User login
Child obesity risk reduced with family meals
Positive communication and warm interpersonal dynamics during family meals are necessary components for family meals to decrease the risk of obesity in children, according to a new study.
“This study identified characteristics of family meals (e.g., interpersonal and food-related dynamics) through direct observational methods that may help explain the inconsistencies found in previous studies regarding the frequency of family meal and childhood obesity status,” Jerica Berge and her colleagues at the University of Minnesota, Minneapolis, reported online (Pediatrics 2014 Oct. 13 [doi:10.1542/peds.2014-1936]).
“Specifically, more positive measures (e.g., group enjoyment, relationship quality, warmth/nurture) were associated with reduced prevalence of child overweight/obesity, and more negative measures (e.g., hostility, indulgent/permissive, inconsistent discipline) were associated with increased prevalence of child overweight/obesity,” they wrote.
For example, the more warmth identified in more family relationships, the less likely it was that a child was overweight or obese, yet higher levels of hostility increased the likelihood of an overweight or obese child, after controlling for age, sex, and race/ethnicity. Findings were similar for family attitudes related to food: Positive food communication correlated with a lower prevalence of overweight/obesity, for example, though some food-related factors were less significant when parents’ body mass index was controlled for.
The researchers used multiple methods to observe the family meals of 120 low-income and/or minority children, average age 9 years, and years in the Minneapolis/St. Paul area over 8 days. Only families who typically ate at least three family dinners a week participated, and half the children were considered overweight (body mass index of 85th percentile or higher).
The researchers video-recorded the meals, inventoried food in the homes, interviewed the participants, and gathered three 24-hour dietary recalls for each child. Then they analyzed positive and negative variables during interactions between each arrangement of two family members over the meals (between the child and each other family member; between caregivers and between each caregiver and sibling).
Positive variables included group enjoyment, relationship quality, communication, parental influence, and positive reinforcement. Negative ones included hostility, lecturing/moralizing, silence, indulgence/permissiveness, inconsistent discipline, and intrusiveness/control.
Overweight/obese children’s family meals lasted an average 13.5 minutes, compared with an average 18.2 minutes for the family meals of the nonoverweight children. Also, 80% of nonoverweight children’s families ate in the kitchen, compared with 55% of overweight/obese children’s families. While only 18% of overweight/obese children had a father/stepfather at the meal, 52% of nonoverweight children did.
The study was supported by the National Institute of Diabetes, Digestive and Kidney Diseases. The authors reported no disclosures.
The most striking finding in this study by Berge et al. is that if the reported relationships are even in part causal, truly simple changes to family meal structure may help families decrease their children’s risks of developing overweight and obesity, and speak to the incredible importance of our food and eating environment on our behaviors and choices. The implications of this study for both clinicians and parents are in the kitchen. For clinicians, this study highlights the importance of going beyond the typical medical history and taking more of a healthy living history, in which the structure, location, and attitudes around meals and cooking are explored.
Berge’s study further hammers home the need for clinicians to place a far greater focus on understanding the patient as a whole person and not simply as a collection of medical problems with a skeleton-bare scaffolding consisting of basic family, employment, and social vices histories. The presence or absence of health is no doubt rife with complexity, but there’s little doubt that gaining an understanding about the barriers patients and parents face trying to live a healthful lifestyle requires more digging and matters more than is generally taught in medical school.
According to the study, an ideal family meal takes place in the kitchen, is 18 minutes or longer in duration, has both parents present, is eaten along with an attentive, warm and supportive conversation, and food is discussed positively and not in the context of weight or good vs. bad. The main caveat is that we don’t yet know whether these results are the consequence of causality. Consequently, it’s impossible to say that changes to family meal time will in turn lead to changes in weight or prevention of weight gain. That said, given there’s no obvious harm associated with implementing more frequent, and more enjoyable family meals and that a glut of studies demonstrating potentially causal benefits to family meals exist, encouraging and exploring barriers to kitchen table love affairs should be a regular part of a primary care provider’s job.
Dr. Yoni Freedhoff is a family medicine physician at the University of Ottawa, medical director of the Bariatric Medical Institute there, and author of The Diet Fix: Why Diets Fail and How to Make Yours Work. These comments were made in an interview. Dr. Freedhoff reported no other disclosures except his book.
The most striking finding in this study by Berge et al. is that if the reported relationships are even in part causal, truly simple changes to family meal structure may help families decrease their children’s risks of developing overweight and obesity, and speak to the incredible importance of our food and eating environment on our behaviors and choices. The implications of this study for both clinicians and parents are in the kitchen. For clinicians, this study highlights the importance of going beyond the typical medical history and taking more of a healthy living history, in which the structure, location, and attitudes around meals and cooking are explored.
Berge’s study further hammers home the need for clinicians to place a far greater focus on understanding the patient as a whole person and not simply as a collection of medical problems with a skeleton-bare scaffolding consisting of basic family, employment, and social vices histories. The presence or absence of health is no doubt rife with complexity, but there’s little doubt that gaining an understanding about the barriers patients and parents face trying to live a healthful lifestyle requires more digging and matters more than is generally taught in medical school.
According to the study, an ideal family meal takes place in the kitchen, is 18 minutes or longer in duration, has both parents present, is eaten along with an attentive, warm and supportive conversation, and food is discussed positively and not in the context of weight or good vs. bad. The main caveat is that we don’t yet know whether these results are the consequence of causality. Consequently, it’s impossible to say that changes to family meal time will in turn lead to changes in weight or prevention of weight gain. That said, given there’s no obvious harm associated with implementing more frequent, and more enjoyable family meals and that a glut of studies demonstrating potentially causal benefits to family meals exist, encouraging and exploring barriers to kitchen table love affairs should be a regular part of a primary care provider’s job.
Dr. Yoni Freedhoff is a family medicine physician at the University of Ottawa, medical director of the Bariatric Medical Institute there, and author of The Diet Fix: Why Diets Fail and How to Make Yours Work. These comments were made in an interview. Dr. Freedhoff reported no other disclosures except his book.
The most striking finding in this study by Berge et al. is that if the reported relationships are even in part causal, truly simple changes to family meal structure may help families decrease their children’s risks of developing overweight and obesity, and speak to the incredible importance of our food and eating environment on our behaviors and choices. The implications of this study for both clinicians and parents are in the kitchen. For clinicians, this study highlights the importance of going beyond the typical medical history and taking more of a healthy living history, in which the structure, location, and attitudes around meals and cooking are explored.
Berge’s study further hammers home the need for clinicians to place a far greater focus on understanding the patient as a whole person and not simply as a collection of medical problems with a skeleton-bare scaffolding consisting of basic family, employment, and social vices histories. The presence or absence of health is no doubt rife with complexity, but there’s little doubt that gaining an understanding about the barriers patients and parents face trying to live a healthful lifestyle requires more digging and matters more than is generally taught in medical school.
According to the study, an ideal family meal takes place in the kitchen, is 18 minutes or longer in duration, has both parents present, is eaten along with an attentive, warm and supportive conversation, and food is discussed positively and not in the context of weight or good vs. bad. The main caveat is that we don’t yet know whether these results are the consequence of causality. Consequently, it’s impossible to say that changes to family meal time will in turn lead to changes in weight or prevention of weight gain. That said, given there’s no obvious harm associated with implementing more frequent, and more enjoyable family meals and that a glut of studies demonstrating potentially causal benefits to family meals exist, encouraging and exploring barriers to kitchen table love affairs should be a regular part of a primary care provider’s job.
Dr. Yoni Freedhoff is a family medicine physician at the University of Ottawa, medical director of the Bariatric Medical Institute there, and author of The Diet Fix: Why Diets Fail and How to Make Yours Work. These comments were made in an interview. Dr. Freedhoff reported no other disclosures except his book.
Positive communication and warm interpersonal dynamics during family meals are necessary components for family meals to decrease the risk of obesity in children, according to a new study.
“This study identified characteristics of family meals (e.g., interpersonal and food-related dynamics) through direct observational methods that may help explain the inconsistencies found in previous studies regarding the frequency of family meal and childhood obesity status,” Jerica Berge and her colleagues at the University of Minnesota, Minneapolis, reported online (Pediatrics 2014 Oct. 13 [doi:10.1542/peds.2014-1936]).
“Specifically, more positive measures (e.g., group enjoyment, relationship quality, warmth/nurture) were associated with reduced prevalence of child overweight/obesity, and more negative measures (e.g., hostility, indulgent/permissive, inconsistent discipline) were associated with increased prevalence of child overweight/obesity,” they wrote.
For example, the more warmth identified in more family relationships, the less likely it was that a child was overweight or obese, yet higher levels of hostility increased the likelihood of an overweight or obese child, after controlling for age, sex, and race/ethnicity. Findings were similar for family attitudes related to food: Positive food communication correlated with a lower prevalence of overweight/obesity, for example, though some food-related factors were less significant when parents’ body mass index was controlled for.
The researchers used multiple methods to observe the family meals of 120 low-income and/or minority children, average age 9 years, and years in the Minneapolis/St. Paul area over 8 days. Only families who typically ate at least three family dinners a week participated, and half the children were considered overweight (body mass index of 85th percentile or higher).
The researchers video-recorded the meals, inventoried food in the homes, interviewed the participants, and gathered three 24-hour dietary recalls for each child. Then they analyzed positive and negative variables during interactions between each arrangement of two family members over the meals (between the child and each other family member; between caregivers and between each caregiver and sibling).
Positive variables included group enjoyment, relationship quality, communication, parental influence, and positive reinforcement. Negative ones included hostility, lecturing/moralizing, silence, indulgence/permissiveness, inconsistent discipline, and intrusiveness/control.
Overweight/obese children’s family meals lasted an average 13.5 minutes, compared with an average 18.2 minutes for the family meals of the nonoverweight children. Also, 80% of nonoverweight children’s families ate in the kitchen, compared with 55% of overweight/obese children’s families. While only 18% of overweight/obese children had a father/stepfather at the meal, 52% of nonoverweight children did.
The study was supported by the National Institute of Diabetes, Digestive and Kidney Diseases. The authors reported no disclosures.
Positive communication and warm interpersonal dynamics during family meals are necessary components for family meals to decrease the risk of obesity in children, according to a new study.
“This study identified characteristics of family meals (e.g., interpersonal and food-related dynamics) through direct observational methods that may help explain the inconsistencies found in previous studies regarding the frequency of family meal and childhood obesity status,” Jerica Berge and her colleagues at the University of Minnesota, Minneapolis, reported online (Pediatrics 2014 Oct. 13 [doi:10.1542/peds.2014-1936]).
“Specifically, more positive measures (e.g., group enjoyment, relationship quality, warmth/nurture) were associated with reduced prevalence of child overweight/obesity, and more negative measures (e.g., hostility, indulgent/permissive, inconsistent discipline) were associated with increased prevalence of child overweight/obesity,” they wrote.
For example, the more warmth identified in more family relationships, the less likely it was that a child was overweight or obese, yet higher levels of hostility increased the likelihood of an overweight or obese child, after controlling for age, sex, and race/ethnicity. Findings were similar for family attitudes related to food: Positive food communication correlated with a lower prevalence of overweight/obesity, for example, though some food-related factors were less significant when parents’ body mass index was controlled for.
The researchers used multiple methods to observe the family meals of 120 low-income and/or minority children, average age 9 years, and years in the Minneapolis/St. Paul area over 8 days. Only families who typically ate at least three family dinners a week participated, and half the children were considered overweight (body mass index of 85th percentile or higher).
The researchers video-recorded the meals, inventoried food in the homes, interviewed the participants, and gathered three 24-hour dietary recalls for each child. Then they analyzed positive and negative variables during interactions between each arrangement of two family members over the meals (between the child and each other family member; between caregivers and between each caregiver and sibling).
Positive variables included group enjoyment, relationship quality, communication, parental influence, and positive reinforcement. Negative ones included hostility, lecturing/moralizing, silence, indulgence/permissiveness, inconsistent discipline, and intrusiveness/control.
Overweight/obese children’s family meals lasted an average 13.5 minutes, compared with an average 18.2 minutes for the family meals of the nonoverweight children. Also, 80% of nonoverweight children’s families ate in the kitchen, compared with 55% of overweight/obese children’s families. While only 18% of overweight/obese children had a father/stepfather at the meal, 52% of nonoverweight children did.
The study was supported by the National Institute of Diabetes, Digestive and Kidney Diseases. The authors reported no disclosures.
FROM PEDIATRICS
Key clinical point: Happy family meals with positive dynamics decrease children’s obesity risk.
Major finding: Greater warmth decreased he obesity risk while greater hostility increased it.
Data source: Mixed-methods, cross-sectional study involving 120 children and parents from low-income and minority communities.
Disclosures: The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases. The authors reported no disclosures.
AAP issues new teen contraception and sexual health guidelines
Pediatricians should be aware of the most recent updates in contraception and considerations for special populations so they can appropriately counsel their adolescent patients, according to the new American Academy of Pediatrics policy statement on contraception for adolescents.
The statement, prepared by the AAP’s committee on adolescence, updates the one from 2007 with new contraceptive methods available to teens, revised recommendations regarding existing methods, and best practices in counseling teens on contraception (Pediatrics 2014 Sept. 29 [doi: 10.1542/peds.2014-2299]).
