All Posts tagged childhood

Infant obesity widespread in the USA

A study led by Brian Moss of Wayne State University’s School of Social Work reveals that one third of infants in the U.S. are obese or at risk of obesity. In addition, of the 8,000 infants studied, those found to be obese at 9 months had a higher risk of being obese at 2 years. Other studies have revealed that Infant obesity increases the risk for later childhood obesity and could lead to other obesity-related health problems like heart disease, asthma, high blood pressure and cancer. According to the U.S. Centers for Disease Control and Prevention, childhood and infant obesity has more than tripled in the past 30 years.

Moss, in collaboration with William H. Yeaton from the Institute for Social Research at the University of Michigan in Ann Arbor, published their analysis, “Young Children’s Weight Trajectories and Associated Risk Factors: Results from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B),” in the January/February 2011 issue of the American Journal of Health Promotion. The ECLS-B draws from a representative sample of American children born in 2001 with diverse socioeconomic and racial/ethnic backgrounds. It is one of the first studies to monitor weight status changes of a nationally representative sample of very young children.

For their study, Moss and Yeaton used results from ECLS-B to follow the trajectory of the infants’ weight status at 9 months and 2 years, then performed statistical analyses to examine whether weight persistence, loss or gain was linked to demographic characteristics such as sex, race/ethnicity, geographic region or socioeconomic status. Children above the 95th percentile on standard growth charts were considered to have infant obesity, children in the 85th to 95th percentile were considered at risk for obesity.

Some of their results show that:
• 31.9 percent of 9-month-olds were at risk or obese;
• 34.3 percent of 2-year-olds were obese or at risk for obesity;
• 17 percent of the infants were obese at 9 months, rising to 20 percent at 2 years;
• 44 percent of the infants who were obese at 9 months remained obese at 2 years;
• Hispanic and low-income children were at greater risk for weight status gain;
• Females and Asian/Pacific Islanders were at lower risk for undesirable weight changes;
• 40 percent of 2-year-olds from the lowest income homes were at risk or obese compared to 27 percent of those from the highest income homes.

“This study shows that a significant proportion of very young children in the United States is at risk or is obese,” said Moss. The team notes a consistent pattern of obesity starting early in life. “As obesity becomes an increasing public health concern, these findings will help guide health practitioners by targeting high risk populations and foster culturally sensitive interventions aimed at prevention and treatment of obesity,” Moss said.

“We are not saying that overweight babies are doomed to be obese adults. However, we have found evidence that being overweight at 9 months puts you on track for being overweight or obese later in childhood.”

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Does milk fight bowel cancer

The study was carried out by researchers from University of Otago Medical School, New Zealand. Funding was provided by Genesis Oncology Trust, the Dean’s Bequest Funds of the Dunedin School of Medicine, the Gisborne East Coast Cancer Research Trust and the Director’s Cancer Research Trust. The research was published in the peer-reviewed American Journal of Epidemiology. This was a case-control study in New Zealand that compared a group of adults with bowel cancer, and a group without bowel cancer, and looked at whether they drank milk at school. School milk was freely available in most schools in New Zealand until 1967 when the government programme was stopped. Many schools in the Southland region stopped free milk as long ago as 1950.

Case-control studies are appropriate for looking at whether people with and without a disease have had a particular exposure (milk in this case). The difficulty is in accounting for all potential confounding factors, particularly other health and lifestyle factors, which could be related to both diet and bowel cancer risk, for example regular childhood milk consumption could be a reflection of a ‘healthy’ diet and other healthy lifestyle behaviours that may reduce risk of cancer. In addition, when examining such a specific dietary factor – ie milk consumed in school – it is difficult to account for all possible milk or other dairy products consumed outside of school.

