2 spinal muscular atrophy: a longitudinal study. Eur J Pediatr 2022; 181:1923-1932. [PMID: 35048179 PMCID: PMC9056453 DOI: 10.1007/s00431-021-04325-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/09/2021] [Accepted: 11/19/2021] [Indexed: 11/03/2022]
Abstract
UNLABELLED The aim of this retrospective study was to review body mass index (BMI) in a large cohort of Italian pediatric type 2 spinal muscular atrophy (SMA) patients, aged between 0 and 20 years and to establish possible differences in relation to a number of variables such as ventilation, motor function, and survival motor neuron 2 gene copies. Cross-sectional data were collected from 102 patients for a total of 344 visits. Standard growth charts for height and weight were used as reference, with age adjusted BMI calculated using the Center for Disease and Prevention Children's BMI Tool. In the 344 visits, weight ranged between 3.90 and 83 kg, and the BMI between 8.4 and 31.6 with a BMI/age z-scores < - 2SD present in 28% and BMI/age z-scores > + 2SD in 9% of the measurements. The BMI/age z-scores were relatively stable < 5 years of age with an increasing number of patients < - 2SD after the age of 5, and a wider range of BMI/age z-scores after the age of 13. A difference on the BMI/age z-scores was found among the different age subgroups (< 5, 5-12, ≥ 13 years). A multivariate analysis in 58 patients with longitudinal assessments showed that baseline BMI/age z-scores and gender were significantly contributing to the changes while other variables were not. CONCLUSION Our results confirm that careful surveillance of weight and BMI/age z-scores is needed in type 2 SMA. Further studies, including assessments of chewing and swallowing and of lean/fat body mass, will help to better understand the possible mechanisms underlying weight issues. WHAT IS KNOWN • Feeding difficulties have been reported in a few studies and were invariably found in patients with type 1 SMA. • Type 2 SMA patients often have low BMI with a relevant number of patients requiring tube feeding. WHAT IS NEW • Reduction in BMI/age z-score overtime appeared to depend on baseline BMI/age z-score and gender. • Patients with a low BMI/age z-score were at higher risk of developing further reduction.
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Affiliation(s)
- Gloria Ferrantini
- grid.8142.f0000 0001 0941 3192Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.477103.6Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giorgia Coratti
- grid.8142.f0000 0001 0941 3192Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.477103.6Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberta Onesimo
- grid.414603.4Pediatric Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simona Lucibello
- grid.8142.f0000 0001 0941 3192Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.477103.6Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Sarah Bompard
- grid.8142.f0000 0001 0941 3192Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ida Turrini
- grid.8142.f0000 0001 0941 3192Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziamaria Cicala
- grid.8142.f0000 0001 0941 3192Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michela Caprarelli
- grid.8142.f0000 0001 0941 3192Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Carmela Pera
- grid.8142.f0000 0001 0941 3192Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.477103.6Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Chiara Bravetti
- grid.8142.f0000 0001 0941 3192Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.477103.6Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Beatrice Berti
- grid.477103.6Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Valentina Giorgio
- grid.414603.4Pediatric Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudio Bruno
- grid.419504.d0000 0004 1760 0109Center of Experimental and Translational Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Noemi Brolatti
- grid.419504.d0000 0004 1760 0109Center of Experimental and Translational Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Chiara Panicucci
- grid.419504.d0000 0004 1760 0109Center of Experimental and Translational Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Adele D’Amico
- grid.414125.70000 0001 0727 6809Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neurosciences, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Antonella Longo
- grid.414125.70000 0001 0727 6809Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neurosciences, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Chiara Leoni
- grid.414603.4Pediatric Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valeria A. Sansone
- Neurorehabilitation Unit, University of Milan, Neuromuscular Omnicentre Clinical Center, Niguarda Hospital, Milan, Italy
| | - Emilio Albamonte
- Neurorehabilitation Unit, University of Milan, Neuromuscular Omnicentre Clinical Center, Niguarda Hospital, Milan, Italy
| | - Sonia Messina
- grid.10438.3e0000 0001 2178 8421Department of Clinical and Experimental Medicine and Centro Clinico Nemo Sud, University of Messina, Messina, Italy
| | - Maria Sframeli