The most significant change in this policy statement is the recommendation for long-acting reversible contraceptive (LARC) methods, such as the implant and the intrauterine device (IUD), as first-line contraceptive choices for teens who choose not to remain abstinent.
“Adolescents are capable of understanding complex messages about sexual health,” said Dr. Mary Ott of the Indiana University department of pediatrics. “Adolescents trust pediatricians and understand that their pediatricians can simultaneously encourage abstinence and provide nonjudgmental contraceptive information and care,” said Dr. Ott, the study’s lead author.
Two other important points to emphasize in this updated statement are the special attention that should be paid to the sexual and contraceptive needs of obese, developmentally disabled, and medically complex adolescents, and the fact that all hormonal methods of birth control are safer than pregnancy, Dr. Ott said in an interview.
The report emphasizes the importance of confidentiality, minor consent for contraception, and an “honest, caring, nonjudgmental attitude and a comfortable, matter-of-fact approach to asking questions” when it comes to teens’ sexual health needs.
HIPAA allows parents access to their children’s records, but some states have laws affording greater confidentiality to minors that overrides that access, and parents can opt to allow their children confidential care.
Because lower contraceptive use and higher teen pregnancy rates are associated with limitations on confidentiality and consent, the AAP recommends confidentiality regarding teens’ sexuality and sexually transmitted infections (STIs). It also urges doctors to have an office policy that involves explaining and discussing confidentiality practices and options with patients and their parents.
Effective counseling starts with taking a sexual history with the five Ps, according to the AAP: “partners, prevention of pregnancy, protection from STIs, sexual practices, and past history of STIs and pregnancy.” From there, doctors should employ motivational interviewing, focusing on teens’ future goals and ways of incorporating healthy behaviors into their lives.
The report notes that approximately 80% of the 750,000 teen pregnancies each year are unplanned, and almost half of all U.S. high school students have reported having had intercourse at least once. Yet the most effective contraceptive methods – primarily hormonal ones – are the least utilized by teen girls.
Although abstinence is the only 100% effective way to avoid unplanned pregnancy, “pediatricians should not rely on abstinence counseling alone but should additionally provide access to comprehensive sexual health information to all adolescents,” the report states. Sexually active teens, or those considering sexual activity, should receive counseling on all safe and appropriate contraception options for their needs, on the methods’ risks and effectiveness, and on STI screening.
When advising teens on specific contraception methods, pediatricians should rely on efficacy rates based on typical use rather than perfect use. The most effective methods are those that require the least adherence of patients, such as progestin implants and IUDs.
After these recommended first-line contraceptive choices, Depo Provera injections and the contraceptive patch are very effective and safer than pregnancy. However, pediatricians should still recommend condom use with all sexual intercourse to protect against STIs.
Teens do not need a pelvic exam prior to receiving a contraception prescription or IUD placement referral, the statement recommends, and STI screenings can occur the same day as a prescription or IUD placement.
The report addressed contraception and sexual health counseling for special populations, including obese teens and the 16%-25% of teens with a physical or developmental disability or a complex illness – such as chronic disease or HIV – and organ transplant recipients.
Despite being historically overlooked, teens in these populations have sexual needs and outcomes similar to those of typical teens, the statement notes, but they have additional needs as well. “Issues that arise include safety concerns with estrogen use, medication interactions, and complications from the underlying disease,” the statement notes.
Those taking medications that can cause birth defects may need contraception, and others may need hormonal birth control to help suppress menstruation if they have heavy menstrual bleeding or a bleeding disorder or are undergoing chemotherapy. The report recommends that pediatricians consult the CDC’s online “U.S. Medical Eligibility Criteria for Contraceptive Use” and have a working knowledge of various hormonal contraceptive methods because of their potential value for menstrual cycle control and management of conditions such as acne or dysmenorrhea.
Meanwhile, hormonal birth control for obese teens may differ in efficacy and side effects, compared with nonobese teens, and obese teens may be concerned about gaining more weight with hormonal birth control. “Data suggest that women with obesity are no more likely to gain weight with combined oral contraceptives, the vaginal ring, IUDs, or implants than normal-weight peers,” the report notes, although obese teens using Depo Provera were more likely to gain weight than were normal-weight teens who used it.
No funding or disclosures were noted regarding the policy statement.
Pediatricians should be aware of the most recent updates in contraception and considerations for special populations so they can appropriately counsel their adolescent patients, according to the new American Academy of Pediatrics policy statement on contraception for adolescents.
The statement, prepared by the AAP’s committee on adolescence, updates the one from 2007 with new contraceptive methods available to teens, revised recommendations regarding existing methods, and best practices in counseling teens on contraception (Pediatrics 2014 Sept. 29 [doi: 10.1542/peds.2014-2299]).
The most significant change in this policy statement is the recommendation for long-acting reversible contraceptive (LARC) methods, such as the implant and the intrauterine device (IUD), as first-line contraceptive choices for teens who choose not to remain abstinent.
“Adolescents are capable of understanding complex messages about sexual health,” said Dr. Mary Ott of the Indiana University department of pediatrics. “Adolescents trust pediatricians and understand that their pediatricians can simultaneously encourage abstinence and provide nonjudgmental contraceptive information and care,” said Dr. Ott, the study’s lead author.
Two other important points to emphasize in this updated statement are the special attention that should be paid to the sexual and contraceptive needs of obese, developmentally disabled, and medically complex adolescents, and the fact that all hormonal methods of birth control are safer than pregnancy, Dr. Ott said in an interview.
The report emphasizes the importance of confidentiality, minor consent for contraception, and an “honest, caring, nonjudgmental attitude and a comfortable, matter-of-fact approach to asking questions” when it comes to teens’ sexual health needs.
HIPAA allows parents access to their children’s records, but some states have laws affording greater confidentiality to minors that overrides that access, and parents can opt to allow their children confidential care.
Because lower contraceptive use and higher teen pregnancy rates are associated with limitations on confidentiality and consent, the AAP recommends confidentiality regarding teens’ sexuality and sexually transmitted infections (STIs). It also urges doctors to have an office policy that involves explaining and discussing confidentiality practices and options with patients and their parents.
Effective counseling starts with taking a sexual history with the five Ps, according to the AAP: “partners, prevention of pregnancy, protection from STIs, sexual practices, and past history of STIs and pregnancy.” From there, doctors should employ motivational interviewing, focusing on teens’ future goals and ways of incorporating healthy behaviors into their lives.
The report notes that approximately 80% of the 750,000 teen pregnancies each year are unplanned, and almost half of all U.S. high school students have reported having had intercourse at least once. Yet the most effective contraceptive methods – primarily hormonal ones – are the least utilized by teen girls.
Although abstinence is the only 100% effective way to avoid unplanned pregnancy, “pediatricians should not rely on abstinence counseling alone but should additionally provide access to comprehensive sexual health information to all adolescents,” the report states. Sexually active teens, or those considering sexual activity, should receive counseling on all safe and appropriate contraception options for their needs, on the methods’ risks and effectiveness, and on STI screening.
When advising teens on specific contraception methods, pediatricians should rely on efficacy rates based on typical use rather than perfect use. The most effective methods are those that require the least adherence of patients, such as progestin implants and IUDs.
After these recommended first-line contraceptive choices, Depo Provera injections and the contraceptive patch are very effective and safer than pregnancy. However, pediatricians should still recommend condom use with all sexual intercourse to protect against STIs.
Teens do not need a pelvic exam prior to receiving a contraception prescription or IUD placement referral, the statement recommends, and STI screenings can occur the same day as a prescription or IUD placement.
The report addressed contraception and sexual health counseling for special populations, including obese teens and the 16%-25% of teens with a physical or developmental disability or a complex illness – such as chronic disease or HIV – and organ transplant recipients.
Despite being historically overlooked, teens in these populations have sexual needs and outcomes similar to those of typical teens, the statement notes, but they have additional needs as well. “Issues that arise include safety concerns with estrogen use, medication interactions, and complications from the underlying disease,” the statement notes.
Those taking medications that can cause birth defects may need contraception, and others may need hormonal birth control to help suppress menstruation if they have heavy menstrual bleeding or a bleeding disorder or are undergoing chemotherapy. The report recommends that pediatricians consult the CDC’s online “U.S. Medical Eligibility Criteria for Contraceptive Use” and have a working knowledge of various hormonal contraceptive methods because of their potential value for menstrual cycle control and management of conditions such as acne or dysmenorrhea.
Meanwhile, hormonal birth control for obese teens may differ in efficacy and side effects, compared with nonobese teens, and obese teens may be concerned about gaining more weight with hormonal birth control. “Data suggest that women with obesity are no more likely to gain weight with combined oral contraceptives, the vaginal ring, IUDs, or implants than normal-weight peers,” the report notes, although obese teens using Depo Provera were more likely to gain weight than were normal-weight teens who used it.
No funding or disclosures were noted regarding the policy statement.
Pediatricians should be aware of the most recent updates in contraception and considerations for special populations so they can appropriately counsel their adolescent patients, according to the new American Academy of Pediatrics policy statement on contraception for adolescents.
The statement, prepared by the AAP’s committee on adolescence, updates the one from 2007 with new contraceptive methods available to teens, revised recommendations regarding existing methods, and best practices in counseling teens on contraception (Pediatrics 2014 Sept. 29 [doi: 10.1542/peds.2014-2299]).
The most significant change in this policy statement is the recommendation for long-acting reversible contraceptive (LARC) methods, such as the implant and the intrauterine device (IUD), as first-line contraceptive choices for teens who choose not to remain abstinent.
“Adolescents are capable of understanding complex messages about sexual health,” said Dr. Mary Ott of the Indiana University department of pediatrics. “Adolescents trust pediatricians and understand that their pediatricians can simultaneously encourage abstinence and provide nonjudgmental contraceptive information and care,” said Dr. Ott, the study’s lead author.
Two other important points to emphasize in this updated statement are the special attention that should be paid to the sexual and contraceptive needs of obese, developmentally disabled, and medically complex adolescents, and the fact that all hormonal methods of birth control are safer than pregnancy, Dr. Ott said in an interview.
The report emphasizes the importance of confidentiality, minor consent for contraception, and an “honest, caring, nonjudgmental attitude and a comfortable, matter-of-fact approach to asking questions” when it comes to teens’ sexual health needs.
HIPAA allows parents access to their children’s records, but some states have laws affording greater confidentiality to minors that overrides that access, and parents can opt to allow their children confidential care.
Because lower contraceptive use and higher teen pregnancy rates are associated with limitations on confidentiality and consent, the AAP recommends confidentiality regarding teens’ sexuality and sexually transmitted infections (STIs). It also urges doctors to have an office policy that involves explaining and discussing confidentiality practices and options with patients and their parents.
Effective counseling starts with taking a sexual history with the five Ps, according to the AAP: “partners, prevention of pregnancy, protection from STIs, sexual practices, and past history of STIs and pregnancy.” From there, doctors should employ motivational interviewing, focusing on teens’ future goals and ways of incorporating healthy behaviors into their lives.
The report notes that approximately 80% of the 750,000 teen pregnancies each year are unplanned, and almost half of all U.S. high school students have reported having had intercourse at least once. Yet the most effective contraceptive methods – primarily hormonal ones – are the least utilized by teen girls.
Although abstinence is the only 100% effective way to avoid unplanned pregnancy, “pediatricians should not rely on abstinence counseling alone but should additionally provide access to comprehensive sexual health information to all adolescents,” the report states. Sexually active teens, or those considering sexual activity, should receive counseling on all safe and appropriate contraception options for their needs, on the methods’ risks and effectiveness, and on STI screening.
When advising teens on specific contraception methods, pediatricians should rely on efficacy rates based on typical use rather than perfect use. The most effective methods are those that require the least adherence of patients, such as progestin implants and IUDs.
After these recommended first-line contraceptive choices, Depo Provera injections and the contraceptive patch are very effective and safer than pregnancy. However, pediatricians should still recommend condom use with all sexual intercourse to protect against STIs.
Teens do not need a pelvic exam prior to receiving a contraception prescription or IUD placement referral, the statement recommends, and STI screenings can occur the same day as a prescription or IUD placement.
The report addressed contraception and sexual health counseling for special populations, including obese teens and the 16%-25% of teens with a physical or developmental disability or a complex illness – such as chronic disease or HIV – and organ transplant recipients.
Despite being historically overlooked, teens in these populations have sexual needs and outcomes similar to those of typical teens, the statement notes, but they have additional needs as well. “Issues that arise include safety concerns with estrogen use, medication interactions, and complications from the underlying disease,” the statement notes.
Those taking medications that can cause birth defects may need contraception, and others may need hormonal birth control to help suppress menstruation if they have heavy menstrual bleeding or a bleeding disorder or are undergoing chemotherapy. The report recommends that pediatricians consult the CDC’s online “U.S. Medical Eligibility Criteria for Contraceptive Use” and have a working knowledge of various hormonal contraceptive methods because of their potential value for menstrual cycle control and management of conditions such as acne or dysmenorrhea.