In this case-control study, 562 adults (aged 30 to 69) with newly diagnosed bowel cancer were identified from the New Zealand Cancer Registry in 2007. For a control group, 571 age-matched adults without cancer were randomly selected from the electoral register. All participants were mailed a questionnaire that asked about any previous illness, use of aspirin or dietary supplements in childhood, participation in school milk programmes, other childhood milk consumption, childhood diet (including other milk and dairy), smoking, alcohol consumption prior to 25 years of age, screening tests for bowel cancer, family history of cancer, education and sociodemographic characteristics. Childhood weight and height were not questioned. For school milk consumption they were specifically asked:

  • Whether they drank school milk
  • How many half-pint bottles they drank a week
  • What age they first drank school milk
  • When they stopped drinking school milk

Statistical risk associations between school milk participation and cancer were calculated. The calculations took into account several risk factors for bowel cancer risk including age, sex, ethnicity and family history.

What were the basic results?

Data on school milk consumption was available for 552 cases and 569 controls. As expected, people who started school before 1967 were more likely to have had free school milk than those who began school after 1968. Seventy-eight percent of cases participated in the school milk programme compared with 82% of controls. School milk consumption was associated with a 30% reduced risk of developing bowel cancer (odds ratio 0.70, 95% confidence interval 0.51 to 0.96).

When looking at the effect of number of bottles consumed per week they found that compared with no bottles, five bottles per week was associated with 32% significantly decreased risk, and 10 or more bottles with 61% significantly decreased risk. However, there was no significant association with one to four bottles or six to nine bottles. The researchers found a similar trend when the total school consumption of milk was compared with no consumption: 1,200-1,599 bottles was associated with 38% significantly decreased risk; 1,600-1,799 with 43% decreased risk; and 1,800 or more bottles associated with 38% significantly decreased risk. There was no significant association with fewer than 1,200 bottles. The researchers calculated that for every 100 half-pint bottles consumed at school there was a 2.1% reduction in the risk of bowel cancer. Outside of school, there was a significantly reduced risk of bowel cancer with more than 20 dairy products a week compared with none to nine dairy products a week.

The researchers conclude that their national case-control study ‘provides evidence that school milk consumption was associated with a reduction in the risk of adult colorectal cancer in New Zealand. Furthermore, a dose-dependent relation was evident’. This study has strengths in its relatively large size, its reliable and nationally representative identification of cases and controls, and its thorough data collection. However, the conclusion that school milk consumption is associated with a reduced risk of bowel cancer in adulthood must be interpreted in light of a number of considerations:

The analysis took into account established risk factors for bowel cancer including age, sex, ethnicity and family history. However, many other potential confounders were not considered, including diet, physical activity, overweight and obesity, smoking or alcohol consumption. Diet in particular has been implicated in bowel cancer risk, with diets high in saturated fat, red meat and processed foods and low in fibre, fruit and vegetables thought to increase risk. Potentially, any of these lifestyle behaviours could be confounding the relationship between school milk consumption and bowel cancer and regular childhood milk consumption could be a reflection of a ‘healthy’ diet and other healthy lifestyle behaviours that reduce risk of cancer. When looking at the effect of number of bottles consumed per week, the researchers found that, compared with no bottles, five bottles were associated with 32% significantly decreased risk and 10 or more bottles with 61% significantly decreased risk. However, there was no significant association with one to four bottles or six to nine bottles. Therefore, the trend here is not very clear. Particularly as only 16 cases and 31 controls drank 10 or more bottles a week, statistical comparison between such small numbers should be viewed with caution. With many food questionnaires there is the potential for recall bias. For example, adults may have difficulty remembering how many bottles of school milk they drank many years before. When estimating their average weekly amount, it is highly possible that this could be inaccurate or that their consumption varied slightly from week to week and year to year. Particularly when researchers were using this response and combining it with the number of weeks in the school year and their total years at school to give a total number of bottles consumed at school (figures in 100s or 1,000s), there is the possibility of being incorrectly categorised. Hence, there may be less reliability when calculating risk according to the category of total milk bottles consumed. Cancer prevalence, and particularly environmental and lifestyle risk factors for cancer, can vary between countries. These findings in New Zealand may not be represented elsewhere. Of note, the researchers acknowledge that a cohort study in the UK found the opposite: increased childhood dairy consumption was associated with increased risk of bowel cancer. Case-control studies are most appropriate for looking at rare diseases, where you would expect there to be only a small number of cases developing among a large number of people. In the case of bowel cancer, which is common, the slightly more reliable cohort design could have also been used, where children who drank milk at school and those who didn’t were followed over time to see if they developed cancer. However, such a cohort would consequently need extensive long-term follow-up.