- grid.10438.3e0000 0001 2178 8421Department of Clinical and Experimental Medicine and Centro Clinico Nemo Sud, University of Messina, Messina, Italy
| | - Enrico Bertini
- grid.414125.70000 0001 0727 6809Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neurosciences, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Marika Pane
- grid.8142.f0000 0001 0941 3192Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.477103.6Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Eugenio Mercuri
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy. .,Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
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Rao S, Esvaran M, Chen L, Keil AD, Gollow I, Simmer K, Wemheuer B, Conway P, Patole S. Probiotic supplementation in neonates with congenital gastrointestinal surgical conditions: a pilot randomised controlled trial. Pediatr Res 2022; 92:1122-1131. [PMID: 34980887 PMCID: PMC8722408 DOI: 10.1038/s41390-021-01884-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/09/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate whether probiotic supplementation attenuates gut-dysbiosis in neonates with congenital gastrointestinal surgical conditions (CGISC). METHODS Sixty-one neonates (≥35 weeks gestation) with CGISC were randomised to receive daily supplementation with a triple-strain bifidobacterial probiotic (n = 30) or placebo (n = 31) until discharge. Stool microbiota was analysed using 16S ribosomal RNA gene sequencing on samples collected before (T1), 1 week (T2), and 2 weeks (T3) after supplementation and before discharge (T4). The primary outcome was the sum of the relative abundance of potentially pathogenic families of Clostridiaceae, Enterobacteriaceae, Enterococcaceae, Pseudomonaceae, Staphylococcaeae, Streptococcaceae, and Yersiniaceae at T3. RESULTS The median gestational age [38 weeks (IQR: 37.1-38.9)] was similar in both groups. The probiotic group had lower rates of caesarean deliveries (40% versus 70%, p = 0.02). The relative abundance of potentially pathogenic families was lower in the probiotic group compared to placebo at T3 [(median: 50.4 (IQR: 26.6-67.6) versus 67.1 (IQR: 50.9-96.2); p = 0.04). Relative abundance of Bifidobacteriaceae was higher in the probiotic group at T3 [(median: 39.8 (IQR: 24.9-52.1) versus 0.03 (IQR 0.02-2.1); p < 0.001). Stratified analysis continued to show a higher abundance of Bifidobacteriaceae in the probiotic group, irrespective of the mode of delivery. CONCLUSIONS Probiotic supplementation attenuated gut dysbiosis in neonates with CGISC. TRIAL REGISTRATION http://www.anzctr.org.au (ACTRN12617001401347). IMPACT Probiotic supplementation attenuates gut dysbiosis and improves stool short-chain fatty acid levels in neonates with congenital gastrointestinal surgical conditions. This is the second pilot RCT of probiotic supplementation in neonates with congenital gastrointestinal conditions. These findings will pave the way for conducting multicentre RCTs in this area.
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Affiliation(s)
- Shripada Rao
- Neonatal Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia. .,Neonatal Intensive Care Unit, King Edward Memorial Hospital for Women, Perth, WA, Australia. .,School of Medicine, University of Western Australia, Crawley, WA, Australia.
| | - Meera Esvaran
- grid.1005.40000 0004 4902 0432Centre for Marine Science and Innovation at the University of New South Wales (UNSW), Sydney, NSW Australia
| | - Liwei Chen
- grid.59025.3b0000 0001 2224 0361School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
| | - Anthony D. Keil
- grid.2824.c0000 0004 0589 6117Department of Microbiology, PathWest Laboratory Medicine, Perth, WA Australia
| | - Ian Gollow
- grid.410667.20000 0004 0625 8600Department of Paediatric Surgery, Perth Children’s Hospital, Perth, WA Australia
| | - Karen Simmer
- grid.410667.20000 0004 0625 8600Neonatal Intensive Care Unit, Perth Children’s Hospital, Perth, WA Australia ,grid.415259.e0000 0004 0625 8678Neonatal Intensive Care Unit, King Edward Memorial Hospital for Women, Perth, WA Australia ,grid.1012.20000 0004 1936 7910School of Medicine, University of Western Australia, Crawley, WA Australia
| | - Bernd Wemheuer
- grid.1005.40000 0004 4902 0432Centre for Marine Science and Innovation at the University of New South Wales (UNSW), Sydney, NSW Australia ,grid.7450.60000 0001 2364 4210Department of Genomic and Applied Microbiology, University of Göttingen, Göttingen, Germany
| | - Patricia Conway
- grid.1005.40000 0004 4902 0432Centre for Marine Science and Innovation at the University of New South Wales (UNSW), Sydney, NSW Australia ,grid.59025.3b0000 0001 2224 0361School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
| | - Sanjay Patole
- grid.410667.20000 0004 0625 8600Neonatal Intensive Care Unit, Perth Children’s Hospital, Perth, WA Australia ,grid.415259.e0000 0004 0625 8678Neonatal Intensive Care Unit, King Edward Memorial Hospital for Women, Perth, WA Australia ,grid.1012.20000 0004 1936 7910School of Medicine, University of Western Australia, Crawley, WA Australia
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