Meanwhile, hormonal birth control for obese teens may differ in efficacy and side effects, compared with nonobese teens, and obese teens may be concerned about gaining more weight with hormonal birth control. “Data suggest that women with obesity are no more likely to gain weight with combined oral contraceptives, the vaginal ring, IUDs, or implants than normal-weight peers,” the report notes, although obese teens using Depo Provera were more likely to gain weight than were normal-weight teens who used it.
No funding or disclosures were noted regarding the policy statement.
FROM PEDIATRICS
Early broad-spectrum antibiotics exposure increases risk for child obesity
Children receiving broad-spectrum antibiotics before age 2 years are at a slightly higher risk for obesity in early childhood, according to a recent study.
Children exposed to any antibiotics at least four times before turning 2 years old were 11% more likely to be obese between ages 2 and 5 years, even after accounting for other risk factors, compared with children receiving no antibiotics, reported Dr. L. Charles Bailey of Children’s Hospital of Philadelphia, and his associates.
But this association was driven primarily by broad-spectrum antibiotics, which increased the risk of obesity 16% in children who took them at least four times before 24 months old. No association with obesity was seen for narrow-spectrum antibiotics, which included penicillin and amoxicillin.
“If validated in other studies, this observation suggests a potentially modifiable risk factor for childhood obesity, given the relatively high use of broad-spectrum drugs, although interventions in this area have proven difficult in practice, Dr. Bailey’s team reported.
Dr. Bailey and his associates analyzed data from the medical records of 65,480 children who had at least three primary care visits between 2001 and 2009: one before 11 months old, one between 12 and 23 months, and one between 24 and 59 months as long as height and weight had been taken to calculate body mass index (BMI). The researchers defined obesity as 95th percentile or higher on the 2000 National Health and Nutrition Examination Survey growth norms.
Antibiotics were the most commonly prescribed medication to young children – provided an average 2.3 times each to 69% of the children before 24 months old – followed by oral steroids and antireflux medications.
Children exposed to just one round of broad-spectrum antibiotics between 0 and 5 months old had an 11% higher risk of obesity by age 5 years, compared with those receiving no antibiotics. Only 14% of children received antibiotics before 6 months old.
Children also were more likely to be obese if they had received steroids, were male, were Hispanic, had public insurance, went to an urban practice, or had been diagnosed with asthma or wheezing. But the researchers found no association between child obesity and antireflux medications or with pharyngitis, otitis media, or any other common infections.
The study was supported by the American Beverage Foundation for a Healthy America. The authors had no disclosures.
Children receiving broad-spectrum antibiotics before age 2 years are at a slightly higher risk for obesity in early childhood, according to a recent study.
Children exposed to any antibiotics at least four times before turning 2 years old were 11% more likely to be obese between ages 2 and 5 years, even after accounting for other risk factors, compared with children receiving no antibiotics, reported Dr. L. Charles Bailey of Children’s Hospital of Philadelphia, and his associates.
But this association was driven primarily by broad-spectrum antibiotics, which increased the risk of obesity 16% in children who took them at least four times before 24 months old. No association with obesity was seen for narrow-spectrum antibiotics, which included penicillin and amoxicillin.
“If validated in other studies, this observation suggests a potentially modifiable risk factor for childhood obesity, given the relatively high use of broad-spectrum drugs, although interventions in this area have proven difficult in practice, Dr. Bailey’s team reported.
Dr. Bailey and his associates analyzed data from the medical records of 65,480 children who had at least three primary care visits between 2001 and 2009: one before 11 months old, one between 12 and 23 months, and one between 24 and 59 months as long as height and weight had been taken to calculate body mass index (BMI). The researchers defined obesity as 95th percentile or higher on the 2000 National Health and Nutrition Examination Survey growth norms.
Antibiotics were the most commonly prescribed medication to young children – provided an average 2.3 times each to 69% of the children before 24 months old – followed by oral steroids and antireflux medications.
Children exposed to just one round of broad-spectrum antibiotics between 0 and 5 months old had an 11% higher risk of obesity by age 5 years, compared with those receiving no antibiotics. Only 14% of children received antibiotics before 6 months old.
Children also were more likely to be obese if they had received steroids, were male, were Hispanic, had public insurance, went to an urban practice, or had been diagnosed with asthma or wheezing. But the researchers found no association between child obesity and antireflux medications or with pharyngitis, otitis media, or any other common infections.
The study was supported by the American Beverage Foundation for a Healthy America. The authors had no disclosures.
Children receiving broad-spectrum antibiotics before age 2 years are at a slightly higher risk for obesity in early childhood, according to a recent study.
Children exposed to any antibiotics at least four times before turning 2 years old were 11% more likely to be obese between ages 2 and 5 years, even after accounting for other risk factors, compared with children receiving no antibiotics, reported Dr. L. Charles Bailey of Children’s Hospital of Philadelphia, and his associates.
But this association was driven primarily by broad-spectrum antibiotics, which increased the risk of obesity 16% in children who took them at least four times before 24 months old. No association with obesity was seen for narrow-spectrum antibiotics, which included penicillin and amoxicillin.
“If validated in other studies, this observation suggests a potentially modifiable risk factor for childhood obesity, given the relatively high use of broad-spectrum drugs, although interventions in this area have proven difficult in practice, Dr. Bailey’s team reported.
Dr. Bailey and his associates analyzed data from the medical records of 65,480 children who had at least three primary care visits between 2001 and 2009: one before 11 months old, one between 12 and 23 months, and one between 24 and 59 months as long as height and weight had been taken to calculate body mass index (BMI). The researchers defined obesity as 95th percentile or higher on the 2000 National Health and Nutrition Examination Survey growth norms.
Antibiotics were the most commonly prescribed medication to young children – provided an average 2.3 times each to 69% of the children before 24 months old – followed by oral steroids and antireflux medications.
Children exposed to just one round of broad-spectrum antibiotics between 0 and 5 months old had an 11% higher risk of obesity by age 5 years, compared with those receiving no antibiotics. Only 14% of children received antibiotics before 6 months old.
Children also were more likely to be obese if they had received steroids, were male, were Hispanic, had public insurance, went to an urban practice, or had been diagnosed with asthma or wheezing. But the researchers found no association between child obesity and antireflux medications or with pharyngitis, otitis media, or any other common infections.
The study was supported by the American Beverage Foundation for a Healthy America. The authors had no disclosures.
FROM JAMA PEDIATRICS
Key clinical point: Broad-spectrum antibiotic use in infancy raises child obesity risk.
Major finding: Childhood obesity is 16% more likely in infants receiving broad-spectrum antibiotics (rate ratio, 1.11).
Data source: Cohort study of 65,480 children in Philadelphia and the surrounding area between 2001 and 2009.
Disclosures: The study was supported by the American Beverage Foundation for a Healthy America. The authors had no disclosures.
Preterm babies see no long-term magnesium sulfate benefits
Giving pregnant women magnesium sulfate within 24 hours of delivering a very preterm baby reduced the risk of cerebral palsy but showed no additional effect in the children’s outcomes 6-11 years later, found a new study.
“There were no substantial differences between groups on any of the cognitive, academic, attention, executive function, or behavioral outcomes, and none of the differences reached statistical significance,” Dr. Lex W. Doyle, professor of neonatal pediatrics at the University of Melbourne and head of clinical research development at the Royal Women’s Hospital, also in Melbourne, and his associates reported online.
“There were no statistically significant differences between groups on any of the growth, functional, or other neurosensory outcomes,” they wrote. (JAMA 2014;312:1105-13 [doi:10.1001/jama.2014.11189]). They also noted, however, that “a mortality advantage could not be excluded.”
From 1996 to 2000, a total of 1,255 pregnant women who were expected to give birth within 24 hours, at less than 30 weeks’ gestation, were randomized to receive either 4 g of intravenous magnesium sulfite with 1 g/hour thereafter or saline placebo.
During 2005-2011, the researchers followed 334 children whose mothers received magnesium and 335 whose mothers received placebo.
Using data from parent and teacher questionnaires and various assessments, Dr. Doyle’s group evaluated the children’s cerebral palsy, motor function, IQ, academic skills, attention, executive function, behavior, growth, and functional and neurosensory outcomes at ages 6-11 years old, corrected for prematurity.
Minor differences in cerebral palsy or its severity and motor function between the two groups did not reach statistical significance. In both groups, 27% of children showed definite motor dysfunction. On all other assessments, the children in both groups had similar results and no differences reached statistical significance.
“The absence of benefit associated with antenatal magnesium sulfate into school age from the current trial does not negate the proven value of magnesium sulfate in reducing cerebral palsy, based on the collective evidence from all of the RCTs [randomized, clinical trials],” the authors noted.
The study was supported by the Australian National Health and Medical Research Council and the Victorian Government’s Operational Infrastructure Support Program. The authors reported no disclosures.
Giving pregnant women magnesium sulfate within 24 hours of delivering a very preterm baby reduced the risk of cerebral palsy but showed no additional effect in the children’s outcomes 6-11 years later, found a new study.
“There were no substantial differences between groups on any of the cognitive, academic, attention, executive function, or behavioral outcomes, and none of the differences reached statistical significance,” Dr. Lex W. Doyle, professor of neonatal pediatrics at the University of Melbourne and head of clinical research development at the Royal Women’s Hospital, also in Melbourne, and his associates reported online.
“There were no statistically significant differences between groups on any of the growth, functional, or other neurosensory outcomes,” they wrote. (JAMA 2014;312:1105-13 [doi:10.1001/jama.2014.11189]). They also noted, however, that “a mortality advantage could not be excluded.”
From 1996 to 2000, a total of 1,255 pregnant women who were expected to give birth within 24 hours, at less than 30 weeks’ gestation, were randomized to receive either 4 g of intravenous magnesium sulfite with 1 g/hour thereafter or saline placebo.
During 2005-2011, the researchers followed 334 children whose mothers received magnesium and 335 whose mothers received placebo.
Using data from parent and teacher questionnaires and various assessments, Dr. Doyle’s group evaluated the children’s cerebral palsy, motor function, IQ, academic skills, attention, executive function, behavior, growth, and functional and neurosensory outcomes at ages 6-11 years old, corrected for prematurity.
Minor differences in cerebral palsy or its severity and motor function between the two groups did not reach statistical significance. In both groups, 27% of children showed definite motor dysfunction. On all other assessments, the children in both groups had similar results and no differences reached statistical significance.
“The absence of benefit associated with antenatal magnesium sulfate into school age from the current trial does not negate the proven value of magnesium sulfate in reducing cerebral palsy, based on the collective evidence from all of the RCTs [randomized, clinical trials],” the authors noted.
The study was supported by the Australian National Health and Medical Research Council and the Victorian Government’s Operational Infrastructure Support Program. The authors reported no disclosures.
Giving pregnant women magnesium sulfate within 24 hours of delivering a very preterm baby reduced the risk of cerebral palsy but showed no additional effect in the children’s outcomes 6-11 years later, found a new study.
“There were no substantial differences between groups on any of the cognitive, academic, attention, executive function, or behavioral outcomes, and none of the differences reached statistical significance,” Dr. Lex W. Doyle, professor of neonatal pediatrics at the University of Melbourne and head of clinical research development at the Royal Women’s Hospital, also in Melbourne, and his associates reported online.
“There were no statistically significant differences between groups on any of the growth, functional, or other neurosensory outcomes,” they wrote. (JAMA 2014;312:1105-13 [doi:10.1001/jama.2014.11189]). They also noted, however, that “a mortality advantage could not be excluded.”
From 1996 to 2000, a total of 1,255 pregnant women who were expected to give birth within 24 hours, at less than 30 weeks’ gestation, were randomized to receive either 4 g of intravenous magnesium sulfite with 1 g/hour thereafter or saline placebo.
During 2005-2011, the researchers followed 334 children whose mothers received magnesium and 335 whose mothers received placebo.
Using data from parent and teacher questionnaires and various assessments, Dr. Doyle’s group evaluated the children’s cerebral palsy, motor function, IQ, academic skills, attention, executive function, behavior, growth, and functional and neurosensory outcomes at ages 6-11 years old, corrected for prematurity.
Minor differences in cerebral palsy or its severity and motor function between the two groups did not reach statistical significance. In both groups, 27% of children showed definite motor dysfunction. On all other assessments, the children in both groups had similar results and no differences reached statistical significance.
“The absence of benefit associated with antenatal magnesium sulfate into school age from the current trial does not negate the proven value of magnesium sulfate in reducing cerebral palsy, based on the collective evidence from all of the RCTs [randomized, clinical trials],” the authors noted.
The study was supported by the Australian National Health and Medical Research Council and the Victorian Government’s Operational Infrastructure Support Program. The authors reported no disclosures.
FROM JAMA
Key clinical point: Magnesium sulfate for very preterm babies shows no added long-term benefits.
Major finding: No statistically significant differences existed between school-age children whose mothers did or did not receive magnesium sulfate immediately prior to the onset of labor.
Data source: Follow-up from a randomized clinical trial at 16 centers in Australia and New Zealand.
Disclosures: The study was supported by the Australian National Health and Medical Research Council and the Victorian Government’s Operational Infrastructure Support Program. The authors reported no disclosures.
Epileptic seizures after vaccination usually have genetic causes
In nearly all epileptic children who experienced their first seizure immediately after vaccination, an underlying cause for the epilepsy unrelated to the vaccine can be identified or else the epilepsy is benign, according to a new study.