The possible association between milk/dairy consumption, or calcium intake, in childhood, or in later years, is worthy of further study. However, from this study alone, it cannot be concluded that school milk prevents bowel cancer later in life.

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‘No evidence’ for Vitamin B allergy

Consumption of Vitamin B during pregnancy does not increase the risk of allergy in the infants, says a new study from Japan that challenges previous findings. Maternal consumption of folate and vitamins B2, B6, and B12 during pregnancy was not associated with the risk of the infant developing asthma or eczema, according to findings from 763 infants published in Pediatric Allergy and Immunology.

Contradictory science

The link between folate and folic acid, the synthetic form of the vitamin, and respiratory health is not clear cut, with contradictory results reported in the literature. A study from Johns Hopkins Children’s Center found that higher levels of folate were associated with a 16 per cent reduction of asthma in (Journal of Allergy & Clinical Immunology, June 2009, Vol. 123, pp. 1253-1259.e2). However, a Norwegian study reported that folic acid supplements during the first trimester were associated with a 6 per cent increase in wheezing, a 9 per cent increase in infections of the lower respiratory tract, and a 24 per cent increase in hospitalisations for such infections, (Archives of Diseases in Childhood, doi:10.1136/adc.2008.142448). In addition, researchers from the University of Adelaide in Australia reported that folic acid supplements in late pregnancy may increase the risk of asthma by about 25 per cent in children aged between 3 and 5 years (American Journal of Epidemiology, 2010, doi:10.1093/aje/kwp315).

Illumination from the Land of the Rising Sun?

The new study, performed by researchers from Fukuoka University, the University of Tokyo, and Osaka City University, goes beyond folate and folic acid, and reports no link between Vitamin B intake and the risk of asthma or eczema in children. “To the best of our knowledge, there has been no birth cohort study on the relationship between maternal consumption of Vitamin B during pregnancy and the risk of allergic disorders in the offspring,” wrote the researchers. The findings were based on data from 763 pairs of Japanese mother and child. A diet history questionnaire was used to assess maternal intakes of the various B vitamins during pregnancy, and the infants were followed until the age of 16 to 24 months. Japan has no mandatory fortification of flour with folic acid.

Results showed that, according to criteria from the International Study of Asthma and Allergies in Childhood, 22 and 19 percent of the children had symptoms of wheeze and eczema, respectively, but there was no association between these children and the dietary intakes of the various B vitamins by their mothers. “Our results suggest that maternal intake of folate, vitamin B12, vitamin B6, and vitamin B2 during pregnancy was not measurably associated with the risk of wheeze or eczema in the offspring,” said the researchers. “Further investigation is warranted to draw conclusions as to the question of whether maternal Vitamin B intake during pregnancy is related to the risk of childhood allergic,” they concluded.

According to the European Federation of Allergy and Airway Diseases Patients Association (EFA), over 30m Europeans suffer from asthma, costing Europe €17.7bn every year. The cost due to lost productivity is estimated to be around €9.8bn. The condition is on the rise in the Western world and the most common long-term condition in the UK today. According to the American Lung Association, almost 20m Americans suffer from asthma. The condition is reported to be responsible for over 14m lost school days in children, while the annual economic cost of asthma is said to be over $16.1bn.

Source: Pediatric Allergy and Immunology. Volume 22, Issue 1-Part-I, February 2011, Pages: 69–74 DOI: 10.1111/j.1399-3038.2010.01081.x
“Maternal B vitamin intake during pregnancy and wheeze and eczema in Japanese infants aged 16–24 months: The Osaka Maternal and Child Health Study”. Authors: Y. Miyake, S. Sasaki, K. Tanaka, Y. Hirota

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Caffeine consumption common in kids

Even young children appear to be consuming more caffeine, so much so that caffeine could be contributing to sleep problems in primary school children, researchers found. Three-quarters of children ages 5 to 12 consumed caffeine on an average day in a survey of parents at routine clinic visits by William J. Warzak, PhD, of the University of Nebraska Medical Center in Omaha, and colleagues. The more caffeine children consumed, the fewer hours they slept on average (P=0.02), the researchers reported online in the Journal of Pediatrics, although not drawing a causal link. The average intake was two or three times higher than the 22- to 23-mg daily average reported nearly a decade ago, they noted.