Previous research had shown that vaccination could induce the first seizures in children who were already genetically predisposed to go on to develop Dravet syndrome, previously called severe myoclonic epilepsy of infancy. This study revealed similar findings for other epilepsies involving a first seizure after vaccination.
“These underlying causes were not limited to SCN1A-related Dravet syndrome but extended to other genetically determined fever-sensitive epilepsies,” Nienke E. Verbeek of University Medical Centre Utrecht in the Netherlands, and her associates reported online. “These results imply that early genetic testing should be considered in all children with vaccination-related onset of epilepsy and might help to support public faith in vaccination programs,” they wrote (Pediatrics 2014 Sept. 15 [doi:10.1542/peds.2014-0690]).
Researchers reviewed the medical data of 990 children in the Netherlands who experienced a seizure after vaccination in their first 2 years of life between 1997 and 2006. Seizures were considered related to vaccination if they occurred within 24 hours of an inactivated vaccine or within 5-12 days of a live vaccine.
Of these children, 26 were later diagnosed with epilepsy and had their first seizure after vaccination. The researchers followed up with 23 of these children when they were an average 10 years old and found them to fall within one of three groups.
The first group included three children (13%) who had already shown developmental delay before their first seizure and were therefore presumed to have preexisting encephalopathy. The second group of 12 children (52%) had epileptic encephalopathy, with an underlying cause found for 10 of them (including 8 with Dravet syndrome).
The third group of eight children (23%) had benign epilepsy, and researchers identified a likely genetic cause in three of these children. Seven children in the third group no longer had seizures, even without taking antiepileptic drugs, “showing that vaccination-related epilepsy onset does not necessarily have a poor prognosis,” the researchers wrote.
The study was supported by the Friends of the UMC Utrecht Foundation on behalf of the Janivo Foundation and the Nuts-Ohra Fund. The authors reported no disclosures.
In nearly all epileptic children who experienced their first seizure immediately after vaccination, an underlying cause for the epilepsy unrelated to the vaccine can be identified or else the epilepsy is benign, according to a new study.
Previous research had shown that vaccination could induce the first seizures in children who were already genetically predisposed to go on to develop Dravet syndrome, previously called severe myoclonic epilepsy of infancy. This study revealed similar findings for other epilepsies involving a first seizure after vaccination.
“These underlying causes were not limited to SCN1A-related Dravet syndrome but extended to other genetically determined fever-sensitive epilepsies,” Nienke E. Verbeek of University Medical Centre Utrecht in the Netherlands, and her associates reported online. “These results imply that early genetic testing should be considered in all children with vaccination-related onset of epilepsy and might help to support public faith in vaccination programs,” they wrote (Pediatrics 2014 Sept. 15 [doi:10.1542/peds.2014-0690]).
Researchers reviewed the medical data of 990 children in the Netherlands who experienced a seizure after vaccination in their first 2 years of life between 1997 and 2006. Seizures were considered related to vaccination if they occurred within 24 hours of an inactivated vaccine or within 5-12 days of a live vaccine.
Of these children, 26 were later diagnosed with epilepsy and had their first seizure after vaccination. The researchers followed up with 23 of these children when they were an average 10 years old and found them to fall within one of three groups.
The first group included three children (13%) who had already shown developmental delay before their first seizure and were therefore presumed to have preexisting encephalopathy. The second group of 12 children (52%) had epileptic encephalopathy, with an underlying cause found for 10 of them (including 8 with Dravet syndrome).
The third group of eight children (23%) had benign epilepsy, and researchers identified a likely genetic cause in three of these children. Seven children in the third group no longer had seizures, even without taking antiepileptic drugs, “showing that vaccination-related epilepsy onset does not necessarily have a poor prognosis,” the researchers wrote.
The study was supported by the Friends of the UMC Utrecht Foundation on behalf of the Janivo Foundation and the Nuts-Ohra Fund. The authors reported no disclosures.
In nearly all epileptic children who experienced their first seizure immediately after vaccination, an underlying cause for the epilepsy unrelated to the vaccine can be identified or else the epilepsy is benign, according to a new study.
Previous research had shown that vaccination could induce the first seizures in children who were already genetically predisposed to go on to develop Dravet syndrome, previously called severe myoclonic epilepsy of infancy. This study revealed similar findings for other epilepsies involving a first seizure after vaccination.
“These underlying causes were not limited to SCN1A-related Dravet syndrome but extended to other genetically determined fever-sensitive epilepsies,” Nienke E. Verbeek of University Medical Centre Utrecht in the Netherlands, and her associates reported online. “These results imply that early genetic testing should be considered in all children with vaccination-related onset of epilepsy and might help to support public faith in vaccination programs,” they wrote (Pediatrics 2014 Sept. 15 [doi:10.1542/peds.2014-0690]).
Researchers reviewed the medical data of 990 children in the Netherlands who experienced a seizure after vaccination in their first 2 years of life between 1997 and 2006. Seizures were considered related to vaccination if they occurred within 24 hours of an inactivated vaccine or within 5-12 days of a live vaccine.
Of these children, 26 were later diagnosed with epilepsy and had their first seizure after vaccination. The researchers followed up with 23 of these children when they were an average 10 years old and found them to fall within one of three groups.
The first group included three children (13%) who had already shown developmental delay before their first seizure and were therefore presumed to have preexisting encephalopathy. The second group of 12 children (52%) had epileptic encephalopathy, with an underlying cause found for 10 of them (including 8 with Dravet syndrome).
The third group of eight children (23%) had benign epilepsy, and researchers identified a likely genetic cause in three of these children. Seven children in the third group no longer had seizures, even without taking antiepileptic drugs, “showing that vaccination-related epilepsy onset does not necessarily have a poor prognosis,” the researchers wrote.
The study was supported by the Friends of the UMC Utrecht Foundation on behalf of the Janivo Foundation and the Nuts-Ohra Fund. The authors reported no disclosures.
FROM PEDIATRICS
Key clinical point: Underlying causes exist for most epilepsies first presenting after vaccination.
Major finding: 65% of children have identifiable genetic causes for postvaccination epileptic seizures.
Data source: A retrospective cohort study with prospective follow-up of 990 children with seizures after vaccination in the first year of life.
Disclosures: The study was supported by the Friends of the UMC Utrecht Foundation on behalf of the Janivo Foundation and the Nuts-Ohra Fund. The authors reported no disclosures.
Longer Breastfeeding Linked to Better Nutritional and Health Outcomes
Earn 0.25 hours AMA PRA Category 1 credit: Read this article, and click the link at the end to take the posttest.
The longer children breastfed, the less likely they were to have ear, throat, and sinus infections at age 6 years and the more likely they were to have a healthier diet as 6-year-olds, according to data from two studies.
The research is based on 6-year follow-up data from the longitudinal Infant Feeding Practices Study II, initiated in 2005-2007 by the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention to track mothers from late pregnancy until a year after birth.
In the first paper, the amount and duration of breastfeeding were linked to ear, throat, and sinus infections in children at age 6 years but not to upper respiratory tract, lung, or urinary tract infections, Dr. Ruowei Li of the CDC, Atlanta, and her colleagues reported online (Pediatrics 2014;134:S13-20).
Among 1,281 pairs of mothers and children with 6-year follow-up data, 86% of the mothers initiated breastfeeding, although 28% of these stopped before 3 months and 79% stopped exclusive breastfeeding before 4 months.
Six-year-old children who had been breastfed for at least 9 months (not necessarily exclusively) had 31% reduced odds of an ear infection, 32% reduced odds of a throat infection, and 53% reduced odds of a sinus infection in the past year, compared with peers breastfed less than 3 months. Those exclusively breastfed at least 6 months had 63% reduced odds of an ear infection, 77% reduced odds of a throat infection, and 87% reduced odds of a sinus infection, compared with those exclusively breastfed less than 4 months.
Among children who received supplemental formula in addition to breast milk, their odds of a sinus infection were 47% lower if breast milk constituted at least two-thirds of their intake than if it was only one-third of their intake.
These findings were adjusted for the mother’s age, race/ethnicity, education, household income, marital status, parity, prepregnancy body mass index, and participation in the Special Supplemental Nutrition Program for Women, Infants and Children. The child’s age and sex also were controlled for, as well as who cared for the child, the child’s type of school at age 6 years, and whether the child attended after-school child care.
In the second study, CDC researcher Cria Perrine, Ph.D., and her associates analyzed 6-year nutritional data for 1,355 children using a dietary history screener that asked parents how frequently their children had consumed any of 28 items in the past month. Breastfeeding was not linked to how much milk, sweets, or savory snacks the children consumed, but 6-year-olds who had ever been breastfed were more likely to regularly consume water, fruits, and vegetables and less likely to consume sugar-sweetened beverages, compared with those never breastfed.
"There is substantial evidence documenting the many benefits of breastfeeding; improved child diet may be one additional benefit," Dr. Perrine’s team reported online (Pediatrics 2014;134:S50-5).
At age 6 years, children who had been breastfed for at least 12 months drank water a median three times a day, compared with a median two times a day for those who had been breastfed less than 12 months (all findings P less than .05). Those breastfed at least 12 months also ate fruit a median two times a day, compared with once daily for those breastfed shorter durations or not at all.
Six-year-olds who had been breastfed less than 6 months or not at all drank slightly more 100% juice and ate slightly more vegetables than those breastfed longer. And the longer a child had been breastfed as an infant, the fewer sugar-sweetened beverages they drank at age 6 years, with each additional 6 months of breastfeeding linked to fewer sugary drinks.
Children who had been exclusively breastfed at least 3 months consumed more water and fruit than those exclusively breastfed shorter durations or not at all. Exclusive breastfeeding beyond 3 months also was linked to lower consumption of 100% juice and sugary drinks than exclusive breastfeeding for less than 3 months or not at all. These findings all were adjusted for the same maternal characteristics as in the first study, minus parity and prepregnancy BMI, and using poverty income ratio instead of household income. Child characteristics adjusted for in these findings included sex, birth weight, gestational age, and having older siblings or not.
Both studies were funded by the U.S. Food and Drug Administration, the Centers for Disease Control and Prevention, the Office on Women’s Health, the National Institutes of Health, and the Maternal and Child Health Bureau in the U.S. Department of Health and Human Services. The authors of both studies reported no disclosures.
To earn 0.25 hours AMA PRA Category 1 credit after reading this article, take the post-test here.
Evidence on the long-term effects of infant diet is increasing quickly. Because of the depth of detail they supply, the IFPS II and its year-6 follow-up offer a unique opportunity to examine the relationship of infant feeding with later health outcomes and behaviors. Although certainly not conclusive, these studies show that infant feeding is predictive of some later health outcomes but not others.
The study by Dr. Li and her colleagues reveals that longer breastfeeding and later introduction of foods or beverages other than breast milk were linked with lower rates of ear, throat, and sinus infections in the year before the survey. However, they found no ties with upper or lower respiratory or urinary tract infections.
Dr. Perrine and her colleagues looked at the link between breastfeeding duration and markers of a healthful or poor diet at age 6 years. Breastfeeding duration was positively associated with some markers of a healthful diet, such as higher consumption of water, fruits, and vegetables, but negatively linked with other markers of a poor diet, such as higher ingestion of sugar-sweetened beverages and juice. No connection was found, however, between breastfeeding duration and intake of milk, sweets, or savory snacks. It is not clear whether these relationships indicate the development of taste preference during infancy or a family eating pattern that occurs at various ages, but the studies do point to the need to start healthful eating behaviors early in life.
These articles embody just the beginning of the many research opportunities provided by the year-6 IFPS II follow-up. The data sets from both the IFPS II and the follow-up are available from the Centers for Disease Control and Prevention for researchers to explore many other aspects of the prenatal and postpartum environment.
This commentary was adapted from the one accompanying these studies (Pediatrics 2014;134:S1-3). It was written by Laurence M. Grummer-Strawn, Ph.D.; Ruowei Li, M.D., Ph.D.; Cria G. Perrine, Ph.D.; and Kelley S. Scanlon, Ph.D., all of the division of nutrition, physical activity and obesity in the CDC’s National Center for Chronic Disease Prevention and Health Promotion, and by Sara B. Fein, Ph.D., of McKing Consulting Corporation in Fairfax, Va. The authors reported no disclosures.
Evidence on the long-term effects of infant diet is increasing quickly. Because of the depth of detail they supply, the IFPS II and its year-6 follow-up offer a unique opportunity to examine the relationship of infant feeding with later health outcomes and behaviors. Although certainly not conclusive, these studies show that infant feeding is predictive of some later health outcomes but not others.
The study by Dr. Li and her colleagues reveals that longer breastfeeding and later introduction of foods or beverages other than breast milk were linked with lower rates of ear, throat, and sinus infections in the year before the survey. However, they found no ties with upper or lower respiratory or urinary tract infections.
Dr. Perrine and her colleagues looked at the link between breastfeeding duration and markers of a healthful or poor diet at age 6 years. Breastfeeding duration was positively associated with some markers of a healthful diet, such as higher consumption of water, fruits, and vegetables, but negatively linked with other markers of a poor diet, such as higher ingestion of sugar-sweetened beverages and juice. No connection was found, however, between breastfeeding duration and intake of milk, sweets, or savory snacks. It is not clear whether these relationships indicate the development of taste preference during infancy or a family eating pattern that occurs at various ages, but the studies do point to the need to start healthful eating behaviors early in life.
These articles embody just the beginning of the many research opportunities provided by the year-6 IFPS II follow-up. The data sets from both the IFPS II and the follow-up are available from the Centers for Disease Control and Prevention for researchers to explore many other aspects of the prenatal and postpartum environment.
This commentary was adapted from the one accompanying these studies (Pediatrics 2014;134:S1-3). It was written by Laurence M. Grummer-Strawn, Ph.D.; Ruowei Li, M.D., Ph.D.; Cria G. Perrine, Ph.D.; and Kelley S. Scanlon, Ph.D., all of the division of nutrition, physical activity and obesity in the CDC’s National Center for Chronic Disease Prevention and Health Promotion, and by Sara B. Fein, Ph.D., of McKing Consulting Corporation in Fairfax, Va. The authors reported no disclosures.
Evidence on the long-term effects of infant diet is increasing quickly. Because of the depth of detail they supply, the IFPS II and its year-6 follow-up offer a unique opportunity to examine the relationship of infant feeding with later health outcomes and behaviors. Although certainly not conclusive, these studies show that infant feeding is predictive of some later health outcomes but not others.
The study by Dr. Li and her colleagues reveals that longer breastfeeding and later introduction of foods or beverages other than breast milk were linked with lower rates of ear, throat, and sinus infections in the year before the survey. However, they found no ties with upper or lower respiratory or urinary tract infections.
Dr. Perrine and her colleagues looked at the link between breastfeeding duration and markers of a healthful or poor diet at age 6 years. Breastfeeding duration was positively associated with some markers of a healthful diet, such as higher consumption of water, fruits, and vegetables, but negatively linked with other markers of a poor diet, such as higher ingestion of sugar-sweetened beverages and juice. No connection was found, however, between breastfeeding duration and intake of milk, sweets, or savory snacks. It is not clear whether these relationships indicate the development of taste preference during infancy or a family eating pattern that occurs at various ages, but the studies do point to the need to start healthful eating behaviors early in life.
These articles embody just the beginning of the many research opportunities provided by the year-6 IFPS II follow-up. The data sets from both the IFPS II and the follow-up are available from the Centers for Disease Control and Prevention for researchers to explore many other aspects of the prenatal and postpartum environment.
This commentary was adapted from the one accompanying these studies (Pediatrics 2014;134:S1-3). It was written by Laurence M. Grummer-Strawn, Ph.D.; Ruowei Li, M.D., Ph.D.; Cria G. Perrine, Ph.D.; and Kelley S. Scanlon, Ph.D., all of the division of nutrition, physical activity and obesity in the CDC’s National Center for Chronic Disease Prevention and Health Promotion, and by Sara B. Fein, Ph.D., of McKing Consulting Corporation in Fairfax, Va. The authors reported no disclosures.
Earn 0.25 hours AMA PRA Category 1 credit: Read this article, and click the link at the end to take the posttest.
The longer children breastfed, the less likely they were to have ear, throat, and sinus infections at age 6 years and the more likely they were to have a healthier diet as 6-year-olds, according to data from two studies.
The research is based on 6-year follow-up data from the longitudinal Infant Feeding Practices Study II, initiated in 2005-2007 by the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention to track mothers from late pregnancy until a year after birth.
In the first paper, the amount and duration of breastfeeding were linked to ear, throat, and sinus infections in children at age 6 years but not to upper respiratory tract, lung, or urinary tract infections, Dr. Ruowei Li of the CDC, Atlanta, and her colleagues reported online (Pediatrics 2014;134:S13-20).
Among 1,281 pairs of mothers and children with 6-year follow-up data, 86% of the mothers initiated breastfeeding, although 28% of these stopped before 3 months and 79% stopped exclusive breastfeeding before 4 months.
Six-year-old children who had been breastfed for at least 9 months (not necessarily exclusively) had 31% reduced odds of an ear infection, 32% reduced odds of a throat infection, and 53% reduced odds of a sinus infection in the past year, compared with peers breastfed less than 3 months. Those exclusively breastfed at least 6 months had 63% reduced odds of an ear infection, 77% reduced odds of a throat infection, and 87% reduced odds of a sinus infection, compared with those exclusively breastfed less than 4 months.
Among children who received supplemental formula in addition to breast milk, their odds of a sinus infection were 47% lower if breast milk constituted at least two-thirds of their intake than if it was only one-third of their intake.
These findings were adjusted for the mother’s age, race/ethnicity, education, household income, marital status, parity, prepregnancy body mass index, and participation in the Special Supplemental Nutrition Program for Women, Infants and Children. The child’s age and sex also were controlled for, as well as who cared for the child, the child’s type of school at age 6 years, and whether the child attended after-school child care.
In the second study, CDC researcher Cria Perrine, Ph.D., and her associates analyzed 6-year nutritional data for 1,355 children using a dietary history screener that asked parents how frequently their children had consumed any of 28 items in the past month. Breastfeeding was not linked to how much milk, sweets, or savory snacks the children consumed, but 6-year-olds who had ever been breastfed were more likely to regularly consume water, fruits, and vegetables and less likely to consume sugar-sweetened beverages, compared with those never breastfed.
"There is substantial evidence documenting the many benefits of breastfeeding; improved child diet may be one additional benefit," Dr. Perrine’s team reported online (Pediatrics 2014;134:S50-5).
At age 6 years, children who had been breastfed for at least 12 months drank water a median three times a day, compared with a median two times a day for those who had been breastfed less than 12 months (all findings P less than .05). Those breastfed at least 12 months also ate fruit a median two times a day, compared with once daily for those breastfed shorter durations or not at all.
Six-year-olds who had been breastfed less than 6 months or not at all drank slightly more 100% juice and ate slightly more vegetables than those breastfed longer. And the longer a child had been breastfed as an infant, the fewer sugar-sweetened beverages they drank at age 6 years, with each additional 6 months of breastfeeding linked to fewer sugary drinks.
Children who had been exclusively breastfed at least 3 months consumed more water and fruit than those exclusively breastfed shorter durations or not at all. Exclusive breastfeeding beyond 3 months also was linked to lower consumption of 100% juice and sugary drinks than exclusive breastfeeding for less than 3 months or not at all. These findings all were adjusted for the same maternal characteristics as in the first study, minus parity and prepregnancy BMI, and using poverty income ratio instead of household income. Child characteristics adjusted for in these findings included sex, birth weight, gestational age, and having older siblings or not.
Both studies were funded by the U.S. Food and Drug Administration, the Centers for Disease Control and Prevention, the Office on Women’s Health, the National Institutes of Health, and the Maternal and Child Health Bureau in the U.S. Department of Health and Human Services. The authors of both studies reported no disclosures.
To earn 0.25 hours AMA PRA Category 1 credit after reading this article, take the post-test here.
Earn 0.25 hours AMA PRA Category 1 credit: Read this article, and click the link at the end to take the posttest.
The longer children breastfed, the less likely they were to have ear, throat, and sinus infections at age 6 years and the more likely they were to have a healthier diet as 6-year-olds, according to data from two studies.
The research is based on 6-year follow-up data from the longitudinal Infant Feeding Practices Study II, initiated in 2005-2007 by the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention to track mothers from late pregnancy until a year after birth.
In the first paper, the amount and duration of breastfeeding were linked to ear, throat, and sinus infections in children at age 6 years but not to upper respiratory tract, lung, or urinary tract infections, Dr. Ruowei Li of the CDC, Atlanta, and her colleagues reported online (Pediatrics 2014;134:S13-20).
Among 1,281 pairs of mothers and children with 6-year follow-up data, 86% of the mothers initiated breastfeeding, although 28% of these stopped before 3 months and 79% stopped exclusive breastfeeding before 4 months.
Six-year-old children who had been breastfed for at least 9 months (not necessarily exclusively) had 31% reduced odds of an ear infection, 32% reduced odds of a throat infection, and 53% reduced odds of a sinus infection in the past year, compared with peers breastfed less than 3 months. Those exclusively breastfed at least 6 months had 63% reduced odds of an ear infection, 77% reduced odds of a throat infection, and 87% reduced odds of a sinus infection, compared with those exclusively breastfed less than 4 months.
Among children who received supplemental formula in addition to breast milk, their odds of a sinus infection were 47% lower if breast milk constituted at least two-thirds of their intake than if it was only one-third of their intake.
These findings were adjusted for the mother’s age, race/ethnicity, education, household income, marital status, parity, prepregnancy body mass index, and participation in the Special Supplemental Nutrition Program for Women, Infants and Children. The child’s age and sex also were controlled for, as well as who cared for the child, the child’s type of school at age 6 years, and whether the child attended after-school child care.
In the second study, CDC researcher Cria Perrine, Ph.D., and her associates analyzed 6-year nutritional data for 1,355 children using a dietary history screener that asked parents how frequently their children had consumed any of 28 items in the past month. Breastfeeding was not linked to how much milk, sweets, or savory snacks the children consumed, but 6-year-olds who had ever been breastfed were more likely to regularly consume water, fruits, and vegetables and less likely to consume sugar-sweetened beverages, compared with those never breastfed.
"There is substantial evidence documenting the many benefits of breastfeeding; improved child diet may be one additional benefit," Dr. Perrine’s team reported online (Pediatrics 2014;134:S50-5).
At age 6 years, children who had been breastfed for at least 12 months drank water a median three times a day, compared with a median two times a day for those who had been breastfed less than 12 months (all findings P less than .05). Those breastfed at least 12 months also ate fruit a median two times a day, compared with once daily for those breastfed shorter durations or not at all.
Six-year-olds who had been breastfed less than 6 months or not at all drank slightly more 100% juice and ate slightly more vegetables than those breastfed longer. And the longer a child had been breastfed as an infant, the fewer sugar-sweetened beverages they drank at age 6 years, with each additional 6 months of breastfeeding linked to fewer sugary drinks.
Children who had been exclusively breastfed at least 3 months consumed more water and fruit than those exclusively breastfed shorter durations or not at all. Exclusive breastfeeding beyond 3 months also was linked to lower consumption of 100% juice and sugary drinks than exclusive breastfeeding for less than 3 months or not at all. These findings all were adjusted for the same maternal characteristics as in the first study, minus parity and prepregnancy BMI, and using poverty income ratio instead of household income. Child characteristics adjusted for in these findings included sex, birth weight, gestational age, and having older siblings or not.
Both studies were funded by the U.S. Food and Drug Administration, the Centers for Disease Control and Prevention, the Office on Women’s Health, the National Institutes of Health, and the Maternal and Child Health Bureau in the U.S. Department of Health and Human Services. The authors of both studies reported no disclosures.
To earn 0.25 hours AMA PRA Category 1 credit after reading this article, take the post-test here.
FROM PEDIATRICS
Complications from flulike illnesses occur in 35% of children
One in three (35.3%) children developed complications with influenzalike illnesses, and children with neurologic or neuromuscular conditions were at highest risk for complications, according to a recent study.
The most common pediatric complication was pneumonia, seen in 26.1% of the study patients. Dr. Rakesh D. Mistry of the University of Colorado in Aurora, and his colleagues reported in the journal Pediatrics that the complication rate did not vary between influenza and other respiratory viruses. Seizures was another complication that was common, at 5.8%. Interestingly, children with neurological or neuromuscular conditions were also four times more likely to develop complications in general.
The researchers prospectively assessed 241 children aged 0-19 years who presented to a children’s hospital emergency department with influenzalike illness – fever plus a cough or sore throat without another cause – from early winter 2008 to late spring 2010. The study included only children with moderate to severe symptoms (defined by physicians’ decision to do venipuncture and respiratory viral testing) who did not already have severe complications (including seizures, encephalopathy, pneumonia, bacteremia, bacterial tracheitis, respiratory failure, myocarditis, or death.
Overall, 24.9% of the children had influenza, 28.2% had no virus detected, 14.5% had rhinovirus, 11.6% had respiratory syncytial virus, and the remainder had human metapneumovirus, adenovirus, or parainfluenza viruses. Among children with influenza, the risk of developing pneumonia was 7.6 times higher with the H1N1 strain than with other strains.
Asthma was the most common chronic medical condition in the study population but of note, 53.5% of patients in the study were identified as having a chronic underlying disease state. With the finding that children with neurological and neuromuscular disorders also are at higher risk for respiratory viral complications, the authors emphasized that children with chronic health problems need an increased focus by health care providers to provide yearly influenza vaccinations and early institution of antiviral treatment (Pediatrics 2014 Aug. 4 [doi:10.1542/peds.2014-0505]).
The Pennsylvania Department of Health supported the study in part. The authors reported no disclosures.
 |
|
Dr. Susan Millard, FCCP, comments: Another breath of fresh air – we keep telling parents that all babies from 6 months, children, and young adults should get yearly flu shots – and this study again supports all the hard work we are doing!
Susan Millard, M.D., FCCP, is a pediatric pulmonologist at Helen DeVos Children’s Hospital (HDVCH) in Grand Rapids, Michigan.
|
|
Dr. Susan Millard, FCCP, comments: Another breath of fresh air – we keep telling parents that all babies from 6 months, children, and young adults should get yearly flu shots – and this study again supports all the hard work we are doing!