Eight- to 12-year-olds in Warzak's study averaged 109 mg of caffeine — the equivalent of nearly three 12-oz cans of soda each day. But even the 52 mg of caffeine consumed by 5- to 7-year-olds on an typical day was well above the level known to have a physiologic effect on adults, the researchers noted. “There's really no role for caffeine in kids,” Marcie Schneider, MD, of the Albert Einstein College of Medicine in New York City, emphasized in commenting on the study. “We know that caffeine raises your blood pressure, raises your heart rate, and can be addictive.” Unlike older teens who are likely drinking coffee to wake up in the mornings for school, the assumption is that younger kids are getting most of their caffeine from soda, noted Schneider, who serves as a member of the American Academy of Pediatrics Committee on Nutrition.

She urged pediatricians to raise parents' awareness of the issue, perhaps as part of the yearly checkup. “We routinely ask kids what they're eating and drinking,” “It may be something that is worth pediatricians pointing out to parents that this kid does not need caffeine in their life partially because it does some things that are negative.”

Warzak's group surveyed parents of 228 children seen at an urban outpatient pediatric clinic during routine visits about the children's average daily consumption of drinks and snacks with an emphasis on caffeine-containing items. None of the children had a known sleep disorder or medical condition that might cause bedwetting. Illustrated depictions were provided to help parents accurately estimate serving sizes.

Nearly all of the caffeine intake was consumed through beverages. Few children got a meaningful amount of caffeine from food. “Caffeine's diuretic properties have encouraged behavioral health practitioners to eliminate caffeine from the diet of children with enuresis,” the researchers noted. However, they found that intake didn't correlate with the number of nights a child wet the bed (P=0.49). Overall, enuresis was actually less likely in children who consumed caffeine.

The researchers cautioned that interpretation of these results may be complicated by cultural differences in reporting children's behavioral health concerns and that their study could not draw any causal conclusions. Schneider also noted the use of parental reports and the relatively small sample as limitations. Although the findings offered no support for removing caffeine from children's diets on the basis of bedwetting, Warzak's group concluded in the paper that “given the potential effects of caffeine on childhood behavior, a screen of caffeine consumption might be beneficial when evaluating childhood behavioral health concerns.”

Source: Warzak WJ, et al “Caffeine consumption in young children” J Pediatr 2011; DOI: 10.1016/j.jpeds.2010.11.022.

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Picky Eating: Its not just for kids

As an example of a picky eater who would not be classified as having an eating disorder, Marcus referenced a woman who spoke on a radio program recently. The woman declared herself “the pickiest eater I've ever met” and explained that the thought of eating any cooked vegetable made her sick, though she didn't mind them raw.

“That is not a disorder,” said Marcus. “She has plenty of other foods to choose from and it's not affecting her health or well-being.”

In her practice at Western Psych, Marcus doesn't see many adults that she would classify as having such a disorder. “I think people don't identify themselves as having an eating disorder and it hasn't been considered an eating disorder,” she said. “They don't come to us.”

At Duke, Zucker encounters adult picky eaters mainly as the parents of children that she is treating for picky eating or other eating disorders.

Adults who are picky tend to like bland foods that are comfortable and colorless, said Marcus, such as plain pasta or french fries.

In both children and adults, picky eating can be caused by “food neophobia,” otherwise known as the fear of new foods, by sensory sensitivity to particular textures, or by traumatic experiences such as forced eating.

Still, the vast universe of picky eaters is poorly defined, Zucker said.

“It's been a pretty poorly operationalized construct — what it means to be a picky eater,” she said. “There's a lot of different definitions floating around. What we'll find is a huge continuum — we all have food quirks.”

Source: Pittsburgh Post-Gazette

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