Susan Millard, M.D., FCCP, is a pediatric pulmonologist at Helen DeVos Children’s Hospital (HDVCH) in Grand Rapids, Michigan.
|
|
Dr. Susan Millard, FCCP, comments: Another breath of fresh air – we keep telling parents that all babies from 6 months, children, and young adults should get yearly flu shots – and this study again supports all the hard work we are doing!
Susan Millard, M.D., FCCP, is a pediatric pulmonologist at Helen DeVos Children’s Hospital (HDVCH) in Grand Rapids, Michigan.
One in three (35.3%) children developed complications with influenzalike illnesses, and children with neurologic or neuromuscular conditions were at highest risk for complications, according to a recent study.
The most common pediatric complication was pneumonia, seen in 26.1% of the study patients. Dr. Rakesh D. Mistry of the University of Colorado in Aurora, and his colleagues reported in the journal Pediatrics that the complication rate did not vary between influenza and other respiratory viruses. Seizures was another complication that was common, at 5.8%. Interestingly, children with neurological or neuromuscular conditions were also four times more likely to develop complications in general.
The researchers prospectively assessed 241 children aged 0-19 years who presented to a children’s hospital emergency department with influenzalike illness – fever plus a cough or sore throat without another cause – from early winter 2008 to late spring 2010. The study included only children with moderate to severe symptoms (defined by physicians’ decision to do venipuncture and respiratory viral testing) who did not already have severe complications (including seizures, encephalopathy, pneumonia, bacteremia, bacterial tracheitis, respiratory failure, myocarditis, or death.
Overall, 24.9% of the children had influenza, 28.2% had no virus detected, 14.5% had rhinovirus, 11.6% had respiratory syncytial virus, and the remainder had human metapneumovirus, adenovirus, or parainfluenza viruses. Among children with influenza, the risk of developing pneumonia was 7.6 times higher with the H1N1 strain than with other strains.
Asthma was the most common chronic medical condition in the study population but of note, 53.5% of patients in the study were identified as having a chronic underlying disease state. With the finding that children with neurological and neuromuscular disorders also are at higher risk for respiratory viral complications, the authors emphasized that children with chronic health problems need an increased focus by health care providers to provide yearly influenza vaccinations and early institution of antiviral treatment (Pediatrics 2014 Aug. 4 [doi:10.1542/peds.2014-0505]).
The Pennsylvania Department of Health supported the study in part. The authors reported no disclosures.
One in three (35.3%) children developed complications with influenzalike illnesses, and children with neurologic or neuromuscular conditions were at highest risk for complications, according to a recent study.
The most common pediatric complication was pneumonia, seen in 26.1% of the study patients. Dr. Rakesh D. Mistry of the University of Colorado in Aurora, and his colleagues reported in the journal Pediatrics that the complication rate did not vary between influenza and other respiratory viruses. Seizures was another complication that was common, at 5.8%. Interestingly, children with neurological or neuromuscular conditions were also four times more likely to develop complications in general.
The researchers prospectively assessed 241 children aged 0-19 years who presented to a children’s hospital emergency department with influenzalike illness – fever plus a cough or sore throat without another cause – from early winter 2008 to late spring 2010. The study included only children with moderate to severe symptoms (defined by physicians’ decision to do venipuncture and respiratory viral testing) who did not already have severe complications (including seizures, encephalopathy, pneumonia, bacteremia, bacterial tracheitis, respiratory failure, myocarditis, or death.
Overall, 24.9% of the children had influenza, 28.2% had no virus detected, 14.5% had rhinovirus, 11.6% had respiratory syncytial virus, and the remainder had human metapneumovirus, adenovirus, or parainfluenza viruses. Among children with influenza, the risk of developing pneumonia was 7.6 times higher with the H1N1 strain than with other strains.
Asthma was the most common chronic medical condition in the study population but of note, 53.5% of patients in the study were identified as having a chronic underlying disease state. With the finding that children with neurological and neuromuscular disorders also are at higher risk for respiratory viral complications, the authors emphasized that children with chronic health problems need an increased focus by health care providers to provide yearly influenza vaccinations and early institution of antiviral treatment (Pediatrics 2014 Aug. 4 [doi:10.1542/peds.2014-0505]).
The Pennsylvania Department of Health supported the study in part. The authors reported no disclosures.
Key clinical point: Keep an eye out for severe complications of influenzalike illness, whether or not children have underlying conditions
Major finding: Severe complications from complications of influenzalike illness occurred in 35.3% of children, and those with neurologic or neuromuscular conditions were four times more likely to develop complications.
Data source: The findings are based on a prospective cohort study of 241 children, aged 0 to 19 years, presenting to an emergency departmentED during respiratory viral seasons during 2008-2010.
Disclosures: The study was supported by the Commonwealth of Pennsylvania Department of Health. The authors reported no disclosures.
Gestational diabetes may increase child’s risk of glucose intolerance
Obese children may have a higher risk of developing type 2 diabetes if their mothers had gestational diabetes during pregnancy, according to a recent study.
"The ever growing number of women with gestational diabetes (18%) suggests that the future will be filled with children with early diabetes at a rate that far exceeds the current prevalence," wrote Tara Holder of Yale University, New Haven, Conn., and her associates in Diabetologia.
"Offspring of GDM [gestational diabetes mellitus] mothers ought to be screened for impaired glucose tolerance and/or impaired fasting glucose, and preventive and therapeutic strategies should be considered before the development of full clinical manifestation of diabetes," the researchers reported online (Diabetologia 2014 Aug. 29 [doi: 10.1007/s00125-014-3345-2]).
The investigators conducted an oral glucose tolerance test to establish normal glucose tolerance among 210 obese teens who had not been exposed to GDM and 45 obese teens who had been exposed. Then they conducted another OGTT at an average follow-up of 2.8 years later.
A fasting glucose level of less than 5.55 mmol/L and a 2-hour glucose level of less than 7.77 mmol/L were defined as normal glucose tolerance. A fasting glucose of 5.55-6.88 mmol/L was considered impaired, and a fasting glucose greater than 6.88 mmol/ L or a 2-hour glucose greater than 11.05 mmol/L was designated type 2 diabetes.
At follow-up, 91.4% of the teens not exposed to GDM had normal glucose tolerance, compared with 68.9% of the teens exposed to GDM. Therefore, 8.6% of those not exposed to GDM and 31.1% of those exposed to GDM had developed either impaired glucose tolerance or type 2 diabetes.
The research and researchers were supported by the National Center for Advancing Translational Science, the Yale Diabetes Endocrinology Research Center, the European Society of Pediatric Endocrinology, the American Heart Association, the Stephen Morse Diabetes Research Foundation, the National Institutes of Health, and the American Diabetes Association. The authors had no disclosures.
The study by Holder et al. confirms previous findings that a child’s exposure to maternal GDM can predispose him or her to developing impaired glucose tolerance or type 2 diabetes later in life. Seminal work by David Pettitt and Peter Bennett, who studied the Pima Indians in Arizona, showed that a child born to a mother without GDM and a child born to the same mother with GDM had different susceptibilities to developing metabolic disease. They found that the child exposed to GDM had a higher likelihood of developing diabetes.
The findings of Holder et al. reinforce the idea that maternal health can greatly influence the long-term health of her offspring. It is conceivable that diabetes may "imprint" information onto the islet cells of the developing fetus, thereby resulting in the reduced beta-cell function and reduced insulin sensitivity observed by the investigators. Although it remains to be elucidated, it is not unlikely that there are diabetes susceptibility genes, which women may pass on to their offspring. If so, this could explain why only some children of GDM mothers develop impaired glucose tolerance or type 2 diabetes mellitus while others do not.
 |
|
Counseling children of diabetic mothers on the importance of a healthy lifestyle, maintaining an ideal weight, consuming a balanced diet, and getting enough physical exercise could reduce their risk of future metabolic disease. Because the exposure to maternal hyperglycemia cannot be reversed, it is vital that children of GDM mothers take steps needed to reduce their risks of developing diabetes.
Dr. E. Albert Reece, M.D., Ph.D., M.B.A., is the Vice President for Medical Affairs at the University of Maryland, Dean of the School of Medicine, and the John Z. and Akiko K. Bowers Distinguished Professor in Obstetrics and Gynecology. He made these comments in an interview. Dr. Reece had no relevant financial disclosures.
The study by Holder et al. confirms previous findings that a child’s exposure to maternal GDM can predispose him or her to developing impaired glucose tolerance or type 2 diabetes later in life. Seminal work by David Pettitt and Peter Bennett, who studied the Pima Indians in Arizona, showed that a child born to a mother without GDM and a child born to the same mother with GDM had different susceptibilities to developing metabolic disease. They found that the child exposed to GDM had a higher likelihood of developing diabetes.
The findings of Holder et al. reinforce the idea that maternal health can greatly influence the long-term health of her offspring. It is conceivable that diabetes may "imprint" information onto the islet cells of the developing fetus, thereby resulting in the reduced beta-cell function and reduced insulin sensitivity observed by the investigators. Although it remains to be elucidated, it is not unlikely that there are diabetes susceptibility genes, which women may pass on to their offspring. If so, this could explain why only some children of GDM mothers develop impaired glucose tolerance or type 2 diabetes mellitus while others do not.
|
|
Counseling children of diabetic mothers on the importance of a healthy lifestyle, maintaining an ideal weight, consuming a balanced diet, and getting enough physical exercise could reduce their risk of future metabolic disease. Because the exposure to maternal hyperglycemia cannot be reversed, it is vital that children of GDM mothers take steps needed to reduce their risks of developing diabetes.
Dr. E. Albert Reece, M.D., Ph.D., M.B.A., is the Vice President for Medical Affairs at the University of Maryland, Dean of the School of Medicine, and the John Z. and Akiko K. Bowers Distinguished Professor in Obstetrics and Gynecology. He made these comments in an interview. Dr. Reece had no relevant financial disclosures.
The study by Holder et al. confirms previous findings that a child’s exposure to maternal GDM can predispose him or her to developing impaired glucose tolerance or type 2 diabetes later in life. Seminal work by David Pettitt and Peter Bennett, who studied the Pima Indians in Arizona, showed that a child born to a mother without GDM and a child born to the same mother with GDM had different susceptibilities to developing metabolic disease. They found that the child exposed to GDM had a higher likelihood of developing diabetes.
The findings of Holder et al. reinforce the idea that maternal health can greatly influence the long-term health of her offspring. It is conceivable that diabetes may "imprint" information onto the islet cells of the developing fetus, thereby resulting in the reduced beta-cell function and reduced insulin sensitivity observed by the investigators. Although it remains to be elucidated, it is not unlikely that there are diabetes susceptibility genes, which women may pass on to their offspring. If so, this could explain why only some children of GDM mothers develop impaired glucose tolerance or type 2 diabetes mellitus while others do not.
|
|
Counseling children of diabetic mothers on the importance of a healthy lifestyle, maintaining an ideal weight, consuming a balanced diet, and getting enough physical exercise could reduce their risk of future metabolic disease. Because the exposure to maternal hyperglycemia cannot be reversed, it is vital that children of GDM mothers take steps needed to reduce their risks of developing diabetes.
Dr. E. Albert Reece, M.D., Ph.D., M.B.A., is the Vice President for Medical Affairs at the University of Maryland, Dean of the School of Medicine, and the John Z. and Akiko K. Bowers Distinguished Professor in Obstetrics and Gynecology. He made these comments in an interview. Dr. Reece had no relevant financial disclosures.
Obese children may have a higher risk of developing type 2 diabetes if their mothers had gestational diabetes during pregnancy, according to a recent study.
"The ever growing number of women with gestational diabetes (18%) suggests that the future will be filled with children with early diabetes at a rate that far exceeds the current prevalence," wrote Tara Holder of Yale University, New Haven, Conn., and her associates in Diabetologia.
"Offspring of GDM [gestational diabetes mellitus] mothers ought to be screened for impaired glucose tolerance and/or impaired fasting glucose, and preventive and therapeutic strategies should be considered before the development of full clinical manifestation of diabetes," the researchers reported online (Diabetologia 2014 Aug. 29 [doi: 10.1007/s00125-014-3345-2]).
The investigators conducted an oral glucose tolerance test to establish normal glucose tolerance among 210 obese teens who had not been exposed to GDM and 45 obese teens who had been exposed. Then they conducted another OGTT at an average follow-up of 2.8 years later.
A fasting glucose level of less than 5.55 mmol/L and a 2-hour glucose level of less than 7.77 mmol/L were defined as normal glucose tolerance. A fasting glucose of 5.55-6.88 mmol/L was considered impaired, and a fasting glucose greater than 6.88 mmol/ L or a 2-hour glucose greater than 11.05 mmol/L was designated type 2 diabetes.
At follow-up, 91.4% of the teens not exposed to GDM had normal glucose tolerance, compared with 68.9% of the teens exposed to GDM. Therefore, 8.6% of those not exposed to GDM and 31.1% of those exposed to GDM had developed either impaired glucose tolerance or type 2 diabetes.
The research and researchers were supported by the National Center for Advancing Translational Science, the Yale Diabetes Endocrinology Research Center, the European Society of Pediatric Endocrinology, the American Heart Association, the Stephen Morse Diabetes Research Foundation, the National Institutes of Health, and the American Diabetes Association. The authors had no disclosures.
Obese children may have a higher risk of developing type 2 diabetes if their mothers had gestational diabetes during pregnancy, according to a recent study.
"The ever growing number of women with gestational diabetes (18%) suggests that the future will be filled with children with early diabetes at a rate that far exceeds the current prevalence," wrote Tara Holder of Yale University, New Haven, Conn., and her associates in Diabetologia.
"Offspring of GDM [gestational diabetes mellitus] mothers ought to be screened for impaired glucose tolerance and/or impaired fasting glucose, and preventive and therapeutic strategies should be considered before the development of full clinical manifestation of diabetes," the researchers reported online (Diabetologia 2014 Aug. 29 [doi: 10.1007/s00125-014-3345-2]).
The investigators conducted an oral glucose tolerance test to establish normal glucose tolerance among 210 obese teens who had not been exposed to GDM and 45 obese teens who had been exposed. Then they conducted another OGTT at an average follow-up of 2.8 years later.
A fasting glucose level of less than 5.55 mmol/L and a 2-hour glucose level of less than 7.77 mmol/L were defined as normal glucose tolerance. A fasting glucose of 5.55-6.88 mmol/L was considered impaired, and a fasting glucose greater than 6.88 mmol/ L or a 2-hour glucose greater than 11.05 mmol/L was designated type 2 diabetes.
At follow-up, 91.4% of the teens not exposed to GDM had normal glucose tolerance, compared with 68.9% of the teens exposed to GDM. Therefore, 8.6% of those not exposed to GDM and 31.1% of those exposed to GDM had developed either impaired glucose tolerance or type 2 diabetes.
The research and researchers were supported by the National Center for Advancing Translational Science, the Yale Diabetes Endocrinology Research Center, the European Society of Pediatric Endocrinology, the American Heart Association, the Stephen Morse Diabetes Research Foundation, the National Institutes of Health, and the American Diabetes Association. The authors had no disclosures.
FROM DIABETOLOGIA
Key clinical point: Children whose mothers had gestational diabetes should be screened for impaired glucose tolerance and preventive strategies taught to forestall type 2 diabetes.
Major finding: A total of 31.1% of obese teens exposed to GDM had developed either impaired glucose tolerance or type 2 diabetes at follow-up, compared with 8.6% of those not exposed to GDM.
Data source: The findings are based on a cohort study of 255 obese adolescents followed for a mean 2.8 years.
Disclosures: The research and researchers were supported by the National Center for Advancing Translational Science, the Yale Diabetes Endocrinology Research Center, the European Society of Pediatric Endocrinology, the American Heart Association, the Stephen Morse Diabetes Research Foundation, the National Institutes of Health, and the American Diabetes Association. The authors had no disclosures.
Longer breastfeeding linked to better nutritional and health outcomes
The longer children breastfed, the less likely they were to have ear, throat, and sinus infections at age 6 years and the more likely they were to have a healthier diet as 6-year-olds, according to data from two studies.
The research is based on 6-year follow-up data from the longitudinal Infant Feeding Practices Study II, initiated in 2005-2007 by the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention to track mothers from late pregnancy until a year after birth.
In the first paper, the amount and duration of breastfeeding were linked to ear, throat, and sinus infections in children at age 6 years but not to upper respiratory tract, lung, or urinary tract infections, Dr. Ruowei Li of the CDC, Atlanta, and her colleagues reported online (Pediatrics 2014;134:S13-20).
Among 1,281 pairs of mothers and children with 6-year follow-up data, 86% of the mothers initiated breastfeeding, although 28% of these stopped before 3 months and 79% stopped exclusive breastfeeding before 4 months.
Six-year-old children who had been breastfed for at least 9 months (not necessarily exclusively) had 31% reduced odds of an ear infection, 32% reduced odds of a throat infection, and 53% reduced odds of a sinus infection in the past year, compared with peers breastfed less than 3 months. Those exclusively breastfed at least 6 months had 63% reduced odds of an ear infection, 77% reduced odds of a throat infection, and 87% reduced odds of a sinus infection, compared with those exclusively breastfed less than 4 months.
Among children who received supplemental formula in addition to breast milk, their odds of a sinus infection were 47% lower if breast milk constituted at least two-thirds of their intake than if it was only one-third of their intake.
These findings were adjusted for the mother’s age, race/ethnicity, education, household income, marital status, parity, prepregnancy body mass index, and participation in the Special Supplemental Nutrition Program for Women, Infants and Children. The child’s age and sex also were controlled for, as well as who cared for the child, the child’s type of school at age 6 years, and whether the child attended after-school child care.
In the second study, CDC researcher Cria Perrine, Ph.D., and her associates analyzed 6-year nutritional data for 1,355 children using a dietary history screener that asked parents how frequently their children had consumed any of 28 items in the past month. Breastfeeding was not linked to how much milk, sweets, or savory snacks the children consumed, but 6-year-olds who had ever been breastfed were more likely to regularly consume water, fruits, and vegetables and less likely to consume sugar-sweetened beverages, compared with those never breastfed.
"There is substantial evidence documenting the many benefits of breastfeeding; improved child diet may be one additional benefit," Dr. Perrine’s team reported online (Pediatrics 2014;134:S50-5).
At age 6 years, children who had been breastfed for at least 12 months drank water a median three times a day, compared with a median two times a day for those who had been breastfed less than 12 months (all findings P less than .05). Those breastfed at least 12 months also ate fruit a median two times a day, compared with once daily for those breastfed shorter durations or not at all.
Six-year-olds who had been breastfed less than 6 months or not at all drank slightly more 100% juice and ate slightly more vegetables than those breastfed longer. And the longer a child had been breastfed as an infant, the fewer sugar-sweetened beverages they drank at age 6 years, with each additional 6 months of breastfeeding linked to fewer sugary drinks.
Children who had been exclusively breastfed at least 3 months consumed more water and fruit than those exclusively breastfed shorter durations or not at all. Exclusive breastfeeding beyond 3 months also was linked to lower consumption of 100% juice and sugary drinks than exclusive breastfeeding for less than 3 months or not at all. These findings all were adjusted for the same maternal characteristics as in the first study, minus parity and prepregnancy BMI, and using poverty income ratio instead of household income. Child characteristics adjusted for in these findings included sex, birth weight, gestational age, and having older siblings or not.
Both studies were funded by the U.S. Food and Drug Administration, the Centers for Disease Control and Prevention, the Office on Women’s Health, the National Institutes of Health, and the Maternal and Child Health Bureau in the U.S. Department of Health and Human Services. The authors of both studies reported no disclosures.
Evidence on the long-term effects of infant diet is increasing quickly. Because of the depth of detail they supply, the IFPS II and its year-6 follow-up offer a unique opportunity to examine the relationship of infant feeding with later health outcomes and behaviors. Although certainly not conclusive, these studies show that infant feeding is predictive of some later health outcomes but not others.
The study by Dr. Li and her colleagues reveals that longer breastfeeding and later introduction of foods or beverages other than breast milk were linked with lower rates of ear, throat, and sinus infections in the year before the survey. However, they found no ties with upper or lower respiratory or urinary tract infections.
Dr. Perrine and her colleagues looked at the link between breastfeeding duration and markers of a healthful or poor diet at age 6 years. Breastfeeding duration was positively associated with some markers of a healthful diet, such as higher consumption of water, fruits, and vegetables, but negatively linked with other markers of a poor diet, such as higher ingestion of sugar-sweetened beverages and juice. No connection was found, however, between breastfeeding duration and intake of milk, sweets, or savory snacks. It is not clear whether these relationships indicate the development of taste preference during infancy or a family eating pattern that occurs at various ages, but the studies do point to the need to start healthful eating behaviors early in life.
These articles embody just the beginning of the many research opportunities provided by the year-6 IFPS II follow-up. The data sets from both the IFPS II and the follow-up are available from the Centers for Disease Control and Prevention for researchers to explore many other aspects of the prenatal and postpartum environment.
This commentary was adapted from the one accompanying these studies (Pediatrics 2014;134:S1-3). It was written by Laurence M. Grummer-Strawn, Ph.D.; Ruowei Li, M.D., Ph.D.; Cria G. Perrine, Ph.D.; and Kelley S. Scanlon, Ph.D., all of the division of nutrition, physical activity and obesity in the CDC’s National Center for Chronic Disease Prevention and Health Promotion, and by Sara B. Fein, Ph.D., of McKing Consulting Corporation in Fairfax, Va. The authors reported no disclosures.
Evidence on the long-term effects of infant diet is increasing quickly. Because of the depth of detail they supply, the IFPS II and its year-6 follow-up offer a unique opportunity to examine the relationship of infant feeding with later health outcomes and behaviors. Although certainly not conclusive, these studies show that infant feeding is predictive of some later health outcomes but not others.
The study by Dr. Li and her colleagues reveals that longer breastfeeding and later introduction of foods or beverages other than breast milk were linked with lower rates of ear, throat, and sinus infections in the year before the survey. However, they found no ties with upper or lower respiratory or urinary tract infections.
Dr. Perrine and her colleagues looked at the link between breastfeeding duration and markers of a healthful or poor diet at age 6 years. Breastfeeding duration was positively associated with some markers of a healthful diet, such as higher consumption of water, fruits, and vegetables, but negatively linked with other markers of a poor diet, such as higher ingestion of sugar-sweetened beverages and juice. No connection was found, however, between breastfeeding duration and intake of milk, sweets, or savory snacks. It is not clear whether these relationships indicate the development of taste preference during infancy or a family eating pattern that occurs at various ages, but the studies do point to the need to start healthful eating behaviors early in life.
These articles embody just the beginning of the many research opportunities provided by the year-6 IFPS II follow-up. The data sets from both the IFPS II and the follow-up are available from the Centers for Disease Control and Prevention for researchers to explore many other aspects of the prenatal and postpartum environment.
This commentary was adapted from the one accompanying these studies (Pediatrics 2014;134:S1-3). It was written by Laurence M. Grummer-Strawn, Ph.D.; Ruowei Li, M.D., Ph.D.; Cria G. Perrine, Ph.D.; and Kelley S. Scanlon, Ph.D., all of the division of nutrition, physical activity and obesity in the CDC’s National Center for Chronic Disease Prevention and Health Promotion, and by Sara B. Fein, Ph.D., of McKing Consulting Corporation in Fairfax, Va. The authors reported no disclosures.
Evidence on the long-term effects of infant diet is increasing quickly. Because of the depth of detail they supply, the IFPS II and its year-6 follow-up offer a unique opportunity to examine the relationship of infant feeding with later health outcomes and behaviors. Although certainly not conclusive, these studies show that infant feeding is predictive of some later health outcomes but not others.
The study by Dr. Li and her colleagues reveals that longer breastfeeding and later introduction of foods or beverages other than breast milk were linked with lower rates of ear, throat, and sinus infections in the year before the survey. However, they found no ties with upper or lower respiratory or urinary tract infections.
Dr. Perrine and her colleagues looked at the link between breastfeeding duration and markers of a healthful or poor diet at age 6 years. Breastfeeding duration was positively associated with some markers of a healthful diet, such as higher consumption of water, fruits, and vegetables, but negatively linked with other markers of a poor diet, such as higher ingestion of sugar-sweetened beverages and juice. No connection was found, however, between breastfeeding duration and intake of milk, sweets, or savory snacks. It is not clear whether these relationships indicate the development of taste preference during infancy or a family eating pattern that occurs at various ages, but the studies do point to the need to start healthful eating behaviors early in life.
These articles embody just the beginning of the many research opportunities provided by the year-6 IFPS II follow-up. The data sets from both the IFPS II and the follow-up are available from the Centers for Disease Control and Prevention for researchers to explore many other aspects of the prenatal and postpartum environment.
This commentary was adapted from the one accompanying these studies (Pediatrics 2014;134:S1-3). It was written by Laurence M. Grummer-Strawn, Ph.D.; Ruowei Li, M.D., Ph.D.; Cria G. Perrine, Ph.D.; and Kelley S. Scanlon, Ph.D., all of the division of nutrition, physical activity and obesity in the CDC’s National Center for Chronic Disease Prevention and Health Promotion, and by Sara B. Fein, Ph.D., of McKing Consulting Corporation in Fairfax, Va. The authors reported no disclosures.
The longer children breastfed, the less likely they were to have ear, throat, and sinus infections at age 6 years and the more likely they were to have a healthier diet as 6-year-olds, according to data from two studies.
The research is based on 6-year follow-up data from the longitudinal Infant Feeding Practices Study II, initiated in 2005-2007 by the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention to track mothers from late pregnancy until a year after birth.
In the first paper, the amount and duration of breastfeeding were linked to ear, throat, and sinus infections in children at age 6 years but not to upper respiratory tract, lung, or urinary tract infections, Dr. Ruowei Li of the CDC, Atlanta, and her colleagues reported online (Pediatrics 2014;134:S13-20).
Among 1,281 pairs of mothers and children with 6-year follow-up data, 86% of the mothers initiated breastfeeding, although 28% of these stopped before 3 months and 79% stopped exclusive breastfeeding before 4 months.
Six-year-old children who had been breastfed for at least 9 months (not necessarily exclusively) had 31% reduced odds of an ear infection, 32% reduced odds of a throat infection, and 53% reduced odds of a sinus infection in the past year, compared with peers breastfed less than 3 months. Those exclusively breastfed at least 6 months had 63% reduced odds of an ear infection, 77% reduced odds of a throat infection, and 87% reduced odds of a sinus infection, compared with those exclusively breastfed less than 4 months.
Among children who received supplemental formula in addition to breast milk, their odds of a sinus infection were 47% lower if breast milk constituted at least two-thirds of their intake than if it was only one-third of their intake.
These findings were adjusted for the mother’s age, race/ethnicity, education, household income, marital status, parity, prepregnancy body mass index, and participation in the Special Supplemental Nutrition Program for Women, Infants and Children. The child’s age and sex also were controlled for, as well as who cared for the child, the child’s type of school at age 6 years, and whether the child attended after-school child care.
In the second study, CDC researcher Cria Perrine, Ph.D., and her associates analyzed 6-year nutritional data for 1,355 children using a dietary history screener that asked parents how frequently their children had consumed any of 28 items in the past month. Breastfeeding was not linked to how much milk, sweets, or savory snacks the children consumed, but 6-year-olds who had ever been breastfed were more likely to regularly consume water, fruits, and vegetables and less likely to consume sugar-sweetened beverages, compared with those never breastfed.
"There is substantial evidence documenting the many benefits of breastfeeding; improved child diet may be one additional benefit," Dr. Perrine’s team reported online (Pediatrics 2014;134:S50-5).
At age 6 years, children who had been breastfed for at least 12 months drank water a median three times a day, compared with a median two times a day for those who had been breastfed less than 12 months (all findings P less than .05). Those breastfed at least 12 months also ate fruit a median two times a day, compared with once daily for those breastfed shorter durations or not at all.
Six-year-olds who had been breastfed less than 6 months or not at all drank slightly more 100% juice and ate slightly more vegetables than those breastfed longer. And the longer a child had been breastfed as an infant, the fewer sugar-sweetened beverages they drank at age 6 years, with each additional 6 months of breastfeeding linked to fewer sugary drinks.
Children who had been exclusively breastfed at least 3 months consumed more water and fruit than those exclusively breastfed shorter durations or not at all. Exclusive breastfeeding beyond 3 months also was linked to lower consumption of 100% juice and sugary drinks than exclusive breastfeeding for less than 3 months or not at all. These findings all were adjusted for the same maternal characteristics as in the first study, minus parity and prepregnancy BMI, and using poverty income ratio instead of household income. Child characteristics adjusted for in these findings included sex, birth weight, gestational age, and having older siblings or not.
Both studies were funded by the U.S. Food and Drug Administration, the Centers for Disease Control and Prevention, the Office on Women’s Health, the National Institutes of Health, and the Maternal and Child Health Bureau in the U.S. Department of Health and Human Services. The authors of both studies reported no disclosures.
The longer children breastfed, the less likely they were to have ear, throat, and sinus infections at age 6 years and the more likely they were to have a healthier diet as 6-year-olds, according to data from two studies.
The research is based on 6-year follow-up data from the longitudinal Infant Feeding Practices Study II, initiated in 2005-2007 by the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention to track mothers from late pregnancy until a year after birth.
In the first paper, the amount and duration of breastfeeding were linked to ear, throat, and sinus infections in children at age 6 years but not to upper respiratory tract, lung, or urinary tract infections, Dr. Ruowei Li of the CDC, Atlanta, and her colleagues reported online (Pediatrics 2014;134:S13-20).
Among 1,281 pairs of mothers and children with 6-year follow-up data, 86% of the mothers initiated breastfeeding, although 28% of these stopped before 3 months and 79% stopped exclusive breastfeeding before 4 months.
Six-year-old children who had been breastfed for at least 9 months (not necessarily exclusively) had 31% reduced odds of an ear infection, 32% reduced odds of a throat infection, and 53% reduced odds of a sinus infection in the past year, compared with peers breastfed less than 3 months. Those exclusively breastfed at least 6 months had 63% reduced odds of an ear infection, 77% reduced odds of a throat infection, and 87% reduced odds of a sinus infection, compared with those exclusively breastfed less than 4 months.
Among children who received supplemental formula in addition to breast milk, their odds of a sinus infection were 47% lower if breast milk constituted at least two-thirds of their intake than if it was only one-third of their intake.
These findings were adjusted for the mother’s age, race/ethnicity, education, household income, marital status, parity, prepregnancy body mass index, and participation in the Special Supplemental Nutrition Program for Women, Infants and Children. The child’s age and sex also were controlled for, as well as who cared for the child, the child’s type of school at age 6 years, and whether the child attended after-school child care.
In the second study, CDC researcher Cria Perrine, Ph.D., and her associates analyzed 6-year nutritional data for 1,355 children using a dietary history screener that asked parents how frequently their children had consumed any of 28 items in the past month. Breastfeeding was not linked to how much milk, sweets, or savory snacks the children consumed, but 6-year-olds who had ever been breastfed were more likely to regularly consume water, fruits, and vegetables and less likely to consume sugar-sweetened beverages, compared with those never breastfed.
"There is substantial evidence documenting the many benefits of breastfeeding; improved child diet may be one additional benefit," Dr. Perrine’s team reported online (Pediatrics 2014;134:S50-5).
At age 6 years, children who had been breastfed for at least 12 months drank water a median three times a day, compared with a median two times a day for those who had been breastfed less than 12 months (all findings P less than .05). Those breastfed at least 12 months also ate fruit a median two times a day, compared with once daily for those breastfed shorter durations or not at all.
Six-year-olds who had been breastfed less than 6 months or not at all drank slightly more 100% juice and ate slightly more vegetables than those breastfed longer. And the longer a child had been breastfed as an infant, the fewer sugar-sweetened beverages they drank at age 6 years, with each additional 6 months of breastfeeding linked to fewer sugary drinks.
Children who had been exclusively breastfed at least 3 months consumed more water and fruit than those exclusively breastfed shorter durations or not at all. Exclusive breastfeeding beyond 3 months also was linked to lower consumption of 100% juice and sugary drinks than exclusive breastfeeding for less than 3 months or not at all. These findings all were adjusted for the same maternal characteristics as in the first study, minus parity and prepregnancy BMI, and using poverty income ratio instead of household income. Child characteristics adjusted for in these findings included sex, birth weight, gestational age, and having older siblings or not.
Both studies were funded by the U.S. Food and Drug Administration, the Centers for Disease Control and Prevention, the Office on Women’s Health, the National Institutes of Health, and the Maternal and Child Health Bureau in the U.S. Department of Health and Human Services. The authors of both studies reported no disclosures.
FROM PEDIATRICS
Key clinical point: Encourage breastfeeding. The longer mothers breastfeed their children, the less likely the children are to have ear, throat, and sinus infections and the more likely they are to establish some healthful eating habits.
Major finding: At 6 years of age, children who had been breastfed had significantly reduced odds of ear, throat, and sinus infections; were significantly less likely to drink 100% juice or sugar-sweetened beverages; and were significantly more likely to consume fruits, vegetables, and water than those not breastfed or breastfed a shorter duration.
Data source: Two analyses from the prospective Infant Feeding Practices Study II at year-6 follow-up, involving more than 1,200 children, started in 2005-2007.
Disclosures: Both studies were funded by the U.S. Food and Drug Administration, the Centers for Disease Control and Prevention, the Office on Women’s Health, the National Institutes of Health, and the Maternal and Child Health Bureau in the U.S. Department of Health and Human Services. The authors of both studies reported no disclosures.
Higher cholesterol levels linked to reduced fertility
A couple’s cholesterol levels may play a part in how long it takes them to conceive, according to a recent study.
The findings, independent of body mass index, "are the first to demonstrate that select serum lipids are associated with reduced couple fecundity as measured by a longer time to pregnancy," reported Enrique Schisterman, Ph.D., of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and his associates.
Between 2005 and 2009, the researchers tracked 501 couples who were attempting to conceive. They were followed for 12 months or until a pregnancy was detected with human chorionic gonadotropin (hCG). During follow-up, 69% of the couples became pregnant, 11% did not and 20% withdrew from the study.
All participants had a lipid analysis that included cholesterol, free cholesterol, phospholipids, triglycerides, and total lipids. For both men and women, age was significantly associated with free cholesterol levels, mean BMI increased as free cholesterol quartiles increased, and participants in lower quartiles for free cholesterol reported more vigorous exercise than did those in higher quartiles (J. Clin. Endocrinol. Metab. 2014 May 20 [doi:10.1210/jc.2013-3936]).
After adjustment for age, BMI, and race and education, free cholesterol (fecundity odds ratio 0.983) and total lipids (fecundity odds ratio .998) in women were significantly associated with time to pregnancy. No serum lipid components in men were significantly associated with time to pregnancy. With couples’ concentrations modeled together, free cholesterol was significantly associated with time to pregnancy (fecundity odds ratio 0.984), as was male free cholesterol (fecundity odds ratio 0.984).
"Of the five lipid components evaluated, free cholesterol was robustly associated with reduced fecundity when modeling female serum lipids individually or in a couple-based approach independent of BMI," the authors wrote. "Male free cholesterol concentrations were also an independent risk factor for reduced fecundability, irrespective of female lipid levels."
The study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institutes of Health. The authors had no disclosures.
A couple’s cholesterol levels may play a part in how long it takes them to conceive, according to a recent study.
The findings, independent of body mass index, "are the first to demonstrate that select serum lipids are associated with reduced couple fecundity as measured by a longer time to pregnancy," reported Enrique Schisterman, Ph.D., of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and his associates.
Between 2005 and 2009, the researchers tracked 501 couples who were attempting to conceive. They were followed for 12 months or until a pregnancy was detected with human chorionic gonadotropin (hCG). During follow-up, 69% of the couples became pregnant, 11% did not and 20% withdrew from the study.
All participants had a lipid analysis that included cholesterol, free cholesterol, phospholipids, triglycerides, and total lipids. For both men and women, age was significantly associated with free cholesterol levels, mean BMI increased as free cholesterol quartiles increased, and participants in lower quartiles for free cholesterol reported more vigorous exercise than did those in higher quartiles (J. Clin. Endocrinol. Metab. 2014 May 20 [doi:10.1210/jc.2013-3936]).
After adjustment for age, BMI, and race and education, free cholesterol (fecundity odds ratio 0.983) and total lipids (fecundity odds ratio .998) in women were significantly associated with time to pregnancy. No serum lipid components in men were significantly associated with time to pregnancy. With couples’ concentrations modeled together, free cholesterol was significantly associated with time to pregnancy (fecundity odds ratio 0.984), as was male free cholesterol (fecundity odds ratio 0.984).
"Of the five lipid components evaluated, free cholesterol was robustly associated with reduced fecundity when modeling female serum lipids individually or in a couple-based approach independent of BMI," the authors wrote. "Male free cholesterol concentrations were also an independent risk factor for reduced fecundability, irrespective of female lipid levels."
The study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institutes of Health. The authors had no disclosures.
A couple’s cholesterol levels may play a part in how long it takes them to conceive, according to a recent study.
The findings, independent of body mass index, "are the first to demonstrate that select serum lipids are associated with reduced couple fecundity as measured by a longer time to pregnancy," reported Enrique Schisterman, Ph.D., of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and his associates.
Between 2005 and 2009, the researchers tracked 501 couples who were attempting to conceive. They were followed for 12 months or until a pregnancy was detected with human chorionic gonadotropin (hCG). During follow-up, 69% of the couples became pregnant, 11% did not and 20% withdrew from the study.
All participants had a lipid analysis that included cholesterol, free cholesterol, phospholipids, triglycerides, and total lipids. For both men and women, age was significantly associated with free cholesterol levels, mean BMI increased as free cholesterol quartiles increased, and participants in lower quartiles for free cholesterol reported more vigorous exercise than did those in higher quartiles (J. Clin. Endocrinol. Metab. 2014 May 20 [doi:10.1210/jc.2013-3936]).
After adjustment for age, BMI, and race and education, free cholesterol (fecundity odds ratio 0.983) and total lipids (fecundity odds ratio .998) in women were significantly associated with time to pregnancy. No serum lipid components in men were significantly associated with time to pregnancy. With couples’ concentrations modeled together, free cholesterol was significantly associated with time to pregnancy (fecundity odds ratio 0.984), as was male free cholesterol (fecundity odds ratio 0.984).
"Of the five lipid components evaluated, free cholesterol was robustly associated with reduced fecundity when modeling female serum lipids individually or in a couple-based approach independent of BMI," the authors wrote. "Male free cholesterol concentrations were also an independent risk factor for reduced fecundability, irrespective of female lipid levels."
The study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institutes of Health. The authors had no disclosures.
FROM THE JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM
Key clinical point: The cholesterol levels of both partners may predict the likelihood of conception.
Major finding: Couples who did not become pregnant within a year of trying to conceive had higher serum free cholesterol levels than did couples who became pregnant (female, P = .04; male, P = .009).
Data source: A 12-month cohort study of 501 couples from Michigan and Texas attempting pregnancy or discontinuing contraception between 2005 and 2009.
Disclosures: The study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institutes of Health. The authors had no disclosures.